Psychometric Properties of the ITQ for Measuring ICD-11 Complex PTSD in a Spanish Sample of Women Survivors of Intimate Partner Violence

Abstract

Complex posttraumatic stress disorder (CPTSD) is related to prolonged, multiple, and interpersonal exposure to traumas. Several studies in different populations have focused on implementing the International Trauma Questionnaire (ITQ) to assess PTSD and CPTSD, though not in women survivors of intimate partner violence. The aim was to assess the psychometric properties of this measure in this population. The results obtained for this sample (N = 340) indicated excellent internal ITQ reliability. Moreover, a six-factor CPTSD first-order correlated model was considered, and concurrent validity supported ITQ administration to this population.

Keywords

International Trauma Questionnaire validation CPTSD intimate partner violence CFA

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Armour

Robinson

Ross

(2021). Factor structure of the international trauma questionnaire in UK armed forces veterans residing in Northern Ireland. European Journal of Psychotraumatology, 12(1), Article 1924954. https://doi.org/10.1080/20008198.2021.1924954

Beard

Hsu

K. J.

Rifkin

L. S.

Busch

A. B.

Björgvinsson

(2016). Validation of the PHQ-9 in a psychiatric sample. Journal of Affective Disorders, 193, 267–273. https://doi.org/10.1016/j.jad.2015.12.075

Ben-Ezra

Karatzias

Hyland

Brewin

C. R.

Cloitre

Bisson

J. I.

Roberts

N. P.

Lueger-Schuster

Shevlin

(2018). Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD-11 proposals: A population study in Israel. Depression and Anxiety, 35(3), 264–274. https://doi.org/10.1002/da.22723

Bland

J. M.

Altman

D. G.

(1997). Statistics notes: Cronbach's alpha. BMJ, 314, Article 572. https://doi.org/10.1136/bmj.314.7080.572

Bondjers

Hyland

Roberts

N. P.

Bisson

J. I.

Willebrand

Arnberg

F. K.

(2019). Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and complex PTSD: The international trauma interview in a Swedish sample. European Journal of Psychotraumatology, 10(1), Article 1665617. https://doi.org/10.1080/20008198.2019.1665617

Bradley

Schwartz

A. C.

Kaslow

N. J.

(2005). Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: Self-esteem, social support, and religious coping. Journal of Traumatic Stress. Official Publication of the International Society for Traumatic Stress Studies, 18(6), 685–696. https://doi.org/10.1002/jts.20077

Brown

(2006). Confirmatory factor analysis for applied research.

Browne

M. W.

Cudeck

(2016). Alternative ways of assessing model fit. Sociological Methods & Research, 21(2), 230–258. https://doi.org/10.1177/0049124192021002005

10.

Cherlin

A. J.

Burton

L. M.

Hurt

T. R.

Purvin

D. M.

(2004). The influence of physical and sexual abuse on marriage and cohabitation. American Sociological Review, 69, 768–789. https://doi.org/10.1177/000312240406900602

11.

Childress

(2013). A meta-summary of qualitative findings on the lived experience among culturally diverse domestic violence survivors. Issues in Mental Health Nursing, 34(9), 693–705. https://doi.org/10.3109/01612840.2013.791735

12.

Cloitre

Garvert

D. W.

Weiss

Carlson

E. B.

Bryant

R. A.

(2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1), Article 25097. https://doi.org/10.3402/ejpt.v5.25097

13.

Cloitre

Hyland

Prins

Shevlin

(2021). The International Trauma Questionnaire (ITQ) measures reliable and clinically significant treatment-related change in PTSD and complex PTSD. European Journal of Psychotraumatology, 12(1), Article 1930961. https://doi.org/10.1080/20008198.2021.1930961

14.

Cloitre

Shevlin

Brewin

C. R.

Bisson

J. I.

Roberts

N. P.

Maercker

Karatzias

Hyland

(2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138(6), 536–546. https://doi.org/10.1111/acps.12956

15.

Costa

E. C.

Gomes

S. C.

(2018). Social support and self-esteem moderate the relation between intimate partner violence and depression and anxiety symptoms among Portuguese women. Journal of Family Violence, 33(5), 355–368. https://doi.org/10.1007/s10896-018-9962-7

16.

