Transcultural Validity of Trauma Measurement Instruments in the Middle East : A Psychometric Analysis
DOI:
https://doi.org/10.57213/caloryjournal.v3i3.794Keywords:
Cultural Adaptation, Middle East, Psychometric, Transcultural Validity, Trauma MeasurementAbstract
This meta-analytic study systematically examines the transcultural validity and psychometric characteristics of various instruments employed to measure psychological trauma in the Middle East. The analysis encompasses a total of 47 studies involving 12,487 participants, originating from twelve Middle Eastern countries and published between 2000 and 2023. Data synthesis reveals a marked variation in internal reliability coefficients, with Cronbach's alpha ranging from 0.73 to 0.92, and construct validity values spanning from 0.65 to 0.87. Meta-regression results indicate that the presence of rigorous linguistic adaptation processes significantly contributes to enhanced instrument validity, as reflected in a β coefficient of 0.43 with a significance level of p less than 0.001. Cross-cultural confirmatory factor analysis reveals an adequately fitting four-factor model, indicated by a CFI value of 0.92 and an RMSEA of 0.058. Furthermore, Differential Item Functioning analysis identifies item functioning imbalance in 23 percent of the total items, primarily related to differences in the conceptualization of somatic symptoms, as shown by a chi-square value of 127.84 and p less than 0.001. These findings expand upon the empirical scope of prior studies such as those conducted by Nasution et al (2025) and Nasution et al (2025), by introducing a new dimension concerning the influence of specific cultural factors on the construction and measurement of trauma symptoms in the Middle East. Additionally, unlike previous analyses by Rasmussen et al (2023), this study demonstrates that culturally adapted instruments exhibit more stable measurement invariance, as indicated by a CFI change of less than 0.01, compared to instruments that are merely translated literally. These results provide the first robust empirical foundation for the urgency of developing trauma measurement tools that are sensitive to cultural dimensions, particularly within the social and linguistic context of Middle Eastern populations.
References
Al Maqbali, M., Dunwoody, L., Rankin, J., Hacker, E., Hughes, C., & Gracey, J. (2020). Psychometric properties and cultural adaptation of sleep disturbance measures in Arabic‐speaking populations: A systematic review. Journal of Sleep Research, 29(1), e12877. https://doi.org/10.1111/jsr.12877
Alfakhry, G., Mustafa, K., Khwanda, R., Alhaffar, M., Alhomsi, K., & Kodmani, R. (2024). Translation, cultural adaptation, and linguistic validation of the postgraduate hospital educational environment measure into Arabic. BMC Medical Education, 24(1), 625. https://doi.org/10.1186/s12909-024-05611-y
Alghamdi, M., & Hunt, N. (2020). Psychometric properties of the Arabic Posttraumatic Diagnostic Scale for DSM-5 (A-PDS-5). Traumatology, 26(1), 109. https://doi.org/10.1037/trm0000204
Ali, A. M., Al-Amer, R., Kunugi, H., Stănculescu, E., Taha, S. M., Saleh, M. Y., ... & Hendawy, A. O. (2022). The Arabic version of the impact of event scale-revised: psychometric evaluation among psychiatric patients and the general public within the context of COVID-19 outbreak and quarantine as collective traumatic events. Journal of Personalized Medicine, 12(5), 681. https://doi.org/10.3390/jpm12050681
Alzaghoul, A. F., McKinlay, A. R., & Archer, M. (2022). Post-traumatic stress disorder interventions for children and adolescents affected by war in low-and middle-income countries in the Middle East: systematic review. BJPsych Open, 8(5), e153. https://doi.org/10.1192/bjo.2022.552
Arafat, S. Y., Chowdhury, H. R., Qusar, M. M. A. S., & Hafez, M. A. (2016). Cross-cultural adaptation and psychometric validation of research instruments: a methodological review. Journal of Behavioral Health, 5(3), 129–136. https://doi.org/10.5455/jbh.20160615121755
Ashraf, A., & Nassar, S. (2018). American Muslims and vicarious trauma: An explanatory concurrent mixed-methods study. American Journal of Orthopsychiatry, 88(5), 516. https://doi.org/10.1037/ort0000354
Awad, G. H., Kia-Keating, M., & Amer, M. M. (2019). A model of cumulative racial-ethnic trauma among Americans of Middle Eastern and North African (MENA) descent. American Psychologist, 74(1), 76. https://doi.org/10.1037/amp0000344
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
Benjamin, L., Gillard, S., Jones Nielsen, J., Costa E. Silva, M., & Sin, J. (2025). Cultural adaptations to the assessment and treatment of trauma experiences among racial and ethnic minority groups: a mixed-methods systematic review and meta-analysis. Trauma, Violence, & Abuse, 15248380251320982. https://doi.org/10.1177/15248380251320982
Berzengi, A., Berzenji, L., Kadim, A., Mustafa, F., & Jobson, L. (2017). Role of Islamic appraisals, trauma-related appraisals, and religious coping in the posttraumatic adjustment of Muslim trauma survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(2), 189. https://doi.org/10.1037/tra0000179
Borsa, J. C., Damásio, B. F., & Bandeira, D. R. (2012). Cross-cultural adaptation and validation of psychological instruments: Some considerations. Paidéia (Ribeirão Preto), 22, 423-432. https://doi.org/10.1590/S0103-863X2012000300014
Bronfenbrenner, U., & Morris, P. A. (1998). The ecology of developmental processes.
