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Abstract

Background:

Despite increasing research on substance use among migrants and refugees, little attention has been paid to the instruments assessing substance use in these populations. This systematic review examines the suitability of substance use instruments for use in migrant and refugee populations and the quality of the instruments.

Methods:

A systematic search of the electronic databases PubMed, Web of Science, PsychINFO, and EMBASE was performed. Articles were eligible if they assessed substance use among refugees using a standardized instrument. Instrument properties were assessed using a standardized checklist, and the measurement properties were evaluated according to Terwee’s criteria.

Results:

In total, n = 2654 studies were retrieved. Of those, we included n = 55 studies. The most frequently used instrument was the Alcohol Disorder Identification Test (n = 20, 36.4%) followed by the CAGE/CAGE4M and the Mini International Neuropsychiatric Interview (n = 7 studies each, 12.7%). Out of 24 instruments, 18 (75%) were developed in English. Content validity, cross-cultural validity, and criterion validity were unreported for most instruments (n = 13, 54.2%). None of the instruments were developed with input from refugees. Completion time of the instruments ranged from 1 to 120 minutes. Psychometric properties were either not assessed in refugees or were moderate.

Conclusion:

None of the assessed instruments met all the psychometric criteria sufficiently. Therefore, it will be necessary to develop a rationale for instruments to better fit the needs of diverse groups of migrants and refugees. Accordingly, these instruments fitted to specific groups will allow for better measurement of substance use, diagnosis, and monitoring of treatment.

Keywords

forced migrants substance use validity refugee instruments measurement

Highlights

The prevalence of substance use among migrants and refugees is largely unknown.

In order to ensure the reliability of the data collected, it is essential to implement instruments that are sensitive to the specific needs of refugees and migrants. Our findings indicate that instruments measuring substance use have been predominantly developed in English-speaking countries.

According to the quality criteria, some instruments, however, have better psychometric properties than others and have been widely used in refugee and migrant populations.

No substance use instrument so far has been developed together with migrants and refugees.

Introduction

Substance use in migrant populations is a significant Public Health challenge.^1-4 The risk for substance use disorders among persons forcibly displaced from their home country, referred to as refugees, increases with the length of residence in the host country. The longer refugees stay in a host country, the more their risk of substance use converges with that of the native population.⁵ However, findings depend on the quality of the measures used to assess substance use including their cultural validity. As of 2021, there were 89.3 million forcibly displaced persons. Eighty-three percent of the world’s forcibly displaced persons live in low- and middle-income countries, as reported by the Global Trends Report.⁶ Accordingly, the number of refugees affected by substance use is likely to increase in the next years, alone due to the increase in refugees. By 2021, the number of individuals using substances is estimated to have increased to 296 million worldwide.⁷ According to the Global Burden of Disease Study, 30.9 million years of healthy lives were lost and approximately 494.000 deaths were attributable to substance use in 2019. In 2018, 132.6 million disability-adjusted life years and 3 million deaths (5.3% of all deaths) were reported as a result of harmful alcohol consumption.⁸

Studies suggest that prevalence rates of substance use and substance use disorders (SUDs) among refugees range from 2% to 60% for alcohol and 0.66% to 31% for other substances.⁹ While research shows that substance use among refugees is significantly lower compared to the general population, it is unclear to what extent instruments capture aspects of substance use that are relevant to refugee populations, and whether available instruments are valid and reliable for the specific groups. Migrant and refugee populations are heterogeneous groups. The course and symptoms of SUDs are linked to differing cultural backgrounds and conditions in host countries.¹⁰ This implies a need for culture-specific measures to be developed or for existing measures not only to be translated but also to be adapted to the specific contexts of particular populations.¹¹

Differences in prevalence rates might be related to the measures used.^12,13 At the moment, some instruments are widely used, such as the Alcohol Disorder Identification Test (AUDIT), the Cut Down, Annoyed, Guilty, Eye-Opener (CAGE), or the Mini International Neuropsychiatric Interview (MINI). Some measures assess the use of one substance, while others assess various substances. In some cases, measures include specific domains or frequency and intensity of use.¹⁴ This heterogeneity of instruments hampers the ability to compare study outcomes. Another issue that limits the ability to generalize study findings is the use of different types of instruments. Substance use instruments can be generic or population-specific. Generic instruments allow for comparisons across populations (refugees and non-refugees), while population-specific instruments measure aspects that are relevant to refugees or a specific group of refugees (e.g., integration into the host community). Instruments can also be uni or multidimensional. Unidimensional measures provide a global assessment of substance use, whereas multidimensional measures assess dimensions of substance use.

While studies suggest that substance use among refugees varies, it is unclear to what extent instruments capture aspects of substance use that are relevant to refugee populations, and whether they are valid and reliable measures for this population. Evaluation of instruments is of utmost importance, as they may affect the accurate detection of mental health conditions in this population group.

This comprehensive systematic review examines the suitability and psychometric properties of substance use instruments for migrants and refugees. The scope of this review is limited to the use of non-prescribed substances, especially drugs and alcohol. It does not include prescribed substances (e.g., opioid dependence in people with chronic pain). We identify substance use instruments that have been used in migrant and refugee populations and evaluate the item content relevance to this population, as well as the instruments’ properties. In line with expert recommendations, that the way forward in substance use research is a holistic and multidimensional approach,¹⁵ single-item measures are excluded from this review, as they are unidimensional and their psychometric values are unspecified. We aimed (1) to summarize existing instruments for measuring substance use and SUDs among migrants and refugees and then to classify them according to their utilization in research and/or in clinical practice, (2) to evaluate the quality of instruments in terms of their measurement properties, and finally (3) make recommendations for the selection of instruments based on best evidence synthesis.

Methods

Search Strategy

We identified articles by searching the electronic databases PubMed (NCBI), Embase (Elsevier, 1974), PsycINFO (EBSCO), CINAHL (EBSCO), Web of Science Core Collection (Clarivate Analytics), and PTSDPubs (ProQuest). The searches, developed by a medical librarian (P.A.B.), covered the key domains of refuge, forced migration, and substance use (Supplemental Table 1). Controlled vocabulary terms were included if available. Searches were carried out between September 19 and 25, 2019. No date or language restrictions were applied. In addition to electronic searches, we screened the references and citations of included full-text reports.

Study Selection

Three researchers (S.A., L.M.S., M.J.) independently screened titles and abstracts of the included records for potential inclusion and independently evaluated full texts for eligibility. Discrepancies in eligibility decisions between the reviewers were resolved by a consensus method. Studies were considered eligible for inclusion in the review if they reported findings related to alcohol or drug use among refugees and migrant populations. Inclusion criteria for articles were as follows: (1) substance use was assessed. (2) a validated substance use instrument was used. (3) Substance use was self-reported by refugees or migrants. Articles were excluded if they were not original peer-reviewed research, did not clearly identify the population as migrants or did not provide separate results for refugees or migrants, did not report any relevant findings, or used single-item instruments to assess substance use. Multiple reports from the same study were excluded unless they reported additional relevant data.

Data Extraction

Basic information (author, year, country where the study was conducted, participants’ original country, type of migrant population, number of participants, their gender, age range, mean age and standard deviation [SD], mental health measures used, setting) and information about substance use measures (instrument name, type, substance, domain, recall period) were extracted from included articles. Before assessing the measurement properties of an instrument, descriptive variables of the instruments used in the included studies were extracted, including the short name of the instrument, country and language of questionnaire development, country in which the questionnaire was used, focus (drugs, alcohol, drug/alcohol, health, other) and type of measure (standardized, individualized, hybrid), delivery format (self-report, interview, mixed), response options (Likert scales, nominal scales, number of days/times, other), and translation modes. Data were extracted into an Excel sheet by S.A., L.M.S., M.J., and K.B. and independently reviewed by J.L.

Assessment of Content Relevance

We assessed the item content relevance of the substance use instruments used in the included studies by examining the extent to which items reflected domains relevant to refugee and migrant populations and measured substance use and SUDs, therefore indicating suitability. A thematic analysis was conducted in order to evaluate the content of the instruments that are available in the peer-reviewed literature. Information on item content was derived from the studies included in this review, from the first publication of the instruments, and from manuals. The content of substance use instruments was systematically differentiated by content analysis by 2 researchers. The researchers (K.-J.B. and S.A.) independently coded the instrument items. Differences in the codings and themes were discussed iteratively until a consensus was reached. The following decision rules were developed during the discussions:

The codings are intended to represent meaning, rather than the exact wording of the items.

If items are subdivided by domains in the original instrument, it is not necessary to automatically code the items according to the given domain.

If the instrument instructions indicate that an item should be considered within a specific context, it is necessary to adopt that context when coding.

Evaluation of Psychometric Properties

The methodological quality of the included studies was evaluated using recommended minimum standards that measures must meet to be considered suitable for use in scientific studies based on the criteria for psychometric properties developed by Terwee et al.^16,17 The assessment was based on the information provided in the studies included in this review, first publications, and manuals. Cross-cultural validity aimed to determine the performance of the items on a translated or culturally adapted instrument and whether or not the adapted instrument adequately reflects the performance of the items of the original version of the instrument.

Best evidence synthesis was performed by applying an assessment property scoring summarized in the Supplemental Table 2, by integrating the results of the studies’ methodological qualities and the results of measurement properties of instruments. The rating included an evaluation of 6 domains (conceptual and measurement model, instrument development methodology, interpretability of scores, measurement error, internal consistencies, and validity) to rate different aspects of the measurement properties of the instruments. Each domain contains 3 items measured on a 3-point scale (2, 1, 0). A higher score indicates stronger evidence.^16,17

Results

The electronic database search returned 2654 unique records. From these, 216 full-text documents were selected for full-text review, of which 55 met our inclusion criteria (Figure 1).

Figure 1.

Flow chart of study selection.

Study Population

The articles reported on 41 787 individuals. Sixty-eight percent of those individuals were non-refugee migrants and 32% were refugees (Table 1), with 50.9% (n = 31) being female and 49.1% (n = 38) being male. The age range of the participants was 18 to 87 years. Most of the studies were conducted in the USA (n = 22, 40%),^18-39 Germany (n = 6, 10.9%),^40-45 and in the UK (n = 4, 7.3%).^40,41,46,47 Twelve studies (21.8%) did not report the countries from which the refugees came.^{36,43-45,48-55}

Table 1.

Characteristics of Studies Investigating Substance Use Among Refugees and migrants.

