Displacement of human population is one of the gravest consequences of wars, conflict or violence in any country or region. The United Nation High Commissioner for Refugees (UNHCR) estimates show that in 2016, around 65.6 million people were forced to flee their homes to seek safety from conflict, human rights violations, organized crimes and other forms of persecution[i]. Forced migration and persecution results in great mental distress and mental health issues are highly prevalent in these displaced populations. Psychological health of migrants is a topic of considerable research interest; it is evident from the fact that one meta-analysis included 181 studies with more than 80,000 war-affected refugees. Research evidence from the meta-analysis showed that more than 30% of refugees suffered from Posttraumatic Stress Disorder (PTSD) and depression[ii].
Language barrier is considered to be one of the leading contributing factors to the mental distress of these people, which prevents them from accessing timely and relevant health care. Guidelines recommend use of trained interpreters to communicate with these refugees in their camps or temporary residences. However, trained interpreters are usually not available due to financial or other reasons.
In the current era of technology, computer-based tools are gaining popularity for screening and diagnostic procedures concerning psychological assessments. These Computer-Assisted Self-Interviews (CASI) tools were initially used only in limited clinical settings, and for the first time, Medical University of Zurich initiated its use in refugees. The Outpatient Unit for Victims of Torture and War at the Department of Psychiatry and Psychotherapy developed software known as Multi-Adaptive Psychological Screening Software (MAPSS). This software is an Audio Computer-Assisted Self-Interview Software (ACASI) used with touchscreen devices and it’s aimed to assist in standardized multi-lingual mental health assessment and research. The research team at Zurich University along with experts from other universities (New South Wales) undertook a study to assess the reliability, feasibility, and usability of MAPSS in refugees and published their findings recently in the journal; Conflict and Health in October 2017 issue[iii]. In a randomized cross-over design, 30 refugees seeking health care were administered with MAPSS through a touch screen or a paper-pencil-interview with a therapist in the presence of a trained interpreter. The results of the study showed that more than 80% of the participating refugees had no technical problem using touch –screens and found them user-friendly. More than 50% of the responders felt that use of MAPSS encouraged them to give more truthful and honest opinions as compared to interview with a therapist. More importantly, approximately 83% refugees reported being more comfortable answering sensitive question while using a touchscreen. Moreover, administration of interview using MAPSS consumed significantly lesser time than the paper-pencil method. Usability of the software was also ranked highly by professionals citing it as easier to use, straightforward, attractive, appealing, integrating and interesting.
The encouraging results from the study call for more robust studies with larger sample size to examine the viability, and cost-effectiveness of computer-based self-interview tools particularly in marginalized population groups such as refugees and in low resource settings.
[ii] Steel Z, et al. Association of Torture and Other Potentially Traumatic Events with Mental Health Outcomes among Populations Exposed to mass conflict and displacement. JAMA. 2009; 302(5):537–49.
[iii] Morina, N., Ewers, S. M., Passardi, S., Schnyder, U., Knaevelsrud, C., Müller, J., … & Schick, M. (2017). Mental health assessments in refugees and asylum seekers: evaluation of a tablet-assisted screening software. Conflict and Health, 11(1), 18.