Crapolicchio

Vezzali

Regalia

(2021). I forgive myself: The association between self-criticism, self-acceptance, and PTSD in women victims of IPV, and the buffering role of self-efficacy. Journal of Community Psychology, 49(2), 252–265. https://doi.org/10.1002/jcop.22454

17.

Cronbach

L. J.

(1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334. https://doi.org/10.1007/BF02310555

18.

Cyr

Belanger

Godbout

(2022). French translation and validation of the International Trauma Questionnaire in a Canadian community sample. Child Abuse & Neglect, 128, Article 105627. https://doi.org/10.1016/j.chiabu.2022.105627

19.

Dekel

Shaked

Ben-Porat

Itzhaky

(2020). The interrelations of physical and mental health: Self-rated health, depression, and PTSD among female IPV survivors. Violence Against Women, 26(3-4), 379–394. https://doi.org/10.1177/1077801219832916

20.

DeVellis

(2003). Scale development: Theory and applications. Sage Publications.

21.

Echeburúa

Amor

P. J.

Sarasua

Zubizarreta

Holgado-Tello

F. P.

Muñoz

J. M.

(2016). Escala de Gravedad de Síntomas Revisada (EGS-R) del Trastorno de Estrés Postraumático según el DSM-5: Propiedades psicométricas. Terapia psicológica, 34(2), 111–128. https://doi.org/10.4067/S0718-48082016000200004

22.

Fernández-Fillol

Hidalgo-Ruzzante

Pérez-García

Daugherty

J. C.

(2020). Translation and adaptation of the Spanish version of the International Trauma Questionnaire (ITQ) following ITC guidelines for translating and adapting tests. https://osf.io/preprints/psyarxiv/gps7k.

23.

Fernández-Fillol

Pitsiakou

Perez-Garcia

Teva

Hidalgo-Ruzzante

(2021). Complex PTSD in survivors of intimate partner violence: Risk factors related to symptoms and diagnoses. European Journal of Psychotraumatology, 12(1), Article 2003616. https://doi.org/10.1080/20008198.2021.2003616

24.

Flasch

Murray

C. E.

Crowe

(2015). Overcoming abuse: A phenomenological investigation of the journey to recovery from past intimate partner violence. Journal of Interpersonal Violence, 32(22), 3373–3401. https://doi.org/10.1177/0886260515599161

25.

Flora

D. B.

Curran

P. J.

(2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9(4), 466–491. https://doi.org/10.1037/1082-989x.9.4.466

26.

Freyd

J. J.

Klest

Allard

C. B.

(2005). Betrayal trauma: Relationship to physical health, psychological distress, and a written disclosure intervention. Journal of Trauma & Dissociation, 6, 83–104. https://doi.org/10.1300/j229v06n03_04

27.

Gelezelyte

Roberts

Kvedaraite

Bisson

Brewin

Cloitre

Kairyte

Karatzias

Shevlin

Kazlauskas

(2022). Validation of the international trauma interview (ITI) for the clinical assessment of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in a Lithuanian sample. European Journal of Psychotraumatology, 13(1), 2037905. https://doi.org/10.1080/20008198.2022.2037905

28.

Golding

J. M.

(1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14(2), 99–132. https://doi.org/10.1023/A:1022079418229

29.

Gonzalez-Guarda

R. M.

Vermeesch

A. L.

Florom-Smith

A. L.

McCabe

B. E.

Peragallo

N. P.

(2013). Birthplace, culture, self-esteem, and intimate partner violence among community-dwelling hispanic women. Violence Against Women, 19(1), 6–23. https://doi.org/10.1177/1077801212475336

30.

Hansen

Armour

McGlinchey

Ross

Ravn

S. L.

Andersen

T. E.

Lindekilde

Elmose

Karsberg

Fried

(2022). Investigating the DSM–5 and the ICD-11 PTSD symptoms using network analysis across two distinct samples. Psychological Trauma: Theory, Research, Practice, and Policy, 15(5), 757–766. https://doi.org/https://psycnet.apa.org/doi/10.1037/tra0001281

31.

