Cross-cultural use of the predetermined scale cutoff points in refugee mental health research

  • Masao Ichikawa
  • Shinji Nakahara
  • Susumu Wakai



Cross-cultural use of the cutoff points determined in Indo-Chinese refugees of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ) is common in refugee mental health research but it might have caused misclassifications.


We assessed the validity of the predetermined cutoff points in identifying depression and post-traumatic stress disorder (PTSD) cases among Afghan refugees, with the algorithm method as a gold standard. We estimated the prevalence of depression and PTSD, using the HSCL-25 and the HTQ with the cutoff points and the algorithm method, and calculated sensitivity, specificity, positive and negative predictive values of the cutoff points.


Nine in ten PTSD cases/non-cases were correctly identified as cases/non-cases, and nine in ten respondents classified as PTSD cases/non-cases were actually cases/non-cases. In contrast, only one in three non-depression cases was correctly identified as a non-case, and three in five respondents who were classified as depression cases was actually a case. The prevalence of depression was estimated to be 86% with the cutoff points and 53% with the algorithm method, and that of PTSD 46% and 44%, respectively.


The cutoff point approach might have low specificity and positive predictive value particularly for depression in our study. Cross-cultural use of the scale cutoff points determined in one cultural group to another needs to be reconsidered.


psychiatric status rating scales validity cross-cultural comparison refugee 



We thank all the participants of this study and acknowledge the generous cooperation of the group of lawyers representing Afghan asylum seekers in Japan, the Japan Association for Refugees, and the Catholic Osaka Archdiocese Social Action Center.


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Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  1. 1.Dept. of Community Health, School of International Health Graduate School of MedicineUniversity of TokyoBukyo-ku TokyoJapan

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