Author, year	Country where the study was conducted	Participants (country, type^a, n, gender, age range, mean age [SD])	Instrument name^a	Type	Substance	Domains	Recall period	Mental health (measure)	Settings
Addo, 2018⁴⁰	Germany, the Netherlands, the UK	Ghana, m, N = 4280, female: N = 2661 (62.2%), male: N = 1619 (37.8%); age range: 25-70, mean age: — (SD: —)	Ghana-FPQ	Use	Alcohol	Quantity	12 months	Distress (Psychological Distress Scale)	Community
Ahn, 2015⁵⁶	South Korea, North Korea	Country: —, r, N = 545, female: N = 425 (78.0%), male: N = 120 (22.0%), 19-65, mean age: 35.5 (SD: 10.6)	PDSQ-Korea	Dependence	Alcohol	Dependence	—	MDD, PTSD, GAD, Panic Disorder, Social Phobia (PDSQ-Korea)	Support Center
Altman, 2018⁵⁷	Mexico	Mexico, Honduras, Central America, m, N = 363, 100% male, age range: —, mean age: 29.15 (SD: 9.02)	MINI	Diagnosis	Alcohol	Abuse, Dependence	12 months	Depression (MINI)	Home
Arcury, 2016¹⁸	The USA	Latin America, m, N = 447, female: N = 212, male: 235, age range: 30-70, mean age: — (SD: —)	CAGE4M	Use	Alcohol	Abuse, dependence	Past 3 months	Depression (CES-D)	Community
Arfken, 2011¹⁹	The USA	Iraq and other Arab countries, r and m, N = 127 (n = 75 Iraq; n = 52 other), gender: —, age range: —, mean age: 38.1 (SD: —)	AUDIT (2 items of it)	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	—	Community
Arli, 2019⁴⁸	Australia	Oceania, Asia, Europe, Northern America, m, N = 408, female: n = 246 (60.7%), males: N = 159 (39.3%), age range: 18+, mean age: — (SD: —)	Scale for the measurement of attitudes toward alcohol	Attitude	Alcohol	Social ease, unease, economic	—	—	Community
Bart, 2018²⁰	The USA	Hmong (ethnicity), r, N = 76, female: N = 22 (28.9%), male: N = 54 (71.1%), age range: —, mean age: 56.6 (SD: 13.2)	ASI	Severity of addiction	Methadone, alcohol, drugs	Treatment progress	Past 30 days	Depression, anxiety, somatization, distress (SCL-90)	Hospital
Bogic, 2012⁴¹	Germany, Italy, the UK	Former Yugoslavia r, N = 854, female: N = 438 (51.3%), male: N = 416 (48.7%), age range: 18-65, mean age: 41.6 (SD: 10.8)	MINI	Mental disorder	Alcohol, drugs	Abuse, dependence	—	Traumatic experiences (LSC-R)	Community
Canfield, 2017⁴⁶	The UK	Brazil, m, N = 164, female: N = 90 (54.9%), male: N = 74 (45.1%), age range: 18+, mean age: 28.69 (SD: 5.86)	SURPS	Personality dimensions	Any substance	Hopelessness, introversion, anxiety sensitivity, impulsivity, sensation seeking	Past 30 days	Positive, negative affect (PANAS)	Community
Cherry, 2009²¹	The USA	El Salvador, Guatemala, Honduras, Mexico, N = 276, female: n = 212 (76.8%), male: N = 64 (23.2%), age: —, mean age: 34.3 (SD: 12.5)	RAPS4-QF	Risk of harmful drinking	Alcohol	Frequency, quantity	Past 12 months	Somatization (PHQ-15), Depression (PHQ-9); GAD (GAD-7)	Clinical
D’Amico, 2007²²	The USA	Cambodia, r, N = 490, female: N = 319 (65.1%), male: N = 171 (34.9%), age range: 35-75, mean age: 52.2 (SD: 11.4)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	Past 12 months	Distress (CIDI)	Community
Eisenman, 2003²³	The USA	Mexico, Central America, N = 512, female: N = 398 (77.7%), male: N = 114 (22.3%), age range: 19-78, mean age: 46.1 (SD: 12.9)	PRIME-MD	Symptoms of alcohol use disorder	Alcohol	Abuse, dependence	Past month	Mood disorders (PRIME-MD, PHQ); PTSD (PCL-C)	Clinical
Emery, 2018⁵⁸	South Korea	North Korea, r, N = 204, 100% female, age range: —, mean age: — (SD: —)	CAGE	Abuse, dependence	Alcohol	Cut down	Past 3 months	PTSD (IES-R-K)	Community
Fortuna, 2019²⁴	The USA, Spain	South-, Central America, m and r, N = 175 (100% female), age range: 18-64, mean age: — (SD: —)	AUDIT, BDEPQ, DAST-10	Dependence, problem drinking, abuse, use	Alcohol, benzodiazepines, drugs	Frequency, quantity, intensity	—	Depression (PHQ-9); anxiety (GAD-7); PTSD (PCL-5); Trauma exposure (BTQ)	Community, clinical
Frank, 2013⁴²	Germany	Italy, Turkey, Spain, m, N = 364, female: N = 204 (56.0%), male: N = 160 (44.0%), age range: ≥45, mean age: 58.6 (SD: 8.9)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	—	Community
Getnet, 2019⁵⁹	Ethiopia	Eritrea, r, N = 562, female: N = 304 (54.1%), male: N = 258 (45.9%), age range: 18-74, mean age: 29.6 (SD: 10.2)	FAST	Use	Alcohol	Frequency, quantity	—	Depression (CES-D); PTSD (PC-PTSD)	Community
Grzywacz, 2006²⁵	The USA	Guatemala, Honduras, Mexico, m, N = 60, 100% male, age range: 18+, mean: 32.1 (SD: 6.2)	CAGE4M	Abuse, dependence	Alcohol	Cut down, criticism, guilt, need	—	Anxiety (PAI); Depression (CES-D)	Community
Hewlett, 2015⁶⁰	Nepal	Bhutan, r, N = 128, female: N = 54 (42.1%), male: N = 74 (57.8%), age range: 18+, mean age: — (SD: —)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	—	Community
Hill, 2019²⁶	The USA	Latin America, m, N = 101, 100% male, age range: 20-70, mean age: 46.5 (SD: 10.7)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	Depression (PHQ-9), Anxiety (GAD-7)	Community
Hiott, 2008²⁷	The USA	Mexico, Central America, m, N = 125, 100% male, age range: 18+, mean age: 30 (SD: 7.8)	CAGE4M	Abuse, dependence	Alcohol	Cut down, criticism, guilt, need	—	Anxiety (PAI), depression (CES-D)	Community
Ismayilova, 2014⁶¹	Kazakhstan	Central Asia, m, N = 287, female: N = 141 (49.1%), male: N = 146 (50.9%), age range: 18+, mean age: 27.7 (SD: 4.8)	CAGE	Abuse, dependence	Alcohol	Cut down, criticism, guilt, need	—	Depression (BSI)	Community
Johansson Blight, 2008⁶²	Sweden	Bosnia, r, N = 413, gender: —, age range: 18-60, mean age: 36.9 (SD: —)	AUDIT, ULF-96	Problem drinking, medication use	Alcohol, medication	Weekly alcohol use	—	Traumatic events (LSC-R)	Community
Kane, JC et al. 2014⁴⁹	15 low- and middle-income countries	Liberia, Nepal, Burundi, Tanzania, Djibouti, Yemen, Kenya, Rwanda, Thailand, Namibia, Chad, Uganda, Ethiopia, Bangladesh, Zambia, r, gender: —, age range: —, mean age: — (SD: —)	Alcohol and substance use disorder	Disorder	Alcohol, any substance	Use	—	Psychotic-, emotional-, somatic disorder, other	Clinical
Kassim, 2010⁴⁷	The UK	Yemen, m, N = 204, 100% male, age range: 18-87, mean age: 44.84 (SD: 19.7)	SDS-Khat	Psychological dependence	Khat	Control, worrying, ability to stop	Past 12 months	—	Community
Kazour, 2017⁶³	Lebanon	Syria, r, N = 452, females: N = 252 (55.8%), males: N = 200 (44.2%), age range: 18-65, mean age: 35.05 (SD: 12.35)	MINI	Disorder	Alcohol, amphetamines, cannabis	Abuse, dependence	—	PTSD (MINI)	Community
Kim, 2018²⁸	The USA	Burma, r, N = 184, females: N = 107 (58.2%), males: N = 77 (41.8%) females, age range: 18-87, mean age: — (SD: —)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	Anxiety, depression (HSCL); PTSD (RHS-15)	Community
Kim, 2017⁶⁴	South Korea	North Korea, r, N = 140 female, age range: 20+, mean age: — (SD: —)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	Past 12 months	PTSD (revised version of DSV-IV), depression (CES-D); suicidal ideation (SSI)	Community
Kissinger, 2013²⁹	The USA	Honduras, Mexico, Central and South America, m, N = 125, 100% male, age range: 18+, mean age: 30.1 (SD: 7.8)	AUDIT	Problem drinking, dependence	Alcohol	Frequency, quantity, intensity	Past 6 months	Depression (CES-D)	Community
Kumparatana, 2017⁶⁵	Kazakhstan	Central Asia, m, N = 333, 100% male, age range: 18-36, mean age: 27.7 (SD: 5)	CAGE	Abuse, dependence	Alcohol	Cut down, criticism, guilt, need	—	Depression (BSI)	Community
Luitel, 2013⁶⁶	Nepal	Bhutan, r, N = 6818; gender: —, age range: 20+, mean age: 35.3 (SD: 16.7)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	—	Community
Marshall, 2005³⁰	The USA	Cambodia, r, N = 490, female: N = 319 (65.1%), male: N = 171 (34.9%), age range: 35-75, mean age: 52 (SD: 13.4)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	PTSD, depression (CIDI)	Community
Miremadi, 2011⁶⁷	Canada	Afghanistan, Iran, Iraq, r, N = 68, female: N = 36 (52.9%), male: N = 32 (47.1%), age range: 18-69, mean age: 34.1 (SD: 12.8)	AUDIT, DUDIT	Dependence, problem drinking	Alcohol, drugs	Frequency, quantity, intensity	—	Depression (PHQ-9)	Community
Mora, 2016³¹	The USA	Latin America, m, N = 371, 100% male, age range: 18+, mean age: — (SD: —)	AUDIT-C	Abuse	Alcohol	Frequency, quantity, intensity	—	Anxiety (PAI); depression (CES-D)	Community
Mundt, 2012⁴³	Germany	Turkey, European Union, Arabic countries, former Yugoslavia, former USSR, Vietnam, m, N = 74, female: N = 47 (63.5%), male: N = 27 (36.5%), age range: 18-57, mean age: 37.2 (SD: 11.4)	AUDIT	Dependence, problem drinking	Alcohol	Frequency, quantity, intensity	—	Somatization, insomnia, anxiety, social dysfunction, depression (GHQ)	Community
Nelson, 1997³²	The USA	Vietnam, m, N = 99 female: N = 47 (47.5%), male: N = 52 (52.5%), age range: 19-71, mean age: 34 (SD: —)	CAGE	Abuse, dependence	Alcohol	Cut down, criticism, guilt, need	—	Depression (VDS)	Clinical
Nikendei, 2019⁴⁴	Germany	Country: —, r, N = 228, female: N = 95 (41.7%), male: N = 133 (58.3%), age range: 18+, mean age: — (SD: —)	SCID (3 items of it)	Harmful alcohol consumption, drug abuse	Alcohol, drugs	Dependence, frequency, intensity, quantity, use	—	Anxiety (GAD-2); depression (PHQ-2); panic disorder (PHQ-PD); PTSD (PC-PTSD)	Clinical
Organista, 2017³³	The USA	Mexico, Guatemala, Salvador, Honduras, other, m, N = 344, 100% male; age range: 18-81, mean age: 40.5 (SD: 10.8)	AUDIT	Dependence, problem drinking	Alcohol	Use, frequency, dependence	Past month	Anxiety (GAD-7); depression (CES-D)	Community
Organista, 2019³⁴	The USA	Mexico, Guatemala, Salvador, Honduras, other, m, N = 344, 100% male; age range: 18-81, mean age: 40.5 (SD: 10.8)	AUDIT	Dependence, problem drinking	Alcohol	Use, frequency, dependence	Past month, past year	Anxiety (GAD-7); depression (CES-D)	Community
Pignon, 2017⁵⁰	France	Country: —, m, N = 1665, female: N = 901 (54.1%), male: N = 764 (45.9%), age range: 18+, mean age: 37.8 (SD: 15.9)	MINI	Disorder	Alcohol, cannabis	Abuse, dependence	Lifetime	Mood disorder, suicide attempts, anxiety, PTSD (MINI)	Community
Pignon, 2018⁵¹	France	Country: —; m; N = 1665, female: N = 901 (54.1%), male: N = 764 (45.9%), age range: 18+, mean age: 37.8 (SD: 15.9)	MINI	Disorder	Alcohol, cannabis	Abuse, dependence	Lifetime	Anxiety, PTSD, suicide attempt, psychotic disorders (MINI)	Community
Qureshi, 2014⁵²	Spain	Country: —, m, N = 1499, female: N = 920 (61.4%), male: N = 579 (38.6%), age range: 18+, mean age: 32.5 (SD: 9.3)	MINI	Disorder	Alcohol, any substance	Abuse, dependence	Past 12 months	DMS-IV disorders (MINI), somatization (SPPI)	Clinical
Ramos, 2019³⁵	The USA	Mexico, Latin America, m, N = 241, female: N = 51 (21.2%), male: N = 190 (78.8%), age range: 19+, mean age: — (SD: —)	AUDIT/AUDIT-C	Dependence, problem drinking	Alcohol	Use, frequency, dependence	Past 12 months	—	Community
Rolland, 2017⁵³	France	Country: —, m, N = 10 198, female: N = 5005 (49.1%), male: N = 5193 (50.9%), age range: 18+, mean age: 36 (SD: —)	MINI	Disorder	Alcohol	Abuse, dependence	—	Depression, mental illness (—)	Community
Rommel, 2015⁴⁵	Germany	Country: —, m, N = 1107, gender: —, age range: 18-79, mean age: — (SD: —)	AUDIT-C	Abuse	Alcohol	Frequency, quantity, intensity	—	Depression (PHQ-9)	Community
Rowe, 2018⁵⁴	Australia	Country: —, m, N = 3638, female: N = 1909 (52.5%), male: N = 1729 (47.5%), age range: 18+, mean age: 44 (SD: —)	AUDIT-C	Abuse	Alcohol	Frequency, quantity, intensity	Past 12 months	Mental Health (1 item)	Community
Salama, 2018⁶⁸	Finland	Iran, Iraq, Russia, Somalia, m, N = 1165, gender: —, age range: 18-64, mean age: — (SD: —)	AUDIT-C	Abuse	Alcohol	Frequency, quantity, intensity	Past 12 months	—	Community
Salas-Wright, 2014³⁶	The USA	Country: —, r, N = 428, female: N = 200 (40.4%), male: N = 228 (59.6%), age range: 18+, mean age: — (SD: —)	AUDADIS-IV	Disorder	Alcohol, amphetamines, cannabis, cocaine, hallucinogens, opioids/heroin	Abuse, dependence	Lifetime	Depression, PTSD (—)	Community
Sanchez, 2015³⁷	The USA	Guatemala, Honduras, Mexico, “other,” m, N = 278, female: N = 127 (45.7%), male: N = 151 (54.3%), age range: 18+, mean age: 37.2 (SD: 5.8)	AUDIT	Dependence, problem drinking	Alcohol	Use, frequency, dependence	Past 30 days	Depression (BDI-II)	Community
Savic, 2014⁵⁵	Australia	Country: —, m, N = 393, gender: —, age range: 18+, mean age: — (SD: —)	AUDIT	Dependence, problem drinking	Alcohol	Use, frequency, dependence	—	Distress (K-10)	Community
Tse, 2015⁶⁹	Hong Kong (China)	India, Pakistan, m, N = 202, 100% males, age range: 18-66, mean age: — (SD: —)	AUDIT	Dependence, problem drinking	Alcohol	Use, frequency, dependence	Past 12 months	—	Community
Westermeyer, 1996³⁸	The USA	Laos, r, N = 57, female: N = 17 (30%), male: N = 40 (70%), age range: —, mean age: 45.3 (SD: 12.5)	MMADST, SAPS	Disorder	Opiates	Use, dependence, psychological problems	—	Anxiety (HAM-A), depression (BDI; SCL-90, HAM-D); phobic anxiety, psychoticism, somatization (SCL)	Clinical
Widmann, 2014⁷⁰	Kenya	Somalia, r, N = 48, 100% male, age range: —, mean age: — (SD: —)	SDS-Khat	Dependence	Khat	Dependence	Past year	Psychotic symptoms (CIDI), PTSD (MINI)	Community
Widmann, 2017⁷¹	Kenya	Somalia, r, N = 330, 100% male, age range: 18+, mean age: 27.8 (SD: 6.6)	ASSIST-linked Brief Intervention	Use, risk	Khat	Consumption pattern, concerns	Current/lifetime	Depression (PHQ-9), psychotic symptoms (CIDI)	Community
Wong, 2007³⁹	The USA	Cambodia, Laos, Vietnam, m, N = 494, gender: —, age range: 18+, mean age: — (SD: —)	26-item checklist	Use	Alcohol, illicit drugs	Use, quantity	Past 30 days	—	Community
Young, 2016⁷²	Australia	Ethiopia, Somalia, other African countries, m, N = 52, female: N = 7 (13.5%), male: N = 45 (86.5%), age range: 18+, mean age: —, (SD: —)	SDS-Khat	Use, dependence	Khat	Days of use, frequency, starting age, quantity per session, session group size, duration	Past 30 days/past 12 months	Psychological consequences (own)	Community

