Outcome Measure
International Trauma Questionnaire
What it measures?
- The ITQ is a self-report measure designed to assess the presence and functional impairment of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the core features outlined in the ICD-11 (Cloitre et al., 2018).
- To differentiate between PTSD and CPTSD, two primary subscales are used, with each containing three secondary symptom clusters.
- The posttraumatic stress disorder (PTSD) subscale contains re-experiencing, avoidance, and sense of current threat symptom clusters.
- The disturbances in self-organisation (DSO) subscale contains affective dysregulation, negative self-concept, and disturbances in relationships symptom clusters.
Who is it for?
Trauma-exposed adults aged 18 years and older (Cloitre et al., 2018; 2021).
Instrument Quality
- The ITQ is an empirically validated measure of ICD-11 PTSD and CPTSD with systematic reviews (Redican et al., 2021) and psychometric studies (Camden et al., 2023; Cloitre et al., 2021; Ho et al., 2019) demonstrating strong reliability and validity of the measure. It has also been validated for use in over twenty-five languages and culturally diverse populations (Cyr et al., 2022; Karatzias et al., 2017; Redican et al., 2021; Tian et al., 2020).
Structure
- 18 items
- Items 1-6 assess the presence of PTSD symptoms
- Items 7 - 9 assess the functional impairment of PTSD symptoms
- Items 10-15 assess the presence of DSO symptoms
- Items 16-18 assess the functional impairment of DSO symptoms
- 5-point Likert scale
- Respondents are asked how much (0 = “Not at all”; 4 = “Extremely”) they have been bothered by a problem listed in the PTSD items during the past month (e.g. “Feeling jumpy or easily startled?”) and how true each symptom is for themselves on the DSO items.
Scoring instructions
- Sum all item responses to derive a full-scale score.
- Sum the relevant subscale-specific items to derive subscale scores.
- Sum the relevant symptom cluster specific items to derive symptom cluster scores.
- Categorical scoring is based on the endorsement of each symptom cluster and corresponding functional impairment for PTSD and/or DSO.
- Dimension scoring is available for PTSD (sum of items 1-6) and DSO (sum of items 10-15) subscales
| Subscale | Item number |
|---|---|
CPTSD (ITQ) |
2,3,4,5,6,7,11,12,13,14,15,16 |
Sense of current threat (ITQ) |
6,7 |
Negative self-concept (ITQ) |
13,14 |
Avoidance (ITQ) |
4,5 |
PTSD (ITQ) |
2,3,4,5,6,7 |
Disturbances in relationships (ITQ) |
15,16 |
DSO functional impairment (ITQ) |
17,18,19 |
Re-experiencing (ITQ) |
|
PTSD functional impairment (ITQ) |
8,9,10 |
DSO (ITQ) |
11,12,13,14,15,16 |
Affective dysregulation (ITQ) |
11,12 |
Score Interpretation
What higher scores mean?
- Increased presence and severity of PTSD and DSO symptoms with greater functional impairment, indicating greater likelihood for a PTSD or CPTSD diagnosis.
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 31 | |
| Complex Post-Traumatic Stress Disorder | >= | Provisional Diagnosis |
| 1 SD above clinical mean | 40.75 | |
| 2 SD above clinical mean | 50.5 | |
| Maximum | 72 |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 2.29 | |
| 1 SD above clinical mean | 3.44 | |
| 2 SD above clinical mean | 4.59 | |
| Maximum | 8 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.6 | Test-retest reliability (Pearson correlation coefficients) over 2 weeks was strong in a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 0.96 | |
| 1 SD above clinical mean | 2.1 | |
| 2 SD above clinical mean | 3.24 | |
| Maximum | 8 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.7 | Test-retest reliability (Pearson correlation coefficients) over 2 weeks was strong in a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 1.49 | |
| 1 SD above clinical mean | 2.58 | |
| 2 SD above clinical mean | 3.67 | |
| Maximum | 8 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.55 | Test-retest reliability (Pearson correlation coefficients) over 2 weeks was strong in a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 15.84 | |
| Post-Traumatic Stress Disorder | >= | Provisional Diagnosis |
| 1 SD above clinical mean | 21.42 | |
| Maximum | 24 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Provisional diagnosis
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.52 | * Test-retest reliability (Pearson correlation coefficients) over 2 weeks was good in a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). * The reliability coefficient has been averaged from the provided subscale test-retest reliability Pearson correlations. |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 1.03 | |
| 1 SD above clinical mean | 2.1 | |
| 2 SD above clinical mean | 3.17 | |
| Maximum | 8 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.75 | Test-retest reliability (Pearson correlation coefficients) over 2 weeks was strong in a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 1.45 | |
| 1 SD above clinical mean | 2.53 | |
| 2 SD above clinical mean | 3.61 | |
| Maximum | 12 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 1.48 | |
| 1 SD above clinical mean | 2.54 | |
| 2 SD above clinical mean | 3.6 | |
| Maximum | 8 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.4 | Test-retest reliability (Pearson correlation coefficients) over 2 weeks was strong in a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 1.85 | |
| 1 SD above clinical mean | 3 | |
| 2 SD above clinical mean | 4.15 | |
| Maximum | 12 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 15.15 | |
| 1 SD above clinical mean | 20.61 | |
| 1.5 SD above clinical mean | 23.34 | |
| Maximum | 24 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.69 | * Test-retest reliability (Pearson correlation coefficients) over 2 weeks was obtained from a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). * The reliability coefficient has been averaged from the provided subscale test-retest reliability Pearson correlations. |
| Description | Score Range | |
|---|---|---|
| Below clinical mean | 0 | |
| Clinical mean | 1.56 | |
| 1 SD above clinical mean | 2.64 | |
| 2 SD above clinical mean | 3.72 | |
| Maximum | 8 |
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability
| Value | Comments |
|---|---|
| 0.62 | Test-retest reliability (Pearson correlation coefficients) over 2 weeks was strong in a sample of young adults (aged 18 - 24) from Hong Kong enrolled in an undergraduate University program (n = 31; Ho et al., 2019). |
Instrument developers
- Cloitre, M., Shevlin M., Brewin, C.R., Bisson, J.I., Roberts, N.P., Maercker, A., Karatzias, T., Hyland, P. (2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and Complex PTSD. Acta Psychiatrica Scandinavica. 138(6), 536–546. https://doi.org/10.1111/acps.12956
Refrences
* Camden, A. A., Petri, J. M., Jackson, B. N., Jeffirs, S. M., & Weathers, F. W. (2023). A psychometric evaluation of the International Trauma Questionnaire (ITQ) in a trauma-exposed college sample. European Journal of Trauma & Dissociation, 7(1), 100305. * Cloitre, M., Shevlin M., Brewin, C.R., Bisson, J.I., Roberts, N.P., Maercker, A., Karatzias, T., Hyland, P. (2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and Complex PTSD. Acta Psychiatrica Scandinavica. 138(6), 536–546. https://doi.org/10.1111/acps.12956 * Cloitre, M., Hyland, P., Prins, A., & Shevlin, M. (2021). The international trauma questionnaire (ITQ) measures reliable and clinically significant treatment-related change in PTSD and complex PTSD. European Journal of Psychotraumatology, 12(1), Article 1930961. https://doi.org/10.1080/20008198.2021.1930961| * Cyr, G., Belanger, C., & Godbout, N. (2022). French translation and validation of the International Trauma Questionnaire in a Canadian community sample. Child Abuse & Neglect, 128, 105627.Chicago * Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. * Ho, G. W., Karatzias, T., Cloitre, M., Chan, A. C., Bressington, D., Chien, W. T., ... & Shevlin, M. (2019). Translation and validation of the Chinese ICD-11 international trauma questionnaire (ITQ) for the assessment of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). European Journal of Psychotraumatology, 10(1), 1608718. * Ho, G. W., Vang, M. L., Martsenkovskyi, D., Karatzias, T., Ben‐Ezra, M., McElroy, E., ... & Shevlin, M. (2023). Investigating the latent structure of the International Trauma Questionnaire to assess ICD‐11 posttraumatic stress disorder (PTSD) and complex PTSD in an adult civilian sample during the Ukraine war. Journal of Traumatic Stress, 36(4), 820-829. * Karatzias, T., Cloitre, M., Maercker, A., Kazlauskas, E., Shevlin, M., Hyland, P., ... & Brewin, C. R. (2017). PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania. European journal of psychotraumatology, 8(sup7), 1418103. * Redican, E., Nolan, E., Hyland, P., Cloitre, M., McBride, O., Karatzias, T., ... & Shevlin, M. (2021). A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire. Journal of Anxiety Disorders, 79, 102381. * Tian, Y., Wu, X., Wang, W., Zhang, D., Yu, Q., & Zhao, X. (2020). Complex posttraumatic stress disorder in Chinese young adults using the International Trauma Questionnaire (ITQ): A latent profile analysis. Journal of Affective Disorders, 267, 137-143
Related Outcome Measures
CORE-10
Clinical Outcomes in Routine Evaluation 10
The Clinical Outcomes in Routine Evaluation 10 (CORE-10) is a 10-item assessment measure for common...
FFMQ
Five Facet Mindfulness Questionnaire
RAADS-R
Ritvo Autism Asperger Diagnostic Scale-Revised
The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) is a 80-item self-report assessment me...
HAI-18
Health Anxiety Inventory-18
The items of the HAI-18 are intended to evaluate health anxiety regardless of physical health stat...
CESD-R
Center for Epidemiological Studies Depression Scale
The Center for Epidemiological Studies Depression Scale (CESD-R) is a self-report questionnaire des...
AQ-Child
Autism Spectrum Disorder in Children
The AQ-Child aims to assess traits of Autism Spectrum Disorder (ASD) in children with average intell...
AQ-Adolescent
Autism Spectrum Disorder in Adolescents
The AQ-Adol aims to assess traits of Autism Spectrum Disorder (ASD) in adolescents with average inte...
MDQ
Mood Disorder Questionnaire
The Mood Disorder Questionnaire (MDQ) was developed as a screening measure for bipolar disorder, us...
DUDIT
Drug Use Disorders Identification Test
The Drug Use Disorders Identification Test (DUDIT) is an 11-item self-report assessment measure whi...
ITQ
International Trauma Questionnaire
The ITQ is a self-report measure designed to assess the presence and functional impairment of postt...
IES-R
Impact of Event Scale-Revised
The Impact of Event Scale-Revised (IES-R) is a tool designed to gauge the presence and severity of s...
ACE-Q
The Adverse Childhood Experiences Questionnaire
The Adverse Childhood Experiences Questionnaire (ACE-Q) is a widely used tool for assessing childho...
MDRS-22
Male Depression Risk Scale
The Male Depression Risk Scale (MDRS) measures the risk of depression in men by assessing externali...
DES-II
Dissociative Experiences Scale-II
The DES-II is the most commonly used measure of dissociation. It measures various types of dissocia...
PSC-17
Pediatric Symptom Checklist-17
The PSC-17 is a screening tool designed to assess a child’s overall psychosocial functioning and i...
PCL-5
PTSD Checklist for DSM-5
The 20 symptoms of Post-Traumatic Stress Disorder, as outlined in the Diagnostic & Statistical Manua...
FAS
Fatigue Assessment Scale
The FAS full-scale assesses symptoms of physical and mental fatigue.
AQ
Autism Spectrum Quotient
The AQ aims to assess traits of Autism Spectrum Disorder (ASD) in adults and adolescents with averag...
PDSS-SR
Panic Disorder Severity Scale – Self-Report
The severity of Panic Disorder symptoms during the past week. Specifically, the instrument assesses...
SCAS-P
Spence Children’s Anxiety Scale – Parent
The SCAS-P measures anxiety symptoms in children in the general population through parent report. T...
PSEQ
Pain Self-Efficacy Questionnaire
The beliefs held by people experiencing chronic pain that they can carry out certain activities even...
PHQ-9
Patient Health Questionnaire 9-Item
Symptoms of Depression over the previous 2 weeks.
RIS
Regensburg Insomnia Scale
Psychological symptoms of insomnia assessing cognitive, emotional and behavioural aspects. The RIS m...
PSWQ
Penn State Worry Questionnaire
The PSWQ assesses pervasive and uncontrollable worry.
TSK-13
Tampa Scale of Kinesiophobia 13-Item
Kinesiophobia, defined as “an excessive, irrational, and debilitating fear of physical movement an...
GAD-7
Generalised Anxiety 7-Item
The symptoms of Generalized Anxiety Disorder, as outlined in the Diagnostic and Statistical Manual ...
CIA
Clinical Impairment Assessment Questionnaire
The severity of psychosocial impairment due to eating disorder pathology.
AUDIT
Alcohol Use Disorder Identification Test
The AUDIT identifies risky or harmful alcohol consumption, as well as alcohol dependence or abuse. ...
OCI-R
Obsessive-Compulsive Inventory – Revised
Symptom severity of Obsessive-Compulsive Disorder (OCD).The OCI-R contains 6 factors representing th...
AAI
Appearance Anxiety Inventory
Cognitive and behavioural symptoms of body image anxiety and body dysmorphic disorder (BDD). In part...
K10
Kessler Psychological Distress Scale
Non-specific psychological distress in the past 2 weeks.
SWLS
The Satisfaction With Life Scale
The Satisfaction With Life Scale (SWLS) examines the extent to which a person is satisfied with thei...
DASS-21
Depression Anxiety Stress Scales – 21-Item
Three self-report subscales assess the emotional states of depression, anxiety and stress.
CORE-OM
Clinical Outcomes in Routine Evaluation
The CORE-OM aims to capture the ‘core’ of client distress and provide a global index of distres...
BSL-23
Borderline Symptom List
The BSL-23 assesses 23 feelings and experiences that are typically reported by patients with Border...
ASRS
Adult ADHD Self-Report Scale
The ASRS aims to examine Attention Deficit Hyperactivity Disorder (ADHD) symptoms in adults consiste...
Severity ranges
Clinical scores were derived from a sample of 2004 war-exposed adult civilians in Ukraine approximately 6 months after the full-scale Russian invasion in 2022 (Ho et al., 2023).
Provisional diagnosis
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Reliability