Psychometric Validation of the International Trauma Questionnaire (ITQ-18) in Middle-Aged Iranian Women in 2023

Document Type : Original Article

Authors

1 PhD to candidate in clinical psychology, Department of Clinical Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran

2 Assistant Professor of Health Psychology, Department of Clinical Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran

3 Department of Clinical Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran

4 Department of Psychology, Tarbiat Modares University,Tehran, Iran

10.30491/ijbs.2024.414330.2024

Abstract

Introduction: Complex Post-Traumatic Stress Disorder (CPTSD) has been recognized as a distinct disorder from Post-Traumatic Stress Disorder (PTSD) in the eleventh revision of the disease classification system (ICD-11). The international trauma Questionnaires have been developed to measure C-PTSD. This study was conducted to enhance the psychometric properties of the Persian version of the 18-item International Trauma Questionnaire (ITQ-18 Items).
Method: This research followed a descriptive-evaluative approach. The last version of ITQ was translated and back-translated, and its content validity was assessed through measurement and obtained above 0.70. The statistical population consisted of non-clinical married middle-aged women in the age range of 30 to 40 years who were registered in the comprehensive health services center electronic system of Bushehr province in the year 2022-2023. They responded to the questionnaires over a two-month period using a multistage cluster sampling method. To assess concurrent validity, the hospital anxiety and depression questionnaire along with adverse childhood experiences were used. The data were analyzed employing confirmatory factor analysis and correlation coefficient analysis.
Results: Findings indicated that, considering SRMR=0.56, RMSEA=0.61, TLI=0.943, CFI=0.959, and BIC=21879.875, the optimal fit was found in the second-order two-factor model. A statistically significant positive relationship was found between CPTSD and clinical anxiety and depression (p<0.01). Additionally, adverse childhood experiences showed a correlation (p<0.01).
Conclusion: According to the findings of the present study, it can be stated that the Persian version of the ITQ-18 Items, by the ICD-11, exhibits appropriate psychometric properties.

