Abstract
BackgroundIn Ukraine, a large number of internally displaced persons (IDPs) and veterans experience social and psychological problems as a result of the ongoing conflict between Ukraine and Russia. Our purpose was to develop reliable and valid instruments to screen for common mental health and alcohol use problems in these populations.MethodsWe used a three-step process of instrument adaptation and testing. The instrument—the Mental Health Assessment Inventory (MHAI)—combines adapted standard screeners with items derived locally in Ukraine. A validity study was conducted using a sample of 153 adults (54% male) ages 18 years and older. All participants in the sample were IDPs or veterans living in or near the major urban areas of Kyiv and Zaporizhia. Reliability testing (internal consistency, test-retest) and validity testing (construct, criterion) of the MHAI were conducted using classical test theory. After initial testing, we used Item Response Theory (IRT) to shorten and further refine the instrument.ResultsThe MHAI showed good internal consistency and test-retest reliability for the main outcomes: depression (α = 0.94; r = .84), post-traumatic stress (PTS; α = 0.97; r = 0.87), anxiety (α = 0.90; r = 0.80), and alcohol use (α = 0.86; r = 0.91). There was good evidence of convergent construct validity among the scales for depression, PTS, and anxiety, but not for alcohol use. Item Response Theory (IRT) analysis supported use of shortened versions of the scales for depression, PTS, and anxiety, as they retained comparable psychometric properties to the full scales of the MHAI.ConclusionThe findings support the reliability and validity of the assessment—the MHAI—for screening of common mental health problems among Ukrainian IDPs and veterans. Use of IRT shortened the instrument to improve practicality and potential sustainability.
Highlights
In Ukraine, a large number of internally displaced persons (IDPs) and veterans experience social and psychological problems as a result of the ongoing conflict between Ukraine and Russia
Instrument adaptation and translation The assessment instrument was developed by combining existing measures of common mental health problems and functioning with items drawn from a rapid qualitative study among Ukrainian IDPs, Ukrainian military veterans of the Anti-Terrorist Operation” (ATO), and people familiar with the mental health problems of IDPs and veterans, including formal service providers
Using a systematic approach, including the incorporation of locally relevant items based on a prior qualitative study we conducted in the same population, we generated a brief, reliable, and valid measure of three mental health problems and alcohol use problems
Summary
In Ukraine, a large number of internally displaced persons (IDPs) and veterans experience social and psychological problems as a result of the ongoing conflict between Ukraine and Russia. More than 10,000 people have been killed and more than 25,000 people have been wounded, including many veterans of the “Anti-Terrorist Operation” (ATO), the Ukrainian government’s military effort to defeat pro-Russian separatists from eastern Ukraine [4]. Reviews of mental health problems among diverse conflict-affected populations, including internally displaced persons (IDPs) and military veterans, reveal that displacement and exposure to violence are consistently associated with elevated psychiatric symptomatology, especially related to depressive, anxiety, and stress-related disorders [6, 7]. Johns Hopkins University (JHU) and its primary implementation partner, the National University of Kyiv-Mohyla Academy (NaUKMA), were chosen to lead this effort, which includes the identification and treatment of mental health problems among IDPs, veterans, and others affected by the conflict
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