Screening for Major Depression and Posttraumatic Stress Disorder among Asylum Seekers: Adapting a Standardized Instrument to the Social and Cultural Context

Abstract

To adapt the PTSD and MDE sections of a validated psychiatric diagnostic instrument, we used the Mini International Neuropsychiatric Interview (MINI) during an initial health assessment into a primary care facility for asylum seekers. A 3-step process was carried out. First, items of the original version of the MINI were adapted to the specific context of life of asylum seekers in the host country (by a multidisciplinary group that included public health nurses, a primary care physician, a psychologist, a psychiatrist, and an epidemiologist). Second, we submitted the reworded and original versions of the MINI to 14 interpreters' who tested for general and cultural acceptability. Each diagnostic criterion was rated according to interpreters' comments on a 4-point Likert scale (1 = an item good for translation and 4 = an unusable or completely inadequate item). In the third step, we rephrased the most problematic items identified by the interpreters. Some original items were considered particularly ill-adapted for this context, and 4 had to be dropped. This final rewording took into account cultural inadequacies and lack of structure (including temporal organization) of the everyday life of newly arrived asylum seekers. The reworded MINI was successfully tested, and its items are presented in the final part of the study.