The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden

Andreas Malm; Petter Tinghög; Jurgita Narusyte; Fredrik Saboonchi

doi:10.1186/s13031-019-0246-5

The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden

Confl Health. 2020 Jan 6:14:2. doi: 10.1186/s13031-019-0246-5. eCollection 2020.

Authors

Andreas Malm^{1

2

3}, Petter Tinghög^{1

2}, Jurgita Narusyte², Fredrik Saboonchi^{1

2}

Affiliations

¹ 1Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, 141 21 Huddinge, Sweden.
² 2Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, 171 77 Stockholm, Sweden.
³ The Swedish Red Cross Treatment Center for Persons Affected by War and Torture, PO Box 166, 201 21 Malmö, Sweden.

Abstract

Background: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees.

Results: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.

Conclusions: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.

Keywords: Assessment; Confirmatory factor analysis; Construct validity; Exploratory factor analysis; Mental health; Post-migration stress; Refugee; Scale development; Syria.