cognitive function and traumatic brain injury in refugees and asylum-seekers attending mental health services a preliminary study ; and clinical research portfolio

Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Christie, Zara (2014) Cognitive function and traumatic brain injury in refugees and asylum- seekers attending mental health services: a preliminary study ; and Clinical Research Portfolio. D Clin Psy thesis. http://theses.gla.ac.uk/5702/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Cognitive function and traumatic brain injury in refugees and asylum- seekers attending mental health services – a preliminary study And Clinical Research Portfolio Volume 1 (Volume 2 bound separately) Zara Christie, BSc Honours Submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology Institute of Health and Wellbeing College of Medical, Veterinary and Life Sciences University of Glasgow October 2014 1 ACKNOWLEDGEMENTS Firstly I would like to thank my supervisors Professor Tom McMillan and Dr Sharon Doherty for their ongoing guidance, support and enthusiasm throughout this project. I would like to thank Sarah McCullough from NHS Health Scotland for her interest in this research and for her role in obtaining funding which made this research possible. Further thanks go to Nicola Greenlaw from the Robertson Centre at the University of Glasgow for her statistical support. I would also like to thank all my participants, as well as Compass staff and interpreters; the success of this research would not have been possible without your support. I would like to thank my friends, both on and off the course for their support and understanding over the last three years. I would also like to say a huge thank you to my fiancé Francisco for his patience and statistical knowledge, my sister Ayesha for her support and proof-reading and mum Nasim for her ongoing encouragement throughout the Doctorate. Finally, I would like to thank my dad, Alastair, for always believing in me and encouraging me to apply to the Doctorate in Glasgow! 2 Dedicated in loving memory to my father, Alastair. Your star shines on. 3 TABLE OF CONTENTS Declaration of Originality Form 5 CHAPTER 1: SYSTEMATIC REVIEW 6 Validity of the translated and modified Mini-Mental State Examination within South, East, and South East Asian countries Summary 7 Introduction 8 Methods 11 Results 15 Discussion 27 Conclusion 30 References 31 CHAPTER 2: MAJOR RESEARCH PROJECT 37 Cognitive function and traumatic brain injury in refugees and asylum-seekers attending mental health services – a preliminary study Plain English Summary 38 Abstract 39 Introduction 40 Methods 45 Results 51 Discussion 57 Conclusion 62 Acknowledgements 63 References 64 CHAPTER 3: ADVANCED CLINICAL PRACTICE I - REFLECTIVE ACCOUNT 72 Reflections on communicating with clients in dyadic, triadic and group therapeutic encounters Abstract 73 CHAPTER 4: ADVANCED CLINICAL PRACTICE II - REFLECTIVE ACCOUNT 74 Research and evaluation within the NHS: reflections on conducting research as a trainee and upon qualification Abstract 75 4 APPENDICES SYSTEMATIC REVIEW Appendix 1.1. Critique of Steis and Schrauf’s (2009) paper 76 Appendix 1.2. Search Strategy 77 Appendix 1.3. Quality Rating Scale 78 Appendix 1.4. Table of inter-rater reliability 79 Appendix 1.5. Methodological Quality Rating 80 Appendix 1.6. Adaptations to the MMSE 82 Appendix 1.7 Authors guidelines for the International Journal of Geriatric Psychiatry… 84 MAJOR RESEARCH PROJECT Appendix 2.1. Ethics Committee Provisional Favourable Opinion 89 Appendix 2.2. Confirmation of Ethical Approval 94 Appendix 2.3. NHS R&D Board Approval 97 Appendix 2.4. Ethical Approval following minor amendment 99 Appendix 2.5. NHS R&D Board Approval following minor amendment 101 Appendix 2.6. Head Injury Screening Form 102 Appendix 2.7. Participant Information sheet 104 Appendix 2.8. Consent Form 106 Appendix 2.9. Table of causes of TBIs 107 Appendix 2.10. Author Guidelines for the Journal of the International Neuropsychological Society. 108 Appendix 2.11. Major Research Project Proposal 112 LIST OF TABLES AND FIGURES SYSTEMATIC REVIEW Figure 1. Flowchart of the selection process 15 Table 1. Demographics table 17 MAJOR RESEARCH PROJECT Figure 1. Recruitment flowchart of the selection process 46 Table 1. Participant demographics and descriptive analysis 52 Table 2. TBI characteristics 53 Table 3. Clinical vignettes 54 Table 4. Comparing TBI and non-TBI groups on CTT and additional tests 55 Table 5. Comparing sample and normative data on CTT and additional tests 56 Table 6. Normative data for comparison with the study sample 57 5 Declaration of Originality Form This form must be completed and signed and submitted with all assignments. Please complete the information below (using BLOCK CAPITALS). Name: ZARA CHRISTIE Student Number: 1104518c Course Name: DOCTORATE IN CLINICAL PSYCHOLOGY Assignment Number/Name: CLINICAL RESEARCH PORTFOLIO An extract from the University’s Statement on Plagiarism is provided overleaf. Please read carefully THEN read and sign the declaration below. I confirm that this assignment is my own work and that I have: Read and understood the guidance on plagiarism in the Doctorate in Clinical Psychology Programme Handbook, including the University of Glasgow Statement on Plagiarism  Clearly referenced, in both the text and the bibliography or references, all sources used in the work  Fully referenced (including page numbers) and used inverted commas for all text quoted from books, journals, web etc. (Please check the section on referencing in the ‘Guide to Writing Essays & Reports’ appendix of the Graduate School Research Training Programme handbook.)  