Abbreviations: ASI, Addiction Severity Index; ASSIST, Alcohol, Smoking and Substance Involvement Screening Test; AUDADIS-IV, The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV; AUDIT, Alcohol Disorder Identification Test; AUDIT-C, Alcohol Disorder Identification Test-Concise; BDEPQ, The Benzodiazepine Dependence Questionnaire; BDI, Beck Depression Inventory; BDI-II, Beck Depression Inventory-II; BSI, Brief Symptom Inventory; BTQ, Brief Trauma Questionnaire; CAGE/CAGE4M, Cut Down, Annoyed, Guilty, Eye-Opener; CES-D, Center for Epidemiologic Studies Depression Scale; CIDI, Composite International Diagnostic Interview; DAST-10, Drug Abuse Screening Test; DUDIT, Drug Use Disorders Identification Test; FAST, Fast Alcohol Screening Test; GAD-2/GAD-7, Generalized Anxiety Disorder Scale; Ghana-FPQ, Ghana Food Propensity Questionnaire; GHQ, General health Questionnaire; HAM-A, Hamilton Anxiety Scale; HAM-D, Hamilton Depression Scale; HSCL, Hopkins Symptoms Checklist; IES-R-K, Impact Event Scale-Revised-Korean;; K10, Kessler Psychological Distress Scale; LSC-R, Life Stressor Checklist-Revised; MINI, Mini International Neuropsychiatric Interview; MMADST, Modified Michigan Alcohol-Drug Screening Test; PAI, Personality Assessment Inventory; PANAS, The Positive and Negative Affect Schedule; PCL-5, Post-Traumatic Stress Disorder (PTSD Checklist for DSM-5); PCL-C, Post-Traumatic Stress Disorder-Checklist-Civilian Version; PC-PTSD, Primary Care PTSD Screener; PDSQ, Psychiatric Diagnostic Screening Questionnaire; PHQ-2/PHQ-9, Patient Health Questionnaire Depression Scale; PHQ-15, Patient Health Questionnaire Somatization Scale; PHQ-PD, Patient Health Questionnaire-Panic Disorder; PRIME-MD, Primary Care Evaluation of Mental Disorders; RAPS4-QF, The Rapid Alcohol Problems Screen 4-Quantity/Frequency; RHS-15, Refugee Health Screener-15; SAPS, Substance Abuse Problem Scale; SCID, Structured Clinical Interview; SCL-90, The Symptom Checklist-90; SDS-Khat, Severity Dependence Scale-Khat; SPPI, Standardized Polyvalent Psychiatric Interview; SSI, Scale for Suicidal Ideation; SURPS, The Substance Use Risk Profile Scale; ULF-96, Immigration Survey Questionnaire 1996; VDS, Vietnamese Depression Scale.

Abbreviations for status of population: m = migrant, r = refugee.

Description of Instruments

Among the 55 articles, we found 24 different standardized instruments (Table 2). The AUDIT was the most frequently applied instrument (n = 20, 36.4%),^{19,22,24,26,28-30,33-35,37,42,43,55-61} followed by^62-73 the CAGE^{18,25,27,32,74-76} and the MINI^{41,50-53,77,78} (each n = 7, 12.7%). Eight instruments exclusively measure alcohol use, 5 focus on drugs and/or medication, and 11 instruments measure both alcohol and drug use. The mean number of items in the instruments was 16.3 (SD = 13.3).

Table 2.

Characteristics of Instruments Used in the Studies to Measure Substance Use Among Refugees and Migrants.

