Cited by 1,489Posttraumatic Stress Disorder ResearchMigration, Health and TraumaPsychometric Methodologies and Testing

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The Harvard Trauma Questionnaire: Validating a Cross-Cultural Instrument for Measuring Torture, Trauma, and Posttraumatic Stress Disorder in Indochinese Refugees

MOLLICA, RICHARD F., CASPI-YAVIN, YAEL, BOLLINI, PAOLA, TRUONG, TOAN, TOR, SVANG, LAVELLE, JAMES·1992·The Journal of Nervous and Mental Disease

DOI 10.1097/00005053-199202000-00008

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Abstract

There are no valid and reliable cross-cultural instruments capable of measuring torture, trauma, and trauma-related symptoms associated with the DSM-III-R diagnosis of posttraumatic stress disorder (PTSD). Generating such standardized instruments for patients from non-Western cultures involves particular methodological challenges. This study describes the development and validation of three Indochinese versions of the Harvard Trauma Questionnaire (HTQ), a simple and reliable screening instrument that is well received by refugee patients and bicultural staff. It identifies for the first time trauma symptoms related to the Indochinese refugee experience that are associated with PTSD criteria. The HTQ's cultural sensitivity may make it useful for assessing other highly traumatized non-Western populations.

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Bhui, K. S., Craig, T., Mohamud, S., Warfa, N., Stansfeld, S. A., Thornicroft, G., Curtis, S. E., & McCrone, P. (2006) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-006-0043-5 · Cited by 182
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Lindauer, R., Olff, M., van Meijel, E. P. M., Carlier, I. V. E., & Gersons, B. P. R. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.06.033 · Cited by 188
The impact of fear for family on mental health in a resettled Iraqi refugee community
Nickerson, A., Bryant, R. A., Steel, Z., Silove, D. M., & Brooks, R. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2009.08.006 · Cited by 175
“The HTQ also provides an index of PTSD symptoms validated against semistructured clinical interviews and the SCID (HTQ; Mollica et al., 1992; Silove et al., 2007).”
Method
Parental styles in the intergenerational transmission of trauma stemming from the Khmer Rouge regime in Cambodia
Field, N. P., Muong, S., & Sochanvimean, V. (2013) · American Journal of Orthopsychiatry · doi:10.1111/ajop.12057 · Cited by 174
A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries
Mughal, A. Y., Devadas, J., Ardman, E., Levis, B., Go, V. F.-L., & Gaynes, B. N. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02753-3 · Cited by 188
Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples
Elklit, A., Hyland, P., & Shevlin, M. (2014) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v5.24221 · Cited by 172
“Twelve items that comprised the PTSD/CPTSD item set were selected from two standardised measures, the Trauma Symptom Checklist (TSC; Briere & Runtz, 1989) and the Harvard Trauma Questionnaire Part IV (HTQ: Mollica et al., 1992).”
Method
Psychological Distress in Afghan Refugees: A Mixed-Method Systematic Review
Alemi, Q., James, S., Cruz, R., Zepeda, V., & Racadio, M. (2014) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-013-9861-1 · Cited by 170
“Harvard Trauma Questionnaire/HTQ [102]) and those adapted for use in refugee research (e.”
Method
Debating war-trauma and post-traumatic stress disorder (PTSD) in an interdisciplinary arena
Kienzler, H. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.03.030 · Cited by 171
“That is, protocols and scales based on the symptom lists such as the DSM and ICD have been translated into local languages, thus permitting investigators to distinguish traumatic suffering from seemingly similar kinds of psychological distress (Mollica et al., 1992).”
BackgroundInfluential
A Systematic Review of Factors Affecting Mental Health and Well-Being of Asylum Seekers and Refugees in Germany
Hajak, V. L., Sardana, S. M., Verdeli, H., & Grimm, S. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.643704 · Cited by 172
“(50) assessed symptoms of PTSD through combining the Post-traumatic Diagnostic Scale [PDS; (72)], which measures the 10 ICD-10 (International Statistical Classification of Diseases and Related Health Problems) criteria of PTSD, with the 25 items of the Harvard TraumaQuestionnaire [HTQ; (73)] and found a rate of 41.”
Method
Dissociative disorders in DSM-5
Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., Cardeña, E., & Dell, P. F. (2011) · Depression and Anxiety · doi:10.1002/da.20923 · Cited by 162
Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study
Onyut, L. P., Neuner, F., Ertl, V., Schauer, E., Odenwald, M. G., & Elbert, T. R. (2009) · Conflict and Health · doi:10.1186/1752-1505-3-6 · Cited by 165
“rightly validated the Havard Trauma Questionnaire among the Indochinese before using it for measurements within the same questionnaire [23].”
Victimization and PTSD in a Danish National Youth Probability Sample
Elklit, A. (2002) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200202000-00011 · Cited by 181
“PSYCHIATRY, 41 :2 , FEBRUARY 2002 177 no HTQ reliability and validity data for adolescents or Danish subjects.”
MethodInfluential
Comparative Efficacy and Acceptability of Pharmacological, Psychotherapeutic, and Combination Treatments in Adults With Posttraumatic Stress Disorder
Merz, J., Schwarzer, G., & Gerger, H. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.0951 · Cited by 178
The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: Results of a randomized controlled trial
Acarturk, C., Konuk, E., Cetinkaya, M., Senay, I., Sijbrandij, M., Gulen, B., & Cuijpers, P. (2016) · Psychological Medicine · doi:10.1017/s0033291716001070 · Cited by 165
“Refugees, in addition to displacement from their homes, have been exposed to many horrifying traumatic events such as threat of death, torture, or serious injury and the injury, death, disappearance of family members, rape, lack of food and water, or lack of shelter (Mollica et al. 1992).”
Background
Moral injury, mental health and behavioural health outcomes: A systematic review of the literature
Hall, N. A., Everson, A. T., Billingsley, M. R., & Miller, M. B. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2607 · Cited by 205
Rates and impact of trauma and current stressors among Darfuri refugees in Eastern Chad.
Rasmussen, A., Nguyen, L., Wilkinson, J., Vundla, S., Raghavan, S. S., Miller, K. E., & Keller, A. S. (2010) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.2010.01026.x · Cited by 164
“…camps and host countries alike clearly supports the positive association between PTEs and psychological distress (Fox & Tang, 2000; Holtz, 1998; Jaranson, Butcher, Halcon, et al., 2000; Keller, Lhewa, Rosenfeld, et al., 2006; Mollica et al., 1992; Shrestha, Sharma, Van Ommeren, et al., 1998).”
