The factor structures and correlates of PTSD in post-conflict Timor-Leste: an analysis of the Harvard Trauma Questionnaire

Alvin Kuowei Tay, Mohammed Mohsin, Susan Rees, Zachary Steel, Natalino Tam, Zelia Soares, Jessica Baker, Derrick Silove

Post-traumatic stress disorder (PTSD) is the most widely assessed form of mental distress in cross-cultural studies conducted amongst populations exposed to mass conflict and displacement. Nevertheless, there have been longstanding concerns about the universality of PTSD as a diagnostic category when applied across cultures. One approach to examining this question is to assess whether the same factor structure can be identified in culturally diverse populations as has been described in populations of western societies. We examine this issue based on an analysis of the Harvard Trauma Questionnaire (HTQ) completed by a large community sample in conflict-affected Timor-Leste. Culturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), ongoing adversities, symptoms of PTSD and psychological distress, and functional impairment amongst a large population sample (n = 2964, response rate: 82.4%) in post-conflict Timor-Leste. Confirmatory factor analyses of the ICD-10, ICD-11, DSM-IV, four-factor Emotional Numbing and five-factor Dysphoric-Arousal PTSD structures, found considerable support for all these models. Based on these classifications, concurrent validity was indicated by logistic regression analyses which showed that being a woman, trauma exposure, ongoing adversity, severe distress, and functional impairment were all associated with PTSD. Although symptom prevalence estimates varied widely based on different classifications, our study found a general agreement in PTSD assignments across contemporary diagnostic systems in a large conflict-affected population in Timor-Leste. Further studies are needed, however, to establish the construct and concurrent validity of PTSD in other cultures.