Instrument	Abbreviation	Country of development	Language of development	Countries/population groups	Target population	Response options	Recall period	N item	Completion time (minutes)	Translation mode	Purpose
26-Item Checklist³⁹	—	The USA	English	Cambodia, Laos, Vietnam	Migrants	Number of days each of the substances and the amount was used	Past 30 days	26	—	—	Screening
Addiction Severity Index⁹¹	ASI²⁰	The USA	English	Hmong	Refugees	Multiple	Lifetime, past 30 days	163	60	Interpreter	Screening
The Alcohol, Smoking and Substance Involvement Screening Test⁹²	ASSIST⁷¹	International	English	Somalia	Migrants	Question 1: yes/no; Questions 2-5: Never, once or twice, monthly, weekly, daily/almost daily; Questions 6-8: No, never; yes, in the past 3 months; yes, but not in the past 3 months.	Lifetime, past 3 months	8	5-10	Translation, back-translation. Items discussed and adapted by an expert team	Screening
The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV^93,94	AUDADIS-IV⁹⁵	The USA	English	Various	Refugees and migrants	Structured diagnostic interview	Past 12 months	39	60	—	Diagnostic
Alcohol use disorders identification test⁹⁶	AUDIT^{24,26,28-30,33-35,37,42,43,55,60,62,64,66,67,69}	International	English	Arab, South/East Asian, European countries, Central and South America	Refugees,^{24,28,30,60,62,64,66,67} Migrants^{26,29,33-35,37,42,43,55,69}	Likert scale	Past year	10	40	Bilingual lay interviewers, Spanish-speaking research staff, bilingual research staff	Screening
Alcohol use disorders identification test-Consumption Questions⁹⁷	AUDIT-C^{31,35,45,54,68}	The USA	English	Iran, Iraq, Russia, Somalia, “various” countries	Migrants	Likert scale	Past 12 months	3	1	Gender-/ethnicity-matched research assistants	Screening
Benzodiazepine Dependence Questionnaire⁸⁵	BDEPQ²⁴	Australia	English	South and Central America	Migrants	Yes/no	Past 1 month	31	—	—	Screening
Cut down-annoyed guilty, eye-opener⁹⁸	CAGE/CAGE4M^{18,25,27,32,37,58,61,65}	The USA	English	Central and South America, Central Asia, North Korea, Vietnam	Migrants,^{18,25,27,32,37,58,61,65} Refugees⁵⁸	Yes/no	Lifetime	4	1	Native bilingual interviewers; translation into Spanish	Screening
Drug abuse screen test – 10⁸⁶	DAST-10²⁴	Canada	English	South, Central America	Migrants	Yes/no	Lifetime	10	<8	—	Screening
Drug use disorders test⁸⁷	DUDIT⁶⁷	Sweden	—	Iraq, Afghanistan, Iran	Refugees	Likert scale	Past 12 months	11	5-10	—	Screening
Fast Alcohol Screening Test⁹⁹	FAST⁵⁹	The USA	English	Eritrea	Refugees	Yes/no	Past year	4	<1	Translation by 2 bilingual experts/back-translation by 4 field experts, consensus meetings
Ghanaian Food Propensity Questionnaire⁹⁰	Ghana-FPQ⁴⁰	Ghana	—	Ghana	Migrants	—	—	—	—	—	Screening
Mini Neuropsychiatric Interview¹⁰⁰	MINI^{41,50-53,57,63,70,103-105}	The USA, Europe	English	Former Yugoslavia, Honduras, Somalia, South America, Syria	Migrants,^50-53,57 Refugees^41,63,70	Yes/no	Past 12 months	24 of 251	15-20	Bilingual trained researchers	Diagnostic
Modified Michigan Alcoholism and Drug Screening Test	MMADST (modified MAST)³⁸	The USA	English	Laos (Hmong)	Refugees	Yes/no	Lifetime	25	—	—
Psychiatric Diagnostic Screening Questionnaire¹⁰¹	PDSQ⁵⁶	The USA	English	North Korea	Refugees	Yes/no	Past 2 weeks	12 of 126	15-20	—	Diagnostic
Primary Care Evaluation of Mental Disorders¹⁰²	PRIME-MD²³	The USA	English	Mexico, Central-South America	Migrants	Likert scale	Past 1 month	4 of 26	Self-report: 5-10. Clinician: 7-10	Bilingual /bicultural interviewers	Screening
Rapid alcohol problems screen – quantity frequency¹⁰³	Raps4-QF²¹	The USA	English	Mexico, El Salvador, Guatemala, Honduras, Puerto Rico	Migrants	Yes/no	Past 12 months	6	2	—	Screening
Severity of Dependence Scale for Khat⁴⁷	SDS-Khat^70,72	The UK	English	African countries, Somalia, Yemen	Migrants,⁴⁷ Refugees⁷⁰	Likert scale	Last 30 days, last 12 months	5	—	Forward/backward translation, consultation with users, field-testing	Screening
Scale for the measurement of attitudes toward alcohol⁸⁹	—⁴⁸	Italy	Italian	—	Migrants	Likert scale	Current	15	—	—	Screening
Structural Clinical Interview	SCID²⁰	The USA	English	Hmong	Refugees	Yes/no	Past 5 years, past 12 months	26	30-120	—	Diagnostic
Structural Clinical Interview – 3 item version	SCID3⁴⁴	The USA	English	Various	Refugees	Yes/no	Past 12 months	3	—	—	Screening
Substance Abuse Problem Scale¹⁰⁴	SAPS³⁸	The USA	English	Laos	Refugees	—	—	59	10	—	Screening
Substance Use Risk Profile Scale	SURPS⁴⁶	The USA	English	Brazil	Migrants	Yes/no	Current	23	—	—	Screening
Swedish Living Conditions Survey⁸⁸	ULF-96⁶²	Sweden	Swedish	Bosnia-Herzegovina	Refugees	Likert Scale	Past 12 months	2	—	—	Screening

The instruments use a variety of scoring scales. These include Likert-type scales (e.g., Alcohol, Smoking and Substance Involvement Screening Test [ASSIST], AUDIT, Drug Use Disorders Identification Test [DUDIT]), binary scales (e.g., CAGE, Severity Dependence Scale [SDS]), and composite scales (e.g., Addiction Severity Index [ASI], MINI). Instruments containing domains for frequency and quantity of substance use apply frequency counts.

The instruments applied in the included studies were predominantly developed in English (n = 18, 75%) (Table 2). Moreover, the majority was developed in the USA, except the AUDIT (several countries), the BDEPQ⁷⁹ (Australia), the DAST-10⁸⁰ (Canada), the DUDIT⁸¹ (Sweden), the ULF-96⁸² (Sweden), the Scale of measurement toward alcohol⁸³ (Italy), the SDS-Khat⁴⁷ (UK) and the Ghana-FPQ⁸⁴ (Ghana). All instruments are available in English. Thirteen instruments (54.2%) are available in more than 2 languages. Completion time was reported for 14 instruments (58.3%) and ranged from 1 to 120 minutes (Table 2).

Description of Studies

The studies investigated substance use among persons coming from 24 specific countries around the world, mostly in Asia and South and Central America (Table 1). One study reported on the ethnicity of participants.²⁰ Twelve studies (21.8%) did not indicate where participants came from.^{36,43-45,47,48-55} Studies used translated versions of the instruments, mainly into Spanish (n = 18,32.7%)^{18,21,24,29,35,36,42,52,78} and French (n = 5, 9.1%).^44,50-53 Furthermore, measures were translated into 28 other languages.^{17,20,22,28,30,32,38,39,41,42,44,46,47,50-53,56-59,61,74-76,85-91} Seven studies (12.7%) applied instruments in more than one language.^{39,41,42,44,85-87}

Most studies investigated a variety of substances (n = 36, 65.5%)^{18,19,21-23,25-35,37,40,42,43,45,48,53-56,58,59,61,75,76,78,87,88,91} other exclusively alcohol use (n = 36, 65.5%),^{38,46,47,85,89,90} drug use (n = 13, 23.6%),^{20,24,39,41,44,49-52,57,60,77} or alcohol and drug use. Forty-five studies (81.8%) evaluated substance use together with other mental health conditions. Twenty-nine investigated depression,^{18,20,21,24-34,36-38,43-45,53,58,60,75,76,78,88,90,91} 15 studies anxiety,^{20,21,24-28,31,33,34,38,44,50,51} and 14 Post-Traumatic Stress Disorder.^{23,24,28,30,36,44,50,51,58,74,77,88,89,91}

Instruments were interviewer-administered in most studies (n = 41, 74.5%),^{18-20,22,23,25-36,38,41,43-45,47,50-53,55,56,59,60,74-78,85,87-91} self-reported (n = 8, 14.5%)^{40,42,46,48,54,57,58,61} or used audio computer-assisted self-interviewing (n = 5, 9.1%).^21,24,37,39 Other instruments were administered heterogeneously.^{18,25,27,32,40,74-76} Four studies (7.3%) used instruments as a diagnostic test for SUDs.^20,78,88,92

Item Content

The 469 items of 24 instruments were coded and assigned to 46 domains (Table 3).

Table 3.

Domains of Instruments Included in the Review.

