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Peer-reviewedCC BYPLOS One

Examining the performance of the International Trauma Questionnaire with clinical checks in a multinational European sample

  • Philip Hyland1
  • Mark Shevlin2
  • Menachem Ben-Ezra3
  • Marylène Cloitre4
  • Matus Adamkovic5,6,7
  • Agata Błachnio8
  • Marek Preiss9
  • Ella Salgo10
  • Mihaela Fadgyas Stanculete11
  • Zsolt Szabolcs Unoka10
  • Thanos Karatzias12
12 affiliations
  1. 1Department of Psychology, Maynooth University, Kildare, Ireland.
  2. 2School of Psychology, Ulster University, Derry, Northern Ireland.
  3. 3School of Social Work, Ariel University, Ariel, Israel.
  4. 4Silver School of Social Work, New York University, New York, New York, United States of America.
  5. 5Institute of Social Sciences CSPS, Slovak Academy of Sciences, Košice, Slovakia.
  6. 6Faculty of Education, Charles University, Prague, Czechia.
  7. 7Faculty of Humanities and Social Sciences, University of Jyväskylä, Jyväskylä, Finland.
  8. 8John Paul II Catholic University of Lublin, Lublin, Poland.
  9. 9National Institute of Mental Health, Klecany, Czech Republic.
  10. 10Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
  11. 11Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
  12. 12Edinburgh Napier University, School of Health and Social Care, Edinburgh, Scotland.
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Abstract

Background: The International Trauma Questionnaire (ITQ) is a widely used self-report measure of PTSD and Complex PTSD (CPTSD). ‘Clinical checks’ – brief follow up questions verifying respondent comprehension of the symptom item – have recently been developed for the ITQ to reduce false-positive diagnostic cases. This study tested whether the ITQ with clinical checks generates psychometrically sound scores and adds clinically relevant information to standard symptom assessment. Methods: Data (N = 5,070) were collected using quota-based sampling procedures from adults living in five European countries (Czech Republic, Poland, Hungary, Romania, and Slovakia). Results: Overall, 82.2% of respondents were trauma-exposed, and 19.2% met diagnostic requirements for PTSD (7.2%) or CPTSD (12.0%) on the standard ITQ. With clinical checks, these fell to 9.8% overall, 3.9% for PTSD, and 5.9% for CPTSD. The ITQ with clinical checks produced scores with excellent factorial validity, internal reliability, and latent classes corresponding to PTSD and CPTSD. Associations with clinically relevant variables including suicidality and anxiety-depression symptoms were stronger with than without the clinical checks. Females, those with more extensive trauma histories, and higher concurrent anxiety-depression symptoms were more likely to retain than lose their diagnostic status when the clinical checks were used. Conclusions: The ITQ with clinical checks generated scores with excellent psychometric properties, captured additional clinically relevant information, and yielded more plausible prevalence estimates compared to the standard ITQ scores. The potential value and limitations of using clinical checks in self-report questionnaires are discussed.

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Cite

BibTeXRIS
BibTeX
@article{hyland2026examining,
  title = {{Examining the performance of the International Trauma Questionnaire with clinical checks in a multinational European sample}},
  author = {Philip Hyland and Mark Shevlin and Menachem Ben-Ezra and Marylène Cloitre and Matus Adamkovic and Agata Błachnio and Marek Preiss and Ella Salgo and Mihaela Fadgyas Stanculete and Zsolt Szabolcs Unoka and Thanos Karatzias},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0360940},
  url = {https://doi.org/10.1371/journal.pone.0360940},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Examining the performance of the International Trauma Questionnaire with clinical checks in a multinational European sample
AU  - Philip Hyland
AU  - Mark Shevlin
AU  - Menachem Ben-Ezra
AU  - Marylène Cloitre
AU  - Matus Adamkovic
AU  - Agata Błachnio
AU  - Marek Preiss
AU  - Ella Salgo
AU  - Mihaela Fadgyas Stanculete
AU  - Zsolt Szabolcs Unoka
AU  - Thanos Karatzias
PY  - 2026
DA  - 2026/10/21
JO  - PLOS One
DO  - 10.1371/journal.pone.0360940
UR  - https://doi.org/10.1371/journal.pone.0360940
AB  - Background: The International Trauma Questionnaire (ITQ) is a widely used self-report measure of PTSD and Complex PTSD (CPTSD). ‘Clinical checks’ – brief follow up questions verifying respondent comprehension of the symptom item – have recently been developed for the ITQ to reduce false-positive diagnostic cases. This study tested whether the ITQ with clinical checks generates psychometrically sound scores and adds clinically relevant information to standard symptom assessment. Methods: Data (N = 5,070) were collected using quota-based sampling procedures from adults living in five European countries (Czech Republic, Poland, Hungary, Romania, and Slovakia). Results: Overall, 82.2% of respondents were trauma-exposed, and 19.2% met diagnostic requirements for PTSD (7.2%) or CPTSD (12.0%) on the standard ITQ. With clinical checks, these fell to 9.8% overall, 3.9% for PTSD, and 5.9% for CPTSD. The ITQ with clinical checks produced scores with excellent factorial validity, internal reliability, and latent classes corresponding to PTSD and CPTSD. Associations with clinically relevant variables including suicidality and anxiety-depression symptoms were stronger with than without the clinical checks. Females, those with more extensive trauma histories, and higher concurrent anxiety-depression symptoms were more likely to retain than lose their diagnostic status when the clinical checks were used. Conclusions: The ITQ with clinical checks generated scores with excellent psychometric properties, captured additional clinically relevant information, and yielded more plausible prevalence estimates compared to the standard ITQ scores. The potential value and limitations of using clinical checks in self-report questionnaires are discussed.
SN  - 1932-6203
ER  -