Translation, contextual adaptation and pilot testing of psychosocial and mental health assessment instruments for Congolese refugees in Rwanda and Uganda – Rwanda

Rosco Kasujja, Paul Bangirana, Anna Chiumento, Tasdik Hasan, Stefan Jansen, Daniel M. Kagabo, Maria Popa, Peter Ventevogel and Ross G. White

Conflict and health volume 16, article number: 17 (2022)



Forcibly displaced people are at high risk of experiencing circumstances that can negatively impact mental health. Culturally and contextually relevant tools to assess their mental health and psychosocial needs are essential to inform the development of appropriate interventions and to investigate the effectiveness of these interventions.


We conducted two related studies: (1) to translate and contextualize the Patient Health Questionnaire (PHQ-9), a measure of depressive symptomatology, as well as assessment instruments measuring daily stress levels (Checklist for Daily & Environmental Stressors; CDES), social capital (Abridged and Adapted Social Capital Assessment Tool; SASCAT) and perceived social support (Multidimensional Perceived Social Support Scale; MSPSS) for use with Congolese refugees; (2) conduct pilot testing of the assessment instruments (including cognitive interviews of participants’ views on their achievement) and validation of the adapted PHQ-9 using a “known group” approach in recruiting refugees Congolese in refugee camps in Rwanda (n=100) and Uganda (n=100).


Study 1 resulted in the translation and adaptation of the assessment instruments. No substantial adaptations were made to SASCAT or MSPSS, while notable linguistic and contextual adaptations were made in both sites to CDES and PHQ-9. Cognitive interviews conducted as part of Study 2 indicated that tailored assessment instruments were generally well received by members of refugee communities. Participants recruited on the basis that local informants judged them to have high levels of depressive symptoms had significantly higher PHQ-9 scores (M = 11.02; SD = 5.84) compared to those in the judged group. as having low levels of depressive symptoms (M = 5.66; SD = 5.04). At both sites, adapted versions of the PHQ-9 demonstrated concurrent validity via significant positive correlations with daily stressor levels. Each of the four adapted assessment instruments demonstrated at least adequate levels of internal consistency across both sites.


Adapted versions of PHQ-9, CDES, SASCAT and MSPSS are appropriate for use among Congolese refugees in Rwanda and Uganda. We recommend further application of the approaches used in current studies to contextually adapt other assessment instruments in humanitarian contexts.