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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Background
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MethodSelf-citation
Impact of refugee trauma on children's occupational role as school students*
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Method
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BackgroundMethod
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Self-citation
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BackgroundMethod
Diagnostic test accuracy of screening tools for post-traumatic stress disorder among refugees and asylum seekers: A systematic review and meta-analysis
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Method
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Method
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Method
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Method
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Method
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Background
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“…profiles on intake as indicated by quantitative measures obtained for the larger study: Harvard Trauma Questionnaire (HTQ-total): M¼ 3.2, SD¼ 0.44 (Mollica et al., 1992); depression and anxiety on Hopkins Symptom Checklist (HSCL): M¼ 2.9, SD¼ 0.48; Hamilton Depression Scale: M¼ 24.0, SD¼ 5.5,…”
BackgroundMethodInfluential
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Method
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Background
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“PTSD symptoms Score, 60+ cut off, binary Thirty items of the Harvard Trauma Questionnaire [38, 39].”
Method
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Method
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Background
Resilience and its association with mental health among forcibly displaced populations: A systematic review and meta-analyses
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PTSD Symptoms Mediate the Effect of Attachment on Pain and Somatisation after Whiplash Injury
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“The HTQ self-report measure of PTSD has an 88% concordance rate with interview based estimates of PTSD [41].”
Method
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“Feeling jumpy, easily startled (D5) Note: HTQ, Harvard Trauma Questionnaire; DSM-IV-TR, Diagnostic and Statistical Manua stress disorder; A, avoidance; N, numbing; H, hyperarousal; D, dysphoria; DA, dysphoria Simms et al. (2002) dysphoria model; 3, Elhai et al. (2011b) five-factor model. arousal) differ from D4-D5 (an…”
BackgroundMethodInfluential
Impact of Traumatic Events on Posttraumatic Stress Disorder among Danish Survivors of Sexual Abuse in Childhood
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“The Harvard Trauma Questionnaire Part IV (HTQ; Mollica et al., 1992) was applied for estimating the occurrence of PTSD at the time of the present study.”
Method
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Method
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Self-citation
Treatment of traumatised refugees with basic body awareness therapy versus mixed physical activity as add-on treatment: Study protocol of a randomised controlled trial
Nordbrandt, M. S., Carlsson, J. M., Lindberg, L. G., Sandahl, H., & Mortensen, E. L. (2015) · Trials · doi:10.1186/s13063-015-0974-9 · Cited by 21
“It is inter-nationally applied [67] and thoroughly validated in several different languages and adapted for refugee populations [58 – 60, 68, 69].”
Rationale and study protocol for a multi-component Health Information Technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting
Biegler, K. A., Mollica, R. F., Sim, S. E., Nicholas, E. A., Chandler, M., Ngo‐Metzger, Q., Paigne, K., Paigne, S., Nguyen, D. V., & Sorkin, D. H. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.07.001 · Cited by 18
Self-citation
Remembering and Responding to Distressing Autobiographical Memories: Exploring Risk and Intervention Targets for Posttraumatic Stress in Traumatized Refugees
Aizik-Reebs, A., Yuval, K., & Bernstein, A. (2017) · Clinical Psychological Science · doi:10.1177/2167702617713786 · Cited by 19
“PTS severity was computed by calculating the mean severity of 46 symptoms (1 = not at all, 2 = a little, 3 = quite a bit, 4 = extremely; Mollica et al., 1992).”
Method
Sexual trauma and post-traumatic stress among African female refugees and migrants in South Africa
Mhlongo, M., Tomita, A. M., Thela, L. T., Maharaj, V., & Burns, J. K. (2018) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v24i0.1208 · Cited by 24
Posttraumatic stress disorder correlates among internally displaced Yazidi population following Islamic state of Iraq and Syria attacks in Iraq
Taha, P. H., Taib, N. I., & Sulaiman, H. M. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03299-8 · Cited by 18
Posttraumatic stress in adult civilians exposed to violent conflict, war and associated human rights abuses in the Eastern Mediterranean Region: A systematic review and meta-analysis
Stein, J., Niemeyer, H., Meyer, C., Wirz, C., Eiling, A., Gruzman, R., Heeke, C., Stammel, N., & Knaevelsrud, C. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.06.042 · Cited by 18
Mental Health Risk and Protective Factors of Nigerian Male Asylum Seekers Hosted in Southern Italy: a Culturally Sensitive Quantitative Investigation
Tessitore, F., Parola, A., & Margherita, G. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01260-3 · Cited by 18
The association between long-distance migration and PTSD prevalence in Syrian refugees
Eiset, A. H., Aoun, M. P., Nielsen, M. S., Gottlieb, A. G., Haddad, R. S., Frydenberg, M., & Naja, W. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03982-4 · Cited by 18
“The outcome, PTSD, was assessed using the Harvard Trauma Questionnaire (HTQ): A self-administered scale to assess symptoms of PTSD in the past week according to the DSM-IV criteria [27] and validated in multiple settings, languages and populations [28–30].”
