Presentation Information
[O-12-01]Asylum seekers should not participate in intervention studies.
*Douwe van der Heide (GGZ Centraal(Netherlands))
Keywords:
Asylum seekers,Symtom validity,Cultural Psychiatry
Introduction
In a refugee mental health center in the Netherlands nine patients with severe therapy-resistant dissociative symptoms participated in a double-blind, placebo-controlled intervention study. The intervention involved caloric vestibular stimulation (causing vertigo) and confrontation with a mirror, provoking specific dissociative symptomatology in these patients. At this time, the results of a project with symptom validity tests in the same center indicated poor validity of symptom reports in fellow patients.
Methods
Assisted by dialogue interpreters eight patients who participated in the intervention study completed the same questionnaire as the patients who participated in the symptom validity project: The Structured Inventory of Malingered Symptomatology (SIMS), a list of implausible symptoms used to index over-reporting. The scores of both groups were compared.
Results
All patients of the intervention study endorsed more items of the SIMS than the cutoff of 16, on average 41.0 items out of a total of 75, 95% CI [29.0, 53.0], with a range of 18 to 58. Of the patients who partipated in the symptom validity project (n = 203) 164 (81%) scored above the cutoff, endorsing on average 33.8 items, 95% CI [31.5, 36.1], with a range of 3 to 62.
The intervention study was aborted. Retrospective analysis of the results of the symptom validity project identified current involvement in a procedure for asylum as an important predictor of poor validity.
Conclusion
Symptom reports of asylum seekers may have poor validity. This, and the possibility that these patients may feel that they are not in a position to refrain from participation, means that it may be unethical to include them for intervention studies. Especially so if the study intervention is aversive.
In a refugee mental health center in the Netherlands nine patients with severe therapy-resistant dissociative symptoms participated in a double-blind, placebo-controlled intervention study. The intervention involved caloric vestibular stimulation (causing vertigo) and confrontation with a mirror, provoking specific dissociative symptomatology in these patients. At this time, the results of a project with symptom validity tests in the same center indicated poor validity of symptom reports in fellow patients.
Methods
Assisted by dialogue interpreters eight patients who participated in the intervention study completed the same questionnaire as the patients who participated in the symptom validity project: The Structured Inventory of Malingered Symptomatology (SIMS), a list of implausible symptoms used to index over-reporting. The scores of both groups were compared.
Results
All patients of the intervention study endorsed more items of the SIMS than the cutoff of 16, on average 41.0 items out of a total of 75, 95% CI [29.0, 53.0], with a range of 18 to 58. Of the patients who partipated in the symptom validity project (n = 203) 164 (81%) scored above the cutoff, endorsing on average 33.8 items, 95% CI [31.5, 36.1], with a range of 3 to 62.
The intervention study was aborted. Retrospective analysis of the results of the symptom validity project identified current involvement in a procedure for asylum as an important predictor of poor validity.
Conclusion
Symptom reports of asylum seekers may have poor validity. This, and the possibility that these patients may feel that they are not in a position to refrain from participation, means that it may be unethical to include them for intervention studies. Especially so if the study intervention is aversive.