Hansen

Vægter

H. B.

Cloitre

Andersen

T. E.

(2021). Validation of the Danish International Trauma Questionnaire for posttraumatic stress disorder in chronic pain patients using clinician-rated diagnostic interviews. European Journal of Psychotraumatology, 12(1), 1880747. https://doi.org/10.1080/20008198.2021.1880747

32.

Haselgruber

Sölva

Lueger-Schuster

(2020). Validation of ICD-11 PTSD and complex PTSD in foster children using the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 141(1), 60–73. https://doi.org/10.1111/acps.13100

33.

G. W. K.

Hyland

Shevlin

Chien

W. T.

Inoue

Yang

P. J.

Chen

F. H.

Chan

A. C.

Karatzias

(2020). 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, 11(1), Article 1717826. https://doi.org/10.1080%2F20008198.2020.1717826

34.

G. W.

Karatzias

Cloitre

Chan

A. C.

Bressington

Chien

W. T.

Hyland

Shevlin

(2019). 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, 10(1), Article 1608718. https://doi.org/10.1080/20008198.2019.1608718

35.

G. W. K.

Liu

Karatzias

Hyland

Cloitre

Lueger-Schuster

Brewin

C. R.

Guo

Wang

Shevlin

(2022). Validation of the International Trauma Questionnaire—Child and Adolescent Version (ITQ-CA) in a Chinese mental health service seeking adolescent sample. Child and Adolescent Psychiatry and Mental Health, 16(1), 1–8. https://doi.org/10.1186/s13034-022-00497-4

36.

Hooper

Coughlan

Mullen

M. R.

(2008). Structural equation modelling: Guidelines for determining model fit. Electronic Journal of Business Research Methods, 6(1), 53–60.

37.

L. T.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

38.

Hyland

Karatzias

Shevlin

Cloitre

Ben-Ezra

(2020). A longitudinal study of ICD-11 PTSD and complex PTSD in the general population of Israel. Psychiatry Research, 286, Article 112871. https://doi.org/10.1016/j.psychres.2020.112871

39.

Hyland

Shevlin

Brewin

C. R.

Cloitre

Downes

A. J.

Jumbe

Karatzias

Bisson

J. I.

Roberts

N. P.

(2017a). Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 136(3), 313–322. https://doi.org/10.1111/acps.12771

40.

Hyland

Shevlin

Elklit

Murphy

Vallières

Garvert

D. W.

Cloitre

(2017b). An assessment of the construct validity of the ICD-11 proposal for complex posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 1–9. https://doi.org/10.1037/tra0000114

41.

Hyland

Shevlin

Fyvie

Karatzias

(2018). Posttraumatic stress disorder and complex posttraumatic stress disorder in DSM-5 and ICD-11: Clinical and behavioral correlates. Journal of Traumatic Stress, 31(2), 174–180. https://doi.org/10.1002/jts.22272

42.

IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. IBM Corp.

43.

Johnson

S. U.

Ulvenes

P. G.

Øktedalen

Hoffart

(2019). Psychometric properties of the general anxiety disorder 7-item (GAD-7) scale in a heterogeneous psychiatric sample. Frontiers in Psychology, 10, Article 1713. https://doi.org/10.3389/fpsyg.2019.01713

44.

Kang

S. K.

Kim

(2011). A study of battered women’s purpose of life and resilience in South Korea. Asian Social Work and Policy Review, 5(3), 145–159. https://doi.org/10.1111/j.1753-1411.2011.00055.x

45.

Karatzias

Shevlin

Fyvie

Hyland

Efthymiadou

Wilson

Roberts

Bisson

J. I.

Brewin

C. R.

Cloitre

(2016). 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, 44, 73–79. https://doi.org/10.1016/j.janxdis.2016.10.009

46.

Kastello

J. C.

Jacobsen

K. H.

Gaffney

K. F.

Kodadek

M. P.

Sharps

P. W.

Bullock

L. C.

(2016). Predictors of depression symptoms among low-income women exposed to perinatal intimate partner violence (IPV). Community Mental Health Journal, 52(6), 683–690. https://doi.org/10.1007/s10597-015-9977-y

47.

