Developing a new refugee assessment tool: The Screening of Refugees Self-Report (ScoReSR)
2. Project period:
February 2016 – December 2020
Charlotte Sonne, MD, PhD, postdoc fellow
4. Supervisors and collaborative partners
The project supervisor and collaborators include Senior Consultant Jessica Carlsson, PhD and
postdoc Erik Vindbjerg (Competence Centre for Transcultural Psychiatry at Mental Health Centre
Ballerup), Professor Etzel Cardeña, University of Lund, Professor Derrick Silove, University of New
South Wales, Australia and The New South Wales Service for the Treatment and Rehabilitation of
Torture and Trauma Survivors (STARTTS).
Refugees and asylum seekers (referred to as refugees henceforth) are at significant risk of
developing psychological complications as a result of exposure to high levels of cumulative trauma
before and during migration as well as exile stressors during the process of cultural transition (1–
4). In order to target intervention towards the actual need of this population we need a concise
measurement tool that takes into account not only the broad range of mental health symptoms
reported by refugees but also matters of social functioning and general wellbeing which will
inevitably influence the individual refugee’s ability take part in the surrounding society including
his/her attachment to the labour market. As such a measurement tool does not presently exist,
the aim of the current project is to design and validate a measurement tool based on previous
research undertaken by the partner organisations and consultations with clients, counsellors and
experts in the field.
The aim of the project is to provide a screening tool for mental health symptoms and psychosocial
problems among trauma-affected refugees that can be used internationally. The objectives are:
1) To undertake a review of measurement tools currently used by partner organisations
2) To undertake focus groups in order to gain a more comprehensive understanding of the
problems experienced by refugee communities who have recently arrived in Australia
3) To design a new measurement tool for refugees based on 1 and 2
4) To pilot-test and translate this new tool into the languages most often spoken by newly
5) To make a final version of the measurement tool which can be used by refugee mental
health service providers internationally
A self-rating screening tool of approximately 40-50 items covering the most common
psychiatric symptoms as well as life quality and social functioning problems among traumaaffected refugees will be developed in cooperation between the Danish, Swedish and
Australian research groups. The screening tool will be constructed on the basis of data collected in previous research projects in Denmark, Sweden and Australia as well as an
ongoing project at CTP about cultural validity of rating scales. The tool will be electronic so
users will be able to complete the ratings on computers, tablets or smart phones. The
screening tool will be available in the participant’s own language and software that read the
questions aloud is currently being tested in order not to exclude illiterate participants. The
screening tool will be piloted among the target group of refugees in Australia and Denmark.
7.1 Number of participants (N):
300 for the pilot phase
7.3 Description of data and data collection
Development and validation of the screening tool
The study consists of four phases. Phase 1 is divided into two parts (1a and 1b) which will run
parallel but independently of each other.
Phase 1a: Review of current assessment tools, including analysis of existing clinical data and
selection of most relevant items.
Phase 1b: Collection of qualitative data from newly arrived refugees whose psychosocial
problems and needs might be different to those of the ethnic and cultural subgroups for whom
we have existing data. This involves two rounds of focus group with refugee clients from
Phase 2: The information obtained from Phase 1a and 1b will form a joint basis for the draft of
a new measurement tool. The process of item development will include consultations with
counsellors and international experts in the field. We will translate and adapt the draft tool
prior to piloting.
Phases 3 and 4: Piloting and final adaptation of the tool. The measurement tool will be piloted
with individual refugee clients at STARTTS and CTP and subject to psychometric analysis to
examine its suitability as a screening assessment tool (Phase 3) and an outcome measure
(Phase 4). When a final version is agreed on, the tool will be translated through standard
translation and back-translation procedures with final corrections made through translational
Success criteria: A screening tool that is appropriate and acceptable for the target group.
7.4 Application/acceptance from the Danish Data Protection Agency, the National
Committee on Health Research Ethics:
All relevant permissions will be obtained before the
Analyses of quantitative data will include descriptive statistics (means and standard
deviations), standard epidemiological analyses, psychometric tests including principal
component analysis, confirmatory factor analyses (CFA), and Multigroup CFA will be applied to
assess the psychometric properties and factorial structures of the core psychiatric constructs
across culturally diverse groupings.
Analyses of qualitative data will be undertaken using NVivo. Deductive coding will be used to
examine how well the participants' statements fit into the proposed structure for the
psychosocial subscale, with additional themes identified where indicated.
8. Expected results
The project is expected to contribute with new important knowledge about the effect of early
interventions on the mental health and wellbeing among refugees. In the long term the results can
be used to prevent that individuals with refugee background develop chronic mental disorders
and thus potentially cut down society’s expenses of treatment, flexible jobs and early retirement.
9. Dissemination of results
Two publications are planned based on the results from the project:
1) Design of a multi-module rating scale for trauma-affected refugees
2) Validation of the ScoRe-SR screening tool for trauma-affected refugees
1. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees
resettled in western countries: a systematic review. Lancet [Internet]. Jan [cited 2013 Oct
31];365(9467):1309–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15823380
2. Nickerson A, Liddell BJ, Asnaani A, Carlsson J, Fazel M, Knaevelsrud C, et al. Trauma and
Mental Health in Forcibly Displaced Populations - An International Society for Traumatic
Stress Studies Briefing Paper. 2017.
3. Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z. Anxiety, depression and PTSD in
asylum-seekers: assocations with pre-migration trauma and post-migration stressors. Br J
Psychiatry [Internet]. 1997 Apr [cited 2015 Dec 10];170:351–7. Available from:
4. Silove D, Steel Z, McGorry P, Miles V, Drobny J. The impact of torture on post-traumatic
stress symptoms in war-affected Tamil refugees and immigrants. Compr Psychiatry
[Internet]. [cited 2016 Jun 27];43(1):49–55. Available from: