Psychometric properties and factor structure of Refugee Health Screener (RHS-13)

Abstract

Refugee Health Screener (RHS–13) is a brief screening tool designed to assess most common symptoms of mental health conditions in refugee population. Despite its indisputable practical value in mental health screening and psychological triage, there has been little evidence on basic psychometric properties of this instrument. Therefore, this study aims to explore internal constancy and factor structure of RHS–13 on a diverse sample of refugees/asylum seekers/migrants. Sample consisted of 567 refugees/asylum seekers/migrants (86.8% male, age range 13 – 65 years (M = 23.37, SD = 8.59) from different countries, including Syria, Afghanistan, Cuba, Nigeria, Iraq, Zimbabwe, etc. RHS–13 consists of 13 Likert-scale items representing most common psychological distress symptoms in refugee population i.e. symptoms of anxiety, depression and post-traumatic stress. Results showed good internal consistency (α = .861). Using the Maximum Likelihood estimation method we te sted the one- , two – and three-factor models. One-factor model was rather poor χ2(54) = 265.15, p < .001; CFI = .888; RMSEA = .083 [CI90%: .073 – .095], two-factor model (factor 1: anxiety and depression symptoms, factor 2: post-traumatic stress symptoms) had better fit χ2(53) = 201.69, p < .001; CFI = .921; RMSEA = .070 [CI90%: .060 – .081], while three-factor model χ2(51) = 190.17, p < .001; CFI = .926, RMSEA = .069 [CI90%: .059 – .080] had also good fit. The results show that three-factor model fits best the data (one- vs three-factor model p < .001; two- vs three-factor model p < .01) indicating a clear factorial structure of RHS-13. Therefore, our data justify the usage of additional cut-off scores, alongside recommended overall RHS-13 cut-off score, in screening for anxiety, depression and post traumatic stress symptoms in refugee population.