Instrument	Substance	Domains
26-Item Checklist³⁹	Alcohol, inhalants, marijuana, cocaine, crack, ecstasy, methamphetamine, LSD, hallucinogens, other	Frequency, quantity
ASI^20,105,106	Alcohol, medicine, drugs	Health-, employment-, school-related, family/social problems, legal problems
ASSIST^71,92	Alcohol, tobacco, cannabis, cocaine, amphetamine, sedatives and sleeping pills, hallucinogens, inhalants, opioids, other, for example, Khat	Frequency; health, social, legal financial problems; craving; failure to perform; expressed concern from others; attempt to cut down/quit; injection
AUDADIS-IV^36,93	Alcohol, medicine	Quantity, heavy drinking, help seeking, family history of substance use, (poly) substance use, help seeking
AUDIT^{19,22,24,26,28-30,33-35,37,42,43,55,60,62,64,66,67,69}	Alcohol	Frequency, quantity, failure to stop, failure to perform, starter/eye-opener, remorse, amnesia, injuries, expressed concern from others
AUDIT-C^{31,35,45,54,68}	Alcohol	Frequency, quantity
BDEPQ²⁴	Benzodiazepine	Frequency, attempt to cut down, tolerance, withdrawal symptoms, craving
CAGE/CAGE4M^{18,25,27,32,37,58,61,65}	Alcohol	Cut down, annoyed, guilt, starter/eye-opener
DAST-10^24,86	Prescribed and non-prescribed drugs, marijuana, solvents, tranquilizers, barbiturates, cocaine, stimulants, hallucinogens, narcotics	Substance use, blackout/flashbacks; feeling bad; social/family, work, legal, health problems; fighting, help seeking
DUDIT⁶⁷	Drugs	Substance use, frequency, quantity, heavy use, craving, failure to stop, failure to perform, starter/eye-opener, remorse, injuries, expressed concern from others
FAST⁵⁹	Alcohol	Heavy drinking, failure to perform, amnesia, expressed concern from others
Ghana-FPQ^40,90	Alcohol	Frequency, quantity
MINI^{41,50-53,63,70,107}	Alcohol, drugs	Heavy drinking; (poly) substance use; tolerance; withdrawal symptoms; failure to quit; neglecting behavior; health, legal, social, work problems; hazardous situations
MMADST (modified MAST)³⁸	Alcohol, drugs	Frequency; quantity; self-perception; amnesia; expressed concerns; ability to quit; guilt; perception of others; help seeking; fighting; social, health, legal, work problems; neglecting behavior; use before noon; help seeking
PDSQ⁵⁶	Alcohol, drugs	Self-perception, expressed concerns, problems in dealing with life
PRIME-MD^23,102	Alcohol	Thinking about cutting down, complaints by others, guilt, heavy drinking
Raps4-QF²¹	Alcohol	Drinks quantity, remorse, amnesia, performance, starter/eye-opener
SAPS¹⁰⁴		Craving; tolerance; use before noon; uncontrollable use; problems with family, at work/school; social, health problems; fighting; guilt; blackouts; cut down; failure to perform; expressed concerns by others; self-perception
SCID²⁰	Alcohol, other substances	Frequency, quantity, heavy drinking, tolerance, withdrawal symptoms, failure to perform, hazardous situations, legal, social problems, fighting
SCID3⁴⁴	Alcohol, other substances	Heavy drinking, types of substances
SURPS⁴⁶	Any substance	Hopelessness, impulsivity, sensation seeking, anxiety sensitivity
SDS-Khat^47,70,72	Khat	Out of control, anxious about withdrawal, worrying about use, wish to quit, difficulty to quit
Scale for the measurement of attitudes toward alcohol^48,89	Alcohol	Frequency, Social ease (driven by the perception that alcohol can ease social relations), unease (driven by persons’ need to escape from feelings or problems), economic (driven by the inexpensiveness of obtaining alcohol)
ULF-96⁶²	Medicine, drugs	Substance use, frequency

Figure 2 shows a map of the 46 domains derived in the content analysis of the instruments’ items sorted by themes. Six themes were identified: Patterns of use, risk of dependence, social factors and resources, psychological factors, performance issues, and health issues. Domains related to patterns of substance, especially frequency, quantity, and heavy intensity, were most frequently assessed across instruments. Sixteen instruments (66.7%) assessed behavior related to risk of dependence, with attempts or failure to quit substance use and concerns about substance use expressed by other persons being included most often. A variety of health issues (e.g., general health problems or specific symptoms of substance use) were investigated in 11 instruments (45.8%). Domains related to the social environment (e.g., problems with other persons or getting into fights) were included in 9 instruments (37.5%). Among the least frequently assessed domains were those related to psychological factors (e.g., feelings of guilt, remorse, or worry because of substance use and other mental health symptoms. The list of articles from which the specific domains are derived is shown in Figure 2.

Figure 2.

Heat map of item content in substance use instruments.

Psychometric Properties

The psychometric properties of the instruments were assessed based on Terwee’s criteria.¹⁶ Most of the instruments performed well in internal consistency and structural validity. Indeterminate results for content validity were mainly due to insufficient information. In the absence of multiple-group confirmatory factor analysis, most results for cross-cultural validity were also indeterminate. Additionally, Pearson correlations between the instruments and these recognized gold standards were less than 0.7, indicating negative results. As a result, criterion validity showed poor overall measurement performance.

Table 4 displays the measurement properties of the substance use instruments. Some instruments have been extensively tested for their psychometric properties, such as the ASI^93-98 and the AUDADIS,^92,99-102 which were found to have good to excellent reliability and validity. Fourteen studies provided the response rate, which varied between 13.7%⁴² and 90.2%⁹⁰ (Table 4).

Table 4.

Summary of Measurement Properties of Instruments Evaluating Substance Use Among Refugees.

Instrument	Mode of administration	Conceptual and measurement model	Development methods	Interpretability of scores	Internal consistency	Reliability	Response Rate	Construct validity	Cross-cultural validity
ASI^20,105,106	Paper and pencil	Alcohol-related health, social, employment and legal problems	—	^a	α = .69-.93	—	—	—	—
ASSIST^71,92,108	Face-to-face	Hazardous or harmful substance use	Reliability, feasibility studies among culturally diverse participants with different substance use patterns	Score 0-21^a	α = .73-.92	Test-retest kappa: .58-.9	—	—	—
AUDADIS-IV^36,94	Face-to-face	DSM-IV symptoms	—	—	α = .75-.89	Test-retest kappa: .66-.97	—	—	—
AUDIT^{24,26,28-30,33-35,37,42,43,55,60,62,64,66,67,69,96}	Face-to-face, paper and pencil, computer-administered	Hazardous alcohol use	Cross-national reliability study	Score 0-40^a	α = .80-.93	—	13.7%-17.9%	Reported as accurate	—
AUDIT-C^{31,35,45,68,97,110}	Face-to-face	Alcohol dependence	Items derived from AUDIT	Score 0-12^a	α = .73	—	42%-70.5%	—	—
CAGE^{18,25,27,32,37,58,61,65,98}	Face-to-face, phone	Alcohol abuse and dependence	—	Score 0-4^a	—	Kuder-Richardson’s coefficient = .73	—	—	Reported as good
DAST-10^24,86	Structured interview	Drug abuse	—	—	α = .92	—	—	—	—
DUDIT^67,87	Structured interview	Drug use	Based on AUDIT	Score 0-44^a	α = .80	—	—	—	—
MINI^{41,50-53,63,70,100,107}	Face-to-face	DSM-IV and ICD-10 diagnostic criteria for substance use disorders	—	—	—	Interrater Kappa: .81, test–retest kappa:0.89	100%	—	Reported as accurate
PDSQ^56,101	Face-to-face	DSM-IV axis I disorders	—	—	α = .87 for alcohol abuse subscale; α = .89 for drug abuse subscale	Test-retest kappa: .71 for alcohol abuse subscale; .83 for drug abuse subscale	85.3%	Mean correlation with other scales: alcohol abuse: 0.03; drug abuse: 0.07	—
PRIME-MD^23,102	Face-to-face	DSM-III diagnostic criteria	—	—	—	Inter-rater kappa: .71	—	—	—
RAPS4-QF^21,103	Audio Computer-assisted self-interviewing	Risk for harmful drinking	—	—	—	—	67.0%	—	—
SDS-Khat^47,70,72	Face-to-face	Khat dependence	—	Score 0 to 15^a; threshold ≥6	α = .76	Test-retest intraclass correlation coefficient: 0.93	—	Reported as accurate	—
SURPS⁴⁶	Computer-assisted	Personality dimensions	—	^a	—	—	—	—	—
Scale for measurement of attitudes toward alcohol^48,89	Computer-assisted	Risky alcohol use	—	—	α = .91	—	—	Reported as confirmed	—

Higher scores indicating greater severity.

The conceptual and measurement models were described for all instruments. Development methodologies vary considerably between them. For three of the most frequently used instruments (AUDIT, MINI, and ASSIST), items were generated with input from the target population, and the instruments were piloted. For AUDIT-C and DUDIT, items were generated with target population input, or they were piloted. For the remaining instruments, no information on development methodology was available in the selected sources.

Data on the psychometric properties of substance use instruments for refugees and migrants were scarce and incomplete. Psychometric properties were tested for 13 instruments. As responsiveness and cultural validity were not assessed for any of the instruments, they were not included in Table 4. Reliability was above the minimum acceptable value for internal consistency for 10 instruments (all Cronbach’s α ≥ .70). No information on reliability was reported for the other instruments. Content validity was not tested for any of the instruments. Construct validity was assessed for 4 instruments (AUDIT, Psychiatric Diagnostic Screening Questionnaire, SDS-Khat, and Scale for measurement of attitudes toward alcohol), although the evidence varies.

Best Evidence Synthesis

A best evidence synthesis was performed according to the method summarized in Supplemental Table 2, by integrating the studies’ methodological qualities and measurement property assessments of instruments. As none of the included studies reported on responsiveness and cross-cultural validity, these properties were not included in the best evidence synthesis. The performance of each instrument’s measurement properties is shown in Table 5. In general, the instruments performed best in the categories of internal consistency and development methodology, where 9 and 3 instruments achieved (“2”) respectively. None of the studies analyzed measurement error.

Table 5.

Evaluation of Best Evidence Synthesis for Substance Use Instruments by Assessment Property Scoring.

Instrument	Conceptual and measurement model	Instrument development methodology	Interpretability of scores	Internal consistency (Cronbach’s alpha)	Validity
ASI	1	0	1	2	0
ASSIST	1	2	0	2	0
AUDADIS-IV	1	0	0	2	0
AUDIT	1	2	1	2	1
AUDIT-C	1	2	1	2	0
CAGE/CAGE4M	1	0	1	0	1
DAST-10	1	0	0	0	0
DUDIT	1	1	1	2	0
MINI	1	0	0	0	0
PDSQ	1	0	0	2	1
PRIME-MD	1	0	0	0	0
RAPS4-QF	1	0	0	0	0
SDS-Khat	1	0	2	2	1
SURPS	1	0	1	0	0
Scale of measurement toward alcohol	1	0	0	2	1

Overall, 4 instruments (DAST-10, MINI, PRIME-MD, and RAPS4-QF) performed poorer than the other instruments included in this review. Six instruments had at least 2 strong positive (“2”) or 3 moderate positive (“1”) ratings for measurement properties and were thus identified as the best rated (AUDIT/AUDIT-C, DUDIT, SDS-Khat, CAGE, ASSIST).

Discussion

Twenty-four different instruments measuring substance use in refugee populations were used in 55 articles included in this review. The item content analysis of the instruments identified 46 domains. The most frequently included domains were related to patterns of use and risk of dependence. Domains related to mental health were investigated less often. Mental health conditions, however, are frequent both in individuals using substances,^103,104 and in refugee populations.^105,106 In addition to mental health conditions, behavior and social roles may be affected by using substances.¹⁰⁷ Domains aiming at describing psychological risk assessments were the least frequently included domains. None of the included instruments contained culture- or refugee-specific domains.

