Cross-cultural adaptation and psychometric validation of The Continuous Traumatic Stress Response Scale: Ukrainian version
DOI:
https://doi.org/10.29038/eejpl.2024.11.1.zasKeywords:
continuous traumatic stress, moral injury, secondary traumatic stress, cross-cultural adaptation, translation, validationAbstract
Adapting and validating diagnostic tools aimed to evaluate the post-traumatic effects of war in low-income countries is essential for assessing needs and planning support programs. This paper will describe the process of cross-cultural adaptation and psychometric validation of The Continuous Traumatic Stress Response (CTSR) Scale for war-affected Ukraine. The study includes Phase 1, Translation and cross-cultural adaptation of the Scale, and Phase 2, Psychometric validation of the Scale. Cross-cultural adaptation goes through four stages: forward translation, expert panel review and back translation (n=3), pretesting and cognitive interviewing mental health professionals (n=8), and final version. Psychometric validation includes exploratory (n=200) and confirmatory (n=419) factor analyses, internal consistency, construct validity and test-retest reliability. Findings from the current research indicate that the components identified through factor analyses differed from those in the original questionnaire. While all original items in the questionnaire were retained, they merged into two new factors: “Exhaustion and Rage” and “Fear and Betrayal”. The results show that the overall Cronbach’s Alpha is .858, indicating a high level of internal consistency. Significant correlations exist between the total CTSR Scale score, the subscale scores, PTSD (PCL-5), moral injury (MISS-C-SF), depression (PHQ-9), and anxiety (GAD-7) symptoms, indicating construct validity. The findings demonstrate the test-retest reliability of the CTSR Scale and have practical implications for how it could be implemented in trauma-informed care.
Acknowledgements
This study was initiated as part of the projects Exposure to Continuous Traumatic Stress and Its Consequences Among Young Adults in Ukraine, which was supported by the British Academy Researchers at Risk Fellowship (2022-2025), and Living on the Edge: Continuous Traumatic Stress in Adolescents During Military Conflict funded by the Leverhulme Research Support Grant (2023-2024).
Data Availability Statement
The data that support the findings of this study are openly available in Mendeley Data: Zasiekina, Larysa (2024), “Exploratory and confirmatory factor analyses of the Ukrainian version of CTSR Scale”, Mendeley Data, V1, https://doi.org/10.17632/22xt2zj86t.1.
Disclosure Statement
The authors reported no potential conflicts of interest.
* Corresponding author: Larysa Zasiekina,
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References
American Psychiatric Association, D. S. M. T. F., & American Psychiatric Association, D. S. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American psychiatric association.
Armour, C., Műllerová, J., & Elhai, J. D. (2016). A systematic literature review of PTSD's latent structure in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV to DSM-5. Clinical Psychology Review, 44, 60-74. https://doi.org/10.1016/j.cpr.2015.12.003
Balqis-Ali, N. Z., Saw, P. S., Jailani, A. S., Fun, W. H., Mohd Saleh, N., Tengku Bahanuddin, T. P. Z., ... & Lee, S. W. H. (2021). Cross-cultural adaptation and exploratory factor analysis of the Person-centred Practice Inventory-Staff (PCPI-S) questionnaire among Malaysian primary healthcare providers. BMC Health Services Research, 21, 1-12. https://doi.org/10.1186/s12913-020-06012-9
Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588. https://psycnet.apa.org/doi/10.1037/0033-2909.88.3.588
Chen, F., Curran, P. J., Bollen, K. A., Kirby, J., & Paxton, P. (2008). An empirical evaluation of the use of fixed cutoff points in RMSEA test statistic in structural equation models. Sociological Methods & Research, 36(4), 462-494. https://doi.org/10.1177/0049124108314720
Fani, N., Currier, J. M., Turner, M. D., Guelfo, A., Kloess, M., Jain, J., … Turner, J. A. (2021). Moral injury in civilians: associations with trauma exposure, PTSD, and suicide behaviour. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1965464
Foley, J., Hassett, A., & Williams, E. (2022). ‘Getting on with the job’: A systematised literature review of secondary trauma and posttraumatic stress disorder (PTSD) in policing within the United Kingdom (UK). The Police Journal, 95(1), 224–252. https://doi.org/10.1093/sw/52.1.63
Goral, A., Feder-Bubis, P., Lahad, M., Galea, S., O’Rourke, N., & Aharonson-Daniel, L. (2021). Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats. PloS one, 16(5), e0251724. https://doi.org/ 10.1371/journal.pone.0251724
Hajjar, S. T. (2018). Statistical analysis: Internal consistency reliability and construct validity. International Journal of Quantitative and Qualitative Research Methods, 6(1), 27-38.
