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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Government-Sanctioned Torture: Status of the Rehabilitation Movement
Jaranson, J. M. (1995) · Transcultural Psychiatric Research Review · doi:10.1177/136346159503200302 · Cited by 24
“Other tools for outcome research, such as culturally-validated assessment instruments, are also clearly needed for this task (e.g., Mollica et al.,1990, 1992; Mollica & Caspi-Yavin, 1992).”
Method
Predictors of Psychological Sequelae of Torture Among South African Former Political Prisoners
Halvorsen, J. Ø., & Kagee, A. (2010) · Journal of Interpersonal Violence · doi:10.1177/0886260509340547 · Cited by 23
“Mollica et al. (1992) selected a cutoff score of 75 (a mean score of 2.5) to maximize classification accuracy of PTSD.”
MethodInfluential
Towards a description of the elements of art therapy practice for trauma: a systematic review
Bowen-Salter, H., Whitehorn, A., Pritchard, R., Kernot, J., Baker, A., Posselt, M., Price, E., Jordan-Hall, J., & Boshoff, K. (2022) · International Journal of Art Therapy · doi:10.1080/17454832.2021.1957959 · Cited by 24
“The Harvard Trauma Questionnaire (Mollica et al., 1992), Impact of Events Scale (Revised) (Weiss, 2007), and Posttraumatic Stress Disorder Scale (Foa et al., 1996), were also used as measures of trauma in the included studies.”
Method
Long-term mental health outcome in post-conflict settings: Similarities and differences between Kosovo and Rwanda
Eytan, A., Munyandamutsa, N., Nkubamugisha, P. M., & Gex‐Fabry, M. (2014) · International Journal of Social Psychiatry · doi:10.1177/0020764014547062 · Cited by 23
“For the first question, surveyors read a list of potentially traumatic events adapted from the first part of the Harvard Trauma Questionnaire (HTQ) (Mollica et al., 1992).”
Background
Health Outcomes of Traumatic Brain Injury Among Refugee Survivors of Torture
Keatley, E. S., d'Alfonso, A., Abeare, C. A., Keller, A. S., & Bertelsen, N. S. (2015) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000103 · Cited by 23
Victimization and PTSD in an Indian youth sample from Pune City
Rasmussen, D. J., Karsberg, S., Karstoft, K., & Elklit, A. (2013) · Open Journal of Epidemiology · doi:10.4236/ojepi.2013.31003 · Cited by 22
“Good validity and reliability on HTQ has been reported cross-culturally [26,27] in very culturally diverse countries, although it seems that certain items may carry different meanings across cultures [28].”
BackgroundMethodInfluential
Fear of Cultural Extinction and Psychopathology Among Mandaean Refugees: An Exploratory Path Analysis
Nickerson, A., Bryant, R. A., Brooks, R., Steel, Z., & Silove, D. M. (2009) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2009.00094.x · Cited by 25
“Exposure to trauma and symptoms of PTSD were assessed using the Harvard Trauma Questionnaire (HTQ) [41].”
Method
Patterns of risk for anxiety-depression amongst Vietnamese-immigrants: a comparison with source and host populations
Liddell, B. J., Chey, T., Silove, D. M., Phan, T. T., Giao, N. M., & Steel, Z. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-329 · Cited by 23
“0 PTSD module), with 14 additional items included from the Harvard Trauma Questionnaire [28] in the Vietnamese surveys due to the particular relevance of these items to the trauma history of Southeast Asian refugees.”
MethodInfluential
Six-year trajectories of post-traumatic stress and severe psychological distress symptoms and associations with timing of trauma exposure, ongoing adversity and sense of injustice: a latent transition analysis of a community cohort in conflict-affected Timor-Leste
Tay, A. K., Rees, S. J., Steel, Z., Tam, N., Soares, Z., Soares, C., & Silove, D. M. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010205 · Cited by 24
“Recruitment was restricted to two localities and the sample cannot be regarded as representative of the broader population of Timor-Leste.”
MethodInfluential
PTSD in Court I: Introducing PTSD for Court
Young, G. C. (2016) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2016.10.012 · Cited by 24
Development and Validation of the Arab Youth Mental Health Scale
Makhoul, J., Nakkash, R. T., Hajj, T. E., Abdulrahim, S., Kanj, M., Mahfoud, Z. R., & Afifi, R. (2010) · Community Mental Health Journal · doi:10.1007/s10597-010-9312-6 · Cited by 23
Trauma-related Emotional Patterns and their Association with Post-Traumatic and Somatic Symptoms
Näätänen, P., Kanninen, K. M., Qouta, S., & Punamäki, R. (2002) · Anxiety Stress & Coping · doi:10.1080/10615800290007308 · Cited by 22
“Distinctive to PTSD are three very different response patterns: re-experiencing the trauma in thoughts, images, flashback and nightmares, avoiding and numbing the related ideations and feelings, and being aroused by and hypervigilant of traumarelated memories (Mollica et al., 1992).”
