Table 1 Instruments used to screen for mental disorders in phase 1

VOLTAC

With the aim of considering culturally relevant terms and expressions of mental disorders in the screening process, vignettes including local terms and concepts for mental illness were developed through focus groups with the camp residents. These concepts included examples of visual and auditory hallucinations, paranoia, self-talking, unsociability, poor appearance, and perceived abnormal behavior. VOLTAC was applied by reading vignette, broken down into its component sections and marking if the household representative identified any individual in their home with each particular item. Vignette components were: 1. Hears voices/sees things others don’t; 2. Complains someone is watching/following; 3. Seen talking to self often; 4. Not sociable/does not like to be with people; 5. Does not take care of appearance/hygiene; 6. Shows abnormal behavior.

WASSS

The WHO-UNHCR Assessment Schedule of Serious Symptoms in Humanitarian Settings [25] is a 2-part instrument designed to detect people with symptoms of severe distress and impaired functioning, and thus in priority need of mental health care. It is a brief, lay-administered instrument well adapted to humanitarian contexts; it is designed to sidestep the frequently confounded transient distress and mental disorders found in these settings, often posing an interpretative challenge when using diagnostic instruments.

- WASSS-H

The household informant portion of WASSS asks the respondent about the experiences of other household members (including symptoms of psychosis, convulsions, and functional impairment). It contains 7 questions eliciting dichotomous responses plus two open-ended questions. As our study was limited to adults at least 18 years or older two questions about children and adolescents were not asked, resulting in 5 items. Scoring positive on any item was considered to indicate a likely need for mental health care. This portion asks the household representative if anyone in their household was so distressed, disturbed or upset that he or she was: 1. completely inactive; 2. unable to carry out normal activities; 3. acting in strange ways; 4. not taking care of him/her self; 5. not caring for young children he/she is responsible for.

- WASSS-I

Individual interview portion of WASSS asks the respondent about severe, common distress symptoms and impaired functioning they have experienced themselves. It is comprised of 6 questions with 5 Likert-scale response options, indicating the frequency with which varieties of symptoms are felt. In our analysis, responses were reclassified with all and most of the time indicating a positive response, and none of the time, a little of the time, and some of the time indicating a negative response. The items are: 1. so afraid that nothing could calm you down; 2. so angry that you felt out of control; 3. so uninterested in things that you used to like that you did not want to do anything at all; 4. so hopeless that you wanted to be dead; 5. so severely upset about an event in your life that you tried to avoid places people, conversations or activities that reminded you of the event?; 6. unable to carry out essential activities for daily living because of these feelings

SRQ

The 20-item Self Reporting Questionnaire (SRQ) [26] is a WHO mental health screening instrument to detect mental disorders across different countries and cultures. It has been validated in many settings, including an Arabic version in Saudi Arabia and the United Arab Emirates [36, 37].