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Measuring mental health burden in humanitarian settings: a critical review of assessment tools

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Title: Measuring mental health burden in humanitarian settings: a critical review of assessment tools
Authors: Ashley Moore, Joris Adriaan Frank van Loenhout, Maria Moitinho de Almeida, Pierre Smith, Debarati Guha-Sapir
Source: Global Health Action, Vol 13, Iss 1 (2020)
Publisher Information: Taylor & Francis Group, 2020.
Publication Year: 2020
Collection: LCC:Public aspects of medicine
Subject Terms: disasters, mental health assessment, emergencies, humanitarian, trauma, Public aspects of medicine, RA1-1270
More Details: Background The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters’ impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement. Objective The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts. Method Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table. Results Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts. Conclusion It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 1654-9880
16549716
Relation: https://doaj.org/toc/1654-9880
DOI: 10.1080/16549716.2020.1783957
Access URL: https://doaj.org/article/2ae0e43db036471f81299e74577fff50
Accession Number: edsdoj.2ae0e43db036471f81299e74577fff50
Database: Directory of Open Access Journals
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  Value: <anid>AN0147862525;[829w]02jan.20;2021Jan02.13:03;v2.2.500</anid> <title id="AN0147862525-1">Measuring mental health burden in humanitarian settings: a critical review of assessment tools </title> <p>The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters' impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement. The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts. Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table. Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts. It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.</p> <p>Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden</p> <hd id="AN0147862525-2">Background</hd> <p>Disasters and conflicts create humanitarian crises that occur globally and affect millions of people yearly. A humanitarian setting is a setting in which a natural or manmade disaster or civil conflict occurs that exceeds local coping capacity and requires external assistance or humanitarian action [[<reflink idref="bib1" id="ref1">1</reflink>]]. In 2018, 315 natural and technological disasters occurred [[<reflink idref="bib2" id="ref2">2</reflink>]]. The majority are natural, and most disasters from 1998 to 2017 were extreme weather events, such as floods, droughts, and heat waves [[<reflink idref="bib3" id="ref3">3</reflink>]]. Other natural and technological disasters include earthquakes, hurricanes, and large-scale accidents. Interest in their mental health effects has grown due to the potential for trauma. Synthesized research about disaster mental health shows that posttraumatic stress disorder (PTSD), major depressive disorder, and substance use disorder are common outcomes [[<reflink idref="bib4" id="ref4">4</reflink>]]. Other outcomes of interest include generalized anxiety disorder (GAD), prolonged grief, panic disorders, and phobias; however, these outcomes are less frequently studied than PTSD, depression, and substance use [[<reflink idref="bib4" id="ref5">4</reflink>]]. In addition to natural and technological disasters, conflicts and related displacement greatly contribute to the global population in need of humanitarian assistance. Mental health research in humanitarian settings is heavily focused on PTSD and indicates that the prevalence of PTSD and depression in these settings is much higher than in the general population [[<reflink idref="bib5" id="ref6">5</reflink>]].</p> <p>Though the morbidity and mortality of conflict-affected populations are decreasing due to effective disease control programs, these populations continue to face safety concerns with the prolonged nature of contemporary conflicts [[<reflink idref="bib6" id="ref7">6</reflink>]]. Furthermore, conflict research shows that civilians who experience war conflicts, especially women and children, are at a high risk for persisting mental health effects [[<reflink idref="bib7" id="ref8">7</reflink>]]. Displacement contributes to stress and is associated with loss of a loved one, destruction of the home, and limited access to stable resources [[<reflink idref="bib7" id="ref9">7</reflink>]]. The damage to infrastructure that conflicts bring to communities removes access to mental health resources and exacerbates individuals' stress [[<reflink idref="bib7" id="ref10">7</reflink>]].</p> <p>Great variability exists among the methods of evaluating mental health in humanitarian settings [[<reflink idref="bib4" id="ref11">4</reflink>]]. The lack of standardization in assessment approaches hinders researchers' and humanitarian organizations' ability to ascertain the true impact of disasters on mental health. For example, a systematic review of literature up to November 2013 on the mental health outcomes of Iraqi refugees in Western countries shows the prevalence of PTSD and depression ranging from 8% to 37% and 28% to 75%, respectively [[<reflink idref="bib8" id="ref12">8</reflink>]]. In-depth diagnostic interviews may be the gold standard for such measures, but research in humanitarian settings warrants more brief and easy-to-use tools that measure only symptoms and thus do not require the presence of a clinician. In addition, rapid screening tools can be useful in decision-making and program planning due to their ability to obtain the burden of mental distress in a time-limited setting. The purpose of this critical review is to evaluate the use of different tools for studying or assessing the mental health effects of disasters and conflicts. The outcomes of interest are PTSD, depression, anxiety, substance use disorder, and general mental health and were chosen due to their high prevalence in disaster and conflict research.</p> <hd id="AN0147862525-3">Methods</hd> <p>Three searches were conducted for this review: the first search collected commonly used mental health assessment tools, the second collected their validation studies, and the third collected studies that used these tools in disaster or conflict mental health research.</p> <hd id="AN0147862525-4">Assessment tool search</hd> <p>A list of mental health assessment tools was compiled using Google Scholar, PsycINFO, and PubMed search engines. Each tool had to be individual, brief, developed in or after 1990, and non-diagnostic to be included in the study. A combination of the following MeSH keywords was used for this search: 'symptom assessment,' 'standards,' 'emergencies,' 'disasters,' 'humanitarian assistance,' 'mental health,' 'posttraumatic stress disorder,' 'depression,' 'substance use disorders.' We employed snowball sampling to obtain comprehensive information about the tools and ascertain which tools are commonly used, since we had limited initial information regarding the properties of commonly used tools in emergency settings. The length, purpose, and existence of translations for each tool were ascertained. We excluded tools that evaluate community needs, assess lifetime mental illness, or involve in-depth interviews. We selected the most recent version if multiple versions of the tool existed.</p> <hd id="AN0147862525-5">Validation study search</hd> <p>We then conducted a search on PubMed and Google Scholar and obtained psychometric properties and validation studies to present consistency in validation and the presence of cross-cultural applications of the tools in the existing literature, regardless of population or setting. Validation studies include studies in which researchers determine if the tool adequately distinguishes between a distressed and a non-distressed person, and the tools are often validated against an existing widely used tool such as the General Health Questionnaire. For this search, we did not employ MeSH search terms; rather, we searched the terms '[assessment tool]' and 'validation study' and recorded the studies that affirm or deny the validity of the tool in specified languages and/or populations.</p> <hd id="AN0147862525-6">Study search</hd> <p>Finally, we conducted a targeted review of peer-reviewed literature that has used one of the selected assessment tools in humanitarian settings, using both PubMed and Google Scholar. For this final search, a combination of the following MeSH keywords was employed: [assessment tool (not MeSH)] <emph>and</emph> 'natural disasters,' 'armed conflicts.' An experienced librarian at UCLouvain validated the search methodology. Inclusion and exclusion criteria are summarized in Table 1.</p> <p>Table 1. Inclusion and exclusion criteria for studies on MH assessment toolsa.</p> <p> <ephtml> <table><thead><tr><td>Criteria type</td><td>Inclusion</td><td>Exclusion</td><td>Justification</td></tr></thead><tbody><tr><td>Population</td><td>Civilians of any age affected by a disaster or conflict</td><td>Veterans</td><td>Veteran populations likely have vastly different experiences than civilian populations, which would fragment the findings.</td></tr><tr><td>Intervention/exposure of interest</td><td>Human-made intentional (conflict/war), human-made unintentional (technological), natural</td><td>Terrorism</td><td>The focus of this paper is on events that result in a humanitarian crisis, and thus excludes terrorism events.</td></tr><tr><td>Comparison</td><td>N/A</td><td>N/A</td><td>The review did not limit studies based on inclusion of comparison groups.</td></tr><tr><td>Outcome</td><td>Any mental health outcome</td><td>N/A</td><td>While there were no exclusion criteria for outcome of interest, the mental health outcomes naturally were limited to PTSD, depression, substance use, and general mental health due to the nature of mental health research in humanitarian settings.</td></tr><tr><td>Study type and year</td><td>Epidemiological studies conducted in 2000–2019</td><td>Systematic or literature review; intervention evaluation; studies conducted before 2000</td><td>Review and evaluation articles are excluded due to the likelihood of a repetition in citations collected. Studies published before 2000 were excluded to ensure timeliness and feasibility.</td></tr></tbody></table> </ephtml> </p> <p>1 <sups>a</sups>Table follows PICO format, where applicable [[<reflink idref="bib9" id="ref13">9</reflink>]].</p> <p>If no studies corresponded with a particular tool, then that tool was dropped from the list, as we could not provide an adequate recommendation without evidence of the tool's utility.</p> <p>Doubts regarding study or tool eligibility were discussed between AM, MMA, PS, and JvL.</p> <p>We extracted the benefits and limitations cited in each study regarding the particular tool and its utility in populations affected by disaster or conflict. Based on these observations, we described the main strengths and weaknesses of each tool in assessing the mental health outcomes in these populations.</p> <hd id="AN0147862525-7">Results</hd> <p></p> <hd id="AN0147862525-8">Assessment tool search results</hd> <p>The assessment tool search resulted in a total of 27 tools for analysis consisting of nine tools for PTSD, seven tools for general mental health, six tools for depression, three tools for anxiety, and two tools for substance use disorder (Figure 1). Fifteen tools were excluded from the study due to a lack of evidence regarding their use in populations affected by disaster or conflict. Twelve tools remained for analysis: seven tools for PTSD, two tools for general mental health, two tools for depression, and one tool for anxiety. We did not identify any tools that evaluated substance use disorder that matched our eligibility criteria. Three tools, the Posttraumatic Symptom Scale – Self Report, SPAN, and Davidson Trauma Scale, required payment to view the full tool details but were nevertheless included due to adequate secondary information.</p> <p>Graph: Figure 1. Flowchart for selection of mental health assessment tools in disaster- and conflict-affected populations resulting in 12 tools.</p> <p>Table 2 presents the year published, psychometric properties, and symptom period of the tools. Most tools exhibit high reliability and validity for the populations in which they were originally developed. Tool length ranges from 4 to 33 items and takes between 5 and 10 minutes. The tools also specify that symptoms should last between 1 week and 1 month.</p> <p>Table 2. Psychometric properties.