Conceptualization and Measurement of Traumatic Events among Refugees and Other War-Affected Populations

  • Andrew RasmussenEmail author
  • Kenneth E. Miller
  • Jay Verkuilen


The literature on mental health in refugee and post-conflict populations has become quite sophisticated in modeling and measuring psychological distress. However, this has not been matched by development in approaches to measuring exposure to trauma. In this chapter we present three critiques of common practices that limit our understanding of refugee and other war-affected populations’ mental health: (1) using trauma exposure checklists that are limited to measuring trauma types and not events per se, (2) examining trauma exposure data using factor analysis (and reflective-indicator models in general), and (3) ignoring how trauma interacts with pre-conflict conditions in models of psychological distress. We argue that addressing these critiques will bring models of mental health closer to refugees’ experiences. Although not an exhaustive list, solutions should include measuring frequency and schedule of trauma exposure, conceptualizing trauma exposure as a composite variable (as opposed to a latent factor), and identifying how trauma moderates the effects of pre-existing stressors on mental health.


Trauma exposure Measurement Reflective-indicator models Trauma event checklists War-affected populations 


  1. Anderberg, M. R. (1973). Cluster analysis for applications. New York, NY: Academic.Google Scholar
  2. Betancourt, T. S., McBain, R., Newnham, E. A., & Brennan, R. T. (2013). Trajectories of internalizing problems in war-affected Sierra Leonean youth: Examining conflict and postconflict factors. Child Development, 84(2), 455–470. CrossRefPubMedPubMedCentralGoogle Scholar
  3. Boothby, N. (1996). Mobilizing communities to meet the psychosocial needs of children in war and refugee crises. In R. J. Apfel & B. Simon (Eds.), Minefields in their hearts: The mental health of children in war and communal violence (pp. 149–164). New Haven, CT: Yale University Press.Google Scholar
  4. Boothby, N. (2008). Political violence and development: An ecologic approach to children in war zones. Child and Adolescent Psychiatric Clinics of North America, 17(3), 497–514. CrossRefPubMedPubMedCentralGoogle Scholar
  5. Brooks, R., Silove, D., Steel, Z., Steel, C. B., & Rees, S. (2011). Explosive anger in post-conflict Timor Leste: Interaction of socio-economic disadvantage and past human rights-related trauma. Journal of Affective Disorders, 131(1–3), 268–276. CrossRefPubMedPubMedCentralGoogle Scholar
  6. Dueck, J., & Aida, M. (1993). HURIDOCS standard formats: A tool for documenting human rights violations. Oslo, Norway: Human Rights Information and Documentation Systems International (HURIDOCS).Google Scholar
  7. Dyregov, A., Gupta, L., Gjestad, R., & Mukanoheli, E. (1999). Trauma exposure and psychological reactions to genocide among Rwandan children. Journal of Traumatic Stress, 13(1), 3–21. CrossRefGoogle Scholar
  8. Fetzer, M. G., Peluso, D. L., & Asmundson, G. J. G. (2014). Tolerating distress after trauma: Differential associations between distress tolerance and posttraumatic stress symptoms. Journal of Psychopathology and Behavioral Assessment, 36(3), 475–484. CrossRefGoogle Scholar
  9. Hammen, C. (2006). Stress generation in depression: Reflections on origins, research, and future directions. Journal of Clinical Psychology, 62(9), 1065–1082. CrossRefPubMedPubMedCentralGoogle Scholar
  10. Hooberman, J., Rosenfeld, B., Lhewa, D., Rasmussen, A., & Keller, A. S. (2007). Classifying the torture experiences of refugees living in the U.S. Journal of Interpersonal Violence, 22(1), 108–123. CrossRefPubMedPubMedCentralGoogle Scholar
