Are culturally specific measures of trauma-related anxiety and depression needed? The case of Sri Lanka.

The hypothesis that psychometric instruments incorporating local idioms of distress predict functional impairment in a non-Western, war-affected population above and beyond translations of already established instruments was tested. Exploratory factor analysis was conducted on the War-Related Psychological and Behavioral Problems section of the Penn/RESIST/Peradeniya War Problems Questionnaire (PRPWPQ; N. Jayawickreme, Jayawickreme, Goonasekera, & Foa, 2009), a measure that incorporates local idioms of distress, using data from 197 individuals living in Northern and Eastern Sri Lanka. Three subscales--Anxiety, Depression, and Negative Perception--were identified. Regression analyses were conducted to test whether these 3 subscales better predicted functional impairment than the PTSD Symptom Scale-Self Report (PSS; Foa, Riggs, Dancu, & Rothbaum, 1993) and the Beck Depression Inventory (BDI; Beck & Steer, 1987), both widely used self-report measures of posttraumatic stress disorder and depression, respectively. Two of the 3 subscales from the PRPWPQ--Anxiety and Depression--were significantly associated with higher rates of functional impairment after controlling for age, the PSS and the BDI. After the inclusion of PRPWPQ, the PSS and the BDI did not significantly contribute to the final regression model predicting functional impairment. These findings suggest that the scores of measures with local idioms of distress have incremental validity in non-Western war-affected populations, predicting functional impairment above and beyond translations of established self-report measures that have been developed in the Western world.