</p> <p> <ephtml> <table><thead><tr><td>Tool</td><td>Year</td><td>Validity</td><td>Reliability</td><td>Length</td><td>Symptom period, time</td></tr></thead><tbody><tr><td><bold>Anxiety tool</bold></td></tr><tr><td>Beck Anxiety Inventory (BAI) [<xref ref-type="bibr" rid="bibr10">10</xref>]</td><td>1993</td><td>Good discriminant validity</td><td>Alpha = 0.92</td><td>21 items</td><td>1 month 5–10 minutes</td></tr><tr><td><bold>Depression tools</bold></td></tr><tr><td>Beck Depression Inventory II (BDI-II) [<xref ref-type="bibr" rid="bibr11">11</xref>]</td><td>1996</td><td>Good content and convergent validity</td><td>Alpha = 0.93</td><td>21 items</td><td>2 weeks 5 minutes</td></tr><tr><td>Patient Health Questionnaire 9 (PHQ-9) [<xref ref-type="bibr" rid="bibr12">12</xref>]</td><td>1999</td><td>Good criterion, construct, and external validity</td><td>Alpha = 0.89</td><td>9–10 items</td><td>2 weeks Unknown time</td></tr><tr><td><bold>PTSD tools</bold></td></tr><tr><td>Children's PTSD Symptom Scale (CPSS) [<xref ref-type="bibr" rid="bibr13">13</xref>]</td><td>2001</td><td>Convergent validity = 0.80; 95% of cases were correctly identified</td><td>Alpha = 0.89</td><td>24 items</td><td>2 weeks 10 minutes</td></tr><tr><td>Davidson Trauma Scale (DTS) [<xref ref-type="bibr" rid="bibr14">14</xref>]</td><td>1997</td><td>Good concurrent, construct, and predictive validity</td><td>Good test-retest and split-half reliability and internal consistency</td><td>17 items</td><td>1 week 10 minutes</td></tr><tr><td>Impact of Events Scale – Revised (IES-R) [<xref ref-type="bibr" rid="bibr15">15</xref>]</td><td>1997</td><td>Construct validity = 0.84</td><td>Alpha = 0.96</td><td>22 items</td><td>7 days Unknown time</td></tr><tr><td>PTSD Checklist – Specific (PCL-S) [<xref ref-type="bibr" rid="bibr16">16</xref>]</td><td>1993</td><td>Good convergent validity</td><td>Good test-retest reliability and internal consistency</td><td>20 items</td><td>1 month 5–10 minutes</td></tr><tr><td>PTSD Symptom Scale – Self Report (PSS-SR) [<xref ref-type="bibr" rid="bibr17">17</xref>]</td><td>1993</td><td>Concurrent validity = 0.68</td><td>Good test-retest reliability and internal consistency</td><td>17 items</td><td>Unknown</td></tr><tr><td>Posttraumatic Cognitions Inventory (PTCI) [<xref ref-type="bibr" rid="bibr18">18</xref>]</td><td>1999</td><td>Good convergent and discriminant validity</td><td>Alpha = 0.97</td><td>33 items</td><td>Unknown</td></tr><tr><td>SPAN Self-Report Screen (SPAN) [<xref ref-type="bibr" rid="bibr19">19</xref>]</td><td>2002</td><td>Unknown</td><td>Unknown</td><td>4 items</td><td>1 week Unknown time</td></tr><tr><td><bold>General mental health tools</bold></td></tr><tr><td>Screening Questionnaire for Disaster Mental Health (SQD) [<xref ref-type="bibr" rid="bibr20">20</xref>]</td><td>2007</td><td>Convergent validity = 0.94</td><td>Alpha = 0.83</td><td>12 items</td><td>1 week Unknown time</td></tr><tr><td>WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings (WASSS) [<xref ref-type="bibr" rid="bibr21">21</xref>]</td><td>2012</td><td>Unknown</td><td>Unknown</td><td>6 items plus a household roster</td><td>2 weeks 7–8 minutes</td></tr></tbody></table> </ephtml> </p> <hd id="AN0147862525-9">Validation study search results</hd> <p>Table 3 presents the validated populations and languages for each tool. The tools have been validated across a variety of different populations and regions. The PHQ-9 had the most validation studies backing it. Most of the tools have been validated in a language other than English. The PSS-SR and the WASSS are the only tools with no validation studies.</p> <p>Table 3. Validation studies.</p> <p> <ephtml> <table><thead><tr><td>Tool</td><td>Validated populations or methods</td><td>Validated languages other than English</td></tr></thead><tbody><tr><td><bold>Anxiety tool</bold></td></tr><tr><td>BAI</td><td><list list-type="Bullet"><list-item><p>German patients [<xref ref-type="bibr" rid="bibr22">22</xref>]</p></list-item><list-item><p>Chinese doctors [<xref ref-type="bibr" rid="bibr23">23</xref>]</p></list-item><list-item><p>Psychiatric inpatient and high school adolescents [<xref ref-type="bibr" rid="bibr24">24</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>German [<xref ref-type="bibr" rid="bibr22">22</xref>]</p></list-item><list-item><p>Chinese [<xref ref-type="bibr" rid="bibr23">23</xref>]</p></list-item><list-item><p>Portuguese [<xref ref-type="bibr" rid="bibr25">25</xref>]</p></list-item></list></td></tr><tr><td><bold>Depression tools</bold></td></tr><tr><td>BDI II</td><td><list list-type="Bullet"><list-item><p>Adolescent and adult inpatients [<xref ref-type="bibr" rid="bibr26">26-27</xref>, <xref ref-type="bibr" rid="bibr29">29</xref>]</p></list-item><list-item><p>Low-income African American medical outpatients [<xref ref-type="bibr" rid="bibr30">30</xref>]</p></list-item><list-item><p>American and Jamaican HIV*-positive patients [<xref ref-type="bibr" rid="bibr31">31-32</xref>]</p></list-item><list-item><p>Family caregivers of children with chronic disease [<xref ref-type="bibr" rid="bibr33">33</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Portuguese [<xref ref-type="bibr" rid="bibr34">34</xref>]</p></list-item><list-item><p>Croatian [<xref ref-type="bibr" rid="bibr35">35</xref>]</p></list-item><list-item><p>Japanese [<xref ref-type="bibr" rid="bibr36">36</xref>]</p></list-item><list-item><p>Korean [<xref ref-type="bibr" rid="bibr37">37</xref>]</p></list-item><list-item><p>Xhosa [<xref ref-type="bibr" rid="bibr28">28</xref>]</p></list-item></list></td></tr><tr><td>PHQ-9</td><td><list list-type="Bullet"><list-item><p>Patients with epilepsy, migraine, multiple sclerosis, stroke, spinal cord injury, traumatic brain injury, Parkinson's disease [<xref ref-type="bibr" rid="bibr38">38</xref>–<xref ref-type="bibr" rid="bibr43">43</xref>]</p></list-item><list-item><p>Chilean adolescents [<xref ref-type="bibr" rid="bibr44">44</xref>]</p></list-item><list-item><p>Primary care in South Africa [<xref ref-type="bibr" rid="bibr45">45</xref>]</p></list-item><list-item><p>Iranian psychiatric outpatients [<xref ref-type="bibr" rid="bibr46">46</xref>]</p></list-item><list-item><p>Korean American elderly [<xref ref-type="bibr" rid="bibr47">47</xref>]</p></list-item><list-item><p>Nepal, with added idioms of distress [<xref ref-type="bibr" rid="bibr48">48</xref>]</p></list-item><list-item><p>MSM* in Haiti [<xref ref-type="bibr" rid="bibr49">49</xref>]</p></list-item><list-item><p>Germans and Turkish immigrants in Germany [<xref ref-type="bibr" rid="bibr50">50</xref>]</p></list-item><list-item><p>Pregnant women [<xref ref-type="bibr" rid="bibr51">51</xref>]</p></list-item><list-item><p>Polish hospitalized elderly [<xref ref-type="bibr" rid="bibr52">52</xref>]</p></list-item><list-item><p>Administered through interactive voice technology [<xref ref-type="bibr" rid="bibr53">53</xref>]</p></list-item><list-item><p>Patients with Type 2 Diabetes in Malawi and The Netherlands [<xref ref-type="bibr" rid="bibr54">54-55</xref>]</p></list-item><list-item><p>Employees on sick leave [<xref ref-type="bibr" rid="bibr56">56</xref>]</p></list-item><list-item><p>Pregnant women in Ethiopia [<xref ref-type="bibr" rid="bibr57">57</xref>]</p></list-item><list-item><p>Chinese Americans in primary care [<xref ref-type="bibr" rid="bibr58">58</xref>]</p></list-item><list-item><p>General population in Hong Kong [<xref ref-type="bibr" rid="bibr59">59</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Chinese [<xref ref-type="bibr" rid="bibr60">60</xref>]</p></list-item><list-item><p>Korean [<xref ref-type="bibr" rid="bibr61">61</xref>]</p></list-item><list-item><p>Malayalam [<xref ref-type="bibr" rid="bibr62">62</xref>]</p></list-item><list-item><p>Portuguese [<xref ref-type="bibr" rid="bibr63">63</xref>]</p></list-item><list-item><p>Polish [<xref ref-type="bibr" rid="bibr52">52</xref>]</p></list-item><list-item><p>Latvian and Russian [<xref ref-type="bibr" rid="bibr64">64</xref>]</p></list-item><list-item><p>Afaan Oromo [<xref ref-type="bibr" rid="bibr57">57</xref>]</p></list-item><list-item><p>Japanese [<xref ref-type="bibr" rid="bibr65">65</xref>]</p></list-item></list></td></tr><tr><td><bold>PTSD tools</bold></td></tr><tr><td>CPSS</td><td>N/A</td><td><list list-type="Bullet"><list-item><p>Hebrew [<xref ref-type="bibr" rid="bibr66">66</xref>]</p></list-item><list-item><p>Spanish [<xref ref-type="bibr" rid="bibr67">67</xref>]</p></list-item><list-item><p>Nepali [<xref ref-type="bibr" rid="bibr68">68</xref>]</p></list-item></list></td></tr><tr><td>DTS</td><td><list list-type="Bullet"><list-item><p>Chilean people exposed to F-27 earthquake [<xref ref-type="bibr" rid="bibr69">69</xref>]</p></list-item><list-item><p>Military veterans served after 9/11 [<xref ref-type="bibr" rid="bibr70">70</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Korean [<xref ref-type="bibr" rid="bibr71">71</xref>]</p></list-item><list-item><p>Chinese [<xref ref-type="bibr" rid="bibr72">72</xref>]</p></list-item><list-item><p>Spanish [<xref ref-type="bibr" rid="bibr73">73</xref>]</p></list-item></list></td></tr><tr><td>IES-R</td><td><list list-type="Bullet"><list-item><p>Women exposed to disaster before or during pregnancy [<xref ref-type="bibr" rid="bibr74">74</xref>]</p></list-item><list-item><p>Adolescents exposed to typhoon in Taiwan [<xref ref-type="bibr" rid="bibr75">75</xref>]</p></list-item><list-item><p>Swedish patients with burns [<xref ref-type="bibr" rid="bibr76">76</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>French [<xref ref-type="bibr" rid="bibr74">74</xref>]</p></list-item><list-item><p>Chinese [<xref ref-type="bibr" rid="bibr77">77</xref>]</p></list-item><list-item><p>Japanese [<xref ref-type="bibr" rid="bibr78">78</xref>]</p></list-item><list-item><p>Malay [<xref ref-type="bibr" rid="bibr79">79</xref>]</p></list-item><list-item><p>Tamil [<xref ref-type="bibr" rid="bibr80">80</xref>]</p></list-item></list></td></tr><tr><td>PCL-S</td><td><list list-type="Bullet"><list-item><p>Norwegian survivors of 2004 Southeast Asian tsunami [<xref ref-type="bibr" rid="bibr81">81</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Japanese [<xref ref-type="bibr" rid="bibr82">82</xref>]</p></list-item></list></td></tr><tr><td>PSS-SR</td><td>N/A</td><td>N/A</td></tr><tr><td>PTCI</td><td><list list-type="Bullet"><list-item><p>Brazilian population [<xref ref-type="bibr" rid="bibr83">83</xref>]</p></list-item></list></td><td>N/A</td></tr><tr><td>SPAN</td><td>N/A</td><td><list list-type="Bullet"><list-item><p>Chinese [<xref ref-type="bibr" rid="bibr84">84</xref>]</p></list-item><list-item><p>Korean [<xref ref-type="bibr" rid="bibr71">71</xref>]</p></list-item></list></td></tr><tr><td><bold>General mental health tools</bold></td></tr><tr><td>SQD</td><td><list list-type="Bullet"><list-item><p>People affected by earthquake in Japan [<xref ref-type="bibr" rid="bibr20">20</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Italian [<xref ref-type="bibr" rid="bibr85">85</xref>]</p></list-item></list></td></tr><tr><td>WASSS</td><td>N/A</td><td>N/A</td></tr></tbody></table> </ephtml> </p> <p>2 *HIV: Human Immunodeficiency virus; MSM: men who have sex with men.</p> <hd id="AN0147862525-10">Study search results</hd> <p>Of the 86 studies included in the review (Figure 2), 82 focused on people affected by natural and technological disasters and four focused on people affected by conflict. Thirty-four different disasters were studied. The 2008 Wenchuan earthquake and 2005 Hurricane Katrina were the top two most frequently studied disasters with 17 and nine studies, respectively. Of the four studies that examined the effects of conflict, three focused on people affected by the Georgian conflict and one focused on those living in the Gaza strip. All tools but the SQD originated in English. The SQD originated in Japanese but was translated into English for validation. The greatest number of tools was available in Nepali, while the greatest number of studies used a Chinese translation of the tools. Other translations may be available for the selected tools but were not identified due to lack of validation.</p> <p>Graph: Figure 2. Flowchart of article selection for studies that used an assessment tool from previous search resulting in 88 total citations.</p> <p>The main strengths and limitations for each tool are presented in Table 4. The IES-R, measuring PTSD symptoms, is by far the most widely used tool among all of the studies, with 44 of the 86 studies using it. The second most widely used tool among the studies is the CPSS, with 11 studies using it to study the posttraumatic effects of crises on children.</p> <p>Table 4. Tool strengths and limitations.