A variety of scoring scales were applied in the reviewed substance use instruments, such as Likert Scales and binary responses. Comparing results between different instruments may be challenging because of the differences in scoring systems. Instruments also use different cutoff points to define problematic substance use, leading to inconsistent interpretations of risk level or problem severity. Instruments assessing different domains may further complicate comparisons, because scores in one domain may not have the same meaning as scores in another domain. The purpose of the instruments—whether for screening or diagnosis—also affects the understanding of the results, creating ambiguity in comparisons between findings.

Assessment of psychometric properties showed that some properties were not as extensively reported as others in the included studies. In particular, evidence of validity, reliability, and responsiveness was scarce. Cross-cultural validity was not reported for any of the instruments. None of the instruments had been tested for all measurement properties, but 6 instruments (AUDIT/AUDIT-C,^{24,29,31,33,34,42,45,55,57,59,61,87} DUDIT,^60,81 SDS-Khat,^47,85,89 CAGE,^{18,25,37,74,76} ASSIST^90,108) had better performance in both methodological quality and measurement properties.

The review suggests that most instruments have been developed in English-speaking countries. Our findings are therefore in line with meta-reviews suggesting that instruments assessing mental health conditions have been developed mostly for white English-speaking populations.^109-113 In place of a mere translation of instruments into languages other than those in which they were developed, we propose the utilization of more sophisticated statistical techniques for the exploration of cross-cultural performance, such as differential item functioning analysis.¹¹⁴ Additionally, the sensitivity and response behavior in non-English-speaking populations were not reported. The response behavior may be similar or different. In order to gain a deeper understanding of the response behavior, it would be beneficial to conduct further studies that investigate this phenomenon in different population groups.

Despite a comprehensive and systematic literature search and consideration of a wide range of domains, including the content and psychometric properties of substance use instruments, our review has some limitations to consider. We did not investigate gray literature, which may have led to the omission of relevant studies. One shortcoming in the assessment of item content and psychometric properties might be that information was derived only from included studies that specifically investigated substance use among migrant and refugee populations, from first publications and manuals. Evidence reported in other studies outside this context was not included in the assessment and the resulting best evidence synthesis. We were not able to assess the psychometric properties of the instruments for specific substances measured and for specific groups to whom the instruments were applied. As the majority of the studies included in this review were cross-sectional, we were unable to investigate whether and how psychometric properties might change over time, for example, due to acculturation processes. Another limitation is that it was not possible to extend the search period or perform an updated search due to the limited time available to conduct this study in the context of a joint research project. With the ongoing changes related to migration worldwide, future research will benefit from conducting an updated literature review starting from 2019. Moreover, to avoid potential cultural bias and consider aspects from an emic perspective, it will be advantageous in the future to conduct reviews in heterogeneous research groups. Despite these potential shortcomings of our review, our study has several strengths, such as the structured and transparent approach to searching and evaluating instruments based on a systematic search and evaluation of studies using substance use instruments.

While research consistently shows that substance use varies among refugee and migrant populations, the use of generic instruments may have shortcomings in enhancing our comprehension of the extent of substance use and the severity of its impact. The advantage of refugee- and migrant-specific instruments is that they provide more relevant and sensitive results than generic instruments, which are applicable across populations.¹¹⁵ Specific instruments may be more suitable to monitor the course of treatment and estimate its effectiveness.¹¹⁶ Yet, no final recommendations can be made for instruments to be used in refugee populations, as the instruments should be validated with the population groups. Moreover, it might be necessary to conduct research on “idioms of distress” and “idioms of substance use” employing interdisciplinary research methods. Idioms of distress are specific ways of communicating emotional suffering and refer to the culturally mediated ways of experiencing distress and emotions.^107,117,118

Conclusion

To our knowledge, this is the first systematic review of instruments used to measure substance use among migrants and refugees. The results highlight the advantages and limitations of existing instruments. Considering the limitations, it might be necessary to conduct further research into the cultural idioms of distress associated with substance use and to consider incorporating these aspects into specific instruments.

Supplemental Material

sj-docx-1-saj-10.1177_29767342251348146 – Supplemental material for Measuring Substance Use in Refugees: A Systematic Review of Assessment Instruments

Supplemental material, sj-docx-1-saj-10.1177_29767342251348146 for Measuring Substance Use in Refugees: A Systematic Review of Assessment Instruments by Jutta Lindert, Kim-Julian Behr, Sarah Arndt, Marija Jakubauskiene, Paul A. Bain, Sascha Milin, Lisa Marie Schuh and Ingo Schäfer in Substance Use & Addiction Journal

Footnotes

Acknowledgements

We thank Martha Nathan for contributing to the study.

Author Contributions

All authors have been actively involved in this study and contributed substantially. In particular, J.L. has designed the study, supervised data searches and analysis, and written the first draft of the manuscript. K.B. and S.M. have collaborated in screening and data extraction. J.L. and K.B. conceptualised the data analysis. K.B. has analysed the data and contributed to the preparation (writing) of the manuscript. M.J. has collaborated in screening and data extraction. P.A.B. and J.L. have conceptualised the search. P.A.B. has done the systematic search. All authors have contributed to the final manuscript.

Data Availability Statement

All data generated or analysed during this study are included in this article. Electronic database searches and assessment criteria are provided in the Supplemental Material.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was supported by the German Federal Ministry of Education and Research (grant no. 01EF1805A-E). The funding sources were not involved in any stage of the study design, collection/analysis/interpretation of data, writing the report, or in the decision to submit the article for publication.

Compliance,Ethical Standards,and Ethical Approval

An ethics statement is not applicable because this study is based exclusively on published literature.

ORCID iDs

Jutta Lindert

Kim-Julian Behr

Supplemental Material

Supplemental material for this article is available online at the SAJ website .

References

Garrido

Weiler

Taussig

HN.

Adverse childhood experiences and health-risk behaviors in vulnerable early adolescents. J Early Adolesc. 2018;38(5):661-680. doi:10.1177/0272431616687671

Dörrie

Föcker

Freunscht

Hebebrand

Fetal alcohol spectrum disorders. Eur Child Adolesc Psychiatry. 2014;23(10):863-875. doi:10.1007/s00787-014-0571-6

O’Connor

Stoecklin-Marois

Schenker

MB.

Examining nervios among immigrant male farmworkers in the MICASA study: sociodemographics, housing conditions and psychosocial factors. J Immigr Minor Health. 2015;17(1):198-207. doi:10.1007/s10903-013-9859-8

Velleman

Templeton

Understanding and modifying the impact of parents’ substance misuse on children. Adv Psychiatr Treat. 2007;13(2):79-89. doi:10.1192/apt.bp.106.002386

Juarez

Honkaniemi

Gustafsson

Rostila

Berg

Health risk behaviours by immigrants’ duration of residence: a systematic review and meta-analysis. Int J Public Health. 2022;67:1604437. doi:10.3389/ijph.2022.1604437

United Nations High Commissioner for Refugees (UNHCR). Global Trends Forced Displacement 2021. 2022.

United Nations Office on Drugs and Crime (UNODC). World Drug Report 2023. 2023. Accessed November 10, 2024.www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html

Global Burden of Disease 2013 Risk Factors Collab-orators, Forouzanfar

Alexander

, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659-1724. doi:10.1016/s0140-6736(16)31679-8

Morina

Akhtar

Barth

Schnyder

Psychiatric disorders in refugees and internally displaced persons after forced displacement: a systematic review. Front Psychiatry. 2018;9:433. doi:10.3389/fpsyt.2018.00433

10.

Kirmayer

Ryder

AG.

Culture and psychopathology. Curr Opin Psychol. 2016;8:143-148. doi:10.1016/j.copsyc.2015.10.020

11.

Romppel

Hinz

Finck

Young

Brähler

Glaesmer

Cross-cultural measurement invariance of the General Health Questionnaire-12 in a German and a Colombian population sample. Int J Methods Psychiatr Res. 2017;26(4):e1532. doi:10.1002/mpr.1532

12.

Horyniak

Melo

Farrell

Ojeda

Strathdee

SA.

Epidemiology of substance use among forced migrants: a global systematic review. PLoS One. 2016;11(7):e0159134. doi:10.1371/journal.pone.0159134

13.

Boness

Sher

KJ.

The case for cognitive interviewing in survey item validation: a useful approach for improving the measurement and assessment of substance use disorders. J Stud Alcohol Drugs. 2020;81(4):401-404. doi:10.15288/jsad.2020.81.401

14.

Santos

Strathdee

El-Bassel

, et al. Psychometric properties of measures of substance use: a systematic review and meta-analysis of reliability, validity and diagnostic test accuracy. BMC Med Res Methodol. 2020;20(1):106. doi:10.1186/s12874-020-00963-7

15.

Boness

Carlos Gonzalez

Sleep

Venner

Witkiewitz

Evidence-based assessment of substance use disorder. Assessment. 2024;31(1):168-190. doi:10.1177/10731911231177252

16.

Terwee

Bot

de Boer

, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. doi:10.1016/j.jclinepi.2006.03.012

17.

Terwee

Mokkink

Knol

Ostelo

Bouter

de Vet

HC.

Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2012;21(4):651-657. doi:10.1007/s11136-011-9960-1

18.

Arcury

Talton

Summers

Chen

Laurienti

Quandt

SA.

Alcohol consumption and risk for dependence among male latino migrant farmworkers compared to latino nonfarmworkers in North Carolina. Alcohol Clin Exp Res. 2016;40(2):377-384. doi:10.1111/acer.12969

19.

Arfken

Arnetz

Fakhouri

Ventimiglia

Jamil

Alcohol use among Arab Americans: what is the prevalence?

J Immigr Minor Health. 2011;13(4):713-718. doi:10.1007/s10903-011-9447-8

20.

Bart

Ethnic differences in psychosocial factors in methadone maintenance: Hmong versus non-Hmong. J Ethn Subst Abuse. 2018;17(2):108-122. doi:10.1080/15332640.2017.1371656

21.

Cherry

Rost

Alcohol use, comorbidities, and receptivity to treatment in Hispanic farmworkers in primary care. J Health Care Poor Underserved. 2009;20(4):1095-1110. doi:10.1353/hpu.0.0215

22.

D’Amico

Schell

Marshall

Hambarsoomians

Problem drinking among Cambodian refugees in the United States: how big of a problem is it?

J Stud Alcohol Drugs. 2007;68(1):11-17. doi:10.15288/jsad.2007.68.11

23.

Eisenman

Gelberg

Liu

Shapiro

MF.

Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA. 2003;290(5):627-634. doi:10.1001/jama.290.5.627

24.

