Exposure to potentially traumatic events is a global health problem, especially in low- and middle-income countries. Assessments for symptoms resulting from trauma exposure rely heavily on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria for post-traumatic stress disorder (PTSD), which may not be relevant in all regions of the globe. We examined posttrauma symptoms that were not limited to Western constructs of mental health (i.e., PTSD). In a systematic review, we searched nine databases to identify posttrauma symptoms arising in qualitative literature published before July 17, 2017. A total of 17,938 records were identified and 392 met inclusion criteria. The 392 studies represented data on 400 study populations from 71 different nationalities/ethnicities. The presence and frequency of posttrauma symptoms were examined across all regions. Fisher’s exact tests were also conducted to compare frequencies in posttrauma symptoms across region and gender. Based on a weighted analysis across regions, a list of global posttrauma symptoms (N = 85) was compiled into an item bank. We found that the majority of DSM-5 PTSD symptoms were mentioned across regions (with the exception of inability to recall specific aspects of the trauma and blame of self or others for the event). Across all regions, we also found a number of symptoms mentioned that were not part of PTSD and its associated features. Findings suggest that assessing posttrauma symptoms solely based on PTSD may be limiting to global populations. Research, policy, and practice implications are discussed.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
2.
BenjetC.BrometE.KaramE. G.KesslerR. C.McLaughlinK. A.RuscioA. M.…KoenenK. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the world mental health survey consortium. Psychological Medicine, 46, 327–343. doi:10.1017/s0033291715001981
3.
BetancourtT. S.SpeelmanL.OnyangoG.BoltonP. (2009). A qualitative study of mental health problems among children displaced by war in northern Uganda. Transcultural Psychiatry, 46, 238–256. doi:10.1177/1363461509105815
4.
CaramanicaK.BrackbillR. M.LiaoT.StellmanS. D. (2014). Comorbidity of 9/11-related PTSD and depression in the world trade center health registry 10–11 years postdisaster. Journal of Traumatic Stress, 27, 680–688. doi:10.1002/jts.21972
5.
CarragherN.SunderlandM.BatterhamP. J.CalearA. L.ElhaiJ. D.ChapmanC.MillsK. (2016). Discriminant validity and gender differences in DSM-5 posttraumatic stress disorder symptoms. Journal of Affective Disorders, 190, 56–67. doi:0.1016/j.jad.2015.09.071
6.
CollinsD. (2003). Pretesting survey instruments: An overview of cognitive methods. Quality of Life Research, 12, 229–238. Retrieved fromhttp://www.jstor.org/stable/4038871
7.
ComptonW. M.GuzeS. B. (1995). The neo-Kraepelinian revolution in psychiatric diagnosis. European Archives of Psychiatry and Clinical Neuroscience, 245, 196–201. doi:10.1007/BF02191797
8.
De JongJ. T.KomproeI. H.SpinazzolaJ.van der KolkB. A.Van OmmerenM. H. (2005). DESNOS in three postconflict settings: Assessing cross-cultural construct equivalence. Journal of Traumatic Stress, 18, 13–21. doi:10.1002/jts.20005
9.
DelkerB. C.FreydJ. J. (2014). From betrayal to the bottle: Investigating possible pathways from trauma to problematic substance use. Journal of Traumatic Stress, 27, 576–584. doi:10.1002/jts.21959
10.
DorahyM. J.CorryM.ShannonM.WebbK.McDermottB.RyanM.DyerK. F. (2013). Complex trauma and intimate relationships: The impact of shame, guilt and dissociation. Journal of Affective Disorders, 147, 72–79. doi:10.1016/j.jad.2012.10.010
11.
ElhaiJ. D.GrayM. J.KashdanT. B.FranklinC. L. (2005). Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects? A survey of traumatic stress professionals. Journal of Traumatic Stress, 18, 541–545. doi:10.1002/jts.20062
12.
ErtlV.PfeifferA.SaileR.SchauerE.ElbertT.NeunerF. (2011). Validation of a mental health assessment in an African conflict population. Psychological Assessment, 22, 318–324. doi:10.1037/a0018810
13.
FoxS. H. (2003). The Mandinka nosological system in the context of post-trauma syndromes. Transcultural Psychiatry, 40, 488–506.
14.
FreydJ. J.DePrinceA. P.GleavesD. H. (2007). The state of betrayal trauma theory: Reply to McNally—Conceptual issues, and future directions. Memory, 15, 295–311. doi:10.1080/096582107012565414
15.
GreeneT.NeriaY.GrossR. (2016). Prevalence, detection and correlates of PTSD in the primary care setting: A systematic review. Journal of Clinical Psychology in Medical Settings, 23, 160–180. doi:10.1007/s10880-016-9449-8
16.