Mental health, social functioning, and feelings of hatred and revenge of Kosovar Albanians one year after the war in Kosovo
Cardozo, B. L., Kaiser, R., Gotway, C. A., & Agani, F. (2003) · Journal of Traumatic Stress · doi:10.1023/a:1024413918346 · Cited by 161
“We used the same three screening tools as in the 1999 survey to assess mental health and social functioning: the General Health Questionnaire-28 (GHQ-28; Goldberg & Hillier, 1979), the Medical Outcomes Study 20 (MOS-20; Ware, Snow, Kosinski, & Gandek, 1997) and the Harvard Trauma Questionnaire (HTQ; Mollica, Casspi-Ya…”
Method
Karenni refugees living in Thai–Burmese border camps: traumatic experiences, mental health outcomes, and social functioning
Cardozo, B. L., Talley, L., Burton, A., & Crawford, C. (2004) · Social Science & Medicine · doi:10.1016/j.socscimed.2003.09.024 · Cited by 158
“Whether the PTSD symptoms score is lower than expected because the concept of PTSD is not known or used in the local culture is not clear, but does not seem likely because survey respondents easily recognized all 16 key PTSD ARTICLE IN PRESS B. Lopes Cardozo et al. / Social Science & Medicine 58 (2004) 2637–2644 2641…”
MethodInfluential
Prevalence of Posttraumatic Stress Disorder in a Coastal Fishing Village in Tamil Nadu, India, After the December 2004 Tsunami
Kumar, M. S., Murhekar, M. V., Hutin, Y. J., Subramanian, T., Ramachandran, V., & Gupte, M. D. (2006) · American Journal of Public Health · doi:10.2105/ajph.2005.071167 · Cited by 159
Compounding of Premigration Trauma and Postmigration Stress in Asylum Seekers
Sinnerbrink, I. B., Silove, D. M., Field, A., et al. (1997) · The Journal of Psychology · doi:10.1080/00223989709603533 · Cited by 157
Understanding mental health needs of Southeast Asian refugees: Historical, cultural, and contextual challenges
Hsu, E., Davies, C. A., & Hansen, D. J. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2003.10.003 · Cited by 156
“Additionally, the Harvard Trauma Questionnaire has been culturally validated as appropriate for evaluation of PTSD symptoms in Cambodian, Laotian, and Vietnamese refugees (Mollica et al., 1992).”
Method
Prevalence of War-Related Mental Health Conditions and Association With Displacement Status in Postwar Jaffna District, Sri Lanka
Husain, F. S., Anderson, M., Cardozo, B. L., Becknell, K., Blanton, C., Araki, D., & Vithana, E. K. (2011) · JAMA · doi:10.1001/jama.2011.1052 · Cited by 154
The mental health of unaccompanied refugee minors on arrival in the host country
Vervliet, M., Demott, M. A. M., Jakobsen, M., Broekaert, E., Heir, T., & Derluyn, I. (2014) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12094 · Cited by 152
“The HTQ has been validated for use with refugee populations in several studies (Mollica et al., 1992; Fawzi, Murphy, Pham, Lin, Poole & Mollica, 1997; Silove, Manicavasagar, Mollica et al., 2007).”
The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway
Jakobsen, M., Demott, M. A. M., Wentzel‐Larsen, T., & Heir, T. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015157 · Cited by 153
Impact of the Russian Invasion on Mental Health of Adolescents in Ukraine
Osokina, O., Silwal, S., Bohdanova, T., Hodes, M., Sourander, A., & Skokauskas, N. (2022) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2022.07.845 · Cited by 153
Resilience in trauma‐exposed refugees: The moderating effect of coping style on resilience variables.
Hooberman, J., Rosenfeld, B., Rasmussen, A., & Keller, A. (2010) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.2010.01060.x · Cited by 151
“Severity of PTSD symptoms was measured using the Harvard Trauma Questionnaire (HTQ), a 16-item self-report measure (Mollica et al., 1992).”
BackgroundMethod
Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study
Das‐Munshi, J., Lund, C., Mathews, C., Clark, C., Rothon, C., & Stansfeld, S. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0154478 · Cited by 149
“Validated instruments assessed mental disorders; these included: Harvard Trauma Questionnaire (PTSD); Short Moods and Feelings Questionnaire (depression); Zung self- rated anxiety scale (anxiety).”
MethodInfluential
Persecution Experiences and Mental Health of LGBT Asylum Seekers
Hopkinson, R. A., Keatley, E. S., Glaeser, E., Erickson‐Schroth, L., Fattal, O., & Sullivan, M. N. (2016) · Journal of Homosexuality · doi:10.1080/00918369.2016.1253392 · Cited by 155
“The Harvard Trauma Questionnaire (HTQ) is a self-report instrument that assesses PTSD symptoms (Mollica et al., 1992).”
BackgroundMethod
Coping and chronic psychosocial consequences of female genital mutilation in the Netherlands
Vloeberghs, E., van der Kwaak, A., Knipscheer, J. W., & van den Muijsenbergh, M. E. T. C. (2012) · Ethnicity and Health · doi:10.1080/13557858.2013.771148 · Cited by 147
“The survey consisted of four questionnaires including: the Harvard Trauma Questionnaire (HTQ-30; Mollica et al. 1992), a 30-item transculturally validated screening instrument for post-traumatic stress disorder (PTSD) symptomatology (Cronbach’s a 0.96 in the current sample); the Hopkins Symptom…”
BackgroundMethodInfluential
How to quantify exposure to traumatic stress? Reliability and predictive validity of measures for cumulative trauma exposure in a post-conflict population
Wilker, S., Pfeiffer, A., Kolassa, S., Koslowski, D., Elbert, T. R., & Kolassa, I. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.28306 · Cited by 168
“93 over intervals of 1 4 weeks (Carlson et al., 2011; Goodman, Corcoran, Turner, Yuan, & Green, 1998; Gray, Litz, Hsu, & Lombardo, 2004; Hollifield et al., 2006; Mollica et al., 1992).”
Influential
Psychological reactions in Icelandic earthquake survivors
Bödvarsdóttir, Í., & Elklit, A. (2004) · Scandinavian Journal of Psychology · doi:10.1111/j.1467-9450.2004.00373.x · Cited by 141
“In this study, the reliability co - efficients were very good and consistent with other studies (Mollica et al. , 1992; Elklit, 2000).”
Result
Prevalence of post-traumatic stress disorder in Sichuan Province, China after the 2008 Wenchuan earthquake
Kun, P., Chen, X., Han, S., Gong, X., Chen, M., Zhang, W., & Yao, L. (2009) · Public Health · doi:10.1016/j.puhe.2009.09.017 · Cited by 142
Mental health literacy of resettled Iraqi refugees in Australia: knowledge about posttraumatic stress disorder and beliefs about helpfulness of interventions
Slewa‐Younan, S., Mond, J., Bussion, E., Mohammad, Y., Guajardo, M. G. U., Smith, M. M., Milosevic, D., Lujic, S., & Jorm, A. F. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0320-x · Cited by 140
“The Harvard Trauma Questionnaire (HTQ) [22] is a widely used, cross-cultural self-report checklist assessing the occurrence and frequency of various types of traumatic events as well as PTSD symptomatology.”
BackgroundMethodInfluential

