ICD-11 PTSD and complex PTSD amongst Syrian refugees in Lebanon: the factor structure and the clinical utility of the International Trauma Questionnaire

Acta Psychiatr Scand. 2018 Dec;138(6):547-557. doi: 10.1111/acps.12973. Epub 2018 Oct 24.


Objective: Support for ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing; however, few studies include refugees or examine the clinical utility of PTSD/CPTSD classifications. This study sought to provide the first evaluations of (i) the factor structure of ICD-11 PTSD/CPTSD amongst refugees in the Middle East; and (ii) the clinical utility of the International Trauma Questionnaire (ITQ) to identify PTSD/CPTSD in a humanitarian context.

Method: Participants were 112 treatment-seeking Syrian refugees living in Lebanon. Factorial validity was assessed using confirmatory factor analysis (CFA) based on responses to the ITQ. Clinical utility of the ITQ was assessed through semi-structured interviews with six Lebanese psychotherapists.

Results: Complex PTSD (36.1%) was more common than PTSD (25.2%), and no sex or age differences were observed at the prevalence or symptomatic levels. CFA results supported a two-factor higher-order model consistent with ICD-11 PTSD/CPTSD. Qualitative findings indicated that the ITQ is generally positively regarded, with some limitations and suggested modifications noted.

Conclusion: This is the first study to support the ICD-11 PTSD/CPTSD amongst refugees in the Middle East and the clinical utility of the ITQ in a humanitarian context. Findings support the growing evidence for the cross-cultural applicability of ICD-11 PTSD/CPTSD.

Keywords: International Trauma Questionnaire; Lebanon; Syrian conflict; complex PTSD; post-traumatic stress disorder; refugees.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Factor Analysis, Statistical
  • Female
  • Humans
  • International Classification of Diseases*
  • Lebanon
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales / standards*
  • Psychological Trauma / diagnosis*
  • Refugees*
  • Reproducibility of Results
  • Stress Disorders, Post-Traumatic / diagnosis*
  • Surveys and Questionnaires
  • Syria
  • Young Adult