{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:42:18Z","timestamp":1792604538333,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The International Trauma Questionnaire (ITQ) is a widely used self-report measure of PTSD and Complex PTSD (CPTSD). \u2018Clinical checks\u2019 \u2013 brief follow up questions verifying respondent comprehension of the symptom item \u2013 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20095,070) were collected using quota-based sampling procedures from adults living in five European countries (Czech Republic, Poland, Hungary, Romania, and Slovakia).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360940","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:27:29Z","timestamp":1792603649000},"page":"e0360940","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Examining the performance of the International Trauma Questionnaire with clinical checks in a multinational European sample"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9574-7128","authenticated-orcid":true,"given":"Philip","family":"Hyland","sequence":"first","affiliation":[{"name":"Maynooth University","place":["Kildare, Ireland"],"department":["Department of Psychology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6262-5223","authenticated-orcid":true,"given":"Mark","family":"Shevlin","sequence":"additional","affiliation":[{"name":"Ulster University","place":["Derry, Northern Ireland"],"department":["School of Psychology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7890-2069","authenticated-orcid":true,"given":"Menachem","family":"Ben-Ezra","sequence":"additional","affiliation":[{"name":"Ariel University","place":["Ariel, Israel"],"department":["School of Social Work"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryl\u00e8ne","family":"Cloitre","sequence":"additional","affiliation":[{"name":"New York University","place":["New York, New York, United States of America"],"department":["Silver School of Social Work"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matus","family":"Adamkovic","sequence":"additional","affiliation":[{"name":"Slovak Academy of Sciences","place":["Ko\u0161ice, Slovakia"],"department":["Institute of Social Sciences CSPS"]},{"name":"Charles University","place":["Prague, Czechia"],"department":["Faculty of Education"]},{"name":"University of Jyv\u00e4skyl\u00e4","place":["Jyv\u00e4skyl\u00e4, Finland"],"department":["Faculty of Humanities and Social Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agata","family":"B\u0142achnio","sequence":"additional","affiliation":[{"name":"John Paul II Catholic University of Lublin","place":["Lublin, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Preiss","sequence":"additional","affiliation":[{"name":"National Institute of Mental Health","place":["Klecany, Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"Salgo","sequence":"additional","affiliation":[{"name":"Semmelweis University","place":["Budapest, Hungary"],"department":["Department of Psychiatry and Psychotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela Fadgyas","family":"Stanculete","sequence":"additional","affiliation":[{"name":"Iuliu Hatieganu University of Medicine and Pharmacy","place":["Cluj-Napoca, Romania"],"department":["Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt Szabolcs","family":"Unoka","sequence":"additional","affiliation":[{"name":"Semmelweis University","place":["Budapest, Hungary"],"department":["Department of Psychiatry and Psychotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanos","family":"Karatzias","sequence":"additional","affiliation":[{"name":"Edinburgh Napier University","place":["Edinburgh, Scotland"],"department":["School of Health and Social Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"6","key":"pone.0360940.ref001","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1111\/acps.12956","article-title":"The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD","volume":"138","author":"M Cloitre","year":"2018","journal-title":"Acta Psychiatr Scand"},{"key":"pone.0360940.ref002","volume-title":"ICD-11: International classification of diseases, eleventh revision","author":"World Health Organization","year":"2019"},{"key":"pone.0360940.