  11. Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 28(1), 36–47. CrossRefPubMedPubMedCentralGoogle Scholar
  12. Jordans, M. J. D., Semrau, M., Thornicroft, G., & van Ommeren, M. (2012). Role of current and perceived needs in explaining the association between past trauma exposure and distress in humanitarian settings in Jordan and Nepal. The British Journal of Psychiatry, 201(4), 276–281. CrossRefPubMedPubMedCentralGoogle Scholar
  13. Kubany, E. S., Leisen, M. B., Kaplan, A. S., Watson, S. B., Haynes, S. N., Owens, J. A., & Burns, K. (2000). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The traumatic life events questionnaire. Psychological Assessment, 12(2), 210–224. CrossRefPubMedPubMedCentralGoogle Scholar
  14. Layne, C. M., Olsen, J. A., Baker, A., Legershi, J. P., Isakson, B., Pasalić, A., … Pynoos, R. S. (2010). Unpacking trauma exposure risk factors and differential pathways of influence: Predicting postwar mental distress in Bosnian adolescents. Child Development, 81(4), 1053–1076. CrossRefPubMedPubMedCentralGoogle Scholar
  15. Liu, Y., & Verkuilen, J. (2013). Item response modeling of presence-severity items: Application to measurement of patient-reported outcomes. Applied Psychological Measurement, 37(1), 58–75. CrossRefGoogle Scholar
  16. Lopes Cardozo, B., Bilukha, O. O., Gotway Crawford, C., Shaikh, I., Workfe, M. I., Gerber, M. L., & Anderson, M. (2004). Mental health, social functioning, and disability in postwar Afghanistan. JAMA, 292(5), 575–584. CrossRefGoogle Scholar
  17. MacDonald, R. P. (1999). Test theory: A unified treatment. Mahwah, NJ: Erlbaum.Google Scholar
  18. Martín Baró, I. (1994). In A. Aron & S. Corne (Eds.), Writings for a liberation psychology. Cambridge, MA: Harvard University Press.Google Scholar
  19. Miller, K., Omidian, P., Rasmussen, A., Yaqubi, A., & Daudzi, H. (2008). Daily stressors, war experiences, and mental health in Afghanistan. Transcultural Psychiatry, 45, 611–639. CrossRefPubMedPubMedCentralGoogle Scholar
  20. Miller, K., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70(1), 7–16. CrossRefGoogle Scholar
  21. Miller, K. E., & Rasmussen, A. (2014). War experiences, daily stressors, and mental health five years on: Elaborations and future directions. Intervention: The International Journal for Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 12, 33–42. CrossRefGoogle Scholar
  22. Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard trauma questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and post traumatic stress disorder in refugees. Journal of Nervous and Mental Disorders, 180(2), 111–116. CrossRefGoogle Scholar
  23. Netland, M. (2001). Assessment of exposure to political violence and other potentially traumatizing events. A critical review. Journal of Traumatic Stress, 14(2), 311–326. CrossRefPubMedPubMedCentralGoogle Scholar
  24. Netland, M. (2005). Event-list construction and treatment of exposure data in research on political violence. Journal of Traumatic Stress, 18(5), 507–517. CrossRefPubMedPubMedCentralGoogle Scholar
  25. Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review, 31(3), 399–417. CrossRefPubMedPubMedCentralGoogle Scholar
  26. Norris, F. H., & Slone, L. B. (2014). Epidemiology of trauma and PTSD. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD (2nd ed., pp. 100–120). New York, NY: Guilford Press.Google Scholar
  27. Olbert, C. M., Gala, G. J., & Tupler, L. A. (2014). Quantifying heterogeneity attributable to polythetic diagnostic criteria: Theoretical framework and empirical application. Journal of Abnormal Psychology, 123(2), 452–462. CrossRefPubMedPubMedCentralGoogle Scholar
