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      The Child Behavior Checklist as a Screening Instrument for PTSD in Refugee Children

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          Abstract

          Thousands of refugees who have entered Europe experienced threatening conditions, potentially leading to post traumatic stress disorder (PTSD), which has to be detected and treated early to avoid chronic manifestation, especially in children. We aimed to evaluate and test suitable screening tools to detect PTSD in children. Syrian refugee children aged 4–14 years were examined using the PTSD-semi-structured interview, the Kinder-DIPS, and the Child Behavior Checklist (CBCL). The latter was evaluated as a potential screening tool for PTSD using (i) the CBCL-PTSD subscale and (ii) an alternative subscale consisting of a psychometrically guided selection of items with an appropriate correlation to PTSD and a sufficient prevalence (presence in more than 20% of the cases with PTSD). For both tools we calculated sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Depending on the sum score of the items, the 20-item CBCL-PTSD subscale as used in previous studies yielded a maximal sensitivity of 85% and specificity of 76%. The psychometrically guided item selection resulted in a sensitivity of 85% and a specificity of 83%. The areas under the ROC curves were the same for both tools (0.9). Both subscales may be suitable as screening instrument for PTSD in refugee children, as they reveal a high sensitivity and specificity.

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          Constructing validity: Basic issues in objective scale development.

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            Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review.

            About 13 million people are classified as refugees worldwide, and many more former refugees have been granted citizenship in their new countries. However, the prevalence of post-traumatic stress disorder, major depression, or psychotic illnesses in these individuals is not known. We did a systematic review of surveys about these disorders in general refugee populations in western countries. We searched for psychiatric surveys that were based on interviews of unselected refugee populations and that included current diagnoses of post-traumatic stress disorder, major depression, psychotic illnesses, or generalised anxiety disorder. We did computer-assisted searches, scanned reference lists, searched journals, and corresponded with authors to determine prevalence rates of these mental disorders and to explore potential sources of heterogeneity, such as diagnostic criteria, sampling methods, and other characteristics. 20 eligible surveys provided results for 6743 adult refugees from seven countries, with substantial variation in assessment and sampling methods. In the larger studies, 9% (99% CI 8-10%) were diagnosed with post-traumatic stress disorder and 5% (4-6%) with major depression, with evidence of much psychiatric comorbidity. Five surveys of 260 refugee children from three countries yielded a prevalence of 11% (7-17%) for post-traumatic stress disorder. Larger and more rigorous surveys reported lower prevalence rates than did studies with less optimum designs, but heterogeneity persisted even in findings from the larger studies. Refugees resettled in western countries could be about ten times more likely to have post-traumatic stress disorder than age-matched general populations in those countries. Worldwide, tens of thousands of refugees and former refugees resettled in western countries probably have post-traumatic stress disorder.
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              Manual for the Child Behavior Checklist/4-18 and 1991 Profile

              The Child Behavior Checklist for ages 4-18 is designed to record children's competencies and problems as reported by their parents or parent surrogates. It can be self-administered or administered by an interviewer. The 20 competence items obtain parents' reports of the amount and quality of their child's participation in sports, hobbies, games, activities, jobs and chores, and friendships; how well the child gets along with others and plays and works alone; and school functioning. Each of the 118 specific problem items and two open-ended problem items are scored on a 3-step response scale. The Checklist is intended as only one component of many, including teacher reports, standardized tests, physical assessment and direct assessment of the child. Reliability and validity are discussed.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Children (Basel)
                Children (Basel)
                children
                Children
                MDPI
                2227-9067
                18 June 2021
                June 2021
                : 8
                : 6
                : 521
                Affiliations
                [1 ]Department of Social Pediatrics, Technische Universität München, D-81377 Munich, Germany; Maesa.Al-Hallak@ 123456kbo.de (M.A.-H.); volker.mall@ 123456kbo.de (V.M.)
                [2 ]Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, D-81377 Munich, Germany; h.sattel@ 123456tum.de (H.S.); martin.sack@ 123456mri.tum.de (M.S.); p.henningsen@ 123456tum.de (P.H.); sigrid.aberl@ 123456muenchen-klinik.de (S.A.)
                Author notes
                [* ]Correspondence: ina.nehring@ 123456kbo.de
                Article
                children-08-00521
                10.3390/children8060521
                8235248
                34207254
                53bc9a61-fc19-45c3-a520-c2b05c54a089
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 31 May 2021
                : 16 June 2021
                Categories
                Article

                child behavior checklist,post traumatic stress disorder,refugee,screening

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