</p> <p> <ephtml> <table><thead><tr><td>Tool, # of studies*</td><td>Strengths</td><td>Limitations</td><td>Populations studied and languages other than English used</td></tr></thead><tbody><tr><td><bold>Anxiety tool</bold></td></tr><tr><td>BAI 5 studies</td><td><list list-type="Bullet"><list-item><p>Availability of multiple languages [<xref ref-type="bibr" rid="bibr87">87</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Not culture-specific [<xref ref-type="bibr" rid="bibr87">87</xref>]</p></list-item><list-item><p>Tool is in English, not Tibetan language [<xref ref-type="bibr" rid="bibr91">91</xref>]</p></list-item><list-item><p>May not be extrapolated to other populations [<xref ref-type="bibr" rid="bibr92">92</xref>]</p></list-item><list-item><p>Not validated in Haitian contexts and Western tools may not be appropriate [<xref ref-type="bibr" rid="bibr93">93</xref>]</p></list-item><list-item><p>Self-report [<xref ref-type="bibr" rid="bibr94">94</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Tibetan refugees in North India [<xref ref-type="bibr" rid="bibr91">91</xref>]</p></list-item><list-item><p>● Chinese elderly 2013 Ya'an earthquake survivors [<xref ref-type="bibr" rid="bibr92">92</xref>]</p></list-item><list-item><p>● 2010 earthquake-exposed Haitians in Florida [<xref ref-type="bibr" rid="bibr87">87</xref>, <xref ref-type="bibr" rid="bibr93">93</xref>]</p></list-item><list-item><p>● 2008 Iceland earthquake survivors [<xref ref-type="bibr" rid="bibr94">94</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Icelandic [<xref ref-type="bibr" rid="bibr94">94</xref>]</p></list-item></list></td></tr><tr><td><bold>Depression tools</bold></td></tr><tr><td>BDI II 4 studies</td><td><list list-type="Bullet"><list-item><p>Can be administered online, convenient, accessible [<xref ref-type="bibr" rid="bibr95">95</xref>]</p></list-item><list-item><p>Widely used [<xref ref-type="bibr" rid="bibr96">96</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Self-report and subjective [<xref ref-type="bibr" rid="bibr94">94</xref>–<xref ref-type="bibr" rid="bibr97">97</xref>]</p></list-item><list-item><p>Valid Nepali language version does not exist [<xref ref-type="bibr" rid="bibr97">97</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● 2008 Iceland earthquake survivors [<xref ref-type="bibr" rid="bibr94">94</xref>]</p></list-item><list-item><p>● Pet owners who survived Hurricane Katrina [<xref ref-type="bibr" rid="bibr95">95</xref>]</p></list-item><list-item><p>● Parents of internally displaced children in Georgia [<xref ref-type="bibr" rid="bibr96">96</xref>]</p></list-item><list-item><p>● Nepalese 2015 earthquake survivors in Phulpingdanda village [<xref ref-type="bibr" rid="bibr97">97</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Icelandic [<xref ref-type="bibr" rid="bibr94">94</xref>]</p></list-item><list-item><p>● Georgian [<xref ref-type="bibr" rid="bibr96">96</xref>]</p></list-item><list-item><p>● Nepali [<xref ref-type="bibr" rid="bibr97">97</xref>]</p></list-item></list></td></tr><tr><td>PHQ-9 9 studies</td><td><list list-type="Bullet"><list-item><p>Adequate clinical applications [<xref ref-type="bibr" rid="bibr98">98</xref>]</p></list-item><list-item><p>Diagnostically accurate estimate of prevalence [<xref ref-type="bibr" rid="bibr99">99</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>May not be culturally sensitive to Georgian population [<xref ref-type="bibr" rid="bibr88">88-89</xref>]</p></list-item><list-item><p>Self-report measure, not diagnostic [<xref ref-type="bibr" rid="bibr98">98</xref>–<xref ref-type="bibr" rid="bibr103">103</xref>]</p></list-item><list-item><p>Conducting survey in-person for illiterate participants may skew results [<xref ref-type="bibr" rid="bibr104">104</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Adults affected by conflicts in Georgia [<xref ref-type="bibr" rid="bibr88">88-89</xref>]</p></list-item><list-item><p>● Women displaced by Hurricane Katrina [<xref ref-type="bibr" rid="bibr98">98</xref>]</p></list-item><list-item><p>● Galveston Bay survivors of Hurricane Ike [<xref ref-type="bibr" rid="bibr100">100</xref>]</p></list-item><list-item><p>● Survivors of the 2016 Fort McMurray, Canada wildfire [<xref ref-type="bibr" rid="bibr99">99</xref>]</p></list-item><list-item><p>● 2009 Australia bushfire disaster [<xref ref-type="bibr" rid="bibr101">101</xref>]</p></list-item><list-item><p>● Workers who experienced the Great East Japan Earthquake [<xref ref-type="bibr" rid="bibr102">102-103</xref>]</p></list-item><list-item><p>● Survivors with spinal cord injury from the 2015 Nepal earthquake [<xref ref-type="bibr" rid="bibr104">104</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Georgian [<xref ref-type="bibr" rid="bibr88">88-89</xref>]</p></list-item><list-item><p>● Nepali [<xref ref-type="bibr" rid="bibr104">104</xref>]</p></list-item></list></td></tr><tr><td><bold>PTSD tools</bold></td></tr><tr><td>CPSS 11 studies</td><td><list list-type="Bullet"><list-item><p>Self-report measures can be valuable [<xref ref-type="bibr" rid="bibr86">86</xref>]</p></list-item><list-item><p>Not a significant time burden [<xref ref-type="bibr" rid="bibr105">105</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Validated measures may produce significant results [<xref ref-type="bibr" rid="bibr86">86</xref>]</p></list-item><list-item><p>Self-report measure, not diagnostic, overestimate [<xref ref-type="bibr" rid="bibr105">105</xref>–<xref ref-type="bibr" rid="bibr113">113</xref>]</p></list-item><list-item><p>Between- and within-population variability in scores [<xref ref-type="bibr" rid="bibr114">114</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Children who experienced 2010 Nashville, Tennessee flood [<xref ref-type="bibr" rid="bibr86">86</xref>]</p></list-item><list-item><p>● School children who survived Hurricane Katrina [<xref ref-type="bibr" rid="bibr105">105</xref>]</p></list-item><list-item><p>● Children and students in Phulpingdanda village who experienced 2015 Nepal earthquakes [<xref ref-type="bibr" rid="bibr106">106</xref>, <xref ref-type="bibr" rid="bibr114">114</xref>]</p></list-item><list-item><p>● Adolescent survivors of the Wenchuan earthquake [<xref ref-type="bibr" rid="bibr107">107-108</xref>, <xref ref-type="bibr" rid="bibr110">110</xref>–<xref ref-type="bibr" rid="bibr113">113</xref>]</p></list-item><list-item><p>● Children who experienced 2013 Ya'an earthquake [<xref ref-type="bibr" rid="bibr109">109</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Chinese [<xref ref-type="bibr" rid="bibr107">107</xref>–<xref ref-type="bibr" rid="bibr112">112</xref>]</p></list-item><list-item><p>● Nepali [<xref ref-type="bibr" rid="bibr114">114</xref>]</p></list-item></list></td></tr><tr><td>DTS 3 studies</td><td><list list-type="Bullet"><list-item><p>Early detection, useful screening tool [<xref ref-type="bibr" rid="bibr115">115</xref>]</p></list-item><list-item><p>Available in several languages [<xref ref-type="bibr" rid="bibr116">116</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Designed for screening, may not catch people with acute PTSD [<xref ref-type="bibr" rid="bibr117">117</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Survivors of 2005 Pakistan earthquake [<xref ref-type="bibr" rid="bibr115">115</xref>]</p></list-item><list-item><p>● Residents during 2017 earthquakes in Mexico [<xref ref-type="bibr" rid="bibr116">116</xref>]</p></list-item><list-item><p>● Rescue workers in 1999 Chi-Chi earthquake [<xref ref-type="bibr" rid="bibr117">117</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Urdu [<xref ref-type="bibr" rid="bibr115">115</xref>]</p></list-item></list></td></tr><tr><td>IES-R 44 studies</td><td><list list-type="Bullet"><list-item><p>Helpful for initiating treatment programs [<xref ref-type="bibr" rid="bibr118">118</xref>]</p></list-item><list-item><p>Symptom assessment and comparison of a large number of people [<xref ref-type="bibr" rid="bibr119">119</xref>]</p></list-item><list-item><p>Useful in time-limited situations [<xref ref-type="bibr" rid="bibr120">120</xref>]</p></list-item><list-item><p>Useful for in-person surveys with low literacy populations [<xref ref-type="bibr" rid="bibr121">121</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Not be totally reliable, may overestimate prevalence [<xref ref-type="bibr" rid="bibr118">118-119</xref>, <xref ref-type="bibr" rid="bibr122">122</xref>–<xref ref-type="bibr" rid="bibr151">151</xref>, <xref ref-type="bibr" rid="bibr173">173-174</xref>]</p></list-item><list-item><p>Not formally validated in Nepalese population [<xref ref-type="bibr" rid="bibr138">138</xref>]</p></list-item><list-item><p>Relies on DSM-IV criteria [<xref ref-type="bibr" rid="bibr152">152</xref>]</p></list-item><list-item><p>No validity or reliability for Turkish, French, Tamil, Sinhalese version [<xref ref-type="bibr" rid="bibr153">153</xref>–<xref ref-type="bibr" rid="bibr155">155</xref>]</p></list-item><list-item><p>Might not be culturally sensitive [<xref ref-type="bibr" rid="bibr156">156</xref>]</p></list-item><list-item><p>Low-range scores may be misdiagnosed [<xref ref-type="bibr" rid="bibr157">157</xref>]</p></list-item><list-item><p>May underestimate prevalence [<xref ref-type="bibr" rid="bibr158">158</xref>]</p></list-item><list-item><p>Lack of a cutoff recommendation [<xref ref-type="bibr" rid="bibr150">150</xref>, <xref ref-type="bibr" rid="bibr159">159</xref>, <xref ref-type="bibr" rid="bibr173">173</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Flood-affected adults in Tamil Nadu [<xref ref-type="bibr" rid="bibr118">118</xref>]</p></list-item><list-item><p>● Survivors of the 2013 North India floods [<xref ref-type="bibr" rid="bibr121">121</xref>]</p></list-item><list-item><p>● Swedish survivors of the 1994 MS Estonia disaster [<xref ref-type="bibr" rid="bibr122">122</xref>]</p></list-item><list-item><p>● People affected by Hurricane Sandy [<xref ref-type="bibr" rid="bibr123">123</xref>]</p></list-item><list-item><p>● Adult survivors, pregnant survivors of Wenchuan earthquake [<xref ref-type="bibr" rid="bibr124">124-125</xref>, <xref ref-type="bibr" rid="bibr133">133</xref>, <xref ref-type="bibr" rid="bibr142">142</xref>]</p></list-item><list-item><p>● General population, students, low-income parents who survived Hurricane Katrina [<xref ref-type="bibr" rid="bibr126">126</xref>, <xref ref-type="bibr" rid="bibr128">128</xref>, <xref ref-type="bibr" rid="bibr130">130</xref>, <xref ref-type="bibr" rid="bibr141">141</xref>, <xref ref-type="bibr" rid="bibr143">143</xref>]</p></list-item><list-item><p>● Survivors of mudslide and Wenchuan earthquake [<xref ref-type="bibr" rid="bibr127">127</xref>]</p></list-item><list-item><p>● Rescue workers of Great East Japan Earthquake [<xref ref-type="bibr" rid="bibr129">129</xref>]</p></list-item><list-item><p>● Survivors of 2000 Miyake Island volcanic eruption [<xref ref-type="bibr" rid="bibr131">131</xref>]</p></list-item><list-item><p>● Survivors of 2010 Canterbury, New Zealand earthquakes [<xref ref-type="bibr" rid="bibr137">137</xref>]</p></list-item><list-item><p>● Those who experienced 2014 flood in Malaysia [<xref ref-type="bibr" rid="bibr140">140</xref>]</p></list-item><list-item><p>● Treatment-seeking individuals who experienced the 2009 L'Aquila earthquake [<xref ref-type="bibr" rid="bibr144">144</xref>]</p></list-item><list-item><p>● Nuclear plant workers, evacuees who experienced the 2011 Fukushima disaster [<xref ref-type="bibr" rid="bibr145">145</xref>]</p></list-item></list></td></tr><tr><td /><td /><td /><td><list list-type="Bullet"><list-item><p>● Chinese students who experienced 2008 snowstorm disaster [<xref ref-type="bibr" rid="bibr148">148</xref>]</p></list-item><list-item><p>● Survivors of 2012 Yiliang earthquakes [<xref ref-type="bibr" rid="bibr149">149</xref>]</p></list-item><list-item><p>● Israeli backpackers & mothers who experienced the 2015 Nepal earthquake [<xref ref-type="bibr" rid="bibr138">138</xref>, <xref ref-type="bibr" rid="bibr150">150</xref>]</p></list-item><list-item><p>● Adolescents and young adults who experienced the 2010 Haiti earthquake [<xref ref-type="bibr" rid="bibr152">152</xref>]</p></list-item><list-item><p>● Rescue workers in 1999 Marmara, Turkey earthquake [<xref ref-type="bibr" rid="bibr153">153</xref>]</p></list-item><list-item><p>● Survivors of 2001 factory explosion in Toulouse, France [<xref ref-type="bibr" rid="bibr154">154</xref>]</p></list-item><list-item><p>● Swedish, Norwegian tourists, Sri Lankan survivors who experienced the 2004 Southeast Asia tsunami [<xref ref-type="bibr" rid="bibr119">119-120</xref>, <xref ref-type="bibr" rid="bibr135">135-136</xref>, <xref ref-type="bibr" rid="bibr155">155</xref>]</p></list-item><list-item><p>● Responders to the 2005 Northern Pakistan earthquake [<xref ref-type="bibr" rid="bibr156">156</xref>]</p></list-item><list-item><p>● Adults, psychiatric patients, cardiovascular patients, Japanese adolescents, junior high students, and Qiang women who survived the Great East Japan Earthquake [<xref ref-type="bibr" rid="bibr132">132</xref>, <xref ref-type="bibr" rid="bibr134">134</xref>, <xref ref-type="bibr" rid="bibr139">139</xref>, <xref ref-type="bibr" rid="bibr146">146</xref>, <xref ref-type="bibr" rid="bibr157">157</xref>, <xref ref-type="bibr" rid="bibr173">173-174</xref>]</p></list-item><list-item><p>● Joso City residents who experienced 2015 Tokyo flooding [<xref ref-type="bibr" rid="bibr158">158</xref>]</p></list-item><list-item><p>● Tamil Nadu, India survivors of 2004 Southeast Asian tsunami [<xref ref-type="bibr" rid="bibr151">151</xref>]</p></list-item><list-item><p>● Survivors of the 2010 Mount Merapi volcano eruption [<xref ref-type="bibr" rid="bibr159">159</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Tamil [<xref ref-type="bibr" rid="bibr118">118</xref>]</p></list-item><list-item><p>● Swedish [<xref ref-type="bibr" rid="bibr119">119</xref>]</p></list-item><list-item><p>● Japanese [<xref ref-type="bibr" rid="bibr129">129</xref>]</p></list-item><list-item><p>● Nepali [<xref ref-type="bibr" rid="bibr138">138</xref>]</p></list-item><list-item><p>● Hebrew [<xref ref-type="bibr" rid="bibr150">150</xref>]</p></list-item><list-item><p>● Turkish [<xref