Fortuna

Norona

Porche

, et al. Trauma, immigration, and sexual health among Latina women: Implications for maternal-child well-being and reproductive justice. Infant Ment Health J. 2019;40(5):640-658. doi:10.1002/imhj.21805

25.

Grzywacz

Quandt

Early

Tapia

Graham

Arcury

TA.

Leaving family for work: ambivalence and mental health among Mexican migrant farmworker men. J Immigr Minor Health. 2006;8(1):85-97. doi:10.1007/s10903-006-6344-7

26.

Hill

Williams

Ornelas

IJ.

Help wanted: mental health and social stressors among Latino day laborers. Am J Mens Health. 2019;13(2):12. doi:10.1177/1557988319838424

27.

Hiott

Grzywacz

Davis

Quandt

Arcury

TA.

Migrant farmworker stress: mental health implications. J Rural Health. 2008;24(1):32-39. doi:10.1111/j.1748-0361.2008.00134.x

28.

Kim

Behavioral health symptoms among refugees from Burma: examination of sociodemographic and migration-related factors. Asian Am J Psychol. 2018;9(3):179-189. doi:10.1037/aap0000103

29.

Kissinger

Althoff

Burton

, et al. Prevalence, patterns and predictors of substance use among Latino migrant men in a new receiving community. Drug Alcohol Depend. 2013;133(3):814-824. doi:10.1016/j.drugalcdep.2013.08.031

30.

Marshall

Schell

Elliott

Berthold

Chun

CA.

Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294(5):571-579. doi:10.1001/jama.294.5.571

31.

Mora

Quandt

Chen

Arcury

TA.

Associations of poor housing with mental health among North Carolina Latino migrant farmworkers. J Agromedicine. 2016;21(4):327-334. doi:10.1080/1059924x.2016.1211053

32.

Nelson

Bui

Samet

JH.

Screening in special populations: a “case study” of recent Vietnamese immigrants. Am J Med. 1997;102(5):435-440. doi:10.1016/s0002-9343(97)89443-0

33.

Organista

Arreola

Neilands

TB.

Depression and risk for problem drinking in Latino migrant day laborers. Subst Use Misuse. 2017;52(10):1320-1327. doi:10.1080/10826084.2016.1276599

34.

Organista

Jung

Neilands

TB.

Working and living conditions and psychological distress in Latino migrant day laborers. Health Educ Behav. 2019;46(4):637-647. doi:10.1177/1090198119831753

35.

Ramos

Trinidad

Correa

Carlo

Correlates and predictors of alcohol consumption and negative consequences of alcohol use among Latino migrant farmworkers in Nebraska. Am J Orthopsychiatry. 2019;89(5):559-568. doi:10.1037/ort0000401

36.

Salas-Wright

Kagotho

Vaughn

MG.

Mood, anxiety, and personality disorders among first and second-generation immigrants to the United States. Psychiatry Res. 2014;220(3):1028-1036. doi:10.1016/j.psychres.2014.08.045

37.

Sánchez

Alcohol use among Latino migrant workers in South Florida. Drug Alcohol Depend. 2015;151:241-249. doi:10.1016/j.drugalcdep.2015.03.025

38.

Westermeyer

Chitasombat

. Ethnicity and the course of opiate addiction: native-born Americans vs. Hmong in Minnesota. Am J Addict. 1996;5(3):231-240. doi:10.3109/10550499609041177

39.

Wong

Huang

Thompson

, et al. Substance use among a sample of foreign- and U.S.-born southeast Asians in an urban setting. J Ethn Subst Abuse. 2007;6(1):45-66. doi:10.1300/J233v06n01_04

40.

Addo

Cook

Galbete

, et al. Differences in alcohol consumption and drinking patterns in Ghanaians in Europe and Africa: the RODAM study. PLoS One. 2018;13(11):e0206286. doi:10.1371/journal.pone.0206286

41.

Bogic

Ajdukovic

Bremner

, et al. Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK. Br J Psychiatry. 2012;200(3):216-223. doi:10.1192/bjp.bp.110.084764

42.

Frank

Bermejo

Alcohol consumption in elderly migrants. Suchttherapie. 2013;14(3):135-139. doi:10.1055/s-0033-1348316

43.

Mundt

Aichberger

Kliewe

, et al. Migrants in socioeconomically deprived areas of Berlin. Psychological distress and substance use. Psychotherapeut. 2012;57(1):29-35. doi:10.1007/s00278-011-0880-x

44.

Nikendei

Kindermann

Brandenburg-Ceynowa

, et al. Asylum seekers’ mental health and treatment utilization in a three months follow-up study after transfer from a state registration-and reception-center in Germany. Health Policy. 2019;123(9):864-872. doi:10.1016/j.healthpol.2019.07.008

45.

Rommel

Saß

Born

Ellert

Die gesundheitliche Lage von Menschen mit Migrationshintergrund und die Bedeutung des sozioökonomischen Status : Erste Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) [Health status of people with a migrant background and impact of socio-economic factors: First results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58(6):543-552. doi:10.1007/s00103-015-2145-2

46.

Canfield

Worrell

Gilvarry

Determinants of substance use amongst Brazilians residing in the UK: the role of acculturation. Drug Alcohol Rev. 2017;36(6):751-760. doi:10.1111/dar.12530

47.

Kassim

Islam

Croucher

Validity and reliability of a Severity of Dependence Scale for Khat (SDS-Khat). J Ethnopharmacol. 2010;132(3):570-577. doi:10.1016/j.jep.2010.09.009

48.

Arli

Kim

Rundle-Thiele

Tkaczynski

Australian migrants’ social cultural adaptation and consumption behaviour towards food and alcohol. Int J Consum Stud. 2019;43(1):2-13. doi:10.1111/ijcs.12439

49.

Kane

Ventevogel

Spiegel

Bass

van Ommeren

Tol

WA.

Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps. BMC Med. 2014;12:228. doi:10.1186/s12916-014-0228-9

50.

Pignon

Geoffroy

Thomas

, et al. Prevalence and clinical severity of mood disorders among first-, second- and third-generation migrants. J Affect Disord. 2017;210:174-180. doi:10.1016/j.jad.2016.12.039

51.

Pignon

Amad

Pelissolo

, et al. Increased prevalence of anxiety disorders in third-generation migrants in comparison to natives and to first-generation migrants. J Psychiatr Res. 2018;102:38-43. doi:10.1016/j.jpsychires.2018.03.007

52.

Qureshi

Garcia Campayo

Eiroa-Orosa

, et al. Epidemiology of substance abuse among migrants compared to native born population in primary care. Am J Addict. 2014;23(4):337-342. doi:10.1111/j.1521-0391.2013.12103.x

53.

Rolland

Geoffroy

Pignon

, et al. Alcohol use disorders and immigration up to the third generation in France: findings from a 39,617-subject survey in the general population. Alcohol Clin Exp Res. 2017;41(6):1137-1143. doi:10.1111/acer.13387

54.

Rowe

Gavriel Ansara

Jaworski

Higgs

Clare

PJ.

What is the alcohol, tobacco, and other drug prevalence among culturally and linguistically diverse groups in the Australian population? A national study of prevalence, harms, and attitudes. J Ethn Subst Abuse. 2020;19(1):101-118. doi:10.1080/15332640.2018.1484310

55.

Savic

Barker

Best

Lubman

DI.

Alcohol problems among migrants in substance use treatment: the role of drinking patterns in countries of birth. Aust J Prim Health. 2014;20(3):220-221. doi:10.1071/py14028

56.

Hewlett

Merry

Mishra

Islam

Wali

Gagnon

Alcohol use among Bhutanese refugees in Nepal. Int J Migr Health Soc Care. 2015;11(3):158-168. doi:10.1108/IJMHSC-05-2014-0017

57.

Johansson Blight

Persson

Ekblad

Ekberg

Medical and licit drug use in an urban/rural study population with a refugee background, 7-8 years into resettlement. Psychosoc Med. 2008;5:Doc04.

58.

Kim

Choi

Nam

Mental health conditions among North Korean female refugee victims of sexual violence. Int Migr. 2017;55(2):68-79. doi:10.1111/imig.12300

59.

Luitel

Jordans

Murphy

Roberts

McCambridge

Prevalence and patterns of hazardous and harmful alcohol consumption assessed using the AUDIT among Bhutanese refugees in Nepal. Alcohol Alcohol. 2013;48(3):349-355. doi:10.1093/alcalc/agt009

60.

Miremadi

Ganesan

McKenna

Pilot study of the prevalence of alcohol, substance use and mental disorders in a cohort of Iraqi, Afghani, and Iranian refugees in Vancouver. Asia Pac Psychiatry. 2011;3(3):137-144. doi:10.1111/j.1758-5872.2011.00136.x

61.

Tse

Wong

KKF

. Comparing of the mediation and the moderation role of coping motive in the relationship between perceived discrimination and hazardous drinking. J Subst Use. 2015;20(6):439-446. doi:10.3109/14659891.2014.943816

62.

Alderete

Vega

Kolody

Aguilar-Gaxiola

Lifetime prevalence of the risk factors for psychiatric disorders among Mexican migrant farmworkers in California. Am J Public Health. 2000;90(4):608-614. doi:10.2105/AJPH.90.4.608

63.

Alderete

Vega

Kolody

Aguilar-Gaxiola

Effects of time in the United States and Indian ethnicity on DSM-III-R psychiatric disorders among Mexican Americans in California. J Nerv Ment Dis. 2000;188(2):90-100. doi:10.1097/00005053-200002000-00005

64.

Alegría

Canino

Shrout

, et al. Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. Am J Psychiatry. 2008;165(3):359-369. doi:10.1176/appi.ajp.2007.07040704

65.

Borges

Breslau

Orozco

, et al. A cross-national study on Mexico-US migration, substance use and substance use disorders. Drug Alcohol Depend. 2011;117(1):16-23. doi:https://doi.org/10.1016/j.drugalcdep.2010.12.022

66.

Chang

Shen

Takeuchi

DT.

Prevalence and demographic correlates of intimate partner violence in Asian Americans. Int J Law Psychiatry. 2009;32(3):167-175. doi:10.1016/j.ijlp.2009.02.004

67.

Cherpitel

Bond

Zemore

Borges

Greenfield

TK.

Border effects on DSM-5 alcohol use disorders on both sides of the U.S.-Mexico border. Drug Alcohol Depend. 2015;148:172-179. doi:10.1016/j.drugalcdep.2015.01.003

68.

Finch

Catalano

Novaco

Vega

WA.

Employment frustration and alcohol abuse/dependence among labor migrants in California. J Immigr Health. 2003;5(4):181-186. doi:10.1023/a:1026119226083

69.

Lacey

Sears

Govia

Forsythe-Brown

Matusko

Jackson

JS.

