Validation of the Italian Version of the STAR-MH Mental Health Screening Tool in a Sample of Asylum Seekers and Refugees in Northern Italy

Abstract

Background:

Asylum seekers and refugees (ASR) are at high risk of mental health disorders including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and anxiety. However, prevalence rates vary significantly due to methodological differences and the diverse socio-demographic characteristics of these populations. Access to mental health care is further complicated by language barriers, cultural differences, and systemic discrimination. The STAR-MH (Screening Tool for Asylum-seeker and Refugee Mental Health) was developed in the original version as a brief, easy-to-administer tool for early detection of MDD and PTSD in this vulnerable group.

Objective:

To standardise the Italian version of the STAR-MH for use in non-clinical contexts, such as migrant reception centres.

Methods:

The English version of the STAR-MH was back-translated into Italian following WHO guidelines; the resulting tool was then tested on a sample of 122 adult ASR in Northern Italy residing in migrant reception centres. Psychometric evaluations included internal consistency (Cronbach’s α), factorial validity (PCA analysis), and construct validity (correlations with standardised psychiatric assessment tools such as the HSCL-25, HTQ-5, and MINI). ROC analyses were run to test its diagnostic properties and derive its cut-off score.

Results:

The Italian version of the STAR-MH showed sufficient, albeit sub-optimal, internal consistency (Cronbach’s α = .68) and a mono-component structure. While it was not sufficiently sensitive to MDD (which may be attributed to content- and culture-related biases), it demonstrated strong convergent validity with established psychiatric assessment tools and high diagnostic accuracy for PTSD (AUC = 0.82, sensitivity = 80%, and specificity = 76.7%).

Conclusion:

The Italian version of the STAR-MH is a clinimetrically sound instrument to screen for PTSD among ASR, although modifications may be needed to improve its ability to capture MDD in different ASR populations. As it is, the STAR-MH can be a valuable resource for non healthcare providers, such as frontline workers, to facilitate timely mental health interventions.