HallB. J.ElhaiJ. D.GrubaughA.TuerkP.MagruderK. (2012). Examining the factor structure of PTSD between male and female veterans in primary care. Journal of Anxiety Disorders, 26, 409–415. doi:10.1016/j.janxdis.2011.12.015
17.
HarozE. E.BassJ. K.LeeC.MurrayL. K.RobinsonC.BoltonP. (2014). Adaptation and testing of psychosocial assessment instruments for cross-cultural use: An example from the Thailand Burma border. BMC Psychology, 2, 31. doi:10.1186/s40359-014-0031-6
18.
HeQ.GlasC. A.VeldkampB. P. (2014). Assessing impact of differential symptom functioning on post-traumatic stress disorder (PTSD) diagnosis. International Journal of Methods in Psychiatric Research, 23, 131–141. doi:10.1002/mpr.1417
19.
HermanJ. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377–391. doi:10.1002/jts.2490050305
20.
HintonD. E.HintonA. L.EngK. T.ChoungS. (2012). PTSD and key somatic complaints and cultural syndromes among rural Cambodians: The results of a needs assessment survey. Medical Anthropology Quarterly, 26, 383–407. doi:10.1111/j.1548-1387.2012.01224.x
21.
HintonD. E.Lewis-FernándezR. (2011). The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety, 28, 783–801. doi:10.1002/da.20753
22.
HintonD. E.ReisR.de JongJ. (2015). The “thinking a lot” idiom of distress and PTSD: An examination of their relationship among traumatized Cambodian refugees using the “Thinking a Lot” Questionnaire. Medical Anthropology Quarterly, 29, 357–380. doi:10.1111/maq.122204
23.
HollifieldM.WarnerT. D.LianN.KrakowB.JenkinsJ. H.KeslerJ.…WestermeyerJ. (2002). Measuring trauma and health status in refugees: A critical review. JAMA, 288, 611–621. doi:10.1001/jama.288.5.611
24.
HruskaB.IrishL. A.PacellaM. L.SledjeskiE. M.DelahantyD. L. (2014). PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims: A latent class analysis. Journal of Anxiety Disorders, 28, 644–649. doi:10.1016/j.janxdis.2014.06.009
25.
KaiserB. N.HarozE. E.KohrtB. A.BoltonP. A.BassJ. K.HintonD. E. (2015). Thinking too much: A systematic review of a common idiom of distress. Social Science & Medicine, 147, 170–183. doi:10.1016/j.socscimed.2015.10.044
26.
KesslerR.ChiuW.DemlerO.MerikangasK.WaltersE. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 709–709. doi:10.1001/archpsyc.62.6.617
27.
KingL. A.OrcuttH. K.KingD. W. (2002). Gender differences in stress, trauma, and PTSD research: Application of two quantitative methods (pp. 403–433). New York, NY: Guilford Press.
28.
LimaE. d. P.VasconcelosA. G.BergerW.KristensenC. H.NascimentoE. d.FigueiraI.MendlowiczM. V. (2016). Cross-cultural adaptation of the Posttraumatic Stress Disorder Checklist 5 (PCL-5) and Life Events Checklist 5 (LEC-5) for the Brazilian context. Trends in Psychiatry and Psychotherapy, 38, 207–215. doi:10.1590/2237-6089-2015-0074
29.
LincolnY. S.GubaE. G. (1985). Naturalistic Inquiry. Newbury Park, CA: Sage.
30.
MacDonaldP. L.GardnerR. C. (2000). Type I error rate comparisons of post hoc procedures for I j Chi-square tables. Educational and Psychological Measurement, 60, 735–754.
31.
MasindaM. T.MuhesiM. (2004). Trauma in children/adolescents: A special focus on third world countries. Journal of Child and Adolescent Mental Health, 16, 69–76. doi:10.2989/17280580409486572
32.
MeyerS. R.RobinsonW. C.ChhimS.BassJ. K. (2014). Labor migration and mental health in Cambodia a qualitative study. Journal of Nervous and Mental Disease, 202, 200–208. doi:10.1097/nmd.0000000000000101
33.
MichalopoulosL. M.UnickG. J.HarozE. E.BassJ.MurrayL. K.BoltonP. A. (2015). Exploring the fit of western PTSD models across three non-western low-and middle-income countries. Traumatology, 21, 55. doi:10.1037/trm0000020
34.
MichalopoulosL. T.MurrayL. K.KaneJ. C.van WykS. S.ChombaE.CohenJ.…BoltonP. A. (2015). Testing the validity and reliability of the shame questionnaire among sexually abused girls in Zambia. PLoS One, 10, e0123820. doi:10.1371/journal.pone.0123820
35.