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cpr.2017.09.001","article-title":"A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD","volume":"58","author":"CR Brewin","year":"2017","journal-title":"Clin Psychol Rev"},{"key":"pone.0360940.ref004","doi-asserted-by":"crossref","first-page":"102381","DOI":"10.1016\/j.janxdis.2021.102381","article-title":"A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire","volume":"79","author":"E Redican","year":"2021","journal-title":"J Anxiety Disord"},{"issue":"4","key":"pone.0360940.ref005","doi-asserted-by":"crossref","first-page":"196","DOI":"10.5765\/jkacap.250017","article-title":"Can we trust the international trauma questionnaire? A comprehensive systematic meta-analytic review of its reliability across cultural contexts in adult and child\/adolescent versions","volume":"36","author":"M Nvo-Fern\u00e1ndez","year":"2025","journal-title":"J Korean Acad Child Adolesc Psychiatry"},{"issue":"4","key":"pone.0360940.ref006","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/NMD.0000000000000790","article-title":"ICD-11 prevalence rates of posttraumatic stress disorder and complex posttraumatic stress disorder in a German Nationwide Sample","volume":"206","author":"A Maercker","year":"2018","journal-title":"J Nerv Ment Dis"},{"issue":"6","key":"pone.0360940.ref007","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1002\/jts.22454","article-title":"ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: A population-based study","volume":"32","author":"M Cloitre","year":"2019","journal-title":"J Trauma Stress"},{"key":"pone.0360940.ref008","doi-asserted-by":"crossref","first-page":"112871","DOI":"10.1016\/j.psychres.2020.112871","article-title":"A longitudinal study of ICD-11 PTSD and complex PTSD in the general population of Israel","volume":"286","author":"P Hyland","year":"2020","journal-title":"Psychiatry Res"},{"issue":"4","key":"pone.0360940.ref009","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s00127-020-01912-x","article-title":"Trauma, PTSD, and complex PTSD in the Republic of Ireland: prevalence, service use, comorbidity, and risk factors","volume":"56","author":"P Hyland","year":"2021","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"pone.0360940.ref010","doi-asserted-by":"crossref","first-page":"919191","DOI":"10.3389\/fpsyt.2022.919191","article-title":"Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood","volume":"13","author":"H Kampling","year":"2022","journal-title":"Front Psychiatry"},{"issue":"8","key":"pone.0360940.ref011","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1177\/00207640211057720","article-title":"Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population","volume":"68","author":"M Kvedaraite","year":"2022","journal-title":"Int J Soc Psychiatry"},{"issue":"1","key":"pone.0360940.ref012","doi-asserted-by":"crossref","DOI":"10.1192\/j.eurpsy.2024.12","article-title":"Mental health in Ukraine in 2023","volume":"67","author":"D Martsenkovskyi","year":"2024","journal-title":"Eur Psychiatry"},{"key":"pone.0360940.ref013","doi-asserted-by":"crossref","first-page":"104045","DOI":"10.1016\/j.ajp.2024.104045","article-title":"Prevalence and validity of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD: A population-based survey of Hong Kong adults","volume":"96","author":"GWK Ho","year":"2024","journal-title":"Asian J Psychiatr"},{"issue":"5","key":"pone.0360940.ref014","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1037\/tra0001472","article-title":"Assessing prevalence, validity, and correlates of ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder in Ireland","volume":"16","author":"G McGinty","year":"2024","journal-title":"Psychol Trauma"},{"key":"pone.0360940.ref015","doi-asserted-by":"crossref","first-page":"116056","DOI":"10.1016\/j.psychres.2024.116056","article-title":"Associations between mental health symptoms, trauma, quality of life and coping in adults living in Ukraine: A cross-sectional study a year after the 2022 Russian invasion","volume":"339","author":"S Wang","year":"2024","journal-title":"Psychiatry Res"},{"issue":"12","key":"pone.0360940.ref016","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1080\/10926771.2024.2428181","article-title":"Self-reported ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD in the General Danish Population","volume":"33","author":"MS J\u00f8rgensen","year":"2024","journal-title":"J Aggress Maltreat Trauma"},{"key":"pone.0360940.ref017","doi-asserted-by":"crossref","first-page":"102963","DOI":"10.1016\/j.janxdis.2024.102963","article-title":"Epidemiology of DSM-5 PTSD and ICD-11 PTSD and complex PTSD in the Netherlands","volume":"110","author":"CM Hoeboer","year":"2025","journal-title":"J Anxiety Disord"},{"issue":"1","key":"pone.0360940.ref018","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/acps.13799","article-title":"Testing