Method
Posttraumatic Stress Disorder After Bereavement: Early Psychological Sequelae of Losing a Close Relative Due to Terminal Cancer
Kristensen, T. E., Elklit, A., & Karstoft, K. (2012) · Journal of Loss and Trauma · doi:10.1080/15325024.2012.665304 · Cited by 18
Reliability of self report questionnaires for epidemiological investigations of adolescent mental health in Cape Town, South Africa
Rothon, C., Stansfeld, S. A., Mathews, C., Kleinhans, A., Clark, C., Lund, C., & Flisher, A. J. (2011) · Journal of Child and Adolescent Mental Health · doi:10.2989/17280583.2011.634551 · Cited by 19
“The scale comprised 27 items addressing exposure to violence (1= experienced, 0 = not experienced) during the previous 12 months (Mollica et al. 1992).”
BackgroundMethod
Prediction of adaptation difficulties by country of origin, cumulate psychosocial stressors and attitude toward integrating: A Swedish study of first-generation immigrants from Somalia, Vietnam and China
Johnsson, E., Zolkowska, K., & Mcneil, T. (2015) · International Journal of Social Psychiatry · doi:10.1177/0020764014537639 · Cited by 19
“…Residential crowding: lived with eight or more persons in the same house (vs 1–7); (c) Experienced trauma per the Harvard Trauma Questionnaire (HTQ, Mollica et al., 1992) (vs no); (d) Lived in a refugee camp (vs no); (e) Sought political asylum in Sweden (vs work/study/family reunion/other…”
Background
Treating post‐traumatic stress disorder by resource activation in Cambodia
Steinert, C., Bumke, P. J., Hollekamp, R. L., Larisch, A., Leichsenring, F., Mattheß, H., Sisokhom, S., Sodemann, U., Stingl, M., Ret, T., et al. (2016) · World Psychiatry · doi:10.1002/wps.20303 · Cited by 16
In War’s Wake
Farwell, N. (2003) · International Journal of Mental Health · doi:10.1080/00207411.2003.11449596 · Cited by 18
A Naturalistic Evaluation of Group Integrative Adapt Therapy (IAT-G) with Rohingya Refugees During the Emergency Phase of a Mass Humanitarian Crisis in Cox's Bazar, Bangladesh
Tay, A. K., Miah, M. A. A., Khan, S. T., Mohsin, M., Alam, A. N. M. M., Ozen, S., Mahmuda, M., Elshazly, M., Ahmed, H. U., Silove, D., et al. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.100999 · Cited by 19
“The HTQ is a widely used measure for PSTD symptoms among refugees, and originally used for Indochinese refugees [47], and it has been validated and used in many post-conflict and humanitarian settings.”
Method
Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo
Lawry, L. L., Kannappan, N. S., Canteli, C., & Clemmer, W. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-052306 · Cited by 17
Meaning in Life, Future Orientation and Support for Violent Radicalization Among Canadian College Students During the COVID-19 Pandemic
Miconi, D., Geenen, G., Frounfelker, R. L., Levinsson, A., & Rousseau, C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.765908 · Cited by 22
Refugee‐related trauma patterns and mental health symptoms across three generations of Hmong Americans
Lor, M., Yu, Z., Chen, W., Xiong, Y., Yonker, J. A., Brown, R., & Krahn, D. D. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22813 · Cited by 16
Discrimination and mental health of Somali immigrants in North America: a longitudinal study from 2013 to 2019
Ellis, B. H., Sideridis, G. D., Davis, S. H., Cardeli, E., Abdi, S. M., & Lincoln, A. K. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02235-9 · Cited by 21
Strange but common bedfellows: The relationship between humanitarians and the military in developing psychosocial interventions for civilian populations affected by armed conflict
Kienzler, H., & Pedersen, D. (2012) · Transcultural Psychiatry · doi:10.1177/1363461512447927 · Cited by 17
Acute Stress Disorder in Physical Assault Victims Visiting a Danish Emergency Ward
Elklit, A., & Brink, O. (2003) · Violence and Victims · doi:10.1891/vivi.2003.18.4.461 · Cited by 17
“The Harvard Trauma Questionnaire-Part IV (HTQ; Mollica et al., 1992) was used to estimate the occurrence of ASD at the time of the event.”
BackgroundMethod
Psychological interventions for post‐traumatic stress disorder in people living with HIV in Resource poor settings: a systematic review
Verhey, R., Chibanda, D., Brakarsh, J., & Seedat, S. (2016) · Tropical Medicine & International Health · doi:10.1111/tmi.12756 · Cited by 18
“As shown in Table 2, the Rwandan study, the only study from Africa, followed up 698 women of whom 75% were HIV-positive and over 60% had a diagnosis of PTSD according to the Harvard Trauma Questionnaire (HTQ) [36].”
