Development and validation of the Stressful Experiences in Transit Questionnaire (SET-Q) and its Short Form (SET-SF)

Danka Purić, Maša Vukčević Marković, Danka Purić, Maša Vukčević Marković

Abstract

Background: Previous studies have demonstrated that traumatic experiences from countries of origin (so-called pre-migratory factors), as well as stressors in countries of destination (so-called post-migratory factors), are related to the extent of mental health difficulties and psychological well-being of refugees. However, numerous risks that this population is exposed to during transit have so far been neglected. Objective: The aim of this research was to construct and validate a questionnaire for assessing stressful and traumatic experiences in transit as well as its short form, which would at the same time provide information on one's stressful experiences as well as existing risks that refugees are exposed to on their journey. Method: The study was realized in three phases - item construction, item revision and instrument validation. In the validation phase, a total of 226 refugees completed the Stressful Experiences in Transit Questionnaire (SET-Q), along with Harvard Trauma Questionnaire (HTQ) Parts I and IV, Hopkins Symptom Checklist-25 (HSCL-25) and Beck Depression Inventory - II (BDI-II). Results: Refugees were exposed to an average of 13 stressful events during transit. SET-Q total score was positively correlated with HTQ Part IV Post-Traumatic Stress Disorder (PTSD) and Self-Perception of Functioning scales (SPFS) while the number of stressful experiences with the local population was positively related to BDI-II depression symptoms. Moreover, SET-Q scores were significant predictors of PTSD and SPFS even after traumatic experiences in the country of origin, assessed by HTQ Part I, were taken into account. A short form of the questionnaire (SET-SF) has also been developed. Conclusions: SET-Q is a valid instrument for measuring the scope of stressful experiences refugees have been exposed to during transit, targeted for this population specifically. Furthermore, SET-SF has the potential to assess the same extent of stressful experiences with a significantly reduced number of items.

Keywords: Harvard Trauma Questionnaire (HTQ); Stressful Experiences in Transit Questionnaire (SET-Q); Stressful Experiences in Transit Questionnaire – Short Form (SET-SF); refugees; transit; trauma; 创伤; 哈佛创伤问卷（HTQ）; 迁移; 迁移体验问卷中的应激经历（SET-Q）; 迁移体验问卷简版中的应激经历（SET-SF）; 难民.

Conflict of interest statement

No potential conflict of interest was reported by the authors.

