18 The criteria have been expanded to include a new criterion of negative alterations in cognitions and mood associated with the traumatic event(s). 17 Key changes were empirically backed and may yield a different prevalence rate of PTSD in particular refugee populations. The diagnostic criteria for PTSD have changed significantly from when the diagnosis of PTSD was introduced in 1980 to the current DSM-5, the American Psychiatric Association’s 2013 version of the Diagnostic and Statistical Manual. Although the HTQ has been widely used in large-scale population studies, 14, 15 clinicians can also use it as an outcome rating scale during treatment, relying on change (if any) in the total score over time and on individual symptom items. 13 Retaining these features was a strong guiding principle. 10–12 The HTQ is relatively brief, easy to administer and score, easy to adapt and translate for different refugee populations and has been well received amongst bicultural workers/professionals, study participants, and refugee patients and communities. 6, 7 It has been used in settings where licensed mental health professionals are scarce or non-existent and by licensed mental health clinicians and by primary care health providers in settings where large groups have been traumatized, providing guidance in directing attention to those who require more comprehensive diagnostic assessments. The HTQ is the most widely used screening measure for trauma-related symptoms in clinical and research work among refugees worldwide. 9 The HTQ has been adapted and norms established for a wide range of refugee populations. It was originally validated for three Indochinese refugee populations 8 and exhibited strong psychometric properties in both clinic and low prevalence community samples. The HTQ comprises four parts: (i) experiences of torture and other traumas frequently experienced by refugees, (ii) a subjective description of the most severe traumatic event(s) experienced, (iii) events associated with head injuries, and (iv) symptoms of PTSD and refugee-specific expressions of functional distress. 6–8 The HTQ is a cross-cultural screening instrument that documents trauma exposure, head trauma and trauma-related symptoms in refugees and others exposed to potentially traumatizing experiences. The Harvard Trauma Questionnaire (HTQ) was developed by the Harvard Program in Refugee Trauma 25 years ago to achieve the latter goal. 7 Accurate screening of these domains enables those working with refugees to triage more effectively, directing scarce resources appropriately to those most at risk. 2–6 It is vital to have access to a brief screening tool to identify those at risk for mental health problems associated with disability and dysfunction. 1 Many have been exposed to significant violence, including head injury and torture, 2, 3 and are at risk of high rates of post-traumatic stress disorder (PTSD) and other mental health problems. There are 68.5 million individuals worldwide who are displaced due to conflict, persecution, or generalized violence according to the United Nations High Commissioner for Refugees.
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