  28. Opaas, M., & Varvin, S. (2015). Relationships of childhood adverse experiences with mental health and quality of life at treatment start for adult refugees traumatized by pre-flight experiences of war and human rights violations. The Journal of Nervous and Mental Disease, 203(9), 684–695. CrossRefPubMedPubMedCentralGoogle Scholar
  29. Palmieri, P. A., Marshall, G. N., & Schell, T. L. (2007). Confirmatory factor analysis of posttraumatic stress symptoms in Cambodian refugees. Journal of Traumatic Stress, 20(2), 207–216. CrossRefPubMedPubMedCentralGoogle Scholar
  30. Powell, S., Rosner, R., Butollo, W., Tedeschi, R. G., & Calhoun, L. G. (2003). Posttraumatic growth after war: A study with former refugees and displaced people in Sarajevo. Journal of Clinical Psychology, 59(1), 71–83. CrossRefPubMedPubMedCentralGoogle Scholar
  31. Priebe, S., Bogic, M., Ashcroft, R., Franciskovic, T., Galeazzi, G. M., Kucukalic, A., … Ajdukovic, D. (2010). Experience of human rights violations and subsequent mental disorders – A study following the war in the Balkans. Social Science & Medicine, 71(12), 2170–2177. CrossRefGoogle Scholar
  32. Rasmussen, A., Keatley, E., & Joscelyne, A. (2014). Posttraumatic stress in humanitarian disaster settings outside North America and Europe: A review of the emic trauma literature. Social Science & Medicine, 109, 44–54. CrossRefGoogle Scholar
  33. Rasmussen, A., Verkuilen, J., Ho, E., & Fan, Y. (2015). Posttraumatic stress among refugees: Measurement invariance across culture in Harvard trauma questionnaire scores. Psychological Assessment, 27(4), 1160–1170. CrossRefPubMedPubMedCentralGoogle Scholar
  34. Reynolds, G. S. (1975). A primer of operant conditioning. Oxford, UK: Scott, Foresman and Company.Google Scholar
  35. Sachs, E., Rosenfeld, B., Lhewa, D., Rasmussen, A., & Keller, A. S. (2008). Entering exile: Trauma, mental health, and coping among Tibetan refugees arriving in Dharamsala, India. Journal of Traumatic Stress, 21(2), 199–208. CrossRefPubMedPubMedCentralGoogle Scholar
  36. Silove, D. (2000). A conceptual framework for mass trauma: Implications for adaptation, intervention and debriefing. In B. Raphael & J. P. Wilson (Eds.), Psychological debriefing: Theory, practice and evidence (pp. 337–350). Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
  37. Silove, D. (2005). From trauma to survival and adaptation. In D. Ingleby (Ed.), Forced migration and mental health (pp. 29–51). New York, NY: Springer.CrossRefGoogle Scholar
  38. Silove, D. (2013). The ADAPT model: A conceptual framework for mental health and psychosocial programming in psychosocial settings. Intervention: The International Journal for Mental Health, Psychosocial Work and Counselling in Areas of Armed Conflict, 11(3), 237–248. CrossRefGoogle Scholar
  39. Trani, J. F., & Bakhshi, P. (2013). Vulnerability and mental health in Afghanistan: Looking beyond war exposure. Transcultural Psychiatry, 50(1), 108–139. CrossRefPubMedPubMedCentralGoogle Scholar
  40. Vinson, G. A., & Chang, Z. (2012). PTSD symptom structure among west African war trauma survivors living in African refugee camps: A factor-analytic investigation. Journal of Traumatic Stress, 25(2), 226–231. CrossRefPubMedPubMedCentralGoogle Scholar
  41. Vujanovic, A. A., Hart, A. S., Potter, C. M., Berenz, E. C., Niles, B., & Bernstein, A. (2013). Main and interactive effects of distress tolerance and negative affect intensity in relation to PTSD symptoms among trauma-exposed adults. Journal of Psychopathology and Behavioral Assessment, 35(2), 235–243. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Andrew Rasmussen
    • 1
    Email author
  • Kenneth E. Miller
    • 2
  • Jay Verkuilen
    • 3
  1. 1.Department of PsychologyFordham UniversityBronxUSA
  2. 2.Research and DevelopmentWar ChildAmsterdamThe Netherlands
  3. 3.Educational PsychologyCity University of New YorkNew YorkUSA

Personalised recommendations