[Development of a culturally sensitive psychiatric screening instrument for detecting emotional problems among Ethiopian immigrants in Israel]

Abstract

Background: Studies have demonstrated that a large percentage of patients in primary care clinics suffer from emotional problems. Many of the patients who suffer from these problems are not diagnosed properly, and do not receive appropriate treatment by the medical staff. The problem is especially severe for patients who immigrated to Israel from Ethiopia. This is mainly due to the difference between the medical belief system familiar to the Ethiopian immigrants and that of the non-Ethiopian doctors. It is also the result of the use of culturally typical idioms of distress by the Ethiopians that are not clearly understood by the doctors. The WHO developed the SRQ--Self-Reporting Questionnaire, a psychiatric screening instrument to assess populations in developing countries. Although this instrument has been widely used both in developing and developed countries, it has been found to be problematic in certain cultures. The difficulties stem partly from differences between the spontaneous idioms of distress used by the interviewees, for example the Ethiopians, and the idioms of distress that appear in the SRQ.

Objective: The goal of this research was to develop a psychiatric screening instrument, based on the SRQ, which would be valid and culturally sensitive to Ethiopian immigrants in Israel.

Methods: The sample included 161 immigrants from Ethiopia, aged 18-55 years, who were born in the Gondar region. The interviewees were divided into three groups according to their "level of treatment": healthy individuals from the general population, who were sampled, mainly using the "quota sampling" method, in those cities where a high percentage of Ethiopian immigrants reside; consecutive patients in primary care clinics and in specialist clinics in the same cities; and consecutive patients in care in psychiatric clinics throughout the country. The research instruments included an expanded version of the SRQ (the SRQ-E) and the expanded version of the BPRS--Brief Psychiatric Rating Scale. The validity of each question of the SRQ-E was examined in order to create a new psychiatric screening questionnaire that is both valid and parsimonious. The internal consistency and the construct and criterion validity of this new screening questionnaire were then examined. The sensitivity and specificity of the instrument for detecting psychopathology were assessed.

Results: The new screening instrument was determined to be valid: a score of 7 distinguishes between those with and without psychopathology, with a sensitivity and a specificity of 87%.