References

    1. Alemi Q., Stempel C., Baek K., Lares L., Villa P., Danis D., & Montgomery S. (2016). Impact of postmigration living difficulties on the mental health of Afghan migrants residing in Istanbul. International Journal of Population Research, 2016, 1–11.
    1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
    1. Beck A. T., Steer R. A., & Brown G. K. (1996). Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation.
    1. Bøe T., Skogen J. C., Sivertsen B., Hysing M., Petrie K. J., Dearing E., & Zachrisson H. D. (2017). Economic volatility in childhood and subsequent adolescent mental health problems: A longitudinal population-based study of adolescents. BMJ open, 7, 9.
    1. Bogic M., Ajdukovic D., Bremner S., Franciskovic T., Galeazzi G. M., Kucukalic A., … Priebe S. (2012). Factors associated with mental disorders in long-settled war refugees: Refugees from the former Yugoslavia in Germany, Italy and the UK. British Journal of Psychiatry, 200(3), 216–223.
    1. Cacioppo J. T., Hughes M. E., Waite L. J., Hawkley L. C., & Thisted R. A. (2006). Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychology and Aging, 21(1), 140–151.
    1. Cantekin D., & Gençöz T. (2017). Mental health of Syrian asylum seekers in Turkey: The role of pre-migration and post-migration risk factors. Journal of Social and Clinical Psychology, 36(10), 835–859.
    1. Carswell K., Blackburn P., & Barker C. (2009). The relationship between trauma, post-migration problems and the psychological well-being of refugees and asylum seekers. International Journal of Social Psychiatry, 57(2), 107–119.
    1. Cleveland J., & Rousseau C. (2013). Psychiatric symptoms associated with brief detention of adult asylum seekers in Canada. CanJPsychiatry, 58(7), 409–416.
    1. Coley R. L., Sims J., Dearing E., & Spielvogel B. (2018). Locating economic risks for adolescent mental and behavioral health: Poverty and affluence in families, neighborhoods, and schools. Child Development, 89(2), 360–369.
    1. Coltman T., Devinney T. M., Midgley D. F., & Venaik S. (2008). Formative versus reflective measurement models : Two applications of formative measurement. Journal of Business Research, 61(12), 1250–1262.
    1. Diamantopoulos A., Riefler P., & Roth K. P. (2008). Advancing formative measurement models. Journal of Business Research, 61(12), 1203–1218.
    1. Fouchier C. D., Blanchet A., Hopkins W., Bui E., Ait-Aoudia M., & Jehel L. (2012). Validation of a French adaptation of the harvard trauma questionnaire among torture surviviors from sub - Saharan African countries. European Journal of Psychotraumatology, 3, 1–9.
    1. Gerritsen A. A. M., Bramsen I., Devillé W., van Willigen L. H. M., Hovens J. E., & van der Ploeg H. M. (2006). Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 41(1), 18–26.
    1. Giordano F., Cipolla A., Ragnoli F., & Brajda Bruno F. (2019). Transit migration and trauma: The detrimental effect of interpersonal trauma on Syrian children in transit in Italy. Psychological Injury & Law, 12(1), 76–87.
    1. Hallas P., Hansen A. R., Stæhr M. A., Munk-Andersen E., & Jorgensen H. L. (2007). Length of stay in asylum centres and mental health in asylum seekers: A retrospective study from Denmark. BMC Public Health, 7, 1–6.
    1. Hebebrand J., Anagnostopoulos D., Eliez S., Linse H., Pejovic-Milovancevic M., & Klasen H. (2016). A first assessment of the needs of young refugees arriving in Europe: What mental health professionals need to know. European Child and Adolescent Psychiatry, 25(1), 1–6.
    1. Hedtke K. A., Ruggiero K. J., Fitzgerald M. M., Zinzow H. M., Saunders B. E., Resnick H. S., & Kilpatrick D. G. (2008). A longitudinal investigation of interpersonal violence in relation to mental health and substance use. Journal of Consulting and Clinical Psychology, 76(4), 633–647.
    1. Kartal D., & Kiropoulos L. (2016). Effects of acculturative stress on PTSD, depressive, and anxiety symptoms among refugees resettled in Australia and Austria. European Journal of Psychotraumatology, 7, 1–12.
    1. Kashyap S., Page A. C., & Joscelyne A. (2019). Post-migration treatment targets associated with reductions in depression and PTSD among survivors of torture seeking asylum in the USA. Psychiatry Research, 271(April2018), 565–572.
    1. Keller A. S., Rosenfeld B., Trinh-Shevrin C., Meserve C., Sachs E., Leviss J. A., … Ford D. (2003). Mental health of detained asylum seekers. Lancet, 362, 1721–1723.
    1. Kendler K. S., Karkowski L. M., & Prescott C. A. (1998). Stressful life events and major depression: Risk period, long-term contextual threat, and diagnostic specificity. Journal of Nervous and Mental Disease, 186(11), 661–669.
    1. Laban C. J., Gernaat H. B. P. E., Komproe I. H., Schreuders B. A., & De Jong J. T. V. M. (2004). Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands. Journal of Nervous and Mental Disease, 192(12), 843–851.
    1. Laban C. J., Gernaat H. B. P. E., Komproe I. H., Van Der Tweel I., & De Jong J. T. V. M. (2005). Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. Journal of Nervous and Mental Disease, 193(12), 825–832.
    1. Laban C. J., Komproe I. H., Gernaat H. B. P. E., & de Jong J. T. V. M. (2008). The impact of a long asylum procedure on quality of life, disability and physical health in Iraqi asylum seekers in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 43, 507–515.
    1. Lhewa D., Banu S., Rosenfeld B., & Keller A. (2007). Validation of a Tibetan translation of the hopkins symptom checklist 25 and the harvard trauma questionnaire. Assessment, 14(3), 223–230.
