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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Method
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“Exposure to PTEs was measured at baseline using the Harvard Trauma Questionnaire (HTQ)-part I (Mollica et al., 1992), considered both in terms of global scale score and in terms of individual items.”
Method
Autobiographical memory and future episodic thinking among trauma‐exposed Rohingya refugee people
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The Impact of Armed Conflict in the Country of Origin on Mental Health after Migration to Canada
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“Instead, during this period we focused on items that were the most comparable to items utilized to assess war-related stress (Mollica et al. 1992).”
Method
Comparative study on social-economic status, trauma and mental health disorders among older and younger refugees in Australia
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“(HTQ; Mollica et al., 1992) was developed to measure the intensity of the three core symptoms of”
Background
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“Exposure to traumatic events was assessed using the Harvard Trauma Questionnaire (Mollica et al., 1992).”
Method
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“In the model, pre-migration trauma is conceptualized using the eight types of trauma identified by Mollica et al. (1992): (1) material deprivation; (2) war-like conditions; (3) bodily injury; (4) brain injury; (5) forced confinement and coercion; (6) forced to harm others; (7) disappearance,…”
MethodInfluential
Trauma Exposure and Intimate Partner Violence Among Young Pregnant Women in Liberia
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“First, for research focusing mainly on trauma, the key factor to bear in mind is direct exposure to violence and potentially traumatic events such as physical assault, the destruction of one’s home, or the disappearance or death of loved ones (Mollica et al., 1992).”
Background
Trauma, Reparation, and Quality of Life in Victims of Armed Conflict after Peace Agreements
Fernández, M. R. S., Rivero, J. C. C., Picón, W. M. S., Ruiz, D. E. S., Londoño, M. C. E., Campos, J. H. V., Guarch-Rubio, M., & Manzanero, A. L. (2021) · Anuario de Psicología Jurídica · doi:10.5093/apj2021a21 · Cited by 11
“, 2013), with the study of mental health being the most frequent study (Ayazi et al., 2014; Bentley et al., 2011; De Fouchier et al., 2012; Eisenman et al., 2003; Gómez-Varas et al., 2016; Guarch-Rubio & Manzanero, 2017; Manzanero et al., 2021; Mollica et al., 2014; Mollica et al., 1992; Sabin et al., 2003; Stanciu &…”
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Method
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“While an interviewer conducted the Genogram and the HTQ with a parent, the other interviewer conducted the HUTQ-C and PTSS-C to the child.”
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Mothering Here and Mothering There: International Migration and Postbirth Mental Health
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BackgroundMethod
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Method
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Forensic evaluation of sequels to torture
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Special competencies for psychological assessment of torture survivors
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“Mollica et al. (1992) have reported data on the psychometric properties of the HTQ.”
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Method
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Method
The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences
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Method
Pooled analysis of the association between mental health and violence against women: evidence from five settings in the Global South
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Self-Reported Emotional and Behavioral Problems, Family Functioning and Parental Bonding Among Psychiatric Outpatient Adolescent Offspring of Croatian Male Veterans with Partial PTSD
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Method
Traumatic Experiences and Post‐traumatic Stress Symptoms in Kurdish Children in their Native Country and in Exile
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“This instrument was developed from the Harvard Trauma Questionnaire (HTQ) ( Mollica et al., 1992 ).”
Method
Measurement Invariance of the Brief Symptom Inventory in Survivors of Torture and Trauma
Raghavan, S. S., Rosenfeld, B. D., & Rasmussen, A. (2015) · Journal of Interpersonal Violence · doi:10.1177/0886260515619750 · Cited by 10
“Although measures such as the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992) and the Hopkins Symptom Checklist (HSCL; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) possess strong psychometric validity in diverse populations, they focus exclusively on symptoms of PTSD (in the case…”
Positive or negative change in outlook on life following sexual assault and associations to PTSD severity
Hansen, N. B., Hansen, M., Nielsen, L. H., & Elklit, A. (2016) · Sexual & Relationship Therapy · doi:10.1080/14681994.2016.1169266 · Cited by 10
“PTSD severity was assessed at 3 and 12 months following the assault using the Danish version of the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992).”
