A Comprehensive Evaluation of PTSD Measurement Tools for Arab Populations : An Analysis of Validity
DOI:
https://doi.org/10.55606/termometer.v3i3.5396Keywords:
Arab Populations, Construct Validity, Cultural Adaptation, Internal Reliability, PTSDAbstract
This study presents a highly comprehensive meta-analysis of the validity of various Post-Traumatic Stress Disorder (PTSD) measurement instruments that have been implemented within the context of Arab populations. By synthesizing data from 47 studies involving 12,384 participants published between 2000 and 2023, this review employed a multilevel meta-analytic approach based on a random-effects model to ensure estimation accuracy that accounts for cultural and methodological heterogeneity. The main findings indicate that PTSD instruments adapted into Arabic generally exhibit an adequate level of internal reliability (α = 0.88, 95% CI [0.85, 0.91]), although construct validity demonstrates significant variability (r = 0.72, 95% CI [0.67, 0.77]). Among the instruments analyzed, the Post-traumatic Diagnostic Scale (PDS) was found to have the highest level of validity (r = 0.83, p < 0.001), followed by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) with r = 0.79 (p < 0.001), and the PTSD Checklist for DSM-5 (PCL-5) with r = 0.76 (p < 0.001). Moderator analysis revealed significant contributions from the translation strategies employed (Q = 18.42, p < 0.001), as well as demographic and psychosocial characteristics of the sample (Q = 15.67, p < 0.01), to fluctuations in instrument validity. When compared to the findings of Alqahtani et al. (2021), which highlighted the low validity of several Arabic-language psychological instruments due to a lack of cultural sensitivity in the adaptation process, and the study by Alhalal et al. (2017), which reported construct validity for the five-factor model of the Arabic version of the PCL-C, the present research successfully identifies a substantial overall increase in validity, particularly in instruments that integrate a deep cultural adaptation approach. Furthermore, one of the distinctive contributions of this study lies in its identification of specific patterns in PTSD symptom manifestation unique to Arab populations, significantly characterized by a tendency toward somatization (β = 0.45, p < 0.001) and the expression of distress in collective forms (β = 0.38, p < 0.001), as two dimensions that have been previously underexplored in cross-cultural psychometric validation studies.
Downloads
References
Abi Ramia, J., Shehadeh, M. H., Kheir, W., Zoghbi, E., Watts, S., Heim, E., & El Chammay, R. (2018). Community cognitive interviewing to inform local adaptations of an e-mental health intervention in Lebanon. Global Mental Health, 5, e39. https://doi.org/-10.1017/gmh.2018.29
Alexander, J. C. (2004). Toward a theory of cultural trauma. Cultural trauma and collective identity, 76(4), 620-639. https://doi.org/10.1525/california/9780520235946.003.0001
Alfadhel, S. A., Vennu, V., Alnahdi, A. H., Omar, M. T., Alasmari, S. H., AlJafri, Z., & Bindawas, S. M. (2018). Cross-cultural adaptation and validation of the Saudi Arabic version of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Rheumatology international, 38(8), 1547-1555. https://doi.org/10.1007/s00296-018-4072-7
Alhalaiqa, F., Alfuqaha, O. A., Masa'Deh, R., Khalifeh, A. H., Alsaraireh, M., Manaa, N. S., ... & Al Omari, O. (2023). Psychometric properties of the post-traumatic stress disorder checklist among the Lebanese population exposed to the Beirut explosion: a cross‐sectional study during the COVID‐19 pandemic. Behavioural neurology, 2023(1), 9286562. https://doi.org/10.1155/2023/9286562
Alhalaiqa, F., Al-Tammemi, A. B., & Al-Dwaikat, T. N. (2023). Psychometric properties of the Post-traumatic Stress Disorder Checklist among the Lebanese population exposed to the Beirut explosion: A cross-sectional study during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 20(19), 6790. https://doi.org/10.1155/2023/9286562
Alhalal, E., Ford-Gilboe, M., Wong, C., & AlBuhairan, F. (2017). Reliability and validity of the Arabic PTSD Checklist Civilian Version (PCL-C) in women survivors of intimate partner violence. Research in Nursing & Health, 40(6), 575-585. https://doi.org/-10.1002/nur.21837
Alhariri, W., McNally, A., & Knuckey, S. (2021). The right to mental health in Yemen: a distressed and ignored foundation for peace. Health and human rights, 23(1), 43.
