Abstract
BackgroundSexual violence against children is a major global health and human rights problem. In order to address this issue there needs to be a better understanding of the issue and the consequences. One major challenge in accomplishing this goal has been a lack of validated child mental health assessments in low-resource countries where the prevalence of sexual violence is high. This paper presents results from a validation study of a trauma-focused mental health assessment tool - the UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI) in Zambia.MethodsThe PTSD-RI was adapted through the addition of locally relevant items and validated using local responses to three cross-cultural criterion validity questions. Reliability of the symptoms scale was assessed using Cronbach alpha analyses. Discriminant validity was assessed comparing mean scale scores of cases and non-cases. Concurrent validity was assessed comparing mean scale scores to a traumatic experience index. Sensitivity and specificity analyses were run using receiver operating curves.ResultsAnalysis of data from 352 youth attending a clinic specializing in sexual abuse showed that this adapted PTSD-RI demonstrated good reliability, with Cronbach alpha scores greater than .90 on all the evaluated scales. The symptom scales were able to statistically significantly discriminate between locally identified cases and non-cases, and higher symptom scale scores were associated with increased numbers of trauma exposures which is an indication of concurrent validity. Sensitivity and specificity analyses resulted in an adequate area under the curve, indicating that this tool was appropriate for case definition.ConclusionsThis study has shown that validating mental health assessment tools in a low-resource country is feasible, and that by taking the time to adapt a measure to the local context, a useful and valid Zambian version of the PTSD-RI was developed to detect traumatic stress among youth. This valid tool can now be used to appropriately measure treatment effectiveness, and more effectively and efficiently triage youth to appropriate services.
Highlights
Sexual violence against children is a major global health and human rights problem
This paper presents a study to address this gap, including a process used for incorporating culture-specific information into the adaptation and validation of a trauma-focused mental health assessment tool, the UCLA Child Post-traumatic stress disorder - Reaction Index [21]
3.2 Assessment Tool Initial development of the measure took place in a meeting with key stakeholders and local experts including the director (EC) and staff of the One-Stop Center, several local medical school students who had expressed interest in mental health issues, a British Psychiatrist who had worked on child sexual abuse issues in Zambia, and a faculty member from the University of Zambia who had worked with the issue child sexual abuse
Summary
Sexual violence against children is a major global health and human rights problem. One major challenge in accomplishing this goal has been a lack of validated child mental health assessments in low-resource countries where the prevalence of sexual violence is high. This paper presents results from a validation study of a trauma-focused mental health assessment tool - the UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI) in Zambia. Discussed in reference to females, is an enormous global health and human-rights problem, and a growing concern in sub-Saharan Africa. 2. Lalor K: Child sexual abuse in sub-Saharan Africa: A literature review. 3. Lalor K: Child sexual abuse and HIV transmission in Sub-Saharan Africa. Perrin S, Smith P, Yule W: Practitioner review: the assessment and treatment of post-traumatic stress dis- order in children and adolescents. J Am Acad Child Adolesc Psychiatry 1995, 34:1174-1184
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