Asylum-seeking and refugee children and youth face a heightened risk of poor mental health, including PTSD, anxiety, and depression. Existing research highlights the high prevalence of these disorders among this population, sometimes ten times higher than in the general population. While previous research in Sweden found no correlation between PTSD risk and factors like country of origin or time spent in Sweden, suggesting a universal risk, the need for easily scalable and cost-effective community-based interventions remains. One such intervention is Teaching Recovery Techniques (TRT), a trauma-focused cognitive behavioral therapy delivered in group sessions. Given the increased suicide risk among these youth and the potential lack of psychological training among TRT group leaders, a robust safety protocol is crucial. This study focuses on evaluating the Cantril Ladder, a simple well-being measure, as a component of this safety protocol, investigating its validity within the context of refugee youth experiencing PTSD symptoms.

The Cantril Ladder, a single-item measure of life satisfaction, is simple to administer and has demonstrated validity and reliability in assessing life satisfaction and psychosocial health among youth. However, concerns exist regarding the validity of single-item measures compared to multi-item scales, particularly within specific populations like refugees who experience unique stressors related to their circumstances and resettlement. Life satisfaction is strongly negatively correlated with depression, social stress, and suicide, while positively correlated with self-efficacy. Low life satisfaction predicts mental health problems, and conversely, higher depression symptoms strongly predict decreased life satisfaction. Self-efficacy enhances coping mechanisms and positively influences life satisfaction. This study aims to address the gap in knowledge regarding the validity of the Cantril Ladder within a population of refugee youth experiencing PTSD symptoms by examining its relationship with depression (PHQ-9) and self-efficacy (GSE).

This cross-sectional study used pre-intervention data from ongoing TRT trials in Sweden (2019-2020). The sample comprised 51 refugee youth (41 male, 10 female; mean age 17.5 years, SD = 2.06) who screened positive for PTSD (CRIES-8 ≥ 17), had lived in Sweden for five years or less, and were not receiving ongoing treatment that precluded TRT participation. Data were collected via a secure online platform (Qualtrics), using the Cantril Ladder, PHQ-9 (depression), and GSE (self-efficacy) scales. Hierarchical multiple linear regression analysis was employed to determine the extent to which PHQ-9 and GSE scores explained variance in Cantril Ladder scores. Descriptive statistics and Cronbach's alpha were also calculated to assess the reliability of the measures. Ethical approval was obtained from the Uppsala Regional Ethics Committee.

The mean Cantril Ladder score was 5.33 (SD = 2.77), significantly lower than the mean score reported in a cross-national study of adolescents (7.58 ± 1.89). The mean PHQ-9 score (12.08, SD = 6.50) indicated moderate depression severity. The mean GSE score (27.31, SD = 6.59) suggested moderate self-efficacy. Regression analysis revealed that PHQ-9 scores significantly predicted Cantril Ladder scores (R² = 0.159, p = 0.004). Adding GSE scores to the model increased the explained variance (Adjusted R² = 0.193, F (2, 48) = 6.997, p = 0.002). For each one-point increase in PHQ-9, Cantril Ladder scores decreased by 0.162; for each one-point increase in GSE, scores increased by 0.109. The influence of PHQ-9 was greater than GSE. All measures showed good internal consistency (Cronbach's alpha > 0.70).

The findings indicate that the Cantril Ladder has moderate concurrent validity with established measures of depression and self-efficacy in refugee youth experiencing PTSD. The lower life satisfaction scores compared to the general adolescent population underscore the need for targeted support and safety protocols within community-based interventions. The significant negative association between depression and life satisfaction and the positive association between self-efficacy and life satisfaction align with previous research. While the explained variance in the regression model was relatively small (19.3%), the statistically significant results support the utility of the Cantril Ladder for monitoring well-being as part of a broader safety protocol. Self-report measures inherently have limitations related to subjectivity.

This study demonstrates the moderate concurrent validity of the Cantril Ladder in assessing life satisfaction among refugee youth experiencing PTSD symptoms. The Cantril Ladder, though a simple measure, offers a valuable tool for tracking well-being within community-based interventions, providing an initial screening for those requiring further mental health assessment. Future research should investigate the Cantril Ladder's face validity and explore its use within a more comprehensive safety protocol in combination with qualitative methods to gain richer insights into the experiences of refugee youth.

The cross-sectional design limits causal inferences. The relatively small sample size and reliance on self-report measures may affect generalizability. Limited demographic information could influence the interpretation of results. The study's focus on a specific intervention setting may limit generalizability to other contexts. The explained variance in the regression model was modest, possibly due to the limitations of using self-report and the complexity of the factors influencing life satisfaction in this population.