Keywords


  1. References

    1. Herman, J., CPTSD is a distinct entity: Comment on Resick et al.(2012). Journal of traumatic stress, 2012. 25(3): 256-257. https://doi.org/10.1002/jts.21697
    2. Van der Kolk, B.A., Developmental trauma disorder: towards a rational diagnosis for chronically traumatized children. Praxis Der Kinderpsychologie Und Kinderpsychiatrie, 2009. 58(8): 572-586. https://doi.org/10.13109/prkk.2009.58.8.572
    3. Brewin, C.R., et al., Reformulating PTSD for DSM‐V: life after criterion A. Journal of traumatic stress, 2009. 22(5): 366-373. https://doi.org/10.1002/jts.20443
    4. Hyland, P., et al., Posttraumatic stress disorder and complex posttraumatic stress disorder in DSM‐5 and ICD‐11: Clinical and behavioral correlates. Journal of Traumatic Stress, 2018. 31(2): 174-180. https://doi.org/10.1002/jts.22272
    5. First, M.B., et al., An organization‐and category‐level comparison of diagnostic requirements for mental disorders in ICD‐11 and DSM‐5. World Psychiatry, 2021. 20(1): 34-51. https://doi.org/10.1002/wps.20825
    6. Maercker, A., et al., Diagnosis and classification of disorders specifically associated with stress: Proposals for ICD‐11. World Psychiatry, 2013. 12(3): 198-206. https://doi.org/10.1002/wps.20057
    7. Hyland, P., et al., An assessment of the construct validity of the ICD-11 proposal for complex posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 2017. 9(1): p. 1. https://psycnet.apa.org/doi/10.1037/tra0000114
    8. Kazlauskas, E., et al., The structure of ICD-11 PTSD and Complex PTSD in adolescents exposed to potentially traumatic experiences. Journal of Affective Disorders, 2020. 265: p. 169-174. https://doi.org/10.1016/j.jad.2020.01.061
    9. Karatzias, T., et al., An initial psychometric assessment of an ICD-11 based measure of PTSD and complex PTSD (ICD-TQ): Evidence of construct validity. Journal of Anxiety Disorders, 2016. 44: 73-79. https://doi.org/10.1016/j.janxdis.2016.10.009
    10. Cloitre, M., et al., Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European journal of psychotraumatology, 2013. 4(1): 20706. https://doi.org/10.3402/ejpt.v4i0.20706
    11. Redican, E., et al., A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire. Journal of Anxiety Disorders, 2021. 79: 102381. https://doi.org/10.1016/j.janxdis.2021.102381
    12. Ghabeshi, M.B., et al., iranian women. Psychological Science, 2022. 20(108): 2181-2194. https://psychologicalscience.ir/article-1-1271-fa.html
    13. Reed, G.M., Toward ICD-11: Improving the clinical utility of WHO's International Classification of mental disorders. Professional Psychology: Research and Practice, 2010. 41(6): 457. https://psycnet.apa.org/doi/10.1037/a0021701
    14. Cloitre, M., et al., The International Trauma Questionnaire: Development of a self‐report measure of ICD‐11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 2018. 138(6): 536-546. https://doi.org/10.1111/acps.12956
    15. Cloitre, M., ICD-11 complex post-traumatic stress disorder: Simplifying diagnosis in trauma populations. The British journal of psychiatry, 2020. 216(3): 129-131. https://doi.org/10.1192/bjp.2020.43
    16. Ho, G.W., et al., The validity of ICD-11 PTSD and complex PTSD in East Asian cultures: Findings with young adults from China, Hong Kong, Japan, and Taiwan. European Journal of Psychotraumatology, 2020. 11(1): 1717826. https://doi.org/10.1080/20008198.2020.1717826
    17. Ho, G.W., et al., Translation and validation of the Chinese ICD-11 international trauma questionnaire (ITQ) for the assessment of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). European Journal of Psychotraumatology, 2019. 10(1): 1608718. https://doi.org/10.1080/20008198.2019.1608718
    18. Shevlin, M., et al., A psychometric assessment of Disturbances in Self-Organization symptom indicators for ICD-11 Complex PTSD using the International Trauma Questionnaire. European Journal of Psychotraumatology, 2018. 9(1): 1419749. https://doi.org/10.1080/20008198.2017.1419749
    19. Meyers, L.S., G. Gamst, and A.J. Guarino, Applied multivariate research: Design and interpretation. 2016: Sage publications.
    20. Kline, R.B., Principles and practice of structural equation modeling. 2023: Guilford publications.
    21. Hyland, P., et al., Are posttraumatic stress disorder (PTSD) and complex-PTSD distinguishable within a treatment-seeking sample of Syrian refugees living in Lebanon? Global Mental Health, 2018. 5: e14. https://doi.org/10.1017/gmh.2018.2
    22. Zigmond, A.S. and R.P. Snaith, The hospital anxiety and depression scale. Acta psychiatrica scandinavica, 1983. 67(6): 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
    23. Herrmann, C., International experiences with the Hospital Anxiety and Depression Scale-a review of validation data and clinical results. Journal of psychosomatic research, 1997. 42(1): 17-41. https://doi.org/10.1016/S0022-3999(96)00216-4
    24. Montazeri, A., et al., The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health and quality of life outcomes, 2003. 1(1): 1-5. http://www.hqlo.com/content/1/1/14
    25. Felitti, V.J., et al., Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 1998. 14(4): 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8
    26. Dube, S.R., et al., Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic. Child abuse & neglect, 2004. https://psycnet.apa.org/doi/10.1016/j.chiabu.2003.08.009
    27. Deinali, S., et al., Psychometric Properties of the Modified Persian Version of Adverse Childhood Experience Questionnaire for Athletes. Journal of Research in Rehabilitation Sciences, 2020. 16(1): p. 87-94. DOI: 10.22122/jrrs.v16i0.3510
    28. Fung, K.W., Xu, Julia, and O. Bodenreider, The new International Classification of Diseases 11th edition: a comparative analysis with ICD-10 and ICD-10-CM. Journal of the American Medical Informatics Association, 2020. 27(5): 738-746. https://doi.org/10.1093/jamia/ocaa030
    29. Choi, H., W. Lee, and P. Hyland, Factor structure and symptom classes of ICD-11 complex posttraumatic stress disorder in a South Korean general population sample with adverse childhood experiences. Child Abuse & Neglect, 2021. 114: 104982. https://doi.org/10.1016/j.chiabu.2021.104982
    30. Peraud, W., et al., French cross-cultural adaptation and validation of the International Trauma Questionnaire (ITQ) in a French community sample. European Journal of Psychotraumatology, 2022. 13(2): 2152109. https://doi.org/10.1080/20008066.2022.2152109
    31. Kazlauskas, E., et al., The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services. European journal of psychotraumatology, 2018. 9(1): 1414559. https://doi.org/10.1080/20008198.2017.1414559
    32. McGinty, G., et al., Sex and age differences in ICD-11 PTSD and complex PTSD: An analysis of four general population samples. European Psychiatry, 2021. 64(1): e66. https://doi.org/10.1192/j.eurpsy.2021.2239
    33. Vallières, F., et al., ICD‐11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 2018. 138(6): 547-557. https://doi.org/10.1111/acps.12973
    34. Akbarizadeh, F., et al., Evaluation of the Reasons of Drug abuse in Women in Bushehr: A Qualitative Study. Journal of Qualitative Research in Health Sciences, 2020. 8(1): 33-43. https://jqr1.kmu.ac.ir/article_90954.html
    35. Gilbar, O., Examining the boundaries between ICD-11 PTSD/CPTSD and depression and anxiety symptoms: A network analysis perspective. Journal of Affective Disorders, 2020. 262: 429-439. https://doi.org/10.1016/j.jad.2019.11.060
    36. Karatzias, T., et al., Childhood trauma, attachment orientation, and complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment. Development and Psychopathology, 2022. 34(3): 1192-1197. https://doi.org/10.1002/jts.21697