Translation and Validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD)

Grace W.K. Ho Ho, Thanos Karatzias, Marylene Cloitre, Athena C.Y. Chan Chan, Daniel Bressington Bressington, Wai Tong Chien Chien, Philip Hyland, M Shevlin

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Background: Two stress-related disorders have been proposed for inclusion in the revised ICD-11: Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). The International Trauma Questionnaire (ITQ) is a bespoke measure of PTSD and CPTSD and has been widely used in English-speaking countries.

Objective: The primary aim of this study was to develop a Chinese version of the ITQ and assess its content, construct, and concurrent validity.

Methods: Six mental health practitioners and experts rated the Chinese translated and back-translated items to assess content validity. A sample of 423 Chinese young adults completed the ITQ, the WHO Adverse Childhood Experiences International Questionnaire, and the Hospital Anxiety and Depression Scale. Among them, 31 participants also completed the English and Chinese versions of the ITQ administered in random order at retest. Four alternative confirmatory factor analysis models were tested using data from participants who reported at least one adverse childhood experience (ACE; N = 314).

Results: The Chinese ITQ received excellent ratings on relevance and appropriateness. Test–retest reliability and semantic equivalence across English and Chinese versions were acceptable. The correlated first-order six-factor model and a second-order two-factor (PTSD and DSO) both provided an acceptable model fit. The six ITQ symptoms clusters were all significantly correlated with anxiety, depression, and the number of ACEs.

Conclusions: The Chinese ITQ generates scores with acceptable psychometric properties and provides evidence for including PTSD and CPTSD as separate diagnoses in ICD-11.

• This study provides the first Chinese translation and validation of the ITQ with a Chinese young adult sample in Hong Kong.• The latent structure of the Chinese ITQ was best supported by a six-correlated first-factor model; a two-factor second-order model was also acceptable.• Each of the six PTSD/CPTSD symptom clusters correlated significantly positively with two criterion variables – anxiety and depression.• Cumulative exposure to adverse childhood experiences was significantly associated with PTSD/CPTSD symptoms.


Antecedentes: Dos trastornos relacionados con estrés han sido propuestos para su inclusión en la CIE-11 revisada: Trastorno de estrés postraumático (TEPT) y TEPT complejo (TEPTC). El Cuestionario Internacional de Trauma (CIT) esta diseñado para medir TEPT y TEPTC, y ha sido utilizado ampliamente en los países de habla inglesa. Objetivo. El objetivo principal de este estudio fue desarrollar una versión china del CIT y evaluar su validez concurrente, de contenido y constructo.

Método: Seis profesionales de salud mental y expertos calificaron los items traducidos al chino y retraducidos para evaluar la validez de contenido. Una muestra de 423 adultos jóvenes chinos completó el CIT, el Cuestionario Internacional de Experiencias Adversas en la Infancia de la OMS y la Escala de Ansiedad y Depresión Hospitalaria. Entre ellos, 31 participantes también completaron las versiones en inglés y chino del CIT administrado en orden aleatorio al realizar la prueba nuevamente. Se probaron cuatro modelos confirmatorios alternativos de análisis factorial utilizando datos de los participantes que informaron al menos una experiencia adversa en la infancia (EAI; N = 314).

Resultados: El CIT chino recibió calificaciones excelentes en relevancia y pertinencia. La fiabilidad test-retest y la equivalencia semántica entre las versiones en inglés y chino fue aceptable. El modelo de seis factores de primer orden correlacionado y uno de dos factores de segundo orden (TEPT y DSO) proporcionaron un ajuste aceptable. Los seis grupos de síntomas de CIT se correlacionaron significativamente con ansiedad, depresión y número de EAI.

Conclusiones: El CIT chino genera cifras con propiedades psicométricas aceptables y proporciona evidencia para incluir el TEPT y el TEPTC como diagnósticos separados en la CIE-11.

背景:两种与压力有关的疾病包括在修订的ICD-11中:创伤后应激障碍 (PTSD) 和复杂PTSD (CPTSD)。国际创伤问卷 (ITQ) 是PTSD和CPTSD的衡量标准,并已广泛应用于英语国家。


方法:六名心理健康从业者和专家对中文翻译和反译题目的内容效度进行了评估。423名中国年轻成人样本完成了ITQ,WHO负性童年经历国际问卷,以及医院焦虑和抑郁量表。其中,31名被试在重测中以随机排序完成了ITQ的英文和中文版本。根据报告了至少一种负性童年经历的数据 (ACE; N = 314)。考察了四种备选的验证性因子分析模型。

结果:中文ITQ在相关性和适当性方面获得了极好的评价。中英文版本的重测信度和语义等效性是可以接受的。相关的一阶六因子模型和二阶二因子 (PTSD和DSO) 都提供了可接受的模型拟合。六个ITQ症状簇都与焦虑、抑郁和ACE数量显著相关。



Original languageEnglish
Article number1608718
Pages (from-to)1-10
JournalEuropean Journal of Psychotraumatology
Issue number1
Early online date15 May 2019
Publication statusPublished online - 15 May 2019

Bibliographical note

Funding Information:
This study was funded by The Hong Kong Polytechnic University Internal Start-Up Fund [1-ZE7A].

Publisher Copyright:
© 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Copyright 2019 Elsevier B.V., All rights reserved.


  • PTSD,
  • Complex PTSD,
  • ICD-11 Trauma Questionnaire,
  • Chinese, trauma
  • trauma
  • PTSD
  • Chinese
  • Complex PTSD
  • ICD-11 Trauma Questionnaire
  • ICD-11
  • Chino
  • Trauma
  • 复杂PTSD
  • trastorno de estrés postraumático complejo
  • trastorno de estrés postraumático
  • Cuestionario de Trauma ICD-11 Trauma


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