Hoyle, R. H., & Duvall, J. L. (2004). Determining the number of factors in exploratory and confirmatory factor analysis. Handbook of quantitative methodology for the social sciences, pp. 301–315.
Kaminer, D., Eagle, G., & Crawford-Browne, S. (2018). Continuous traumatic stress as a mental and physical health challenge: Case studies from South Africa. Journal of Health Psychology, 23(8), 1038–1049. https://doi.org/10.1177/1359105316642831
Kazlauskas, E., Dumarkaite, A., Gelezelyte, O., Nomeikaite, A., & Zelviene, P. (2023). Validation of the recovery experience questionnaire in Lithuanian healthcare personnel. International Journal of Environmental Research and Public Health, 20(3), 2734. https://doi.org/10.3390/ijerph20032734
Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., ... & Pearce, M. (2018). The moral injury symptom scale-military version. Journal of Religion and Health, 57(1), 249-265. https://doi.org/10.1007/s10943-017-0531-9
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–661. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Lina, Y., Michael, C., Souha, F., & Helen, S. (2019). The translation and cultural adaptation validity of the Actual Scope of Practice Questionnaire. https://doi.org/10.26719/emhj.18.028
Lima, E. D. P., Vasconcelos, A. G., Berger, W., Kristensen, C. H., Nascimento, E. D., Figueira, I., & Mendlowicz, M. 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. https://doi.org/10.1590/2237-6089-2015-0074
Schnyder, U., Bryant, R. A., Ehlers, A., Foa, E. B., Hasan, A., Mwiti, G., Kristensen, C. H., Neuner, F., Oe, M., & Yule, W. (2016). Culture-sensitive psychotraumatology. European Journal of Psychotraumatology, 7(1), 31179. https://doi.org/10.3402/ejpt.v7.31179
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (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
Starrs, C. J., & Békés, V. (2024). Historical intergenerational trauma transmission model: A comprehensive framework of family and offspring processes of transgenerational trauma. Traumatology. https://psycnet.apa.org/doi/10.1037/trm0000505
Vukčević Marković, M., & Živanović, M. (2022). Coping with secondary traumatic stress. International Journal of Environmental Research and Public Health, 19(19), 12881. https://doi.org/10.3390%2Fijerph191912881
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5)—Standard [Measurement instrument]. Retrieved 26/03/2023 from https://www.ptsd.va.gov/
World Health Organization. Process of translation and adaptation of instruments. (2020). Retrieved from https://www.who.int/substance_abuse/research_tools/translation/-en/
Zasiekina, L., Duchyminska, T., Bifulco, A., & Bignardi, G. (2023). War trauma impacts in Ukrainian combat and civilian populations: Moral injury and associated mental health symptoms. Military Psychology, 1-12. https://doi.org/10.1080/08995605.2023.2235256
Zasiekina, L., Kokun, O., Kozihora, M., Fedotova, T., Zhuravlova, O., & Bojko, M. (2022). A concept analysis of moral injury in Ukrainian National Guard service members’ narratives: A clinical case study. East European Journal of Psycholinguistics, 9(1), 296-314. https://doi.org/10.29038/eejpl.2022.9.1.zas
Zasiekina, L., & Kozihora, M. (2022). Cultural adaptation and standardisation of Military Injury Symptoms Scale. Psychological Prospects Journal, (39), 139-152. https://doi.org/10.29038/2227-1376-2022-39-zas
APPENDIX
Ukrainian Version of the Continuous Traumatic Stress Response (CTSR) Scale
Українська версія шкали «Реакція на тривалий травматичний стрес» (РТТС)
Назва субшкали #Перелік пунктів
Виснаження та лють
# 1. Я почуваюся демотивованим/-ою.
# 2. Я почуваюся розумово виснаженим/-ою.
# 4. Я відчуваю, що моє життя беззмістовне.
# 5. Мені важко контролювати свої емоції.
# 7. Мені здається, що ніхто не розуміє мене.
# 9. У мене трапляються епізоди люті.
Страх та зрада
# 3. Я відчуваю, що моє життя в небезпеці.
# 6. Мені важко довіряти людям, які мене оточують.
# 8. Я відчуваю сильний страх та тривогу.
# 10. Я почуваюся зрадженим/-ою.
# 11. Я відчуваю, що не можу захистити тих, хто від мене залежить.
.0=Зовсім ні, 1=Деякою мірою, 2=Дуже сильно, 3=Нестерпно сильно
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Copyright (c) 2024 Larysa Zasiekina, Aviva Goral, Tetiana Fedotova, Anastasiya Akimova, Anastasiia Martyniuk
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