Feasibility of an interpreter-mediated neuropsychological test battery for trauma-affected refugees

Abstract

Background: Cognitive impairment in trauma-affected refugees is often unassessed due to the absence of suitable cross-cultural neuropsychological measures, the high prevalence of psychiatric symptoms, and the need for interpreter mediation. This poses both a clinical challenge and a health inequality for trauma-affected refugees who are left without access to much needed rehabilitation. Untreated cognitive impairment is likely to reduce the effectiveness of mental health interventions.Aim: To assess the operational and clinical feasibility of a neuropsychological test battery specifically developed for trauma-affected refugees from Syria.Method: A neuropsychological test battery was developed to assess executive function, mental speed, attention, and memory. The test battery was administered to 27 refugees from Syria recruited after being referred for specialized trauma treatment. Operational feasibility was assessed by examining completion time and completion rate. Clinical feasibility was assessed through performance validity rates, skewness, and floor effects.Results: The test battery included Supermarket Fluency, Color Trails Test, Symbol Digit Modalities Test, World Health Organization/University of California, Los Angeles – Auditory Verbal Learning Test, and Digit Span. The mean completion time was 54 min, with 62% of participants completing the full battery and 70% of all tests being completed. Concerning performance validity, 11% of the participants failed two performance validity tests, while 26% failed one. Tests scores were generally skewed, and one subtest, Color Trails 2, showed evidence of a floor effect.Conclusions: Despite high levels of cognitive impairment in trauma-affected refugee populations, to our knowledge, the feasibility of a neuropsychological test battery has not previously been established for this group. This study supports the operational and clinical feasibility of the proposed interpreter-mediated neuropsychological test battery to trauma-affected refugees, provided that additional time is allocated to complete tests with time limits. The study highlights the need for cross-cultural validation of neuropsychological tests in trauma-affected refugees.

Keywords

• PTSD
• refugees
• torture
• cross-cultural
• neuropsychology
• feasibility