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
Alqahtani, M. M., Salmon, G., Alyahya, H., & Bryant, R. A. (2021). Arabic language psychological measures: A systematic review of the literature. Frontiers in Psychology, 12, 730048.
Alrashdi, D. H., Alyafei, A. H., Alanazi, S. A., Meyer, C., & Gould, R. L. (2024). Cultural adaptations of third-wave psychotherapies in Gulf Cooperation Council countries: A systematic review. Transcultural Psychiatry, 61(2), 209–228. https://doi.org/10.1177/-13634615241227691
Alshehri, F. S., Alatawi, Y., Alghamdi, B. S., Alhifany, A. A., & Alharbi, A. (2020). Prevalence of post-traumatic stress disorder during the COVID-19 pandemic in Saudi Arabia. Saudi Pharmaceutical Journal, 28(12), 1666–1673. https://doi.org/10.1016/j.jsps.2020.10.-013
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
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/10.1177/152483802-51320982
BinDhim, N. F., Althumiri, N. A., Al-Luhaidan, S. M., Alhajji, M., Saad, S. Y. A., Alyami, H., ... & Alhabeeb, A. A. (2024). Cultural adaptation and validation of the mental illness associated stigma scale for Arabic-speaking population in Saudi Arabia. Frontiers in Psychiatry, 14, 1265096. https://doi.org/10.3389/fpsyt.2023.1265096
Davey, C., Heard, R., & Lennings, C. (2015). Development of the Arabic versions of the impact of events Scale‐Revised and the post-traumatic 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
Dietrich, H., Al Ali, R., Tagay, S., Hebebrand, J., & Reissner, V. (2019). Screening for post-traumatic stress disorder in young adult refugees from Syria and Iraq. Comprehensive Psychiatry, 90, 73-81. https://doi.org/10.1016/j.comppsych.2018.11.001
El Miedany, Y., El Gaafary, M., Youssef, S. S., & Ahmed, I. (2008). Validity of the Developed Arabic Multidimensional Health Assessment Questionnaire for use in standard clinical care of patients with rheumatic diseases. International Journal of Rheumatic Diseases, 11(3), 224-236. https://doi.org/10.1111/j.1756-185X.2008.00366.x
ElBarazi, A. S., Tikamdas, R., Ahmed, S., & Ramadan, S. (2022). Cognitive processing therapy for the treatment of PTSD, depression and anxiety in Syrian refugees in Egypt. Intervention Journal Of Mental Health And Psychosocial Support In Conflict-Affected Areas, 20(2), 179-187. https://doi.org/10.4103/intv.intv_33_21
Fekih-Romdhane, F., Jebreen, K., Swaitti, T., Jebreen, M., Radwan, E., Kammoun-Rebai, W., ... & Hallit, S. (2025). Validation of the Perceived Hope Scale in Arabic-speaking adults living in Gaza in the midst of war, destruction, and death. Archives of Public Health, 83(1), 4. https://doi.org/10.1186/s13690-024-01494-z
Gilmoor, A. R., Adithy, A., & Regeer, B. (2019). The cross-cultural validity of post-traumatic stress disorder and post-traumatic stress symptoms in the Indian context: A systematic search and review. Frontiers in Psychiatry, 10, 439. https://doi.org/10.3389/fpsyt.-2019.00439
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
Hawa, S. E. (2012). Trauma and Coping: Culturally-Informed Treatment Considerations for Working with Lebanese Americans. Alliant International University.
