Posttraumatic stress disorder among refugees: Measurement invariance of Harvard Trauma Questionnaire scores across global regions and response patterns

Despite the central role of posttraumatic stress disorder (PTSD) in international humanitarian aid work, there has been little examination of the measurement invariance of PTSD measures across culturally defined refugee subgroups. This leaves mental health workers in disaster settings with little to support inferences made using the results of standard clinical assessment tools, such as the severity of symptoms and prevalence rates. We examined measurement invariance in scores from the most widely used PTSD measure in refugee populations, the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), in a multinational and multilingual sample of asylum seekers from 81 countries of origin in 11 global regions. Clustering HTQ responses to justify grouping regional groups by response patterns resulted in 3 groups for testing measurement invariance: West Africans, Himalayans, and all others. Comparing loglikelihood ratios showed that while configural invariance seemed to hold, metric and scalar invariance did not. These findings call into question the common practice of using standard cut-off scores on PTSD measures across culturally dissimilar refugee populations. In addition, high correlation between factors suggests that the construct validity of scores from North American and European measures of PTSD may not hold globally.