ref-type="bibr" rid="bibr153">153</xref>]</p></list-item><list-item><p>● French [<xref ref-type="bibr" rid="bibr154">154</xref>]</p></list-item><list-item><p>● Sinhalese [<xref ref-type="bibr" rid="bibr155">155</xref>]</p></list-item><list-item><p>● Urdu [<xref ref-type="bibr" rid="bibr156">156</xref>]</p></list-item><list-item><p>● Bahasa Indonesian [<xref ref-type="bibr" rid="bibr159">159</xref>]</p></list-item></list></td></tr><tr><td>PCL-S 7 studies</td><td><list list-type="Bullet"><list-item><p>Can compare results with other studies [<xref ref-type="bibr" rid="bibr102">102</xref>]</p></list-item><list-item><p>Allowed for the collection of comprehensive data [<xref ref-type="bibr" rid="bibr160">160</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Self-report measure [<xref ref-type="bibr" rid="bibr102">102-103</xref>, <xref ref-type="bibr" rid="bibr161">161</xref>–<xref ref-type="bibr" rid="bibr163">163</xref>]</p></list-item><list-item><p>May only assess acute stress symptoms if administered soon after a disaster [<xref ref-type="bibr" rid="bibr164">164</xref>]</p></list-item><list-item><p>Not validated in China [<xref ref-type="bibr" rid="bibr165">165</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Workers who experienced the Great East Japan Earthquake [<xref ref-type="bibr" rid="bibr102">102-103</xref>]</p></list-item><list-item><p>● Hypertensive adults who experienced Hurricane Katrina [<xref ref-type="bibr" rid="bibr160">160</xref>]</p></list-item><list-item><p>● Adult survivors of the 2014 flood disaster in Kashmir [<xref ref-type="bibr" rid="bibr161">161</xref>]</p></list-item><list-item><p>● Survivors of the Wenchuan and Lushan earthquakes [<xref ref-type="bibr" rid="bibr162">162</xref>]</p></list-item><list-item><p>● Survivors of Super Typhoon Haiyan [<xref ref-type="bibr" rid="bibr163">163</xref>]</p></list-item><list-item><p>● Adults who experienced Hurricane Harvey [<xref ref-type="bibr" rid="bibr164">164</xref>]</p></list-item><list-item><p>● Mothers who lost a child in the 2008 Sichuan earthquake [<xref ref-type="bibr" rid="bibr165">165</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Japanese [<xref ref-type="bibr" rid="bibr102">102</xref>]</p></list-item><list-item><p>● Chinese [<xref ref-type="bibr" rid="bibr162">162</xref>, <xref ref-type="bibr" rid="bibr165">165</xref>]</p></list-item></list></td></tr><tr><td>PSS-SR 2 studies</td><td><list list-type="Bullet"><list-item><p>Able to be administered online, convenient, accessible [<xref ref-type="bibr" rid="bibr95">95</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Self-report, not appropriate for diagnostics [<xref ref-type="bibr" rid="bibr92">92</xref>, <xref ref-type="bibr" rid="bibr95">95</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● 2008 Iceland earthquake survivors [<xref ref-type="bibr" rid="bibr94">94</xref>]</p></list-item><list-item><p>● Pet owners who survived Hurricane Katrina [<xref ref-type="bibr" rid="bibr95">95</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Icelandic [<xref ref-type="bibr" rid="bibr94">94</xref>]</p></list-item></list></td></tr><tr><td>PTCI 1 study</td><td>None listed</td><td><list list-type="Bullet"><list-item><p>Self-report measure, not objective [<xref ref-type="bibr" rid="bibr166">166</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Palestinian mothers and their infants living in the Gaza strip [<xref ref-type="bibr" rid="bibr166">166</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Arabic [<xref ref-type="bibr" rid="bibr166">166</xref>]</p></list-item></list></td></tr><tr><td>SPAN 2 studies</td><td>None listed</td><td><list list-type="Bullet"><list-item><p>Poorer diagnostic accuracy than DTS [<xref ref-type="bibr" rid="bibr117">117</xref>]</p></list-item><list-item><p>Self-report may limit the strength of findings [<xref ref-type="bibr" rid="bibr167">167</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Rescue workers, survivors in 1999 Chi-Chi earthquake [<xref ref-type="bibr" rid="bibr117">117</xref>, <xref ref-type="bibr" rid="bibr167">167</xref>]</p></list-item></list></td></tr><tr><td><bold>General mental health tools</bold></td></tr><tr><td>SQD 3 studies</td><td><list list-type="Bullet"><list-item><p>Efficient and easy to use for time-limited situations [<xref ref-type="bibr" rid="bibr90">90</xref>]</p></list-item><list-item><p>Can be used by those without expertise, self-reporting is easy [<xref ref-type="bibr" rid="bibr168">168</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Self-report tool [<xref ref-type="bibr" rid="bibr168">168-169</xref>]</p></list-item><list-item><p>No formal validation in Indian population [<xref ref-type="bibr" rid="bibr168">168</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Adults exposed to the 2009 L'Aquila earthquake [<xref ref-type="bibr" rid="bibr90">90</xref>]</p></list-item><list-item><p>Population affected by 2008 floods in Bihar [<xref ref-type="bibr" rid="bibr168">168</xref>]</p></list-item><list-item><p>Older adults who experienced the Great East Japan Earthquake [<xref ref-type="bibr" rid="bibr169">169</xref>]</p></list-item></list></td></tr><tr><td>WASSS 1 study</td><td><list list-type="Bullet"><list-item><p>Brief measure allows for the inference of mental health symptoms [<xref ref-type="bibr" rid="bibr170">170</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>First use of the WASSS measure [<xref ref-type="bibr" rid="bibr170">170</xref>]</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>● Survivors of 2015 Nepal earthquakes [<xref ref-type="bibr" rid="bibr170">170</xref>]</p></list-item><list-item><p>Language(s):</p></list-item><list-item><p>● Nepali [<xref ref-type="bibr" rid="bibr170">170</xref>]</p></list-item></list></td></tr></tbody></table> </ephtml> </p> <p>3 *May not add up to 86 due to studies using multiple tools.</p> <p>The most common strengths described for the screening tools are convenience and brevity. However, the limitations of the tools comprised the bulk of the information discussed in the studies. The most common limitation described for all tools, cited 64 times, is that a self-report screening tool is not diagnostic and can therefore over or underestimate the prevalence of the given disorder. However, some studies also list the self-report aspect as a benefit and state that it can provide valuable information about an individual's wellbeing [[<reflink idref="bib86" id="ref14">86</reflink>]]. Another common limitation described is the lack of cultural sensitivity. Most of the tools were developed based on the Diagnostic and Statistical Manual (DSM) criteria, which were established by the American Psychological Association. The origins of many tools in this review may result in cultural bias, even if the tool has been validated in a certain population or translated to another language [[<reflink idref="bib87" id="ref15">87</reflink>]–[<reflink idref="bib89" id="ref16">89</reflink>]]. A lack of a suggested cutoff point for diagnosis is the third most common limitation among the studies. Some studies using tools such as the IES-R set their own cutoff point depending on the characteristics of the population and follow previous studies in similar settings. This provides versatility; however, it also lends to inconsistency. Comparisons across populations cannot be made if the cutoff is different for different studies.</p> <p>The SQD and WASSS, though less frequently used than other tools, were designed particularly for humanitarian settings to briefly identify those in distress after a crisis. The SQD has been used more than the WASSS and is designed for time-limited situations [[<reflink idref="bib90" id="ref17">90</reflink>]].</p> <hd id="AN0147862525-11">Discussion</hd> <p>This unprecedented review highlights the high number of existing mental health assessment tools that have been used in the context of disasters and conflict, as well as their benefits and drawbacks. We identified 12 assessment tools for further analysis, most of which have exhibited high reliability and validity in the populations for which they were originally developed. A systematic literature search uncovered 86 studies that assessed mental health in populations affected by disasters and conflict using one of these tools, half of which used the IES-R.</p> <p>Differential use of assessment tools across studies contributes to the fragmentation of knowledge of the burden of mental health issues in humanitarian settings. Each tool has its own levels of sensitivity and specificity, especially those with variable cutoffs. Furthermore, the disorders have different latency periods from exposure to symptom manifestation, as accounted for by the symptom period specified in the tool characteristics. The timing of measurement can greatly affect estimated prevalence. This fragmentation not only impedes synthesis of knowledge of the effects of disasters and conflicts, but also might lead to multiple assessments of the same communities, resulting in increased emotional and time burden for them. In addition, the tools used may not be culturally appropriate for measuring mental health outcomes in these communities.</p> <p>Most of the identified studies assessed PTSD symptoms. This was expected due to PTSD being the most studied outcome of disasters and conflicts, and the tool most used to study PTSD was the IES-R. The second most studied outcome was depression, for which most of the studies used the PHQ-9. Of all the tools, the PHQ-9 was the most frequently validated, indicating its wide usage outside of humanitarian research. Anxiety was the third most studied outcome and was measured by the BAI. General mental health, measured using the WASSS and SQD, was the least studied outcome.</p> <p>While studies that measured the mental health effects of natural and technological disasters and conflicts were eligible for inclusion, the vast majority of studies in this review focused on natural disasters. Surprisingly, the only conflict-affected populations studied were those who lived in the Gaza strip and those who experienced the Georgian conflict, indicating a dearth in mental health research on civilians in conflict. Further, few studies measured the effects of technological disasters on population mental health, which may be due to a generally smaller impact size of technological disasters compared to natural disasters.</p> <p>The primary limitation cited in the studies is that a self-report tool may result in inaccurate estimates of the prevalence of a disorder. Self-report screening tools are inherently not diagnostic, as they are designed to rapidly assess those with the highest likelihood of the outcome of interest. Using screening tools to measure the prevalence of a mental health outcome is problematic, because such tools were not designed to definitively assess an individual. However, the alternative 'gold standard' diagnostic interview is not feasible in humanitarian and emergency settings or for the purposes of medium-scale mental health projects without adequate funding. The benefit of screening tools for these purposes is that they are rapid, while diagnostic interviews are lengthy and require the presence of a clinician.</p> <p>The cultural appropriateness of the tools is an important consideration when using the tools, especially in a global context. Cultural appropriateness of assessment methodology is one of the guiding principles of the Interagency Standing Committee's (IASC) assessment of mental health in humanitarian emergencies [[<reflink idref="bib171" id="ref18">171</reflink>]]. Only one tool, the SQD, was developed in a non-western context. The tools in this review that were developed for high-income western populations and later translated and implemented in low- and middle-income countries could result in culturally insensitive questions, meanings lost in translation, and ultimately inadequate measurement of true effects. Because most assessment tools are based on DSM criteria, they are inherently western-based and may not produce valid findings in cross-cultural mental health research.</p> <p>The third issue is the use of a cutoff in determining a diagnosis. A cutoff is set to balance between sensitivity and specificity, but not all items in a screening tool may be created equal yet are often weighted the same [[<reflink idref="bib172" id="ref19">172</reflink>]]. Individuals whose sum of symptoms breach the set cutoff could be at markedly different levels of distress than others due to the potentially varying importance of items in the questionnaire. In spite of this, cutoffs are sometimes necessary to estimate prevalence or quickly group those who need immediate assistance. If the purpose of the tool's use is to build knowledge to develop programs for disaster mitigation, then inconsistent measures and cutoffs would hinder this goal [[<reflink idref="bib173" id="ref20">173</reflink>]]. Those who work in humanitarian response and research and use these tools must consult the evidence and experts to make an informed decision on where to set the cutoff.