Culturally Sensitive PTSD Screening in Non-Western Youth: Reflections and Indications for Mental Health Practitioners

Abstract

Children around the world are exposed to traumatic events and research confirms that cultural factors play a central role in the psychological experience of trauma and the manifestation of symptoms in trauma and stress-related disorders. The DSM-5 and ICD-11 call on practitioners to consider the role of culture and context in the manifestation, assessment, and treatment of mental health disorders. This article analyzes peer-reviewed literature involving youth and adolescent PTSD screening in non-Western contexts, revealing only few instruments that have undergone validation for cultural contexts outside those for which they were developed. Studies that include cultural validation show marked differences in methodology and conceptual framework for adaptation, translation, and validation, and disagreement on the scale and scope of tools necessary to assess the impact of trauma in non-Western youth. The discussed studies reveal a need to debate a uniform methodology for cultural adaptation and validation of PTSD screening instruments.

Advancing Child Trauma Screening Practices

“…Culture can influence how a child experiences trauma, their appraisal and perception of traumatic experiences, and their responses and reactions (Perry et al, 2019). A child's culture can shape their belief systems, familial relationships and attachment patterns, and coping skills, all of which can influence a child's interpretation of a traumatic event and their expression and communication about the experience (Nader, 2007).…”

“…Cultural differences in the conceptualization of trauma symptoms have been identified, such as the Western method of dichotomizing physical and mental health symptoms, which differs from Eastern medical models that use a more integrated and holistic approach to mindbody connection when framing traumatic reactions (Zheng & Gray, 2015). Cross-cultural differences have also been noted in symptoms related to avoidance, hyperarousal, and cognitive structures related to self-blame (Perry et al, 2019). Moreover, belonging to a collectivist versus individualist culture has also been linked with differences in disclosure, perceptions, interpretations, and healing from trauma (Engelbrecht & Jobson, 2016).…”

“…Moreover, belonging to a collectivist versus individualist culture has also been linked with differences in disclosure, perceptions, interpretations, and healing from trauma (Engelbrecht & Jobson, 2016). Despite this evidence, cultural differences are rarely accounted for in many trauma screening tools (Bartlett, 2020), and little is known about their validity in diverse cultural contexts, particularly among children from non-Western cultures (Perry et al, 2019). Adding to concerns around the use of DSM-V PTSD criteria, Perry and colleagues (2019) note that when PTSD criteria are used as the gold standard by which to establish validity in new screening tools, we may fail to capture cultural differences in trauma symptoms.…”

“…As noted in the aforementioned framework, the traumatic symptom portion of a screener should address all seven domains of functioning for complex trauma (biology, self-concept, affect regulation, behavioral regulation, dissociation, cognition, and attachment; NCTSN, 2018;van der Kolk, 2017). This taps a broader range of symptoms than those defined by DSM-V diagnostic criteria and attends to one of the concerns that have been raised regarding cultural differences in the conceptualization and presenting symptoms of "posttraumatic stress" (Perry et al, 2019). For a pictorial screener, the images that accompany each question must be developed with input from a diverse, multicultural team of researchers, practitioners, and survivors.…”