Kazlauskas

Gegieckaite

Hyland

Zelviene

Cloitre

(2018). The structure of ICD-11 PTSD and complex PTSD in Lithuanian mental health services. European Journal of Psychotraumatology, 9(1), 1414559. https://doi.org/10.1080/20008198.2017.1414559

48.

Kazlauskas

Zelviene

Daniunaite

Hyland

Kvedaraite

Shevlin

Cloitre

(2020). The structure of ICD-11 PTSD and complex PTSD in adolescents exposed to potentially traumatic experiences. Journal of Affective Disorders, 265, 169–174. https://doi.org/10.1016/j.jad.2020.01.061

49.

Kelly

U. A.

(2010). Symptoms of PTSD and major depression in Latinas who have experienced intimate partner violence. Issues in Mental Health Nursing, 31(2), 119–127. https://doi.org/10.3109/01612840903312020

50.

Kessler

R. C.

Aguilar-Gaxiola

Alonso

Benjet

Bromet

E. J.

Cardoso

Degenhardt

de Girolamo

Dinolova

R. V.

Ferry

Florescu

Gureje

Haro

J. M.

Huang

Karam

E. G.

Kawakami

Lee

Lepine

J. P.

Levinson

, … Koenen

K. C.

(2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(Sup 5), Article 1353383. https://doi.org/10.1080/20008198.2017.1353383

51.

Kroenke

Spitzer

R. L.

(2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515. https://doi.org/https://psycnet.apa.org/doi/10.3928/0048-5713-20020901-06

52.

Lammers

Ritchie

Robertson

(2005). Women's experience of emotional abuse in intimate relationships: A qualitative study. Journal of Emotional Abuse, 5(1), 29–64. https://doi.org/https://psycnet.apa.org/doi/10.1300/J135v05n01_02

53.

Wang

Yuan

Zhou

Zhang

(2021). Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International Trauma Questionnaire. European Journal of Psychotraumatology, 12(1), Article 1888525. https://doi.org/10.1080/20008198.2021.1888525

54.

Lilly

M. M.

Howell

K. H.

Graham-Bermann

(2015). World assumptions, religiosity, and PTSD in survivors of intimate partner violence. Violence Against Women, 21(1), 87–104. https://doi.org/10.1177/1077801214564139

55.

Lilly

M. M.

Lim

B. H.

(2012). Shared pathogeneses of posttrauma pathologies: Attachment, emotion regulation, and cognitions. Journal of Clinical Psychology, 69, 737–748. https://doi.org/10.1002/jclp.21934

56.

Matheson

F. I.

Daoud

Hamilton-Wright

Borenstein

Pedersen

O’Campo

(2015). Where did she go? The transformation of self-esteem, self-identity, and mental well-being among women who have experienced intimate partner violence. Women’s Health Issues, 25(5), 561–569. https://doi.org/10.1016/j.whi.2015.04.006

57.

Nathanson

A. M.

Shorey

R. C.

Tirone

Rhatigan

D. L.

(2012). The prevalence of mental health disorders in a community sample of female victims of intimate partner violence. Partner Abuse, 3(1), 59–75. https://doi.org/10.1891/1946-6560.3.1.59

58.

Nerøien

A. I.

Schei

(2008). Partner violence and health: Results from the first national study on violence against women in Norway. Scandinavian Journal of Public Health, 36(2), 161–168. https://doi.org/10.1177/1403494807085188

59.

Nunnally

J. C.

Bernstein

I. H.

(1994). Psychometric theory (3rd ed.). McGraw-Hill.

60.

Owczarek

Ben-Ezra

Karatzias

Hyland

Vallieres

Shevlin

(2020). Testing the factor structure of the International Trauma Questionnaire (ITQ) in African community samples from Kenya, Ghana, and Nigeria. Journal of Loss and Trauma, 25(4), 348–363. https://doi.org/10.1080/15325024.2019.1689718

61.