</p> <p>Some tools have substantially more evidence of use, which might indicate that they are more suitable than others for mental health assessment. While abundant evidence allows for comparisons between and within populations in research, it does not necessarily mean that the tools accurately measure the prevalence of mental health outcomes. On the other hand, tools that were developed specifically for humanitarian situations may be more accurate than other tools when assessing the mental health of those affected by disasters and conflicts. However, these tools that specifically ask about a traumatic event cannot be used in a control group that has not experienced that event. In addition, tools such as the WASSS and the SQD are fairly new and thus do not allow for ready comparison between populations. The motivations behind the use of the assessment tools will ultimately determine which tool is most appropriate for a particular setting.</p> <p>The importance of mental health assessment in crisis-affected populations is clear. Knowing these effects can inform preparedness and response to a large-scale trauma. However, individuals using these tools must consider the utility and implications of their use. As emphasized by the IASC, the needs of the crisis-affected populations should be prioritized.</p> <hd id="AN0147862525-12">Strengths and limitations</hd> <p>The primary strength of this study is that it is among the first to analyze the benefits and limitations of a variety of tools that assess multiple mental health outcomes in populations affected by disasters. Much of the limited existing literature on this topic revolves around a single tool or mental health outcome or only discusses the psychometric properties of the tools [[<reflink idref="bib175" id="ref21">175</reflink>],176]. In addition, the findings of this review can be used by both researchers and humanitarian workers since the tools included were designed for use in informal settings without the presence of a clinician. As the tools discussed are screening tools, they can be used to estimate prevalence and the care needs of the population to quickly identify those who are in distress.</p> <p>Some limitations exist in this review. The search method for assessment tools was not systematic, and thus may have overlooked relevant tools or studies. However, the search was extensive and included a wide range of the literature. In addition, some tools may not have been identified through the snowball sampling method. However, this method allowed for a selection of a variety of tools with limited initial information and a reasonable number of tools have been included. Some tools require payment for access, and we were not able to fully examine them for analysis. Nonetheless, adequate information for these tools was available through secondary sources. Finally, the SQD and WASSS were recently developed, and there was little evidence of their use. This limited the conclusions that could be made about these tools. However, their inclusion in the review provided valuable information, as they were specifically designed for crisis-affected populations.</p> <hd id="AN0147862525-13">Conclusion</hd> <p>The assessment of mental health in humanitarian settings is highly fragmented due to the use of a wide range of assessment tools. This review provided a thorough analysis on each of the identified tools. Moving forward, researchers and humanitarian workers must understand the implications of using brief mental health assessment tools in affected populations in order to better mitigate the impacts of future emergencies. This review provides the basis for further research on instruments to measure the mental health of populations affected by disasters and conflicts.</p> <p>Three prominent gaps exist that must be addressed. First, there is no standard assessment tool for disaster and conflict settings. Second, little is known about assessment tool applicability to conflict settings. Third, these studies lack practical next steps to address the mental health outcomes they measure. Fortunately, greater awareness of mental health effects of mass trauma can motivate key stakeholders to close these gaps.</p> <hd id="AN0147862525-14">Acknowledgments</hd> <p>We thank Christine Lanners, adjunct director of the UCLouvain health sciences library, for validating the search strategy.</p> <hd id="AN0147862525-15">Author contributions</hd> <p>Ashley Moore carried out the tool and study search and wrote the majority of the paper. Joris Adriaan Frank van Loenhout, Maria Moitinho de Almeida, and Pierre Smith proposed the study idea and heavily edited the final manuscript. These authors, along with Ashley Moore, discussed the methodology for the study at length and were involved in deciding which tools to include or exclude. Debarati Guha-Sapir approved the final manuscript and assisted with submission.</p> <hd id="AN0147862525-16">Disclosure statement</hd> <p>No potential conflict of interest was reported by the authors.</p> <hd id="AN0147862525-17">Ethics and consent</hd> <p>Not applicable.</p> <hd id="AN0147862525-18">Paper context</hd> <p>Disasters and conflicts exacerbate and induce psychological symptoms. However, the estimated prevalence of these conditions can vary depending on assessment tool. Little is known about which tools are most effective in measuring mental health in disaster and conflict settings. This paper outlines commonly used tools and provides recommendations based on the tool characteristics discussed by the studies reviewed. Researchers should consider these characteristics and choose the most appropriate tool for the study population.</p> <ref id="AN0147862525-19"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Glossary of Humanitarian Terms [Internet]. World health organization; 2008. Available from : who.int/hac/about/reliefweb-aug2008.pdf?ua=1</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> CRED. Natural disasters 2018. Brussels, Belgium : CRED; 2019.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref3" type="bt">3</bibl> <bibtext> CRED. Cred crunch 52 – economic losses, poverty and disasters: 1998-2017. Brussels, Belgium : CRED; 2018.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref4" type="bt">4</bibl> <bibtext> Goldmann E, Galea S. Mental health consequences of disasters. Annu Rev Public Health. 2014; 35 : 169 – 16. Epub 2013/10/29. PubMed PMID: 24159920.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref6" type="bt">5</bibl> <bibtext> Tol W, Barbui C, Galappatti A, et al. Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet. 2011; 378 : 1581 – 1591. PubMed PMID: TOL20111581.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref7" type="bt">6</bibl> <bibtext> Speigel P, Checchi F, Colombo S, et al. Health-care needs of people affected by conflict: future trends and changing frameworks. Lancet. 2010; 375 : 341 – 345.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref8" type="bt">7</bibl> <bibtext> Rozanov V, Frančišković T, Marinić I, et al. Mental health consequences of war conflicts. In: Javed A, Fountoulakis KN, editors. Advances in psychiatry. Cham : Springer International Publishing; 2019. p. 281 – 304.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref12" type="bt">8</bibl> <bibtext> Slewa-Younan S, Uribe Guajardo MG, Heriseanu A, et al. A systematic review of post-traumatic stress disorder and depression amongst Iraqi refugees located in Western countries. J Immigr Minor Health. 2015; 17 : 1231 – 1239.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref13" type="bt">9</bibl> <bibtext> PICO ontology [Internet]. [cited 2020 May 20 ]. Available from : /pico-ontology</bibtext> </blist> <blist> <bibtext> Beck Anxiety Inventory [Internet]. [cited 2020 May 20 ]. Available from : https://<ulink href="http://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Personality-%26-Biopsychosocial/Beck-Anxiety-Inventory/p/100000251.html">www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Personality-%26-Biopsychosocial/Beck-Anxiety-Inventory/p/100000251.html</ulink></bibtext> </blist> <blist> <bibtext> Beck AT, Steer RA, Brown G. Beck depression inventory–II. PsycTESTS; 1996 Jan 1. Available from: <ulink href="http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-00742-000&site=ehost-live&scope=site">http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-00742-000&site=ehost-live&scope=site</ulink></bibtext> </blist> <blist> <bibtext> Kroenke K, Spitzer RL, Williams JBW. Patient health questionnaire-9. PsycTESTS [Internet]; 1999 Jan 1 [cited 2020 May 20 ]. Available from : <ulink href="http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-06165-000&site=ehost-live&scope=site">http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-06165-000&site=ehost-live&scope=site</ulink></bibtext> </blist> <blist> <bibtext> Foa EB, Johnson KM, Feeny NC, et al. Children's PTSD symptom scale. PsycTESTS; 2001 Jan 1. Available from: <ulink href="http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-05147-000&site=ehost-live&scope=site">http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-05147-000&site=ehost-live&scope=site</ulink></bibtext> </blist> <blist> <bibtext> Davidson J. Davidson trauma scale. PsycTESTS; 1997 Jan 1. Available from: <ulink href="http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-04973-000&site=ehost-live&scope=site">http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-04973-000&site=ehost-live&scope=site</ulink>.</bibtext> </blist> <blist> <bibtext> Weiss DS, Marmar CR. Impact of event scale--revised. PsycTESTS; 1997 Jan 1.</bibtext> </blist> <blist> <bibtext> Weathers FW, Litz BT, Herman DS, et al. PTSD checklist--specific version. PsycTESTS; 1993 Jan 1.</bibtext> </blist> <blist> <bibtext> Hoffart A, Øktedalen T, Langkaas TF, et al. PTSD symptom scale–self-report--Norwegian version. PsycTESTS; 2013 Jan 1.</bibtext> </blist> <blist> <bibtext> Foa EB, Ehlers A, Clark DM, et al. Posttraumatic cognitions inventory. PsycTESTS [Internet]; 1999 Jan 1 [cited 2020 May 20 ]. Available from: <ulink href="http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-00499-000&site=ehost-live&scope=site">http://search.ebscohost.com/login.aspx?direct=true&db=pst&AN=9999-00499-000&site=ehost-live&scope=site</ulink></bibtext> </blist> <blist> <bibtext> SPAN Self-Report Screen - PTSD: National Center for PTSD [Internet]. [cited 2020 May 20 ]. Available from : https://<ulink href="http://www.ptsd.va.gov/professional/assessment/screens/span.asp">www.ptsd.va.gov/professional/assessment/screens/span.asp</ulink></bibtext> </blist> <blist> <bibtext> Fujii S, Kato H, Maeda K. A simple interview-format screening measure for disaster mental health: an instrument newly developed after the 1995 Great Hanshin earthquake in Japan--the Screening Questionnaire for Disaster Mental Health (SQD). Kobe J Med Sci. 2008 Feb 8; 53 : 375 – 385.</bibtext> </blist> <blist> <bibtext> WHO | Assessing mental health and psychosocial needs and resources [Internet]. WHO. [cited 2020 May 20 ]. Available from : https://<ulink href="http://www.who.int/mental%5fhealth/resources/toolkit%5fmh%5femergencies/en/">www.who.int/mental%5fhealth/resources/toolkit%5fmh%5femergencies/en/</ulink></bibtext> </blist> <blist> <bibtext> Geer E, Huetteroth A. Beck anxiety inventory German version - a reliable, valid, patientfriendly instrument for measuring clinical anxiety. Psychother Psychosom Med Psychol. 2018; 68 : 118 – 125. Epub 2018/ 01/20.</bibtext> </blist> <blist> <bibtext> Liang Y, Wang L, Zhu J. Factor structure and psychometric properties of Chinese version of beck anxiety inventory in Chinese doctors. J Health Psychol. 2018; 23 : 657 – 666. Epub 2016/ 08/04.</bibtext> </blist> <blist> <bibtext> Osman A, Hoffman J, Barrios FX, et al. Factor structure, reliability, and validity of the beck anxiety inventory in adolescent psychiatric inpatients. J Clin Psychol. 2002; 58 : 443 – 456. Epub 2002/03/29.PubMed PMID: 11920696.</bibtext> </blist> <blist> <bibtext> Quintão S, Delgado AR, Prieto G. Validity study of the beck anxiety inventory (Portuguese version) by the Rasch rating scale model. Psicologia: Reflexão e Crítica. 2013; 26 : 305 – 310.</bibtext> </blist> <blist> <bibtext> Cole JC, Grossman I, Prilliman C, et al. Multimethod validation of the beck depression inventory-II and Grossman-cole depression inventory with an inpatient sample. Psychol Rep. 2003; 93 : 1115 – 1129. Epub 2004/ 02/10.</bibtext> </blist> <blist> <bibtext> Osman A, Kopper BA, Barrios F, et al. Reliability and validity of the beck depression inventory--II with adolescent psychiatric inpatients. Psychol Assess. 2004; 16 : 120 – 132. Epub 2004/ 06/30.</bibtext> </blist> <blist> <bibtext> Steele GI, Edwards DJA. Development and validation of the Xhosa translations of the beck inventories: 2. Item analysis, internal consistency and factor analysis. J Psychol Afr. 2008; 18 : 217 – 226.</bibtext> </blist> <blist> <bibtext> Subica AM, Fowler JC, Elhai JD, et al. Factor structure and diagnostic validity of the beck depression inventory–II with adult clinical inpatients: comparison to a gold-standard diagnostic interview. Psychol Assess. 2014; 26 : 1106.</bibtext> </blist> <blist> <bibtext> Grothe KB, Dutton GR, Jones GN, et al. Validation of the beck depression inventory-II in a low-income African American sample of medical outpatients. Psychol Assess. 