Disputation i psykologi med Jennifer Meurling

Datum: 9 oktober kl. 09.00

Rum: F234, Campus Östersund

Avhandlingens titel: Screening for mental health problems among refugees in Sweden: development and evaluation of an online tiered screening procedure

Respondent: Jennifer Meurling

Huvudhandledare: Anna Bjärtå

Biträdande handledare: Elisabet Rondung och Gerhard Andersson

Ordförande: Fredrik Åhs, professor i psykologi vid institutionen för pedagogik, psykologi och socialt arbete

Opponent: Michael Hollifield, klinisk professor i psykiatri och beteendemedicin, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, President and CEO of the War Survivors Institute, Long Beach CA, USA

Betygsnämnd:

Docent Anke Witteveen, Vrije Universitet Amsterdam

Docent Petter Tinghög, Röda Korsets Högskola

Professor Sabine Gruber, Mittuniversitetet

Delta via Zoom

Anmälan till mingel efter disputationen

Abstract

Refugees and asylum seekers have commonly experienced substantial adversity and trauma, and are continuously exposed to postmigration stressors. Both previous and ongoing stress increase the risk for mental health problems, and high prevalence of psychiatric symptoms is consistently found in refugee populations. Despite this, mental health services tend to be underused, and access is compromised by structural, linguistic, and cultural barriers, resulting in a treatment gap. Digital screening, particularly using a hierarchical, multi-disorder design, could increase efficiency of identification and early assessment, and facilitate access to mental health services. The overall aim of this thesis was to develop and evaluate an efficient, accurate, and accessible tiered screening tool for identification of clinically relevant symptoms of major depressive disorder, anxiety disorder, post-traumatic stress disorder, and insomnia disorder among individuals with a refugee background in Sweden. 

We designed the i-TAP, an internet-based, adaptive screening model with three tiers. This thesis includes three studies with the respective aims to develop the i-TAP, evaluate its criterion validity, and investigate the user experience, acceptability, and content validity of the i-TAP from a user perspective. In Paper I, the tiered model was developed and optimised, and the first two tiers were evaluated for accuracy; the hierarchical design could decrease item burden without compromising accuracy. Symptom burden was high in the sample with 73.6% reporting moderate to severe symptoms. In Paper II, the i-TAP was tested against a clinical reference standard. In this sample, just over half of the participants met criteria for one or several psychiatric disorders, of whom the i-TAP correctly identified 91.7%. Diagnostic accuracy was 84.3% for any disorder, and somewhat lower for the specific disorders (77.1-78.6%). In Paper III, semi-structured interviews conducted in conjunction with data collection for Paper II were analysed using reflexive thematic analysis. Four themes were constructed addressing the content, usability, prospective implementation, and emotional and cultural aspects of addressing mental health issues. Findings suggested generally high acceptability of the i-TAP, contingent on established trust and follow-up. Participants found the i-TAP relevant and comprehensible, supporting content validity from a user perspective, though not fully comprehensive, as reflected in a clear wish to say more about one’s history and current situation. 

Taken together, findings from the three papers support the i-TAP as an accurate, efficient, and acceptable mental health screening tool that could be used among individuals with a refugee background in Sweden. At the same time, results underscore the importance of follow-up and further assessment: the i-TAP should complement, not replace, a health care visit, and should not be used as a diagnostic tool. Combined with the high symptom prevalence found in both samples, these results support routine mental health screening in this population, with the i-TAP as a suitable tool for this purpose, provided that it is implemented in a system with the resources to act on its findings.