Pico-Alfonso

M. A.

Garcia-Linares

M. I.

Celda-Navarro

Blasco-Ros

Echeburúa

Martinez

(2006). The impact of physical, psychological, and sexual intimate male partner violence on women’s mental health: Depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide. Journal of Women’s Health, 15(5), 599–611. https://doi.org/10.1089/jwh.2006.15.599

62.

Pill

Day

Mildred

(2017). Trauma responses to intimate partner violence: A review of current knowledge. Aggression and Violent Behavior, 34, 178–184. https://doi.org/https://psycnet.apa.org/doi/10.1016/j.avb.2017.01.014

63.

Potter

L. C.

Morris

Hegarty

García-Moreno

Feder

(2021). Categories and health impacts of intimate partner violence in the World Health Organization multi-country study on women’s health and domestic violence. International Journal of Epidemiology, 50(2), 652–662. https://doi.org/10.1093/ije/dyaa220

64.

R Core Team. (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria. URL https://www.R-project.org/.

65.

Rosseel

(2012). Lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48, 1–36. https://doi.org/10.18637/jss.v048.i02

66.

Rzeszutek

Lis-Turlejska

Pięta

Van Hoy

Zawistowska

Drabarek

Kozłowska

Szyszka

Frąc

(2021). Profiles of posttraumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD), and subjective well-being in a sample of adult children of alcoholics. Psychological Trauma: Theory, Research, Practice, and Policy, 16(Suppl 1), S143–S151. https://doi.org/10.1037/tra0001211

67.

Santiago

P. N.

Ursano

R. J.

Gray

C. L.

Pynoos

R. S.

Spiegel

Lewis-Fernandez

Friedman

M. J.

Fullerton

C. S.

(2013). A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: Intentional and non-intentional traumatic events. PloS One, 8(4), Article e59236. https://doi.org/10.1371%2Fjournal.pone.0059236

68.

Spitzer

R. L.

Kroenke

Williams

J. B.

Löwe

(2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092

69.

St. Vil

N. M.

Carter

Johnson

(2018). Betrayal trauma and barriers to forming new intimate relationships among survivors of intimate partner violence. Journal of Interpersonal Violence, 36(7-8), NP3495–NP3509. https://doi.org/10.1177/0886260518779596

70.

Tanaka

J. S.

(1987). “How big is big enough?": Sample size and goodness of fit in structural equation models with latent variables. Child Development, 58(1), 134–146. https://doi.org/10.2307/1130296

71.

Vallières

Ceannt

Daccache

Abou Daher

Sleiman

Gilmore

Byrne

Shevlin

Murphy

Hyland

(2018). 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, 138, 547–557. https://doi.org/https://doi.org/10.1111/acps.12973

72.

Vang

M. L.

Dokkedahl

S. B.

Løkkegaard

S. S.

Jakobsen

A. V.

Møller

Auning-Hansen

M. A.

Elklit

(2021). Validation of ICD-11 PTSD and DSO using the International Trauma Questionnaire in five clinical samples recruited in Denmark. European Journal of Psychotraumatology, 12(1), Article 1894806. https://doi.org/10.1080/20008198.2021.1894806

73.

Vogt

(2007). Research on women, trauma and PTSD. National Center for PTSD. http://www. ptsd. va. gov/professional/pages/women-traumaptsd. asp .

74.

Voorendonk

E. M.

De Jongh

Rozendaal

Van Minnen

(2020). Trauma-focused treatment outcome for complex PTSD patients: Results of an intensive treatment programme. European Journal of Psychotraumatology, 11(1), Article 1783955. https://doi.org/10.1080/20008198.2020.1783955

75.

Walker

L. E.

(2016). The battered woman syndrome. Springer publishing company.

76.

World Health Organization. (2018). International statistical classification of diseases and related health problems (11th Revision). WHO.

77.

World Health Organization, WHO. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. WHO Press.

78.

Yang

Wang

Cao

Fang

Zhang

Elhai

J. D.

(2017). The underlying dimensions of DSM-5 PTSD symptoms and their relations with anxiety and depression in a sample of adolescents exposed to an explosion accident. European Journal of Psychotraumatology, 8(1), 1272789.