2005; 17 : 110 – 114. Epub 2005/ 03/17.</bibtext> </blist> <blist> <bibtext> Hobkirk AL, Starosta AJ, De Leo JA, et al. Psychometric validation of the BDI-II among HIV-positive CHARTER study participants. Psychol Assess. 2015; 27 : 457.</bibtext> </blist> <blist> <bibtext> Lipps GE, Lowe GA, De La Haye W, et al. Validation of the Beck Depression Inventory II in HIV-positive patients. West Indian Med J. 2010; 59 : 374 – 379. Epub 2011/ 03/02.PubMed PMID: 21355511.</bibtext> </blist> <blist> <bibtext> Toledano-Toledano F, Contreras-Valdez JA. Validity and reliability of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases. PLoS One. 2018; 13 : e0206917. Epub 2018/ 11/30.</bibtext> </blist> <blist> <bibtext> Gomes-Oliveira MH, Gorenstein C, Lotufo Neto F, et al. Validation of the Brazilian Portuguese version of the beck depression inventory-II in a community sample. Braz J Psychiatry. 2012; 34 : 389 – 394. Epub 2013/ 02/23.PubMed PMID: 23429809.</bibtext> </blist> <blist> <bibtext> Jaksic N, Ivezic E, Jokic-Begic N, et al. Factorial and diagnostic validity of the Beck Depression Inventory-II (BDI-II) in Croatian primary health care. J Clin Psychol Med Settings. 2013; 20 : 311 – 322. Epub 2013/ 04/04.</bibtext> </blist> <blist> <bibtext> Kojima M, Furukawa TA, Takahashi H, et al. Cross-cultural validation of the beck depression inventory-II in Japan. Psychiatry Res. 2002; 110 : 291 – 299.</bibtext> </blist> <blist> <bibtext> Lee E-H, Lee S-J, Hwang S-T, et al. Reliability and validity of the beck depression inventory-II among Korean adolescents. Psychiatry Investig. 2017; 14 : 30.</bibtext> </blist> <blist> <bibtext> Altura KC, Patten SB, Fiest KM, et al. Suicidal ideation in persons with neurological conditions: prevalence, associations and validation of the PHQ-9 for suicidal ideation. Gen Hosp Psychiatry. 2016; 42 : 22 – 26. Epub 2016/ 09/18.</bibtext> </blist> <blist> <bibtext> Bombardier CH, Kalpakjian CZ, Graves DE, et al. Validity of the patient health questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil. 2012; 93 : 1838 – 1845. Epub 2012/ 05/05.</bibtext> </blist> <blist> <bibtext> Chagas MH, Tumas V, Rodrigues GR, et al. Validation and internal consistency of patient health questionnaire-9 for major depression in Parkinson's disease. Age Ageing. 2013; 42 : 645 – 649. Epub 2013/ 06/14.</bibtext> </blist> <blist> <bibtext> Fann JR, Bombardier CH, Dikmen S, et al. Validity of the patient health questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehabil. 2005; 20 : 501 – 511. Epub 2005/11/24.PubMed PMID: 16304487.</bibtext> </blist> <blist> <bibtext> Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16 : 606 – 613. Epub 2001/ 09/15.</bibtext> </blist> <blist> <bibtext> Rathore JS, Jehi LE, Fan Y, et al. Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. Epilepsy Behav. 2014; 37 : 215 – 220. Epub 2014/ 07/30.</bibtext> </blist> <blist> <bibtext> Borghero F, Martinez V, Zitko P, et al. Screening depressive episodes in adolescents. Validation of the Patient Health Questionnaire-9 (PHQ-9). Rev Med Chil. 2018; 146 : 479 – 486. Epub 2018/ 07/13.</bibtext> </blist> <blist> <bibtext> Cholera R, Gaynes BN, Pence BW, et al. Validity of the patient health questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014; 167 : 160 – 166. Epub 2014/ 06/28.</bibtext> </blist> <blist> <bibtext> Dadfar M, Kalibatseva Z, Lester D. Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. Trends Psychiatry Psychother. 2018; 40 : 144 – 151. Epub 2018/ 07/12.</bibtext> </blist> <blist> <bibtext> Donnelly PL, Kim KS. The Patient Health Questionnaire (PHQ-9K) to screen for depressive disorders among immigrant Korean American elderly. J Cult Divers. 2008; 15 : 24 – 29. Epub 2009/ 01/29.PubMed PMID: 19172976.</bibtext> </blist> <blist> <bibtext> Kohrt BA, Luitel NP, Acharya P, et al. Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal. BMC Psychiatry. 2016; 16 : 58. Epub 2016/ 03/10.</bibtext> </blist> <blist> <bibtext> Marc LG, Henderson WR, Desrosiers A, et al. Reliability and validity of the Haitian Creole PHQ-9. J Gen Intern Med. 2014; 29 : 1679 – 1686. Epub 2014/ 08/06.</bibtext> </blist> <blist> <bibtext> Reich H, Rief W, Brahler E, et al. Cross-cultural validation of the German and Turkish versions of the PHQ-9: an IRT approach. BMC Psychol. 2018; 6 : 26. Epub 2018/06/07. PubMed PMID: 29871664; PubMed Central PMCID: PMCPMC5989477.</bibtext> </blist> <blist> <bibtext> Sidebottom AC, Harrison PA, Godecker A, et al. Validation of the patient health questionnaire (PHQ)-9 for prenatal depression screening. Arch Women's Ment Health. 2012; 15 : 367 – 374. Epub 2012/ 09/18.</bibtext> </blist> <blist> <bibtext> Tomaszewski K, Zarychta M, Bienkowska A, et al. Validation of the patient health questionnaire-9 polish version in the hospitalised elderly population. Psychiatr Pol. 2011; 45 : 223 – 233. Epub 2011/07/01.PubMed PMID: 21714211.</bibtext> </blist> <blist> <bibtext> Turvey C, Sheeran T, Dindo L, et al. Validity of the patient health questionnaire, PHQ-9, administered through interactive-voice-response technology. J Telemed Telecare. 2012; 18 : 348 – 351. Epub 2012/ 08/31.</bibtext> </blist> <blist> <bibtext> Udedi M, Muula AS, Stewart RC, et al. The validity of the patient health questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi. BMC Psychiatry. 2019; 19 : 81. Epub 2019/ 03/01.</bibtext> </blist> <blist> <bibtext> van Steenbergen-weijenburg KM, de Vroege L, Ploeger RR, et al. Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics. BMC Health Serv Res. 2010; 10 : 235. Epub 2010/ 08/14.</bibtext> </blist> <blist> <bibtext> Volker D, Zijlstra-Vlasveld MC, Brouwers EP, et al. Validation of the patient health questionnaire-9 for major depressive DISORDER in the occupational health setting. J Occup Rehabil. 2016; 26 : 237 – 244. Epub 2015/ 09/18.</bibtext> </blist> <blist> <bibtext> Woldetensay YK, Belachew T, Tesfaye M, et al. Validation of the Patient Health Questionnaire (PHQ-9) as a screening tool for depression in pregnant women: Afaan Oromo version. PLoS One. 2018; 13 : e0191782. Epub 2018/ 02/07.</bibtext> </blist> <blist> <bibtext> Yeung A, Fung F, Yu S-C, et al. Validation of the patient health questionnaire-9 for depression screening among Chinese Americans. Compr Psychiatry. 2008; 49 : 211 – 217.</bibtext> </blist> <blist> <bibtext> Yu X, Tam WW, Wong PT, et al. The patient health questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Compr Psychiatry. 2012; 53 : 95 – 102. Epub 2011/ 01/05.</bibtext> </blist> <blist> <bibtext> Chen S, Fang Y, Chiu H, et al. Validation of the nine-item patient health questionnaire to screen for major depression in a Chinese primary care population. Asia Pac Psychiatry. 2013; 5 : 61 – 68. Epub 2013/ 07/17.</bibtext> </blist> <blist> <bibtext> Han C, Jo SA, Kwak JH, et al. Validation of the patient health questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study. Compr Psychiatry. 2008; 49 : 218 – 223. Epub 2008/ 02/05.</bibtext> </blist> <blist> <bibtext> Indu PS, Anilkumar TV, Vijayakumar K, et al. Reliability and validity of PHQ-9 when administered by health workers for depression screening among women in primary care. Asian J Psychiatry. 2018; 37 : 10 – 14.</bibtext> </blist> <blist> <bibtext> Monteiro S, Torres A, Pereira A, et al. 2077–preliminary validation study of a Portuguese version of the patient health questionnaire (PHQ-9). Eur Psychiatry. 2013; 28:1.</bibtext> </blist> <blist> <bibtext> Vrublevska J, Trapencieris M, Rancans E. Adaptation and validation of the patient health questionnaire-9 to evaluate major depression in a primary care sample in Latvia. Nord J Psychiatry. 2018; 72 : 112 – 118. Epub 2017/ 11/07.</bibtext> </blist> <blist> <bibtext> Muramatsu K, Miyaoka H, Kamijima K, et al. The patient health questionnaire, Japanese version: validity according to the mini-international neuropsychiatric interview-plus. Psychol Rep. 2007; 101 : 952 – 960. Epub 2008/ 02/01. PubMed PMID: 18232454.</bibtext> </blist> <blist> <bibtext> Rachamim L, Helpman L, Foa EB, et al. Validation of the child posttraumatic symptom scale in a sample of treatment-seeking Israeli youth. J Trauma Stress. 2011; 24 : 356 – 360. Epub 2011/ 05/14.</bibtext> </blist> <blist> <bibtext> Serrano-Ibanez ER, Ruiz-Parraga GT, Esteve R, et al. Validation of the Child PTSD Symptom Scale (CPSS) in Spanish adolescents. Psicothema. 2018; 30 : 130 – 135. Epub 2018/ 01/25.</bibtext> </blist> <blist> <bibtext> Kohrt B, Jordans M, Tol W, et al. Validation of cross-cultural child mental health and psychosocial research instruments: adapting the depression self-rating scale and child PTSD symptom scale in Nepal. BMC Psychiatry. 2011; 11. DOI: 10.1186/1471-244X-11-127</bibtext> </blist> <blist> <bibtext> Leiva-Bianchi MC, Araneda A. Validation of the Davidson trauma scale in its original and a new shorter version in people exposed to the F-27 earthquake in Chile. Eur J Psychotraumatol. 2013; 4 : 21239.</bibtext> </blist> <blist> <bibtext> McDonald SD, Beckham JC, Morey RA, et al. The validity and diagnostic efficiency of the Davidson trauma scale in military veterans who have served since September 11th, 2001. J Anxiety Disord. 2009; 23 : 247 – 255. Epub 2008/ 09/12.</bibtext> </blist> <blist> <bibtext> Seo HJ, Chung S, Lim HK, et al. A validation study of the Korean version of SPAN. Yonsei Med J. 2011; 52 : 673 – 679. Epub 2011/ 05/31.</bibtext> </blist> <blist> <bibtext> Chen CH, Lin SK, Tang HS, et al. The Chinese version of the Davidson trauma scale: a practice test for validation. Psychiatry Clin Neurosci. 2001; 55 : 493 – 499. PubMed PMID: 11555345.</bibtext> </blist> <blist> <bibtext> Bobes J, Calcedo-Barba A, García M, et al. Evaluación de las propiedades psicométricas de la versión española de cinco cuestionarios para la evaluación del trastorno de estrés postraumático. Actas Esp Psiquiatr. 2000; 28 : 207 – 218.</bibtext> </blist> <blist> <bibtext> Brunet A, St-Hilaire A, Jehel L, et al. Validation of a French version of the impact of event scale-revised. Can J Psychiatry. 2003; 48 : 56 – 61. Epub 2003/ 03/15.</bibtext> </blist> <blist> <bibtext> Chen CS, Cheng CP, Yen CF, et al. Validation of the impact of event scale-revised for adolescents experiencing the floods and mudslides. Kaohsiung J Med Sci. 2011; 27 : 560 – 565. Epub 2012/ 01/03.</bibtext> </blist> <blist> <bibtext> Sveen J, Low A, Dyster-Aas J, et al. Validation of a Swedish version of the Impact of Event Scale-Revised (IES-R) in patients with burns. J Anxiety Disord. 2010; 24 : 618 – 622. Epub 2010/ 05/04.</bibtext> </blist> <blist> <bibtext> Wu KK, Chan KS. The development of the Chinese version of Impact of Event Scale – Revised (CIES-R). Soc Psychiatry Psychiatr Epidemiol. 2003; 38 : 94 – 98.</bibtext> </blist> <blist> <bibtext> Asukai N, Kato H, Kawamura N, et al. Reliability and validity of the Japanese-language version of the impact of event scale-revised (Ies-RJ): four studies of different traumatic events. J Nerv Ment Dis. 2002; 190 : 175 – 182.</bibtext> </blist> <blist> <bibtext> Norhayati M, Aniza A. Psychometric properties of the Malay version of Impact of Event Scale-Revised (IES-R). Int J Collab Res Inter Med Public Health. 2014; 6 : 39 – 51.</bibtext> </blist> <blist> <bibtext> Pyari TT, Kutty RV, Sarma PS. Risk factors of post-traumatic stress disorder in tsunami survivors of Kanyakumari District, Tamil Nadu, India. Indian J Psychiatry. 2012; 54 : 48 – 53. Epub 2012/05/05. PubMed PMID: 22556437; PubMed Central PMCID: PMCPMC3339219.</bibtext> </blist> <blist> <bibtext> Hem C, Hussain A, Wentzel-Larsen T, et al. The Norwegian version of the PTSD checklist (PCL): construct validity in a community sample of 2004 tsunami survivors. Nord J Psychiatry. 2012; 66 : 355 – 359. Epub 2012/ 02/14.</bibtext> </blist> <blist> <bibtext> Ito M, Takebayashi Y, Suzuki Y, et al. Posttraumatic stress disorder checklist for DSM-5: psychometric properties in a Japanese population. J Affect Disord. 2019; 247 : 11 – 19.</bibtext> </blist> <blist> <bibtext> Sbardelloto G, Schaefer LS, Justo AR, et al. Adaptation and content validation of the Brazilian version of the posttraumatic cognitions inventory. Rev Saude Publica. 2013; 47 : 326 – 334. Epub 2013/ 09/17.</bibtext> </blist> <blist> <bibtext> Chen CH, Shen WW, Tan HK, et al. The validation study and application of stratum-specific likelihood ratios in the Chinese version of SPAN. Compr Psychiatry. 2003; 44 : 78 – 81. Epub 2003/ 01/14.</bibtext> </blist> <blist> <bibtext> Valenti M, Fujii S, Kato H, et al. Validation of the Italian version of the Screening Questionnaire for Disaster Mental Health (SQD) in a post-earthquake urban environment. Ann Ist Super Sanita. 2013; 49 : 79 – 85. Epub 2013/ 03/29.</bibtext> </blist> <blist> <bibtext> Martin NC, Felton JW, Cole DA. Predictors of youths' posttraumatic stress symptoms following a natural disaster: the 2010 Nashville, Tennessee, flood. J Clin Child Adolesc Psychol. 2015; 45 : 335 – 347.</bibtext> </blist> <blist> <bibtext> Messiah A, Vaiva G, Gokalsing E, et al. Mental health symptoms in post-earthquake Miami Haitians: cumulative effect of disaster-related stressful events. Int J Ment Health Psychiatry. 