    1. Li C., Yin X., & Jiang S. (2017). Effects of multidimensional child poverty on children’s mental health in Mainland China. Journal of Health Psychology, 135910531771837. doi:10.1177/1359105317718379
    1. Li S., Liddell B., & Nickerson A. (2016). The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports, 18(9), 1–9.
    1. Matthews T., Danese A., Wertz J., Ambler A., Kelly M., Diver A., … Arseneault L. (2015). Social isolation and mental health at primary and secondary school entry: a longitudinal cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 54(3), 225–232.
    1. Mollica R., McDonald L., Massagli M., & Silove D. (2004). Measuring trauma, measuring torture. Cambridge, UK: Harvard Program in Refugee Trauma.
    1. Murray R. (1974). The influence of crowding on children’s behaviour In Canter D. & Lee T. (Eds.), Psychology and the built environment (pp. 112–117). London: Architectural Press.
    1. Pevalin D. J., Reeves A., Baker E., & Bentley R. (2017). The impact of persistent poor housing conditions on mental health: A longitudinal population-based study. Preventive Medicine, 105(April), 304–310.
    1. Pevalin D. J., Taylor M. P., & Todd J. (2008). The dynamics of unhealthy housing in the UK: A panel data analysis. Housing Studies, 23(5), 679–695.
    1. Priebe S., Giacco D., & El-Nagib R. (2016). Public health aspects of mental health among migrants and refugees: A review of the evidence on mental health care for refugees, asylum seekers and irregular migrants in the WHO European region. Health Evidence Network Synthesis Report, 47, ix–pp. Retrieved from
    1. Raghavan S., Rasmussen A., Rosenfeld B., & Keller A. S. (2012). Correlates of symptom reduction in treatment-seeking survivors of torture. Psychological Trauma: Theory, Research, Practice, and Policy. doi:10.1037/a0028118
    1. Rudge J., & Nicol F. (2000). Cutting the cost of cold: Affordable warmth for healthier homes. London and New York: E & FN Spon.
    1. Schock K., Bo M., Rosner R., Wenk-Ansohn M., & Knaevelsrud C. (2016). Impact of new traumatic or stressful life events on pre-existing PTSD in traumatized refugees: Results of a longitudinal study. European Journal of Psychotraumatology, 7, 1–12.
    1. Schock K., Rosner R., & Knaevelsrud C. (2015). Impact of asylum interviews on the mental health of traumatized asylum seekers. European Journal of Psychotraumatology, 6, 1–10.
    1. Schweitzer R. D., Brough M., Vromans L., & Asic-Kobe M. (2011). Mental health of newly arrived Burmese refugees in Australia: Contributions of pre-migration and post-migration experience. Australian and New Zealand Journal of Psychiatry, 45, 299–307.
    1. Schweitzer R. D., Melville F., Steel Z., & Lacherez P. (2006). Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Australian and New Zealand Journal of Psychiatry, 40, 2.
    1. Shoeb M., Weinstein H., & Mollica R. (2007). The Harvard trauma questionnaire: Adapting a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees. The International Journal of Social Psychiatry. doi:10.1177/0020764007078362
    1. Steel Z., Chey T., Silove D., Marnane C., Bryant R. A., & Van Ommeren M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA - Journal of the American Medical Association, 302(5), 537–549.
    1. Steel Z., Silove D., Bird K., & McGorry P. (1999). Pathways from war trauma to posttraumatic stress symptoms among tamil asylum seekers, refugees, and immigrants. Journal of Traumatic Stress, 12, 3.
    1. Steel Z., Silove D., Brooks R., Momartin S., Alzuhairi B., & Susljik I. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. British Journal of Psychiatry, 188(1), 58–64.
    1. Steel Z., Silove D., Phan T., & Bauman A. (2002). Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study. Lancet, 360, 1056–1063.
    1. Su M., Tekin M., Tekin A., & Karadag H. (2016). Prevalence and gender differences in symptomatology of posttraumatic stress disorder and depression among Iraqi Yazidis displaced into Turkey. European Journal of Psychotraumatology, 7, 1–9.
    1. Tinghög P., Malm A., Arwidson C., Sigvardsdotter E., Lundin A., & Saboonchi F. (2017). Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: A population-based survey. BMJ open, 7, 12.
    1. Tracy M., Morgenstern H., Zivin K., Aiello A. E., & Galea S. (2014). Traumatic event exposure and depression severity over time: Results from a prospective cohort study in an urban area. Social Psychiatry and Psychiatric Epidemiology, 49, 1769–1782.
    1. Turner R., & Brown R. (2010, May). Social support and mental health In T. N. Brown & L. T. Scheid (Eds.). A handbook for the study of mental health. (pp. 200–212). New York, NY: Cambridge University Press. Retrieved from
    1. United Nations High Commissioner for Refugees [UNHCR] (2017). Global trends: Forced displacement in 2016. Geneva, Switzerland: Retrieved from .
    1. United Nations High Commissioner for Refugees [UNHCR] (2018, July 26). Medditerranean situation. Retrieved from
    1. Vukčević M., Dobrić J., & Purić D. (2014). Mental health of asylum seekers in Serbia. Serbia, Belgrade: UNHCR.
    1. Vukčević M., Momirović J., & Purić D. (2016). Adaptation of harvard trauma questionnaire for working with refugees and asylum seekers in Serbia. Psihologija, 49(3), 277–299.
    1. Vukčević Marković M., Gašić J., & Bjekić J. (2017). Refugees’ mental health. Serbia, Belgrade: Psychosocial Innovation Network.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe