Crossing cultural barriers: an initial cross-cultural validation of the Arabic compared to the German version of the Posttraumatic Stress Disorder Checklist for DSM-5 using multi-group confirmatory factor analysis.

Background

Post-traumatic stress disorder (PTSD) is prevalent worldwide, yet its phenomenology and prevalence vary according to individual and contextual factors. Due to heightened exposure to (post-) conflict environments, many Arabic-speaking individuals are at high risk of PTSD. The PTSD Checklist for DSM-5 (PCL-5) is a widely used screening tool for PTSD symptoms, validated in several languages, including German and Arabic. However, despite its frequent cross-linguistic and cross-cultural use, a comprehensive cross-linguistic and cross-cultural validation of the PCL-5 Arabic version still remains outstanding.

Objective

To ensure the cross-linguistic and cross-cultural comparability of the PCL-5 German and Arabic versions, this study examined the measurement invariance in a heterogeneous sample of German-speaking (n = 283) and Arabic-speaking individuals (n = 295).Method: Sociodemographic data and characteristics of stressful life events were assessed. Subsequently, we examined the internal consistency of the PCL-5 Arabic and German versions and broaden current investigations on structural validity as conducted via confirmatory factor analyses (CFA) by multi-group confirmatory factor analyses (MGCFA) across both language versions.

Results

The present findings show that the Arabic-speaking subsample reported more man-made trauma, which was associated with higher PCL-5 sum scores compared to the German-speaking subsample. The PCL-5 showed excellent internal consistency (Cronbach's α = .96). CFA indicated good model fit for all models tested, favouring the Anhedonia and Hybrid models. While MGCFA confirmed configural, threshold, and metric invariance, the scalar invariance could not be established.

Conclusions

The present study supports previous research indicating that the factorial structure of the PCL-5 is consistent across both language versions in the CFA. Nevertheless, our findings show a lack of scalar invariance in the MGCFA, which suggests potential bias in the cross-linguistic and cross-cultural comparability of the PCL-5 sum scores between the Arabic and the German versions. This highlights the need for context-, language-, and culture-sensitive diagnostics to ensure accurate PTSD assessments.