Method
A Case Study of the Effects of Posttraumatic Stress Disorder on Operational Fire Service Personnel Within the Lancashire Fire and Rescue Service
Khan, K., Charters, J., Graham, T. L., Nasriani, H. R., Ndlovu, S., & Mai, J. (2017) · Safety and Health at Work · doi:10.1016/j.shaw.2017.11.002 · Cited by 10
“While a number of historic USA-derived screening tools were available, the development of culturally sensitive psychological tests and symptom checklists for assessing anxiety and depression is promoted [67].”
Background
Daily Worry in Trauma-Exposed Afghan Refugees: Relationship with Affect and Sleep in a Study Using Ecological Momentary Assessment
Koch, T., Liedl, A., Takano, K., & Ehring, T. W. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10091-7 · Cited by 10
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Elklit, A., Nielsen, L. H., Lasgaard, M., & Duch, C. (2012) · Journal of Loss and Trauma · doi:10.1080/15325024.2012.679125 · Cited by 10
“The Harvard Trauma Questionnaire (HTQ), developed by Mollica, Caspi-Yavin, Bollini, and Truong ( 1992 ), includes items derived from the DSM-II-R criteria for PTSD.”
Method
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Shannon, P. J., McCleary, J. S., Wieling, E. A., et al. (2015) · Journal of Immigrant & Refugee Studies · doi:10.1080/15562948.2014.894170 · Cited by 10
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Background
Somatic Complaint and Social Suffering Among Survivors of the Cambodian Killing Fields
Uehara, E. S., Morelli, P. T. T., & Abe-Kim, J. S. (2000) · Journal of Human Behavior in the Social Environment · doi:10.1300/j137v03n03_15 · Cited by 10
“Modified versions of the traumatic events list from the Cambodian version of the Harvard Trauma Questionnaire (Mollica et al., 1992) and a post-traumatic stress disorder screening protocol (DSM-IV APA 1994) were used to determine history of distress.”
Method
Using an Interpreter as Cofacilitator
Dubus, N. (2014) · Social Work With Groups · doi:10.1080/01609513.2014.931670 · Cited by 10
Victimization and PTSD in Ugandan Youth
Mandrup, L., & Elklit, A. (2014) · Open Journal of Epidemiology · doi:10.4236/ojepi.2014.43020 · Cited by 10
“The Harvard Trauma Questionnaire—Part IV (HTQ) was used to estimate the occurrence of PTSD in the time following the most distressing event as chosen by the student [30].”
Method
Investigating the psychological impact of bank robbery: A cohort study
Hansen, M., Armour, C., Shevlin, M. E., & Elklit, A. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.04.005 · Cited by 10
“The estimated acute stress disorder (ASD) rate (T1; N = 450) was 11.8% and the estimated PTSD rate (T2; N = 371) was 6.2% according the DSM-IV (APA, 1994) assessed by the ASDS (Bryant et al., 2000) and the HTQ (Mollica et al., 1992) (cf., Hansen & Elklit, 2013 for more details on this procedure).”
MethodInfluential
Neural Correlates of Posttraumatic Stress Disorder Symptoms, Trauma Exposure, and Postmigration Stress in Response to Fear Faces in Resettled Refugees
Liddell, B. J., Cheung, J., Outhred, T., Das, P., Malhi, G. S., Felmingham, K. L., Nickerson, A., Den, M. L., Askovic, M., Coello, M., et al. (2019) · Clinical Psychological Science · doi:10.1177/2167702619841047 · Cited by 12
The Injury Distress Index: Development and Validation
Victorson, D. E., Enders, C. K., Burnett, K. F., & Ouellette, E. A. (2008) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2008.02.032 · Cited by 10
Adolescence and Youth among Displaced Ethiopians: A Case Study in Kaliti Camp
Aptekar, L., Paardekooper, B., & Kuebli, J. E. (2000) · International Journal of Group Tensions · doi:10.1023/a:1005130830462 · Cited by 10
Common practice elements of school-based trauma interventions for children and adolescents exhibiting symptoms of post-traumatic stress disorder: a systematic review
Kenyon, G. D. M., & Schirmer, J. (2020) · Journal of Psychologists and Counsellors in Schools · doi:10.1017/jgc.2019.31 · Cited by 11
“…Post-Traumatic Stress Disorder Reaction Index (UCLA PTSD Index; Steinberg, Brymer, Decker, & Pynoos, 2004); 3Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992); 4Cognitive-behavioural therapy (CBT); 5Cognitive-Behavioural Intervention for Trauma in Schools (CBITS; Jaycox et al.,…”
Background
Integrating a Transdiagnostic Psychological Intervention Into Routine HIV Care: A Mixed-Methods Evaluation of the Common Elements Treatment Approach in Mozambique
Fabian, K. E., Muanido, A., Cumbe, V., Mukunta, C., Manaca, N., Dorsey, S., Hammett, W. H., & Wagenaar, B. H. (2021) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000002863 · Cited by 10
Mental health of asylum seekers and refugees: The role of trauma and postmigration living difficulties and the moderating effect of intergroup contact
Pouraghajan, S., Ullrich, J., & Morina, N. (2023) · Current Research in Ecological and Social Psychology · doi:10.1016/j.cresp.2023.100118 · Cited by 13
The structure of ICD ‐11 post traumatic stress disorder in a clinical sample of refugees based on the International Trauma Interview
Vindbjerg, E., Sandahl, H., Mortensen, E. L., Roberts, N. P., & Carlsson, J. M. (2023) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13592 · Cited by 10
“The original validation study of the Harvard Trauma Questionnaire 36 demonstrates a test – retest correlation of just 0.32 for internal avoidance.”
MethodInfluential
Compassion buffers the association between trauma exposure and PTSD symptom severity: Findings of a cross-sectional study
Wesarg, C., Gallistl, M., Niconchuk, M., Böckler, A., O’Malley, B., & Engert, V. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107036 · Cited by 11
“Trauma was measured with the trauma events section of the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), in which participants indicated whether they had experienced any of 42 traumatic events (e. g., oppression, imprisonment, combat exposure) before coming to Germany.”
MethodInfluential
Self-construal modulates default mode network connectivity in refugees with PTSD
Liddell, B. J., Das, P., Malhi, G. S., Jobson, L., Lau, W., Felmingham, K. L., Nickerson, A., Askovic, M., Aroche, J., Coello, M., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.06.009 · Cited by 10
The longitudinal relationship between psychological symptoms and social functioning in displaced refugees
Nickerson, A., Kurt, G., Liddell, B. J., Keegan, D., Nandyatama, R. W., Yuanita, A., Rachmah, R. A., Hoffman, J., Kashyap, S., Mastrogiovanni, N., et al. (2025) · Psychological Medicine · doi:10.1017/s0033291724003519 · Cited by 10
“Exposure to PTEs was indexed using the 16-item Harvard Trauma Questionnaire (Mollica et al., 1992) and 3 additional items relating to natural disaster, physical assault or exposure to serious accident, fire, or explosion (Nickerson et al., 2023).”
Clinical Correlates of Deliberate Self-Harm Among Migrant Trauma-Affected Subgroups
Baralla, F., Ventura, M., Negay, N., Napoli, A. D., Petrelli, A., Mirisola, C., & Sarchiapone, M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.529361 · Cited by 9
“To obtain information about the type of PTEs that had occurred during an individual’s lifetime, and/or during the migration process, we used the Harvard Trauma Questionnaire (HTQ) (50).”
MethodInfluential
“I Have No Capacities That Can Help Me”: Young Asylum Seekers in Norway and Serbia – Flight as Disturbance of Developmental Processes
Varvin, S., Vladisavljević, I., Jović, V., & Sagbakken, M. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.786210 · Cited by 10
“God was with me”: A qualitative study of Christian meaning‐making among refugees
Shannonhouse, L., Dosal‐Terminel, D., Kwag, D., Hall, M. E. L., Park, C. L., McMartin, J., Silverman, E. J., Aten, J. D., O’Connor, M. H., & Kapic, K. M. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22997 · Cited by 13
Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial
Stein, J., Vöhringer, M., Wagner, B., Stammel, N., Nesterko, Y., Böttche, M., & Knaevelsrud, C. (2023) · JMIR Mental Health · doi:10.2196/48689 · Cited by 9
Stressors Related to Immigration and Migration Background in Turkish Patients with Psychiatric Disorder: Validity of a Short Questionnaire (MIGSTR10)
Müller, M. J., & Koch, E. (2011) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-011-9510-5 · Cited by 9
Seeking Life Balance
Catolico, O. (2013) · Journal of Transcultural Nursing · doi:10.1177/1043659613481624 · Cited by 9
“…diagnostic framework of posttraumatic stress disorder or psychiatric disorder (Boehnlein, Kinzie, Ben, & Fleck, 1985; Carlson & Rosser-Hogan, 1994; Kinzie et al., 1990; Kinzie, Fredrickson, Ben, Fleck, & Karls, 1984; Mollica et al., 1992; Mollica, Wyshak, de Marneffe, Khuon, & Lavelle, 1987).”
Trauma in Resettled Iraqi Refugees: Differences between Those Seeking Psychological Treatment and Those Not Seeking Psychological Treatment
Slewa‐Younan, S., Radulovic, M., Lujic, S., Hasan, T., & Raphael, B. (2014) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2014.955897 · Cited by 9
Politics and Research of Immigration: Implications for Counseling and Psychological Scholarship and Action
Yakushko, O. F., & Consoli, M. L. M. (2014) · Journal for Social Action in Counseling & Psychology · doi:10.33043/jsacp.6.1.98-121 · Cited by 11
“Among these measures is, for example, the Harvard Trauma Questionnaire (Mollica et al., 1992), which can be used to assess exposure to traumatic events and post-traumatic symptoms among refugees and immigrants.”
Background
Psychology, migration studies, and their disconnections: a review of existing research and future possibilities
Palmary, I. (2018) · South African Journal of Psychology · doi:10.1177/0081246317751276 · Cited by 9
“While this is a field that is less explicitly aligned with psychology (and indeed a large part of this literature is more oriented towards political studies or anthropology), there are clear overlaps with the psychological literature on identity and belonging (see Narchal, 2007). Indeed, Berry (1995), in his book on p…”
BackgroundInfluential
Vocal emotion expressions in infant‐directed singing: The impact of war trauma and maternal mental health and the consequences on infant development
Punamäki, R., Vänskä, M., Quota, S. R., Perko, K., & Diab, S. Y. (2020) · Infant and Child Development · doi:10.1002/icd.2176 · Cited by 9
“The 16-item scale of posttraumatic stress disorder (PTSD) symptoms, obtained from the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), was applied.”
Method
Trauma-Associated Psychiatric Disorders Among South Sudanese Dinka and Nuer Women Resettled in the USA
Tutlam, N. T., Flick, L. H., Xian, H., Matsuo, H., Glowinski, A. L., & Tutdeal, N. (2020) · Global Social Welfare · doi:10.1007/s40609-020-00171-7 · Cited by 9
“A small number (six) of the women who spoke fluent classical Arabic completed the Iraqi Arabic version of the HTQ.”
MethodInfluential
Women health: Psychological and most prominent somatic problems in 3-year follow-up in Bosnian refugees
Vuković, I. S., Jovanović, N., Kulenović, A. D., Britvić, D., & Mollica, R. F. (2020) · International Journal of Social Psychiatry · doi:10.1177/0020764020972433 · Cited by 10
“Both instruments have been widely used in a number of studies among diverse cultural groups (Mollica et al., 1992, 1996; Mughal et al., 2020; Wind et al., 2017).”
BackgroundSelf-citation
A Sense of No Future in an Uncertain Present: Altruism and Risk-Seeking among Syrian Refugees in Jordan
El‐Bialy, N., Aranda, E. F., Nicklisch, A., Saleh, L., & Voigt, S. (2021) · Journal of Refugee Studies · doi:10.1093/jrs/feab037 · Cited by 10
Chronic Pain and Psychological Distress Among Undocumented Latinx Immigrants in the USA
Garcini, L. M., Brown, R. L., Ziauddin, K., Chen, M. A., Saucedo, L., LeRoy, A. S., Morales, P., Fagundes, C. P., & Tsevat, J. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-020-05910-2 · Cited by 9
“Participants completed an adapted version of the Traumatic Events Inventory of the Harvard Trauma Questionnaire (HTQ), designed to assess traumatic experiences among at-risk immigrants .(23) The adapted version consisted of 25 items assessing traumatic events along 7 Garcini et al.”
Method
The Development of Posttraumatic Stress Disorder and Depression Symptoms in Iraqi Refugees
Yamin, J. B., Sudan, S., Lumley, M. A., Dhalimi, A., Arnetz, J. E., Stemmer, P. M., Burghardt, P. R., Jamil, H. J., & Arnetz, B. B. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001360 · Cited by 10
“Copyright © 2021 Wolters Kluwer H Predisplacement trauma exposure was assessed with the Harvard Trauma Questionnaire (Mollica et al., 1992; Shoeb et al., 2007).”
Method
Resilience and Hope Among Yazidi Women Released From ISIS Enslavement
Taha, P. H., Nguyen, T. P., & Slewa‐Younan, S. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001400 · Cited by 9
“The Harvard Trauma Questionnaire (HTQ) is a widely used self-reported checklist that measures the occurrence and frequency of different types of traumatic events along with PTSD symptoms (Mollica et al., 1992).”
Method
Prevalence and factors associated with PTSD among female urban slum dwellers in Ibadan, Nigeria: a cross-sectional study
Sekoni, O. O., Mall, S., & Christofides, N. J. (2021) · BMC Public Health · doi:10.1186/s12889-021-11508-y · Cited by 11
Moderator effects in a randomized controlled trial of the Common Elements Treatment Approach (CETA) for intimate partner violence and hazardous alcohol use in Zambia
Fine, S. L., Kane, J. C., Murray, S. M., Skavenski, S. V. W., Paul, R., & Murray, L. K. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108995 · Cited by 11
“…experiences of trauma (binary response scale; range 0–17; threshold for high trauma exposure defined using a median split) and 39 items assessing past-week symptoms of PTSD (4-point response scale; range 0–117; threshold for PTSD was average item-level score of ≥2.5) (Mollica et al., 1992).”
MethodInfluential
Psychometric Concerns in the Assessment of Trauma-related Symptoms in Older Adults
van Zelst, W. H., & Beekman, A. T. F. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195399066.013.0019 · Cited by 8
Coping with Trauma and Symptoms of Post-Traumatic Stress Disorder: Exploring Intentions and Lay Beliefs about Appropriate Strategies among Asylum-Seeking Migrants from Sub-Saharan Africa in Germany
Grupp, F., Moro, M. R., Skandrani, S., & Mewes, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031783 · Cited by 9
“The list of potentially traumatic events (23 items) was extended by items from the Harvard trauma questionnaire [34] which are frequently experienced by asylumseekers.”
Background
Association between unmet post-arrival expectations and psychological symptoms in recently arrived refugees
Allinson, C. H., & Berle, D. (2022) · Transcultural Psychiatry · doi:10.1177/13634615221111022 · Cited by 9
“The PTSD-8 was derived from the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), and has demonstrated strong psychometric properties.”
Method
Prolonged grief disorder in Arabic-speaking treatment-seeking populations: Relationship with socio-demographic aspects, loss- and trauma-related characteristics, and mental health support
Specht, F., Vöhringer, M., Knaevelsrud, C., Wagner, B., Stammel, N., & Böttche, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.933848 · Cited by 9

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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