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1
Cruchinho, P., López-Franco, M. D., Capelas, M. L., Almeida, S., Bennett, P. M., Miranda da Silva, M., ... & Gaspar, F. (2024). Translation, cross-cultural adaptation, and validation of measurement instruments: a practical guideline for novice researchers. Journal of Multidisciplinary Healthcare, 2701-2728. https://doi.org/10.2147/JMDH.S419714
Davey, C., Heard, R., & Lennings, C. (2015). Development of the Arabic versions of the impact of events Scale‐Revised and the posttraumatic growth inventory to assess trauma and growth in middle Eastern refugees in Australia. Clinical Psychologist, 19(3), 131–139. https://doi.org/10.1111/cp.12043
de Graaff, A. M., Cuijpers, P., Leeflang, M., Sferra, I., Uppendahl, J. R., De Vries, R., & Sijbrandij, M. (2021). A systematic review and meta-analysis of diagnostic test accuracy studies of self-report screening instruments for common mental disorders in Arabic-speaking adults. Global Mental Health, 8, e43. https://doi.org/10.1017/gmh.2021.39
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56(2), 455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x
Eremenco, S. L., Cella, D., & Arnold, B. J. (2005). A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Evaluation & the Health Professions, 28(2), 212-232. https://doi.org/10.1177/0163278705275342
Fekih-Romdhane, F., Fawaz, M., Hallit, R., Sawma, T., Obeid, S., & Hallit, S. (2024). Psychometric properties of an Arabic translation of the 10-item Connor-Davidson resilience scale (CD-RISC-10), the 8-and 10-item post-traumatic growth inventory-short form (PTGI-SF) scales. Plos One, 19(1), e0293079. https://doi.org/10.1371/journal.pone.0293079
Fuchs, C. (1999). Diversity in linguistic representations. A challenge for cognition. Language Diversity and Cognitive Representations. Amsterdam, Philadelphia: John Benjamins, 3–19. https://doi.org/10.1075/hcp.3.03fuc
Gearing, R. E., Schwalbe, C. S., MacKenzie, M. J., Brewer, K. B., Ibrahim, R. W., Olimat, H. S., ... & Al-Krenawi, A. (2013). Adaptation and translation of mental health interventions in Middle Eastern Arab countries: A systematic review of barriers to and strategies for effective treatment implementation. International Journal of Social Psychiatry, 59(7), 671-681. https://doi.org/10.1177/0020764012452349
Hamadeh, A., El-Shamy, F., Billings, J., & Alyafei, A. (2024). The experiences of people from Arab countries in coping with trauma resulting from war and conflict in the Middle East: a systematic review and meta-synthesis of qualitative studies. Trauma, Violence, & Abuse, 25(2), 1278–1295. https://doi.org/10.1177/15248380231176061
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
Hinton, D. E., & Lewis‐Fernández, R. (2011). The cross‐cultural validity of posttraumatic stress disorder: Implications for DSM‐5. Depression and Anxiety, 28(9), 783-801. https://doi.org/10.1002/da.20753
Hosny, N., Bovey, M., Dutray, F., & Heim, E. (2023). How is trauma-related distress experienced and expressed in populations from the Greater Middle East and North Africa? A systematic review of qualitative literature. SSM-Mental Health, 4, 100258. https://doi.org/10.1016/j.ssmmh.2023.100258
Hosny, N., Tanous, O., Koga, P. M., Abbott, B. T., & Joseph, S. (2024). Who is the subject of trauma? An interdisciplinary scoping review of trauma and selfhood in the Arab region. SSM-Mental Health, 5. https://doi.org/10.1016/j.ssmmh.2024.100321
Huang, W. Y., & Wong, S. H. (2024). Cross-cultural validation. In Encyclopedia of Quality of Life and Well-Being Research (pp. 1517–1520). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-17299-1_630
Javier, R. A., & Lamela, M. (2020). Cultural and linguistic issues in assessing trauma in a forensic context. Assessing Trauma in Forensic Contexts, 151-176. https://doi.org/10.1007/978-3-030-33106-1_7
Kirmayer, L. J. (1989). Cultural variations in the response to psychiatric disorders and emotional distress. Social Science & Medicine, 29(3), 327-339. https://doi.org/10.1016/0277-9536(89)90281-5
Mahmood, O. M., & Ahmed, S. R. (2015). Psychological assessment: Distinguishing the clinically relevant from the culturally unique. In Handbook of Arab American Psychology (pp. 275–288). Routledge.
