Eastern African expressions of suffering: A new Cultural Scripts of Trauma Inventory

Many people who have experienced trauma feel that PTSD criteria do not describe their experiences. They report culturally specific symptoms, in our new theory referred to as Cultural Scripts of Trauma, yet no study has systematically mapped these experiences or developed tools to measure them.

This study aims to map cultural scripts of trauma suffering and to develop and validate the Cultural Scripts of Trauma Inventory (CSTI) across Eastern African countries, including Rwanda, Uganda, Tanzania, and Kenya.

A qualitative study involving 115 participants across nine focus groups of trauma survivors and experts was conducted to map the main cultural scripts of trauma experiences and generate initial pool of items. This was followed by a quantitative validation study involving 1,208 participants from Rwanda, Uganda, Tanzania, and Kenya. In an online survey, participants completed the pre-CSTI and additional measures for convergent and divergent validity, such as the International Trauma Questionnaire, Clinical Aspects of Historical Trauma, Purpose in Life Questionnaire, Subjective Vitality, and General Self-Efficacy.

The results yield 71 Cultural Scripts of Trauma Sufferings (CSTs). The confirmatory factor analysis confirms 15 most relevant CSTs regrouped in five factors such as cognitive, body related, frame of mind, meaning disruption and family stress demonstrating excellent model fit. Those constitute 15 item-inventory that showed strong overall reliability and validity. Additionally, the model exhibited configural, metric, and partial scalar invariance, confirming its consistency across various groups.

This study is advancing culturally informed diagnosis and treatment of post traumatic sequelae by identification of culturally specific post trauma suffering and development and validation of CSTI in East African countries. It provides clinicians and researchers with a resource to adopt a model of beyond and including PTSD by offering a deeper understanding of post-traumatic stress in diverse cultural contexts.