Background
Examining the relationship between coping strategies and post-traumatic stress disorder in forcibly displaced populations: A systematic review
Figueiredo, S., & Petravičiūtė, A. (2025) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2025.100535 · Cited by 24
Mediators of focused psychosocial support interventions for children in low‐resource humanitarian settings: analysis from an Individual Participant Dataset with 3,143 participants
Purgato, M., Tedeschi, F., Betancourt, T. S., Bolton, P. A., Bonetto, C., Gastaldon, C., Gordon, J. S., O’Callaghan, P., Papola, D., Peltonen, K., et al. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13151 · Cited by 24
“To measure improvement in PTSD symptoms, the Child Post-traumatic Symptom Scale (Foa et al., 2001), the 8-item Impact of Events Scale (CRIES-8) (Yule et al., 1994), the Harvard Trauma Questionnaire (Mollica et al., 1992), and the University of California Los Angeles (UCLA) Post-Traumatic Stress Disorder Reaction Index…”
The Association Between Trauma Centrality and Posttraumatic Stress Among Syrian Refugees: The Impact of Cognitive Distortions and Trauma-Coping Self-Efficacy
Chung, M. C., & Shakra, M. (2020) · Journal of Interpersonal Violence · doi:10.1177/0886260520926311 · Cited by 24
Social comorbidities? A qualitative study mapping syndemic theory onto gender-based violence and co-occurring social phenomena among Brazilian women
Hall, C. D. X., & Evans, D. (2020) · BMC Public Health · doi:10.1186/s12889-020-09352-7 · Cited by 23
“It is important to note that experiencing, witnessing, and awareness of violence are recognized as indicators of trauma in the literature, including validated measures [23].”
Background
Resilience and associated factors in women survivors of Intimate Partner Violence: a systematic review
Álvarez, N. F., Gómez, Y. F., & Rodríguez, Á. A. (2022) · Anales de Psicología · doi:10.6018/analesps.461631 · Cited by 40
“Harvard Trauma Questionnaire (Mollica et al., 1992).”
Risk Assessment Instruments for Intimate Partner Femicide: A Systematic Review
Garcia-Vergara, E., Almeda, N., Fernández-Navarro, F., & Becerra-Alonso, D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.896901 · Cited by 20
“Questionnaire (Mollica et al., 1992), the PPS-R (Johnson et al.”
Deep Learning based techniques for Neuro-degenerative disorders detection
Kasyap, V. L. V. S. K. B., & Dasari, C. M. (2023) · Engineering Applications of Artificial Intelligence · doi:10.1016/j.engappai.2023.106103 · Cited by 23
Perceived discrimination and its association with self-rated health, chronic pain, mental health, and utilization of health services among Syrian refugees in Norway: a cross-sectional study
Dadras, O., & Díaz, E. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1264230 · Cited by 25
The impact of detention on the health of asylum seekers: An updated systematic review: A systematic review
Filges, T., Bengtsen, E., Montgomery, E., & Kildemoes, M. W. (2024) · Campbell Systematic Reviews · doi:10.1002/cl2.1420 · Cited by 23
“…Thompson [Thompson et al., 1998; Silove et al., 1998]) used the HTQ, probably the Indochinese version as they all refer FIGURE 1 Flow chart. to (Mollica et al., 1992), which describes the development and validation of an Indochinese version of the HTQ which originally included 17 items…”
Method
Startle habituation, sensory, and sensorimotor gating in trauma-affected refugees with posttraumatic stress disorder
Meteran, H., Vindbjerg, E., Uldall, S. W., Glenthoj, B. Y., Carlsson, J. M., & Oranje, B. (2018) · Psychological Medicine · doi:10.1017/s003329171800123x · Cited by 22
“Symptom severity at the time of electrophysiological testing was further evaluated by administering the Harvard Trauma Questionnaire (HTQ), a validated 16-item self-report rating scale developed for trauma-affected refugees (Mollica et al. , 1992).”
Community Resilience and Long-Term Impacts of Mental Health and Psychosocial Support in Northern Rwanda
Otake, Y. (2018) · Medical Sciences · doi:10.3390/medsci6040094 · Cited by 22
Pathways to perinatal depressive symptoms after mass conflict in Timor-Leste: a modelling analysis using cross-sectional data
Silove, D. M., Rees, S. J., Tay, A. K., Costa, Z. M. D., Savio, E., Soares, C., & Tol, W. A. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)00054-6 · Cited by 23
Tobacco Use and Nicotine Dependence among Conflict-Affected Men in the Republic of Georgia
Roberts, B., Chikovani, I., Makhashvili, N., Patel, V., & McKee, M. (2013) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph10062185 · Cited by 24
Prevalence of posttraumatic stress disorder and associated factors among displaced people in Africa: a systematic review and meta-analysis
Andualem, F., Melkam, M., Takelle, G. M., Nakie, G., Tinsae, T., Fentahun, S., Rtbey, G., Begashaw, T. D., Seid, J., Tegegn, L. F., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1336665 · Cited by 24
Primary Care Screening Methods and Outcomes for Asylum Seekers in New York City
Bertelsen, N. S., Selden, E. B., Krass, P., Keatley, E. S., & Keller, A. S. (2016) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-016-0507-y · Cited by 22
Patterns of violence and coercion with mental health among female and male trafficking survivors: a latent class analysis with mixture models
Iglesias-Ríos, L., Harlow, S. D., Burgard, S. A., West, B. T., Kiss, L., & Zimmerman, C. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796019000295 · Cited by 23
“The HTQ has been used extensively in cross-cultural settings and among Southeast Asian populations exposed to trauma (Mollica et al., 1992, 1993, 1996; Kleijn et al., 2001).”
Method

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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