Authors: MOLLICA, R. F., CASPI-YAVIN, Y., BOLLINI, P., TRUONG, T., TOR, S., & LAVELLE, J.
Affiliations: Harvard University (US)
St. Elizabeth's Medical Center (US)
ORCID: MOLLICA, RICHARD F.
Venue: The Journal of Nervous and Mental Disease
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1992-02
Volume: 180
Issue: 2
Pages: 111-116
ISSN: 0022-3018 (ISSN-L)
DOI: 10.1097/00005053-199202000-00008
OpenAlex: W4292855834
Cited by: 1,489
References: 0
Citations by year: 2026: 56 · 2025: 92 · 2024: 66 · 2023: 92 · 2022: 100 · 2021: 98 · 2020: 103 · 2019: 73 · 2018: 90 · 2017: 86 · 2016: 71 · 2015: 59 · 2014: 63 · 2013: 50 · 2012: 54
FWCI: 6.74
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Nervous and Mental Disease (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords: Harvard Trauma Questionnaire, post-traumatic stress disorder, torture, trauma symptoms, Indochinese refugees, cross-cultural assessment, screening tool, cultural sensitivity, instrument validation, refugee mental health

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The Harvard Trauma Questionnaire: Validating a Cross-Cultural Instrument for Measuring Torture, Trauma, and Posttraumatic Stress Disorder in Indochinese Refugees

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