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Table 2 The Refugee-Mental Health Assessment Package (R-MHAP) and recommended supplementary measures

From: The Refugee-Mental Health Assessment Package (R-MHAP); rationale, development and first-stage testing amongst West Papuan refugees

Module Content Description
1 Traumatic events (TEs) This module comprises 23 items (rated as “not-experienced” or “experienced”) derived from a pool of 46 items. It assesses exposure to conflict-related TEs prior to, during, and following migration
2 Ongoing adversities This module comprises 26 items (rated as “a serious problem” or “not a serious problem”) developed based on the item pool derived from the Humanitarian Emergency Settings Perceived Needs (HESPER) scale [23]
3 Adaptation and Development After Persecution and Trauma (ADAPT) Index This module comprises 22 items (rated on a 4-point Likert scale: 0 = none, 1 = moderately, 2 = very strongly, 3 = extremely) derived from a pool of 63 items, assessing five domains of psychosocial disruptions related to mass conflict: safety/security, bonds/networks, justice, roles/identities, and existential meaning
4 Loss of statehooda This module comprises 10 items (rated on a 4-point Likert scale: 0 = none, 1 = moderately, 2 = very strongly, 3 = extremely) assessing refugees’ perception of statelessness and loss of statehood
5 Local idioms of distressa This module comprises 45 items assessing locally understood syndromes amongst West Papuans
6 Mental health module This module assesses nine current (last 12 months) and lifetime prevalence of mental disorders defined by the DSM-IV/V, Diagnostic and Statistical Manual of Mental Disorders (Fourth and Fifth Editions): Posttraumatic stress disorder, depression, generalized anxiety disorder, panic disorder, somatic symptom disorder, persistent complex bereavement related disorder, separation anxiety, psychosis, and intermittent explosive disorder
7 Alcohol and substance useb This module comprises 5 items (rated as “no” and “yes”) based on the WHO Alcohol Use Disorders Inventory Test (AUDIT) [24] assessing excessive use of alcohol and other substances
8 Functional impairmentc This module comprises 12 items (rated on a 5-point Likert scale: 1 = none, 2 = mild, 3 = moderate, 4 = severe, 5 = extreme) based on the WHO Disability Assessment Schedule (WHODAS) 2.0 [25] assessing disability related to health and mental health conditions in the previous 30-day period
9 General physical wellbeing This module comprises 11 items (rated as “no” and “yes”) assessing general health status, health-related disability, help-seeking behaviour, and barriers to accessing health care in the last 12 months
10 Suicidal ideation and behaviour This module comprises 12 items (rated as “no” and “yes”) assessing episodes of suicidal ideation and behaviour in the last 12 months
11 Exposure to Intimate Partner Violence (IPV)d This module is based on the WHO Multi-Country Study on Women’s Health and Domestic Violence [26] assessing current and lifetime exposure to Intimate Partner Violence (IPV)
  1. aTo be reported elsewhere.
  2. b, c, dRecommended supplementary measures used to supplement the R-MHAP.