Substance use, mental disorders and physical health of Caribbeans at-home compared to those residing in the United States. Int J Environ Res Public Health. 2015;12(1):710-734. doi:10.3390/ijerph120100710

70.

Orozco

Borges

Medina-Mora

Aguilar-Gaxiola

Breslau

A cross-national study on prevalence of mental disorders, service use, and adequacy of treatment among Mexican and Mexican American populations. Am J Public Health. 2013;103(9):1610-1618. doi:10.2105/ajph.2012.301169

71.

Steel

Silove

Chey

Bauman

Phan

Mental disorders, disability and health service use amongst Vietnamese refugees and the host Australian population. Acta Psychiatr Scand. 2005;111(4):300-309. doi:10.1111/j.1600-0447.2004.00458.x

72.

Steel

Silove

Giao

, et al. International and indigenous diagnoses of mental disorder among Vietnamese living in Vietnam and Australia. Br J Psychiatry. 2009;194(4):326-333. doi:10.1192/bjp.bp.108.050906

73.

Patterson

Kyu

Georgiades

Age at immigration to Canada and the occurrence of mood, anxiety, and substance use disorders. Can J Psychiatry. 2013;58(4):210-217. doi:10.1177/070674371305800406

74.

Emery

Yoo

Lieblich

Hansen

After the escape: physical abuse of offspring, posttraumatic stress disorder, and the legacy of political violence in the DPRK. Violence Against Women. 2018;24(9):999-1022. doi:10.1177/1077801217731540

75.

Ismayilova

Lee

Shaw

, et al. Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia. J Immigr Minor Health. 2014;16(6):1138-1148. doi:10.1007/s10903-013-9942-1

76.

Kumparatana

Cournos

Terlikbayeva

Rozental

Gilbert

Factors associated with self-rated health among migrant workers: results from a population-based cross-sectional study in Almaty, Kazakhstan. Int J Public Health. 2017;62(5):541-550. doi:10.1007/s00038-017-0944-y

77.

Kazour

Zahreddine

Maragel

, et al. Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon. Compr Psychiatry. 2017;72:41-47. doi:10.1016/j.comppsych.2016.09.007

78.

Altman

Gorman

Chávez

Ramos

Fernández

The mental well-being of Central American transmigrant men in Mexico. Glob Public Health. 2018;13(4):383-399. doi:10.1080/17441692.2016.1177568

79.

Baillie

Mattick

RP.

The benzodiazepine dependence questionnaire: development, reliability and validity. Br J Psychiatry. 1996;169(3):276-281. doi:10.1192/bjp.169.3.276

80.

Skinner

The drug abuse screening test. Addict Behav. 1982;7(4):363-371. doi:10.1016/0306-4603(82)90005-3

81.

Berman

Bergman

Palmstierna

Schlyter

Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. Eur Addict Res. 2005;11(1):22-31. doi:10.1159/000081413

82.

Swedish National Data Service. Living Conditions Survey. ULF:1. Accessed July 7, 2022. https://snd.gu.se/en/catalogue/study/ext0001

83.

Francalanci

Chiassai

Ferrara

Ferretti

Mattei

Scale for the measurement of attitudes towards alcohol. Alcohol Alcohol. 2011;46(2):133-137. doi:10.1093/alcalc/agq094

84.

Galbete

Nicolaou

Meeks

, et al. Food consumption, nutrient intake, and dietary patterns in Ghanaian migrants in Europe and their compatriots in Ghana. Food Nutr Res. 2017;61(1):1341809. doi:10.1080/16546628.2017.1341809

85.

Young

Butt

Hersi

Tohow

Mohamed

DH.

Khat dependence, use patterns, and health consequences in Australia: an exploratory study. J Stud Alcohol Drugs. 2016;77(2):343-348. doi:10.15288/jsad.2016.77.343

86.

Salas-Wright

Vaughn

MG.

A “refugee paradox” for substance use disorders?

Drug Alcohol Depend. 2014;142:345-349. doi:10.1016/j.drugalcdep.2014.06.008

87.

Salama

Niemelä

Suvisaari

Laatikainen

Koponen

Castaneda

AE.

The prevalence of substance use among Russian, Somali and Kurdish migrants in Finland: a population-based study. BMC Public Health. 2018;18(1):651. doi:10.1186/s12889-018-5564-9

88.

Ahn

Kim

Choi

Jeon

Song

Bae

JN.

Stigma of mental illnesses as perceived by north korean defectors living in South Korea. Psychiatry Investig. 2015;12(1):9-15. doi:10.4306/pi.2015.12.1.9

89.

Widmann

Warsame

Mikulica

, et al. Khat use, PTSD and psychotic symptoms among Somali Refugees in Nairobi—a pilot study. Front Public Health. 2014;2:71. doi:10.3389/fpubh.2014.00071

90.

Widmann

Apondi

Musau

, et al. Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use. Soc Psychiatry Psychiatr Epidemiol. 2017;52(11):1425-1434. doi:10.1007/s00127-017-1368-y

91.

Getnet

Alem

Construct validity and factor structure of sense of coherence (SoC-13) scale as a measure of resilience in Eritrean refugees living in Ethiopia. Confl Health. 2019;13:3. doi:10.1186/s13031-019-0185-1

92.

Grant

Dawson

Stinson

Chou

Kay

Pickering

The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend. 2003;71(1):7-16. doi:10.1016/s0376-8716(03)00070-x

93.

Alterman

Brown

Zaballero

McKay

JR.

Interviewer severity ratings and composite scores of the ASI: a further look. Drug Alcohol Depend. 1994;34(3):201-209. doi:https://doi.org/10.1016/0376-8716(94)90157-0

94.

Hodgins

el-Guebaly

More data on the Addiction Severity Index. Reliability and validity with the mentally ill substance abuser. J Nerv Ment Dis. 1992;180(3):197-201. doi:10.1097/00005053-199203000-00009

95.

Joyner

Wright

Devine

JA.

Reliability and validity of the addiction severity index among homeless substance misusers. Subst Use Misuse. 1996;31(6):729-751. doi:10.3109/10826089609045836

96.

Kosten

Rounsaville

Kleber

HD.

Concurrent validity of the addiction severity index. J Nerv Ment Dis. 1983;171(10):606-610. doi:10.1097/00005053-198310000-00003

97.

McLellan

Luborsky

Cacciola

, et al. New data from the Addiction Severity Index. Reliability and validity in three centers. J Nerv Ment Dis. 1985;173(7):412-423. doi:10.1097/00005053-198507000-00005

98.

McLellan

Kushner

Metzger

, et al. The Fifth Edition of the Addiction Severity Index. J Subst Abuse Treat. 1992;9(3):199-213. doi:10.1016/0740-5472(92)90062-s

99.

Canino

Bravo

Ramírez

, et al. The Spanish Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): reliability and concordance with clinical diagnoses in a Hispanic population. J Stud Alcohol. 1999;60(6):790-799. doi:10.15288/jsa.1999.60.790

100.

Hasin

Carpenter

McCloud

Smith

Grant

BF.

The alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability of alcohol and drug modules in a clinical sample. Drug Alcohol Depend. 1997;44(2-3):133-141. doi:10.1016/s0376-8716(97)01332-x

101.

Chatterji

Saunders

Vrasti

Grant

Hasin

Mager

Reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Alcohol/Drug-Revised (AUDADIS-ADR): an international comparison. Drug Alcohol Depend. 1997;47(3):171-185. doi:10.1016/s0376-8716(97)00088-4

102.

Vrasti

Grant

Chatterji

, et al. Reliability of the Romanian version of the alcohol module of the WHO Alcohol Use Disorder and Associated Disabilities: Interview Schedule-Alcohol/Drug-Revised. Eur Addict Res. 1998;4(4):144-149. doi:10.1159/000018947

103.

Weaver

Roberts

Drinking and displacement: a systematic review of the influence of forced displacement on harmful alcohol use. Subst Use Misuse. 2010;45(13):2340-2355. doi:10.3109/10826081003793920

104.

Graham

Maslin

Copello

, et al. Drug and alcohol problems amongst individuals with severe mental health problems in an inner city area of the UK. Soc Psychiatry Psychiatr Epidemiol. 2001;36(9):448-455. doi:10.1007/s001270170023

105.

Kouvonen

Bosqui

Patel

O’Reilly

Donnelly

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Global Health. 2016;12(1):47. doi:10.1186/s12992-016-0187-3

106.

Blackmore

Boyle

Fazel

, et al. The prevalence of mental illness in refugees and asylum seekers: a systematic review and meta-analysis. PLoS Med. 2020;17(9):e1003337. doi:10.1371/journal.pmed.1003337

107.

Amaro

Sanchez

Bautista

Cox

Social vulnerabilities for substance use: stressors, socially toxic environments, and discrimination and racism. Neuropharmacology. 2021;188:108518. doi:10.1016/j.neuropharm.2021.108518

108.

Humeniuk

Henry-Edwards

Ali

Poznyak

Monteiro

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for Use in Primary Care. World Health Organization; 2010.

109.

Sheehan

Lecrubier

Sheehan

, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):34-57.

110.

Westermeyer

Crosby

Nugent

The Minnesota Substance Abuse Problems Scale. Am J Addict. 1998;7:24-34.

111.

Zimmerman

Mattia

JI.

A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Arch Gen Psychiatry. 2001;58(8):787-794. doi:10.1001/archpsyc.58.8.787

112.

Spitzer

Williams

Kroenke

, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994;272(22):1749-1756.

113.

Saunders

Aasland

Babor

de la Fuente

Grant

Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791-804.

114.

Petersen

Groenvold

Bjorner

, et al. Use of differential item functioning analysis to assess the equivalence of translations of a questionnaire. Qual Life Res. 2003;12(4):373-385. doi:10.1023/A:1023488915557

115.

Health NIo. PROMIS—Instrument Development and Psychometric Evaluation Scientific Standards. National Institutes of Health; 2012.

116.

Patel

Hall

BJ.

Beyond the DSM-5 diagnoses: a cross-cultural approach to assessing trauma reactions. Focus. 2021;19(2):197-203. doi:10.1176/appi.focus.20200049

117.

Kohrt

Rasmussen

Kaiser

, et al. Cultural concepts of distress and psychiatric disorders: literature review and research recommendations for global mental health epidemiology. Int J Epidemiol. 2014;43(2):365-406. doi:10.1093/ije/dyt227

118.

Kirmayer

Dao

THT

Smith

. Somatization and psychologization: understanding cultural idioms of distress. In: Okpaku

, ed. Clinical Methods in Transcultural Psychiatry. American Psychiatric Press; 1998:233-265.

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