2015; 1 : 3.</bibtext> </blist> <blist> <bibtext> Chikovani I, Makhashvili N, Gotsadze G, et al. Health service utilization for mental, behavioural and emotional problems among conflict-affected population in Georgia: a cross-sectional study. PLoS One. 2015; 10 : e0122673. Epub 2015/ 04/09. PubMed PMID: 25853246; PubMed Central PMCID: PMCPMC4390285.</bibtext> </blist> <blist> <bibtext> Saxon L, Makhashvili N, Chikovani I, et al. Coping strategies and mental health outcomes of conflict-affected persons in the Republic of Georgia. Epidemiol Psychiatr Sci. 2017; 26 : 276 – 286. Epub 2016/ 01/26. PubMed PMID: 26804972; PubMed Central PMCID: PMCPMC5419062.</bibtext> </blist> <blist> <bibtext> Masedu F, Mazza M, Giovanni CD, et al. Facebook, quality of life, and mental health outcomes in post-disaster urban environments: the L'Aquila earthquake experience. Front Public Health. 2014; 2. DOI: 10.3389/fpubh.2014.00286</bibtext> </blist> <blist> <bibtext> Alexander B, David E, Grills N. High prevalence of anxiety disorders among adolescent Tibetan refugees. Asian J Psychiatr. 2013; 6 : 218 – 221.</bibtext> </blist> <blist> <bibtext> Liang Y. Depression and anxiety among elderly earthquake survivors in China. J Health Psychol. 2017; 22 : 1869 – 1879.</bibtext> </blist> <blist> <bibtext> Messiah A, Acuna JM, Castro G, et al. Mental health impact of the 2010 Haiti earthquake on the Miami Haitian population: A random-sample survey. Disaster Health. 2014; 2 : 130 – 137.</bibtext> </blist> <blist> <bibtext> Thordardottir EB, Gudmundsdottir H, Gudmundsdottir B, et al. Development and predictors of psychological outcomes following the 2008 earthquake in Iceland: a longitudinal cohort study. Scand J Public Health. 2018;4:269–279.</bibtext> </blist> <blist> <bibtext> Hunt M, Al-Awadi H, Johnson M. Psychological sequelae of pet loss following Hurricane Katrina. Anthrozoös. 2008; 21 : 109 – 121.</bibtext> </blist> <blist> <bibtext> Sakhelashvili I, Eliozishvili M, Oniani N, et al. Sleep and psycho-behavioral problems in internally displaced children in Georgia. Sleep Med. 2018; 50 : 42 – 47.</bibtext> </blist> <blist> <bibtext> Schwind JS, Norman SA, Brown R, et al. Association between earthquake exposures and mental health outcomes in Phulpingdanda Village after the 2015 Nepal earthquakes. Community Ment Health J. 2019;55: 1103 – 1113.</bibtext> </blist> <blist> <bibtext> Anastario MP, Larrance R, Lawry L. Using mental health indicators to identify postdisaster gender-based violence among women displaced by Hurricane Katrina. J Women's Health (Larchmt). 2008; 17 : 1437 – 1444. Epub 2008/ 10/24. PubMed PMID: 18945206.</bibtext> </blist> <blist> <bibtext> Agyapong VI, Juhás M, Brown MR, et al. Prevalence rates and correlates of probable major depressive disorder in residents of Fort McMurray 6 months after a wildfire. Int J Ment Health Addict. 2019; 17 : 120 – 136.</bibtext> </blist> <blist> <bibtext> Pietrzak RH, Tracy M, Galea S, et al. Resilience in the face of disaster: prevalence and longitudinal course of mental disorders following hurricane Ike. PLoS One. 2012; 7 : e38964.</bibtext> </blist> <blist> <bibtext> Bryant RA, Gallagher HC, Gibbs L, et al. Mental health and social networks after disaster. Am J Psychiatry. 2017; 174 : 277 – 285. Epub 2016/ 11/15. PubMed PMID: 27838935.</bibtext> </blist> <blist> <bibtext> Sakuma A, Takahashi Y, Ueda I, et al. Post-traumatic stress disorder and depression prevalence and associated risk factors among local disaster relief and reconstruction workers fourteen months after the Great East Japan Earthquake: a cross-sectional study. BMC Psychiatry. 2015; 15 : 58.</bibtext> </blist> <blist> <bibtext> Ueda I, Sakuma A, Takahashi Y, et al. Criticism by community people and poor workplace communication as risk factors for the mental health of local welfare workers after the great East Japan earthquake: a cross-sectional study. PloS One. 2017; 12 : e0185930.</bibtext> </blist> <blist> <bibtext> Bhattarai M, Maneewat K, Sae-Sia W. Psychosocial factors affecting resilience in Nepalese individuals with earthquake-related spinal cord injury: a cross-sectional study. BMC Psychiatry. 2018; 18 : 60. Epub 2018/03/04. PubMed PMID: 29499688; PubMed Central PMCID: PMCPMC5833058.</bibtext> </blist> <blist> <bibtext> Langley AK, Cohen JA, Mannarino AP, et al. Trauma exposure and mental health problems among school children 15 months post-Hurricane Katrina. J Child Adol Trauma. 2013; 6 : 143 – 156.</bibtext> </blist> <blist> <bibtext> Silwal S, Dybdahl R, Chudal R, et al. Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquakes. J Affect Disord. 2018; 234 : 239 – 246.</bibtext> </blist> <blist> <bibtext> Wu X, Zhou X, Wu Y, et al. The role of rumination in posttraumatic stress disorder and posttraumatic growth among adolescents after the Wenchuan earthquake. Front Psychol. 2015; 6 : 1335.</bibtext> </blist> <blist> <bibtext> Ying L-H, Wu X-C, Chen C. Prevalence and predictors of posttraumatic stress disorder and depressive symptoms among child survivors 1 year following the Wenchuan earthquake in China. Eur Child Adolesc Psychiatry. 2013; 22 : 567 – 575.</bibtext> </blist> <blist> <bibtext> Zhou X, Wu X. The relationship between rumination, posttraumatic stress disorder, and posttraumatic growth among Chinese adolescents after earthquake: A longitudinal study. J Affect Disord. 2016; 193 : 242 – 248. Epub 2016/ 01/17. PubMed PMID: 26773915.</bibtext> </blist> <blist> <bibtext> Zhou X, Wu X. Moderating role of negative venting in the relationship between PTSD and violent behaviors and suicidal ideation in Chinese children after an earthquake. Child Indic Res. 2017; 10 : 221 – 230.</bibtext> </blist> <blist> <bibtext> Zhou X, Zhen R, Wu X. Posttraumatic stress disorder symptom severity and control beliefs as the predictors of academic burnout amongst adolescents following the Wenchuan earthquake. Eur J Psychotraumatol. 2017; 8 : 1412227.</bibtext> </blist> <blist> <bibtext> Zhou X, Wu X, Zhen R, et al. Trajectories of posttraumatic stress disorders among adolescents in the area worst-hit by the Wenchuan earthquake. J Affect Disord. 2018; 235 : 303 – 307.</bibtext> </blist> <blist> <bibtext> Zhou X, Zhen R, Wu X. Trajectories of sleep problems among adolescents after the Wenchuan earthquake: the role of posttraumatic stress disorder symptoms. Psychol Health. 2019;34:811–827.</bibtext> </blist> <blist> <bibtext> Schwind JS, Formby CB, Santangelo SL, et al. Earthquake exposures and mental health outcomes in children and adolescents from Phulpingdanda village, Nepal: a cross-sectional study. Child Adolesc Psychiatry Ment Health. 2018; 12 : 54. Epub 2019/ 01/02. PubMed PMID: 30598695; PubMed Central PMCID: PMCPMC6300918.</bibtext> </blist> <blist> <bibtext> Ali M, Farooq N, Bhatti MA, et al. Assessment of prevalence and determinants of posttraumatic stress disorder in survivors of earthquake in Pakistan using Davidson trauma scale. J Affect Disord. 2012; 136 : 238 – 243. Epub 2012/01/03. PubMed PMID: 22209270.</bibtext> </blist> <blist> <bibtext> Zuniga RAA, Reyes GG, Murrieta JIS, et al. Posttraumatic stress symptoms in people exposed to the 2017 earthquakes in Mexico. Psychiatry Res. 2019; 275 : 326 – 331. Epub 2019/04/08. PubMed PMID: 30954842.</bibtext> </blist> <blist> <bibtext> Guo YJ, Chen CH, Lu ML, et al. Posttraumatic stress disorder among professional and non-professional rescuers involved in an earthquake in Taiwan. Psychiatry Res. 2004; 127 : 35 – 41. Epub 2004/07/21. PubMed PMID: 15261703.</bibtext> </blist> <blist> <bibtext> Ashok V, Premarajan K, Rajkumar RP, et al. Mental health status of flood-affected adults in rural Tamil Nadu: A cross-sectional study. CHRISMED J Health Res. 2019; 6 : 97.</bibtext> </blist> <blist> <bibtext> Dyster-Aas J, Arnberg FK, Lindam A, et al. Impact of physical injury on mental health after the 2004 Southeast Asia tsunami. Nord J Psychiatry. 2012; 66 : 203 – 208.</bibtext> </blist> <blist> <bibtext> Heir T, Sandvik L, Weisæth L. Hallmarks of posttraumatic stress: symptom Z-scores in a tsunami-affected tourist population. Psychopathology. 2009; 42 : 157 – 164.</bibtext> </blist> <blist> <bibtext> Sharma S, Sharma S, Chandra M, et al. Psychological well-being in primary survivors of Uttarakhand disaster in India. Ind J Soc Psych. 2015; 31 : 29.</bibtext> </blist> <blist> <bibtext> Arnberg FK, Eriksson NG, Hultman CM, et al. Traumatic bereavement, acute dissociation, and posttraumatic stress: 14 years after the MS Estonia disaster. J Trauma Stress. 2011; 24 : 183 – 190. Epub 2011/ 03/29. PubMed PMID: 21442665.</bibtext> </blist> <blist> <bibtext> Ben-Ezra M, Goodwin R, Palgi Y, et al. Concomitants of perceived trust in hospital and medical services following Hurricane Sandy. Psychiatry Res. 2014; 220 : 1160 – 1162. Epub 2014/09/17. PubMed PMID: 25223254.</bibtext> </blist> <blist> <bibtext> Chan CLW, Wang CW, Qu Z, et al. Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China. J Trauma Stress. 2011; 24 : 295 – 302.</bibtext> </blist> <blist> <bibtext> Chan CL, Wang C-W, Ho AH, et al. Symptoms of posttraumatic stress disorder and depression among bereaved and non-bereaved survivors following the 2008 Sichuan earthquake. J Anxiety Disord. 2012; 26 : 673 – 679.</bibtext> </blist> <blist> <bibtext> Chan CS, Rhodes JE. Religious coping, posttraumatic stress, psychological distress, and posttraumatic growth among female survivors four years after Hurricane Katrina. J Trauma Stress. 2013; 26 : 257 – 265.</bibtext> </blist> <blist> <bibtext> Chen H, Chen Y, Au M, et al. The presence of post‐traumatic stress disorder symptoms in earthquake survivors one month after a mudslide in southwest China. Nurs Health Sci. 2014; 16 : 39 – 45.</bibtext> </blist> <blist> <bibtext> Davis TE III, Grills-Taquechel AE, Ollendick TH. The psychological impact from hurricane Katrina: effects of displacement and trauma exposure on university students. Behav Ther. 2010; 41 : 340 – 349.</bibtext> </blist> <blist> <bibtext> Fushimi M. Posttraumatic stress in professional firefighters in Japan: rescue efforts after the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai). Prehosp Disaster Med. 2012; 27 : 416 – 418. Epub 2012/ 08/11. PubMed PMID: 22877787.</bibtext> </blist> <blist> <bibtext> Fussell E, Lowe SR. The impact of housing displacement on the mental health of low-income parents after Hurricane Katrina. Soc Sci Med. 2014; 113 : 137 – 144.</bibtext> </blist> <blist> <bibtext> Goto T, Wilson JP, Kahana B, et al. The Miyake Island volcano disaster in Japan: loss, uncertainty, and relocation as predictors of PTSD and depression. J Appl Social Psychol. 2006; 36 : 2001 – 2026.</bibtext> </blist> <blist> <bibtext> Guo J, He H, Qu Z, et al. Post-traumatic stress disorder and depression among adult survivors 8 years after the 2008 Wenchuan earthquake in China. J Affect Disord. 2017; 210 : 27 – 34. Epub 2016/ 12/23. PubMed PMID: 28006696.</bibtext> </blist> <blist> <bibtext> Guo J, Wu P, Tian D, et al. Post-traumatic stress disorder among adult survivors of the Wenchuan Earthquake in China: A repeated cross-sectional study. J Anxiety Disord. 2014; 28 : 75 – 82.</bibtext> </blist> <blist> <bibtext> Guo J, Wang X, Yuan J, et al. The symptoms of posttraumatic stress disorder and depression among adult earthquake survivors in China. J Nerv Ment Dis. 2015; 203 : 469 – 472.</bibtext> </blist> <blist> <bibtext> Johannesson KB, Lundin T, Frojd T, et al. Tsunami-exposed tourist survivors: signs of recovery in a 3-year perspective. J Nerv Ment Dis. 2011; 199 : 162 – 169. Epub 2011/ 02/25. PubMed PMID: 21346486.</bibtext> </blist> <blist> <bibtext> Johannesson KB, Lundin T, Hultman CM, et al. Prolonged grief among traumatically bereaved relatives exposed and not exposed to a tsunami. J Trauma Stress. 2011; 24 : 456 – 464.</bibtext> </blist> <blist> <bibtext> Kuijer RG, Marshall EM, Bishop AN. Prospective predictors of short-term adjustment after the Canterbury earthquakes: personality and depression. Psychol Trauma Theory Res Prac Policy. 2014; 6 : 361.</bibtext> </blist> <blist> <bibtext> Kvestad I, Ranjitkar S, Ulak M, et al. Earthquake exposure and post-traumatic stress among Nepalese mothers after the 2015 earthquakes. Front Psychol. 2019; 10. DOI: 10.3389/fpsyg.2019.00734</bibtext> </blist> <blist> <bibtext> Onose T, Sakata Y, Nochioka K, et al. Sex differences in post-traumatic stress disorder in cardiovascular patients after the Great East Japan earthquake: a report from the CHART-2 study. Eur Heart J Qual Care Clin Outcomes. 2017; 3 : 224 – 233. Epub 2017/ 08/26. PubMed PMID: 28838093.</bibtext> </blist> <blist> <bibtext> Othman AZ, Dahlan A, Borhani SN, et al. Posttraumatic stress disorder and quality of life among flood disaster victims. Procedia – Soc Behav Sci. 2016; 234 : 125 – 134.</bibtext> </blist> <blist> <bibtext> Paxson C, Fussell E, Rhodes J, et al. Five years later: recovery from post-traumatic stress and psychological distress among low-income mothers affected by Hurricane Katrina. Soc Sci Med. 2012; 74 : 150 – 157.</bibtext> </blist> <blist> <bibtext> Qu Z, Tian D, Zhang Q, et al. The impact of the catastrophic earthquake in China's Sichuan province on the mental health of pregnant women. J Affect Disord. 