Cross-cultural symptom patterns in PTSD, depression and anxiety (This project is linked to the randomised clinical trials P

​1. Title: 

Cross-cultural symptom patterns in PTSD, depression and anxiety (This project is linked to the randomised clinical trials PTF1 and PTF2) 

2. Project period: 

01-04-2014 – 01-04-2017 

3. Investigator: 

Erik Vindbjerg, MSc, PhD student 

4. Supervisors and collaborative partners:

  • Prof. Ask Elklit (University of Southern Denmark) 
  • Prof. Erik Lykke Mortensen (University of Copenhagen) 
  • Prof. Guido Makransky (University of Southern Denmark) 
  • Jessica Carlsson Lohmann, MD, PhD (CTP) 

5. Background: 

Existing studies show that symptom patterns in PTSD, depression and anxiety vary between cultures (Hinton & Lewis-Fernández, 2011; Kirmayer, 2001). However, the included samples are small and do not permit advanced statistical analyses, which could provide detailed information on cultural differences. This gap has implications for the cross-cultural assessment of psychiatric disorders. For example, for many cultures, the validity of questionnaires used to measure PTSD, anxiety and depression has not been fully established. 

6. Aim: 

To provide a detailed analysis of how the most widely used scales for assessing PTSD, anxiety and depression work with refugee populations in Denmark. 

7. Methods 

7.1 Number of participants: 

800 – 1000 

7.2 Population: 

PTSD-diagnosed refugees from Afghanistan, Iran, Iraq, Lebanon and the former Yugoslavia. 

7.3 Description of data and data collection: 

The data for the current project consist primarily of the Harvard Trauma Questionnaire, the Hopkins Symptoms Checklist for anxiety and depression (HSCL-25), and the Hamilton Depression Rating Scale. Responses are collected as part of existing trials at CTP. For the current project, only baseline ratings are utilised. 

7.4 Application/acceptance from the Danish Data Protection Agency, the National Committee on Health Research Ethics: 

Data are collected and stored as part of existing trials at CTP, in each case with permission from the National Committee on Health Research Ethics, and with informed consent of each patient. The current study uses solely anonymous data. 

7.5 Analysis: 

In contrast to most previous studies, the current study uses Item Response Theory to analyse psychometric properties and cultural differences at the item level. 

8. Expected results: 

The study is expected to yield new knowledge about cultural variations of symptom display in PTSD, depression and anxiety. Furthermore, we expect to be able to derive more culturally neutral versions of the HTQ and HSCL-25, by excluding or compensating items which function differently across cultures. 

9. Dissemination of results: 

A total of three articles are outlined and will be submitted for peerreviewed journals. Results are presented at conferences on a regular basis (e.g. Nordic Congress of Psychiatry 2015). 

10. References

Hinton, D. E., & Lewis-Fernández, R. (2011). The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depression and Anxiety, 28(9), 783–801. doi:10.1002/da.20753 

Kirmayer, L. J. (2001). Clinical Presentation of Depression and Anxiety : Implications for Diagnosis and Treatment. Journal of Clinical Psychology, 62(suppl 13), 22–30.

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