Provided the sources for all tables, figures, data etc. that are not my own work  Not made use of the work of any other student(s) past or present without acknowledgement. This includes any of my own work, that has been previously, or concurrently, submitted for assessment, either at this or any other educational institution, including school (see overleaf at 31.2)  Not sought or used the services of any professional agencies to produce this work  In addition, I understand that any false claim in respect of this work will result in disciplinary action in accordance with University regulations  DECLARATION: I am aware of and understand the University’s policy on plagiarism and I certify that this assignment is my own work, except where indicated by referencing, and that I have followed the good academic practices noted above Signature Date 6 CHAPTER 1: SYSTEMATIC REVIEW Validity of the translated and modified Mini-Mental State Examination within South, East, and South East Asian countries Zara Christie 1 1 Address for Correspondence: Mental Health and Wellbeing University of Glasgow 1 st Floor, Administrative Building Gartnavel Royal Hospital 1055 Great Western Road Glasgow, G12 0XH Submitted in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology. Written in accordance with the manuscript preparation guidelines for the International Journal of Geriatric Psychiatry (Appendix 1.7). 7 SUMMARY Objective: Approximately 16 million people with dementia live in low-economy countries; however, most cognitive screens have been developed in Western societies. This review considers studies that have validated the Mini-Mental State Examination (MMSE), the most commonly used cognitive screen, in native languages spoken in Asia, and explores its validity for illiterate or poorly-educated individuals. Methods: Studies included in the review were identified by searching electronic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science), reviewing the reference lists of included articles and hand-searching a key journal. Included were studies that attempted to validate the MMSE in South, East and South East Asia. Eligible studies were rated for methodological quality using a rating scale devised for this review. Results: Nine studies were eligible for inclusion; their quality was rated as high for 3, moderate for 4, and low for 2 studies. The MMSE was translated and validated in 5 languages across 6 countries. Cut-offs for impairment ranged from 17-24, which yielded wide-ranging sensitivity (83.87-100%) and specificity (60.6-100%). Conclusion: Translations of the MMSE are valid and reliable to screen for cognitive impairment; however, these results cannot be generalised due to limited reporting on the severity of dementia. There were mixed results regarding the validity of the MMSE to detect cognitive impairment in illiterate or poorly-educated people. Keywords: Systematic review, MMSE, translation, validity, South East Asia 8 INTRODUCTION Cognitive impairment ranges in severity, can occur at any point in a person’s lifetime, and can result in difficulties remembering, learning new concepts, concentrating, or making decisions about everyday life. Mild cognitive impairment (MCI) is defined as the objective and subjective decline in cognition and function, which is greater than expected for an individual’s age and level of education. An individual with MCI does not meet the criteria for a diagnosis of dementia (Peterson, 2004). There are multiple causes of cognitive impairment, including acquired and traumatic brain injuries (TBI), strokes, diabetes, hypertension, and the ageing process itself (Manly et al., 2005). Every year, approximately 10 million people are affected by a TBI. The World Health Organisation states that by 2020, TBIs will become the biggest cause of death and disabilities worldwide (Hyder et al., 2007). Severe cognitive impairment results in more profound difficulties, which include a diagnosis of dementia. It is recommended that for all patients presenting with cognitive complaints, a brief cognitive screen is administered to assess the presence and severity of any memory or cognitive deficits (Jacova et al., 2007). There are a number of screening measures which aim to highlight genuine cognitive impairment. Cullen et al. (2007) highlight that the following six core domains should be covered in a screening tool: attention/working memory, new verbal learning/recall, expressive language, visual construction, executive function, and abstract reasoning. High sensitivity (the proportion of people with cognitive impairment with a positive result), and high specificity (the proportion of people without cognitive impairment with a negative result; Cullen et al., 2007) are important to establish the validity of a screening measure (O’Bryant et al., 2008). However, the diagnostic utility of a particular person’s score is represented by the screen’s predictive values. Positive [...]... elderly Age Ageing 1: 233-238 Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye, OC 2007 The impact of traumatic brain injuries: A global perspective NeuroRehabilitation, 22: 341-353 Ibrahim NM, Shohaimi S, Chong H, et al 2009 Validation study of the Mini -Mental State Examination in a Malay-speaking elderly population in Malaysia Dement Geriatr Cogn Disord 27: 247-253 32 Jacova C, Kertesz A, ... quality articles Ibrahim et al (2009) - 88.24% This study validated the MMSE in an elderly Malaysian population between 2004-2007 Two groups, dementia and neurology outpatients and healthy controls, were matched on age, gender and education, and assessed on the Malay MMSE (M-MMSE) The MMSE was translated and back-translated; minimal adaptations were made Ibrahim et al compared the M-MMSE-7 (serial... (P-MMSE) The MMSE was translated and 19 back-translated into Persian and externally evaluated for accuracy and cultural appropriateness; minimal adaptations were made As age increased, P-MMSE scores decreased (Pearson’s correlation, r=-0.7 7; p . CHAPTER 2: MAJOR RESEARCH PROJECT 37 Cognitive function and traumatic brain injury in refugees and asylum-seekers attending mental health services – a preliminary study Plain English Summary. Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Christie, Zara (2014) Cognitive function and traumatic brain injury in refugees and asylum- seekers attending mental. injury in refugees and asylum- seekers attending mental health services – a preliminary study And Clinical Research Portfolio Volume 1 (Volume 2 bound separately) Zara Christie, BSc Honours