Henry, H. M. (2012). African refugees in Egypt: Trauma, loss, and cultural adjustment. Death Studies, 36(7), 583–604. https://doi.org/10.1080/07481187.2011.553330
Hosny, N., Tanous, O., Koga, P. M., Abbot, B., & Joseph, S. (2024). Who is the Subject of Trauma? An Interdisciplinary Scoping Review of Trauma and Selfhood in the Arab Region. SSM-Mental Health, 100321. https://doi.org/10.1016/j.ssmmh.2024.100321
Ibrahim, H., Ertl, V., Catani, C., Ismail, A. A., & Neuner, F. (2018). The validity of Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq. BMC Psychiatry, 18, 1-8. https://doi.org/10.1186/s12888-018-1839-z
Jordans, M. J., Komproe, I. H., Tol, W. A., & De Jong, J. T. V. M. (2009). Screening for psychosocial distress amongst war‐affected children: Cross‐cultural construct validity of the CPDS. Journal of Child Psychology and Psychiatry, 50(4), 514-523. https://doi.org/10.1111/j.1469-7610.2008.02028.x
Kayrouz, R., Dear, B. F., Kayrouz, B., Karin, E., Gandy, M., & Titov, N. (2018). Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder. Cognitive Behaviour Therapy, 47(5), 412-430. https://doi.org/10.1080/16506073.-2018.1445124
Khaled, S. M., & Gray, R. (2019). Depression in migrant workers and nationals of Qatar: An exploratory cross-cultural study. International Journal of Social Psychiatry, 65(5), 354–367. https://doi.org/10.1177/0020764019850589
Kira, I. A., Shuwiekh, H. A., Alhuwailah, A., & Balaghi, D. (2022). Does COVID-19 Type III Continuous Existential Trauma Deplete the Traditional Coping, Diminish Health and Mental Health, and Kindle Spirituality?: An Exploratory Study on Arab Countries. Journal of Loss and Trauma, 27(4), 297-317. https://doi.org/10.1080/15325024.-2021.2006501
Magwood, O., Bellai-Dussault, K., Fox, G., McCutcheon, C., Adams, O., Saad, A., & Kassam, A. (2023). Diagnostic test accuracy of screening tools for post-traumatic stress disorder among refugees and asylum seekers: A systematic review and meta-analysis. Journal of Migration and Health, 7, 100144. https://doi.org/10.1016/j.jmh.2022.100144
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
Nasif, J., Din, N. C., AL-Khawaja, M., Alawi, A. F., Al-Khatib, N., Ayash, A., ... & Sze, A. C. S. (2024). Scoping Review for the Adaptation of Cognitive Behavioral Therapy to the Arab Culture. International Journal of Cognitive Therapy, 17(4), 919-945. https://doi.org/10.1007/s41811-024-00227-y
Slewa-Younan, S., Uribe Guajardo, M. G., Heriseanu, A., & Hasan, T. (2015). A systematic review of post-traumatic stress disorder and depression amongst Iraqi refugees located in Western countries. Journal of immigrant and minority health, 17, 1231-1239. https://doi.org/10.1007/s10903-014-0046-3
Turrini, G., Tedeschi, F., Cuijpers, P., Del Giovane, C., Kip, A., Morina, N., ... & Barbui, C. (2021). A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD. BMJ Global Health, 6(6), e005029. https://doi.org/10.1136/bmjgh-2021-005029
Vallières, F., Ceannt, R., Daccache, F., Abou Daher, R., Sleiman, J., Gilmore, B., ... & Hyland, P. (2018). ICD‐11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire. Acta Psychiatrica Scandinavica, 138(6), 547-557. https://doi.org/10.1111/acps.12973
Veronese, G., Mahamid, F., Bdier, D., Obaid, H., & Cavazzoni, F. (2024). The development and validation of the Palestinian children's traumatic events checklist in a war-torn environment. BMC psychiatry, 24(1), 254. https://doi.org/10.1186/s12888-024-05731-1
von Haumeder, A., Ghafoori, B., & Retailleau, J. (2019). Psychological adaptation and post-traumatic stress disorder among Syrian refugees in Germany: a mixed-methods study investigating environmental factors. European Journal of Psychotraumatology, 10(1), 1686801. https://doi.org/10.1080/20008198.2019.1686801
Wan, R., Wan, R., Xie, Q., Hu, A., Xie, W., Chen, J., & Liu, Y. (2024). Current Status and Future Directions of Artificial Intelligence in Post-Traumatic Stress Disorder: A Literature Measurement Analysis. Behavioral Sciences, 15(1), 27. https://doi.org/10.3390/-bs15010027
Wells, R., Wells, D., & Lawsin, C. (2015, January). Understanding psychological responses to trauma among refugees: The importance of measurement validity in cross-cultural settings. In Journal and Proceedings of the Royal Society of New South Wales (Vol. 148, No. 455/456, pp. 60–69). https://doi.org/10.5962/p.361729
World Health Organization. (2022). Mental health in emergencies. https://www.who.int/news-room/fact-sheets/detail/mental-health-in-emergencies
Wrobel, N. H. (2015). Research measures: Psychometric methods and challenges to valid assessment of constructs. Handbook of Arab American Psychology, 361-398.
Yagoub, U., Al Qahtani, B., Hariri, I. A., Al Zahrani, A., & Siddique, K. (2019). Antibiotic resistance: a hospital-based multicenter study in Tabuk city, Kingdom of Saudi Arabia. Infection and Drug Resistance, 1815-1825. https://doi.org/10.2147/IDR.S200996
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
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.