Mawar, L., Rahmadi, M. A., Nasution, H., & Sihombing, N. (2025). Standardization of Research Methodology on War Trauma in the Middle Eastern Context. Jurnal Praba: Jurnal Rumpun Kesehatan Umum, 3(2), 151-170. https://doi.org/10.62027/praba.v3i2.373
Merhy, G., Azzi, V., Salameh, P., Obeid, S., & Hallit, S. (2021). Anxiety among Lebanese adolescents: scale validation and correlates. BMC Pediatrics, 21(1), 288. https://doi.org/10.1186/s12887-021-02763-4
Milich, S., & Moghnieh, L. (2018). Trauma: Social realities and cultural texts. Middle East-Topics & Arguments, 11, 5–15.
Mokkink, L. B., Terwee, C. B., Patrick, D. L., Alonso, J., Stratford, P. W., Knol, D. L., … de Vet, H. C. W. (2010). The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An international Delphi study. Quality of Life Research, 19(4), 539-549. https://doi.org/10.1007/s11136-010-9606-8
Mughal, A. Y., Devadas, J., Ardman, E., Levis, B., Go, V. F., & Gaynes, B. N. (2020). A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle-income countries. BMC Psychiatry, 20, 1–18. https://doi.org/10.1186/s12888-020-02753-3
Nasution, H., Rahmadi, M. A., Mawar, L., & Sihombing, N. (2025). A Comprehensive Evaluation of PTSD Measurement Tools for Arab Populations: An Analysis of Validity. Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran, 3(3), 76-95.
Okasha, A., & Okasha, T. (1999). Somatoform disorders-an Arab perspective. In Somatoform Disorders: A Worldwide Perspective (pp. 38-46). Springer Japan. https://doi.org/10.1007/978-4-431-68500-5_5
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Raghavan, S., & Sandanapitchai, P. (2024). The relationship between cultural variables and resilience to psychological trauma: A systematic review of the literature. Traumatology, 30(1), 37. https://doi.org/10.1037/trm0000239
Rasmussen, A., Leon, M., & Elklit, A. (2023). Cross-cultural measurement invariance of the Harvard Trauma Questionnaire across nine adolescent samples. Assessment, 30(5), 1369–1378. https://doi.org/10.1177/10731911221101912
Rasmussen, A., Verkuilen, J., Ho, E., & Fan, Y. (2015). Posttraumatic stress disorder among refugees: Measurement invariance of Harvard Trauma Questionnaire scores across global regions and response patterns. Psychological Assessment, 27(4), 1160. https://doi.org/10.1037/pas0000115
Salimi, Y., Hoeboer, C., Motevalli Haghi, S. A., Williamson, R. E., Rahimi, M. D., Rajabi-Gilan, N., ... & Olff, M. (2023). Trauma and its consequences in Iran: Cross-cultural adaption and validation of the Global Psychotrauma Screen in a representative sample. BMC Psychiatry, 23(1), 65. https://doi.org/10.1186/s12888-023-04564-8
Stamm, B. H., & Friedman, M. J. (2000). Cultural diversity in the appraisal and expression of trauma. In International Handbook of Human Response to Trauma (pp. 69–85). Boston, MA: Springer US. https://doi.org/10.1007/978-1-4615-4177-6_5
Stevanovic, D., Jafari, P., Knez, R., Franic, T., Atilola, O., Davidovic, N., ... & Lakic, A. (2017). Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data. Transcultural Psychiatry, 54(1), 125–152. https://doi.org/10.1177/1363461516689215
Stevelink, S. A. M., & van Brakel, W. H. (2013). The cross-cultural equivalence of participation instruments: a systematic review. Disability and Rehabilitation, 35(15), 1256-1268. https://doi.org/10.3109/09638288.2012.731132
Wilson, J. P., & Tang, C. C. S. K. (Eds.). (2007). Cross-cultural Assessment of Psychological Trauma and PTSD. Springer Science & Business Media. https://doi.org/10.1007/978-0-387-70990-1
Zeinoun, P., Iliescu, D., & El Hakim, R. (2022). Psychological tests in Arabic: A review of methodological practices and recommendations for future use. Neuropsychology Review, 32(1), 1–19. https://doi.org/10.1007/s11065-021-09476-6
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