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Validation of the UCLA Child Post traumatic stress disorder-reaction index in Zambia
Laura K Murray1, Judith Bass, Elwyn Chomba
1Johns Hopkins University Bloomberg School of Public Health, Dept, of International Health, Baltimore, MD, USA. lamurray@jhsph.edu.
Insights
A validated trauma assessment tool, the UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI), was developed for youth in Zambia. This tool accurately identifies traumatic stress and aids in treatment and service triage.
Area of Science:
- Global Health
- Child Mental Health
- Trauma Studies
Background:
- Child sexual violence is a significant global health and human rights issue.
- Lack of validated mental health assessments hinders understanding and intervention in low-resource settings.
- The UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI) is a trauma-focused assessment tool.
Purpose of the Study:
- To validate the PTSD-RI for use with youth in Zambia, a low-resource country.
- To adapt the PTSD-RI to the local context for improved cultural relevance and accuracy.
- To assess the reliability and validity of the adapted PTSD-RI.
Main Methods:
- The PTSD-RI was culturally adapted with locally relevant items.
- Cross-cultural criterion validity was assessed using local responses.
- Reliability was measured using Cronbach's alpha.
- Discriminant, concurrent, sensitivity, and specificity validity were evaluated.
Main Results:
- The adapted PTSD-RI demonstrated high reliability (Cronbach's alpha > .90).
- The tool effectively discriminated between cases and non-cases of trauma.
- Higher symptom scores correlated with increased trauma exposure, indicating concurrent validity.
- Sensitivity and specificity analyses confirmed the tool's appropriateness for case definition.
Conclusions:
- Validating mental health tools in low-resource settings is feasible.
- The adapted Zambian version of the PTSD-RI is a useful and valid measure for youth.
- This validated tool can improve treatment effectiveness measurement and youth service triage.
Background:
Sexual 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.
Methods:
The 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.
Results:
Analysis 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.
Conclusions:
This 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.