2012; 136 : 117 – 123.</bibtext> </blist> <blist> <bibtext> Rhodes J, Chan C, Paxson C, et al. The impact of Hurricane Katrina on the mental and physical health of low-income parents in New Orleans. Am J Orthopsych. 2010; 80 : 237.</bibtext> </blist> <blist> <bibtext> Roncone R, Giusti L, Mazza M, et al. Persistent fear of aftershocks, impairment of working memory, and acute stress disorder predict post-traumatic stress disorder: 6-month follow-up of help seekers following the L'Aquila earthquake. Springerplus. 2013; 2 : 636. Epub 2013/ 12/11. PubMed PMID: 24324929; PubMed Central PMCID: PMCPMC3856328.</bibtext> </blist> <blist> <bibtext> Shigemura J, Tanigawa T, Nishi D, et al. Associations between disaster exposures, peritraumatic distress, and posttraumatic stress responses in Fukushima nuclear plant workers following the 2011 nuclear accident: the Fukushima NEWS project study. PLoS One. 2014; 9 : e87516. Epub 2014/ 03/04. PubMed PMID: 24586278; PubMed Central PMCID: PMCPMC3929434.</bibtext> </blist> <blist> <bibtext> Takeda T, Tadakawa M, Koga S, et al. Relationship between dysmenorrhea and posttraumatic stress disorder in Japanese high school students 9 months after the Great East Japan earthquake. J Pediatr Adolesc Gynecol. 2013; 26 : 355 – 357. Epub 2013/10/01. PubMed PMID: 24075088.</bibtext> </blist> <blist> <bibtext> Tsujiuchi T, Yamaguchi M, Masuda K, et al. High prevalence of post-traumatic stress symptoms in relation to social factors in affected population one year after the Fukushima nuclear disaster. PLoS One. 2016; 11 : e0151807. Epub 2016/03/24. PubMed PMID: 27002324; PubMed Central PMCID: PMCPMC4803346.</bibtext> </blist> <blist> <bibtext> Wu D, Yin H, Xu S, et al. Risk factors for posttraumatic stress reactions among Chinese students following exposure to a snowstorm disaster. BMC Public Health. 2011; 11 : 96. Epub 2011/02/15. PubMed PMID: 21314959; PubMed Central PMCID: PMCPMC3047427.</bibtext> </blist> <blist> <bibtext> Wu K, Zhang Y, Liu Z, et al. Coexistence and different determinants of posttraumatic stress disorder and posttraumatic growth among Chinese survivors after earthquake: role of resilience and rumination. Front Psychol. 2015; 6 : 1043.</bibtext> </blist> <blist> <bibtext> Itzhaky H, Weiss-Dagan S, Taubman-Ben-Ari O. Internal and community recourses' contribution to level of posttraumatic symptoms—the case of tourists after the earthquake in Nepal, 2015. Psychol Trauma Theory Res Prac Policy. 2018; 10 : 239.</bibtext> </blist> <blist> <bibtext> Pyari TT, Sundari Ravindran TK. Sex differentials in the risk factors of post traumatic stress disorder among tsunami survivors in Tamil Nadu, India. Asian J Psychiatr. 2016; 23 : 46 – 50. Epub 2016/12/15. PubMed PMID: 27969078.</bibtext> </blist> <blist> <bibtext> Cadichon JM, Lignier B, Cénat J-M, et al. Symptoms of PTSD among adolescents and young adult survivors six years after the 2010 Haiti earthquake. J Loss Trauma. 2017; 22 : 646 – 659.</bibtext> </blist> <blist> <bibtext> Cetin M, Kose S, Ebrinc S, et al. Identification and posttraumatic stress disorder symptoms in rescue workers in the Marmara, Turkey, earthquake. Journal of Traumatic Stress. 2005; 18 : 485 – 489. Epub 2005/11/11. PubMed PMID: 16281246.</bibtext> </blist> <blist> <bibtext> Diene E, Agrinier N, Albessard A, et al. Relationships between impact on employment, working conditions, socio-occupational categories and symptoms of post-traumatic stress disorder after the industrial disaster in Toulouse, France. Soc Psychiatry Psychiatr Epidemiol. 2012; 47 : 1309 – 1319. Epub 2011/10/25. PubMed PMID: 22020864.</bibtext> </blist> <blist> <bibtext> Henderson SEK, Elsass P. Predictors of trauma and distress in Sri Lanka five years after the Indian Ocean tsunami: A cross-sectional study. Int J Disaster Risk Reduct. 2015; 14 : 438 – 444.</bibtext> </blist> <blist> <bibtext> Ehring T, Razik S, Emmelkamp PMG. Prevalence and predictors of posttraumatic stress disorder, anxiety, depression, and burnout in Pakistani earthquake recovery workers. Psychiatry Res. 2011; 185 : 161 – 166.</bibtext> </blist> <blist> <bibtext> Inoue K, Inoue K, Suda S, et al. Differences in vulnerability to traumatic stress among patients with psychiatric disorders: one-year follow-up study after the Great East Japan Earthquake. Psychiatry Clin Neurosci. 2015; 69 : 587 – 595. Epub 2015/ 02/25. PubMed PMID: 25708877.</bibtext> </blist> <blist> <bibtext> Lebowitz A, Tachikawa H, Aiba M, et al. Post-flood social support networks and morbidity in Joso City, Japan. Psychiatry Res. 2019; 271 : 708 – 714. Epub 2019/02/23. PubMed PMID: 30791345.</bibtext> </blist> <blist> <bibtext> Warsini S, Buettner P, Mills J, et al. Post‐traumatic stress disorder among survivors two years after the 2010 Mount Merapi volcano eruption: A survey study. Nurs Health Sci. 2015; 17 : 173 – 180.</bibtext> </blist> <blist> <bibtext> Lenane Z, Peacock E, Joyce C, et al. Association of post-traumatic stress disorder symptoms following Hurricane Katrina with incident cardiovascular disease events among older adults with hypertension. Am J Geriatric Psychiatry. 2019; 27 : 310 – 321.</bibtext> </blist> <blist> <bibtext> Dar KA, Iqbal N, Prakash A, et al. PTSD and depression in adult survivors of flood fury in Kashmir: the payoffs of social support. Psychiatry Res. 2018; 261 : 449 – 455. Epub 2018/ 01/23. PubMed PMID: 29353771.</bibtext> </blist> <blist> <bibtext> Duan W, Guo P. Association between virtues and posttraumatic growth: preliminary evidence from a Chinese community sample after earthquakes. PeerJ. 2015; 3 : e883.</bibtext> </blist> <blist> <bibtext> Labarda CE, Chan CS. Sleep disturbances, posttraumatic stress, and psychological distress among survivors of the 2013 super typhoon Haiyan. Psychiatry Res. 2018; 266 : 284 – 290.</bibtext> </blist> <blist> <bibtext> Schwartz RM, Tuminello S, Kerath SM, et al. Preliminary assessment of hurricane harvey exposures and mental health impact. Int J Environ Res Public Health. 2018; 15 : 974. Epub 2018/05/15. PubMed PMID: 29757262; PubMed Central PMCID: PMCPMC5982013.</bibtext> </blist> <blist> <bibtext> Xu Y, Herrman H, Bentley R, et al. Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study. Bull World Health Organ. 2014; 92 : 348 – 355.</bibtext> </blist> <blist> <bibtext> Diab SY, Isosävi S, Qouta SR, et al. The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants. Infant Behav Dev. 2018; 50 : 284 – 299.</bibtext> </blist> <blist> <bibtext> Chen C-H, Tan HK-L, Liao L-R, et al. Long-term psychological outcome of 1999 Taiwan earthquake survivors: a survey of a high-risk sample with property damage. Compr Psychiatry. 2007; 48 : 269 – 275.</bibtext> </blist> <blist> <bibtext> Telles S, Singh N, Joshi M. Risk of posttraumatic stress disorder and depression in survivors of the floods in Bihar, India. Ind J Med Sci. 2009; 63 : 330 – 334.</bibtext> </blist> <blist> <bibtext> Hikichi H, Aida J, Tsuboya T, et al. Can community social cohesion prevent posttraumatic stress disorder in the aftermath of a disaster? A natural experiment from the 2011 Tohoku earthquake and tsunami. Am J Epidemiol. 2016; 183 : 902 – 910.</bibtext> </blist> <blist> <bibtext> Kane JC, Luitel NP, Jordans MJD, et al. Mental health and psychosocial problems in the aftermath of the Nepal earthquakes: findings from a representative cluster sample survey. Epidemiol Psychiatr Sci. 2018; 27 : 301 – 310. Epub 2017/ 01/10. PubMed PMID: 28065208; PubMed Central PMCID: PMCPMC5502203.</bibtext> </blist> <blist> <bibtext> IASC Reference Group on Mental Health and Psychosocial Support in Emergency Settings: IASC [Internet]. IASC reference group on mental health and psychosocial support in emergency settings | IASC. [cited 2020 Mar 5 ]. Available from : https://interagencystandingcommittee.org/iasc-reference-group-on-mental-health-and-psychosocial-support-in-emergency-settings</bibtext> </blist> <blist> <bibtext> Clarke DM, Mckenzie DP. A caution on the use of cut-points applied to screening instruments or diagnostic criteria. J Psychiatr Res. 1994; 28 : 185 – 188.</bibtext> </blist> <blist> <bibtext> Liu Z, Zeng Z, Xiang Y, et al. A cross-sectional study on posttraumatic impact among Qiang women in Maoxian County 1 year after the Wenchuan Earthquake, China. Asia Pac J Public Health. 2012; 26 : 673 – 677. Epub 2011/ 01/21. PubMed PMID: 21247977.</bibtext> </blist> <blist> <bibtext> Pan X, Liu W, Deng G, et al. Symptoms of posttraumatic stress disorder, depression, and anxiety among junior high school students in worst-hit areas 3 years after the Wenchuan earthquake in China. Asia Pac J Public Health. 2015; 27 : Np1985 – 94. Epub 2013/ 05/21. PubMed PMID: 23687258.</bibtext> </blist> <blist> <bibtext> Balaban V. Psychological assessment of children in disasters and emergencies. Disasters. 2006; 30 : 178 – 198.</bibtext> </blist> <blist> <bibtext> North CS, Pfefferbaum B. Mental health response to community disasters. Jama. 2013; 310 : 507.</bibtext> </blist> </ref> <aug> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib86" firstref="ref14"></nolink> <nolink nlid="nl2" bibid="bib87" firstref="ref15"></nolink> <nolink nlid="nl3" bibid="bib89" firstref="ref16"></nolink> <nolink nlid="nl4" bibid="bib90" firstref="ref17"></nolink> <nolink nlid="nl5" bibid="bib171" firstref="ref18"></nolink> <nolink nlid="nl6" bibid="bib172" firstref="ref19"></nolink> <nolink nlid="nl7" bibid="bib173" firstref="ref20"></nolink> <nolink nlid="nl8" bibid="bib175" firstref="ref21"></nolink>
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  Data: Measuring mental health burden in humanitarian settings: a critical review of assessment tools
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Ashley+Moore%22">Ashley Moore</searchLink><br /><searchLink fieldCode="AR" term="%22Joris+Adriaan+Frank+van+Loenhout%22">Joris Adriaan Frank van Loenhout</searchLink><br /><searchLink fieldCode="AR" term="%22Maria+Moitinho+de+Almeida%22">Maria Moitinho de Almeida</searchLink><br /><searchLink fieldCode="AR" term="%22Pierre+Smith%22">Pierre Smith</searchLink><br /><searchLink fieldCode="AR" term="%22Debarati+Guha-Sapir%22">Debarati Guha-Sapir</searchLink>
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  Data: Global Health Action, Vol 13, Iss 1 (2020)
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  Label: Publisher Information
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  Data: Taylor & Francis Group, 2020.
– Name: DatePubCY
  Label: Publication Year
  Group: Date
  Data: 2020
– Name: Subset
  Label: Collection
  Group: HoldingsInfo
  Data: LCC:Public aspects of medicine
– Name: Subject
  Label: Subject Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22disasters%22">disasters</searchLink><br /><searchLink fieldCode="DE" term="%22mental+health+assessment%22">mental health assessment</searchLink><br /><searchLink fieldCode="DE" term="%22emergencies%22">emergencies</searchLink><br /><searchLink fieldCode="DE" term="%22humanitarian%22">humanitarian</searchLink><br /><searchLink fieldCode="DE" term="%22trauma%22">trauma</searchLink><br /><searchLink fieldCode="DE" term="%22Public+aspects+of+medicine%22">Public aspects of medicine</searchLink><br /><searchLink fieldCode="DE" term="%22RA1-1270%22">RA1-1270</searchLink>
– Name: Abstract
  Label: Description
  Group: Ab
  Data: Background The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters’ impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement. Objective The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts. Method Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table. Results Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts. Conclusion It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.
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  Data: English
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  Data: 1654-9880<br />16549716
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  Data: https://doaj.org/toc/1654-9880
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  Data: 10.1080/16549716.2020.1783957
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        Value: 10.1080/16549716.2020.1783957
    Languages:
      – Text: English
    Subjects:
      – SubjectFull: disasters
        Type: general
      – SubjectFull: mental health assessment
        Type: general
      – SubjectFull: emergencies
        Type: general
      – SubjectFull: humanitarian
        Type: general
      – SubjectFull: trauma
        Type: general
      – SubjectFull: Public aspects of medicine
        Type: general
      – SubjectFull: RA1-1270
        Type: general
    Titles:
      – TitleFull: Measuring mental health burden in humanitarian settings: a critical review of assessment tools
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          Name:
            NameFull: Ashley Moore
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            NameFull: Maria Moitinho de Almeida
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            NameFull: Pierre Smith
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              M: 12
              Type: published
              Y: 2020
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