Exploring the fit of western PTSD models across three non-western low- and middle-income countries

Lynn Murphy Michalopoulos, George J. Unick, Emily E. Haroz, Judith Bass, Laura K. Murray, Paul A. Bolton

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


The purpose of this study was to examine the fit of existing Western posttraumatic stress disorder (PTSD) models across 3 non-Western low and middle income countries (LMIC). Secondary data analysis was conducted from studies among torture survivors in Northern Iraq, sexual violence survivors in the Democratic Republic of Congo (DRC), and Burmese refugees in Thailand. Confirmatory factor analyses were conducted on Harvard Trauma Questionnaire (HTQ) data to compare established Western PTSD models using (a) the 3-factor Diagnostic and Statistical Manual (DSM) 4th edition model, (b) the 4-factor “numbing” model, (c) the 4-factor “dysphoria” model, and (d) the 4- factor DSM-5 model. For both the DRC and Burma all models had adequate fit. Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) determined that the 4-factor “numbing” model was the best fit for the DRC and the 4-factor “dysphoria” model was the best fit for Burma. For Iraq, none of the models had adequate fit. Results support previous research which indicates inconsistency among Western models of PTSD among populations from LMIC. Further research should explore whether this is indicative of the context or potentially other factors.

Original languageEnglish (US)
Pages (from-to)55-63
Number of pages9
Issue number2
StatePublished - Mar 2 2015


  • Cross-cultural
  • Factor analysis
  • Low- and middle-income country
  • Posttraumatic stress disorder
  • Validation

ASJC Scopus subject areas

  • Nursing(all)
  • Emergency Medicine
  • Public Health, Environmental and Occupational Health


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