The measurement of war-related trauma amongst internally displaced men and women in South Sudan: Psychometric analysis of the Harvard Trauma Questionnaire

Abstract

BackgroundStudies from armed conflict settings, including South Sudan, have revealed the deleterious mental health impact of exposure to war atrocities. However, there is little consensus on what is meant by war trauma, how it should be measured, and how levels of trauma vary across men and women. MethodsWe used psychometric analyses to measure war trauma among 1178 internally displaced adults (mean age = 39 years, 50% women) in the Malakal region of South Sudan. We used cross-sectional survey data and applied classical test theory, factor analysis, item response theory, and differential item functioning with the war events subscale (17 items) of the Harvard Trauma Questionnaire (HTQ). ResultsWe found good validity and internal consistency reliability for the HTQ. We found evidence for unidimensionality using factor analyses, and item response theory models showed that some war events (like witnessing the killing of family or friends) were more sensitive to the underlying ‘war-related trauma’ trait than others (like abduction). Differential item functioning analyses revealed that the measure performed differently for men and women, indicating the need for sex-stratified analysis in the measurement of trauma. LimitationsThe use of self-report may lead to recall and response bias, and the study sample may not be representative of the broader population in South Sudan. ConclusionThis study emphasizes the need for cultural adaptation and psychometric evaluation of commonly used measurement instruments, especially in humanitarian settings where survey data are used to set priorities for mental health and psychosocial support services.