MethodInfluential
Collective trauma among displaced populations in Northern Iraq: A case study evaluating the therapeutic interventions of the Free Yezidi Foundation
Womersley, G., & Arikut-Treece, Y. (2019) · Intervention · doi:10.4103/intv.intv_56_18 · Cited by 16
“PTSD was defined according to a scoring algorithm previously described by the Harvard Refugee Trauma Group on the basis of DSM-IV diagnostic criteria (American Psychiatric Association, 1994; Mollica et al., 1992).”
Method
Seeking sanctuary: rethinking asylum and mental health
Jannesari, S., Hatch, S. L., & Oram, S. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796020000669 · Cited by 17
“The HSCL-25 was created with US participants (Parloff et al., 1954) and the HTQ with participants from South East Asia (Mollica et al., 1992).”
Measuring psychological trauma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Psychological Trauma item bank and short form
Kisala, P. A., Victorson, D. E., Pace, N. M., Heinemann, A. W., Choi, S. W., & Tulsky, D. S. (2015) · Journal of Spinal Cord Medicine · doi:10.1179/2045772315y.0000000022 · Cited by 20
Risk factors for posttraumatic stress disorder following an industrial disaster in a residential area: A note on the origin of observed gender differences
Spindler, H., Elklit, A., & Christiansen, D. M. (2010) · Gender Medicine · doi:10.1016/j.genm.2010.04.001 · Cited by 17
Methodology for the identification of vulnerable asylum seekers
Visentin, S., Pelletti, G., Bajanowski, T., & Ferrara, S. D. (2017) · International Journal of Legal Medicine · doi:10.1007/s00414-017-1645-z · Cited by 17
Post-Traumatic Stress Disorder (PTSD) Symptoms in Secondary Stalked Children of Danish Stalking Survivors—A Pilot Study
Elklit, A., Vangsgaard, L. A. G., Olsen, A. S. W., & Ali, S. A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16050725 · Cited by 16
“The HTQ has been reported to have high reliability and validity, internal consistency, test–retest reliability, and concurrent validity [33,35,36].”
BackgroundMethod
Effect of post-migration detention on mental health among Afghan asylum seekers in Japan
Ichikawa, M., Nakahara, S., & Wakai, S. (2006) · Australian & New Zealand Journal of Psychiatry · doi:10.1111/j.1440-1614.2006.01800.x · Cited by 17
The Relationship between Statement Giving at the South African Truth and Reconciliation Commission and Psychological Distress among Former Political Detainees
Kagee, A. (2006) · South African Journal of Psychology · doi:10.1177/008124630603600102 · Cited by 16
The transmission of intergenerational trauma and protective factors in survivors of the lebanese civil war and their adult offspring
Tarabay, J., & Golm, D. (2024) · International Journal of Intercultural Relations · doi:10.1016/j.ijintrel.2024.101952 · Cited by 18
Do good, stay well. Well-being and work satisfaction among German refugee helpers: A national cross-sectional study
Jobst, E., Gall, C. M., Eiche, C., Birkholz, T., & Prottengeier, J. (2018) · PLoS ONE · doi:10.1371/journal.pone.0209697 · Cited by 16
Development, feasibility, acceptability and preliminary evaluation of the internet and mobile phone-based BSHAPE intervention for Immigrant survivors of cumulative trauma
Sabri, B., Vroegindewey, A., & Hagos, M. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106591 · Cited by 16
“The scores equal to or above average of 2.5 indicate PTSD (Mollica et al., 1992).”
Influential
Lessons learned from conducting a study of emotions and positive personality change in Syrian origin young adults who have recently resettled in the Netherlands
Chung, J. M., Meijer, L., Zonneveld, R., Sawaf, Z. A., Alajak, K., Moopen, N., Rahim, H. F., Çiftçi, L., Alisic, E., Stellar, J. E., et al. (2022) · European Journal of Personality · doi:10.1177/08902070221081319 · Cited by 20
“We were able to access Arabic versions of the Big Five Inventory-2-S1 (Soto & John, 2017) and the Harvard Trauma Questionnaire (Mollica et al., 1992; Shoeb et al., 2007); for all other measures, we implemented a backtranslation procedure with the goal of having Arabic versions of the questionnaires that were appropria…”
BackgroundMethodInfluential
The Longitudinal Association Between Posttraumatic Stress Disorder, Emotion Dysregulation, and Postmigration Stressors Among Refugees
Specker, P., Liddell, B. J., O'Donnell, M. L., Bryant, R. A., Mau, V., McMahon, T., Byrow, Y., & Nickerson, A. (2023) · Clinical Psychological Science · doi:10.1177/21677026231164393 · Cited by 19
“The 16-item Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992) was used at T1 to index exposure to different types of traumatic events commonly experienced by refugees.”
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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