MoherD.LiberatiA.TetzlaffJ.AltmanD. & The Prima Group (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–269. doi:10.7326/0003-4819-151-4-200908180-00135
36.
MollicaR. F.Caspi-YavinY.BolliniP.TruongT.TorS.LavelleJ. (1992). The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180, 111–116.
37.
MurrayL. K.HaworthA.SemrauK.SinghM.AldrovandiG. M.SinkalaM.…BoltonP. A. (2006). Violence and abuse among HIV-infected women and their children in Zambia: A qualitative study. Journal of Nervous and Mental Disease, 194, 610. doi:10.1097/01.nmd.0000230662.01953.bc
38.
NguyenT. H.HanH. R.KimM. T.ChanK. S. (2014). An introduction to item response theory for patient-reported outcome measurement. The Patient-Patient-Centered Outcomes Research, 7, 23–35. doi:10.1007/s40271-013-0041-0
39.
NorrisF. H.SloneL. B. (2013). Understanding research on the epidemiology of trauma and PTSD. PTSD Research Quarterly, 24, 1–13.
40.
PalmK. M.StrongD. R.MacPhersonL. (2009). Evaluating symptom expression as a function of a posttraumatic stress disorder severity. Journal of Anxiety Disorders, 23, 27–37. doi:10.1016/j.janxdis.2008.03.012
41.
PelcovitzD.Van der KolkB.RothS.MandelF.KaplanS.ResickP. (1997). Development of a criteria set and a structured interview for disorders of extreme stress (SIDES). Journal of Traumatic Stress, 10, 3–16. doi:10.1002/jts.2490100103
42.
PorterM.HaslamN. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Journal of the American Medical Association, 294, 602–612. doi:10.1001/jama.294.5.602
43.
RasmussenA.EustacheE.RaviolaG.KaiserB.GrelottiD. J.BelkinG. S. (2015). Development and validation of a Haitian Creole screening instrument for depression. Transcultural Psychiatry, 52, 33–57. doi:10.1177/1363461514543546
44.
RasmussenA.KeatleyE.JoscelyneA. (2014). Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature. Social Science & Medicine, 109, 44–54. doi:10.1016/j.socscimed.2014.03.015
45.
RivollierF.PeyreH.HoertelN.BlancoC.LimosinF.DelormeR. (2015). Sex differences in DSM-IV posttraumatic stress disorder symptoms expression using item response theory: A population-based study. Journal of Affective Disorders, 187, 211–217. doi:10.1016/j.jad.2015.07.047
46.
SantiagoP. N.UrsanoR. J.GrayC. L.PynoosR. S.SpiegelD.Lewis-FernandezR.…FullertonC. 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, e59236. doi:10.1371/journal.pone.0059236
47.
SmithJ. R.PattonD. U. (2016). Posttraumatic stress symptoms in context: Examining trauma responses to violent exposures and homicide death among Black males in urban neighborhoods. American Journal of Orthopsychiatry, 86, 212–223. doi:10.1037/ort0000101
48.
StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: Author.
49.
SummerfieldD. (2000). Conflict and health: War and mental health: A brief overview. British Medical Journal, 321, 232–235. Retrieved fromhttp://www.jstor.org/stable/25225155
50.
SummerfieldD. (2004). 12 Cross-cultural perspectives on the medicalization of human suffering. Issues and Controversies, 233–245. doi:10.1002/9780470713570
51.
TalbotJ. A.TalbotN. L.TuX. (2004). Shame-proneness as a diathesis for dissociation in women with histories of childhood sexual abuse. Journal of Traumatic Stress, 17, 445–448. doi:10.1023/B:JOTS.0000048959.29766.ae
52.
ThomasE.MagilvyJ. K. (2011). Qualitative rigor or research validity in qualitative research. Journal for Specialists in Pediatric Nursing, 16, 151–155. doi:10.1111/j.1744-6155.2011.00283.x
53.
TobinG. A.BegleyC. M. (2004). Methodological rigour within a qualitative framework. Journal of Advanced Nursing, 48, 388–396. doi:10.1111/j.1365-2648.2004.03207.x
54.
VieraA. J.GarrettJ. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine, 37, 360–363.
55.
VreemanR. C.NyandikoW. M.AyayaS. O.WalumbeE. G.InuiT. S. (2014). Cognitive interviewing for cross-cultural adaptation of pediatric antiretroviral therapy adherence measurement items. International Journal of Behavioral Medicine, 21, 186–196. doi:10.1007/s12529-012-9283-9
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