the use of \u201cclinical checks\u201d with the International Trauma Questionnaire to measure PTSD and complex PTSD","volume":"152","author":"M Shevlin","year":"2025","journal-title":"Acta Psychiatr Scand"},{"issue":"2","key":"pone.0360940.ref019","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/wps.21191","article-title":"The value and limitations of self-administered questionnaires in clinical practice and epidemiological studies","volume":"23","author":"M Zimmerman","year":"2024","journal-title":"World Psychiatry"},{"issue":"6","key":"pone.0360940.ref020","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.psym.2013.05.009","article-title":"The prevalence of bipolar disorder in primary care patients with depression or other psychiatric complaints: A systematic review","volume":"54","author":"JM Cerimele","year":"2013","journal-title":"Psychosomatics"},{"issue":"1","key":"pone.0360940.ref021","doi-asserted-by":"crossref","first-page":"2447182","DOI":"10.1080\/20008066.2024.2447182","article-title":"Validation of the International Trauma Interview (ITI) among treatment-seeking people with adverse childhood experiences in South Korea","volume":"16","author":"H Choi","year":"2025","journal-title":"Eur J Psychotraumatol"},{"issue":"1","key":"pone.0360940.ref022","doi-asserted-by":"crossref","first-page":"2037905","DOI":"10.1080\/20008198.2022.2037905","article-title":"Validation of the International Trauma Interview (ITI) for the Clinical Assessment of ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) in a Lithuanian Sample","volume":"13","author":"O Gelezelyte","year":"2022","journal-title":"Eur J Psychotraumatol"},{"issue":"6","key":"pone.0360940.ref023","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.janxdis.2011.03.016","article-title":"The challenge of estimating PTSD prevalence in the context of ongoing trauma: the example of Israel during the Second Intifada","volume":"25","author":"YSG Hoffman","year":"2011","journal-title":"J Anxiety Disord"},{"issue":"22","key":"pone.0360940.ref024","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1001\/jama.2020.6504","article-title":"Accuracy of the PHQ-2 alone and in combination with the PHQ-9 for screening to detect major depression: Systematic review and meta-analysis","volume":"323","author":"B Levis","year":"2020","journal-title":"JAMA"},{"issue":"1","key":"pone.0360940.ref025","doi-asserted-by":"crossref","first-page":"2494361","DOI":"10.1080\/20008066.2025.2494361","article-title":"The International Trauma Interview (ITI): Development of a semi-structured diagnostic interview and evaluation in a UK sample","volume":"16","author":"NP Roberts","year":"2025","journal-title":"Eur J Psychotraumatol"},{"key":"pone.0360940.ref026","doi-asserted-by":"crossref","first-page":"101072","DOI":"10.1016\/j.newideapsych.2023.101072","article-title":"Clinician-administered interviews should not be considered the \u2018gold standard\u2019 method of assessing psychological distress","volume":"73","author":"P Hyland","year":"2024","journal-title":"New Ideas Psychol"},{"issue":"1","key":"pone.0360940.ref027","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1002\/jts.23100","article-title":"Assessing self-reported prolonged grief disorder with \u201cclinical checks\u201d: A proof of principle study","volume":"38","author":"M Shevlin","year":"2025","journal-title":"J Trauma Stress"},{"key":"pone.0360940.ref028","volume-title":"Process of translation and adaptation of instruments","author":"World Health Organization","year":"2010"},{"issue":"2","key":"pone.0360940.ref029","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1037\/tra0000908","article-title":"Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM-5","volume":"13","author":"P Hyland","year":"2021","journal-title":"Psychol Trauma"},{"key":"pone.0360940.ref030","volume-title":"Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014","author":"S McManus","year":"2016"},{"issue":"6","key":"pone.0360940.ref031","first-page":"613","article-title":"An ultra-brief screening scale for anxiety and depression: The PHQ-4","volume":"50","author":"K Kroenke","year":"2009","journal-title":"Psychosomatics"},{"issue":"2","key":"pone.0360940.ref032","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jaclp.2023.11.685","article-title":"A systematic review of the psychometric properties of the Patient Health Questionnaire-4 in clinical and nonclinical populations","volume":"65","author":"S Caro-Fuentes","year":"2024","journal-title":"J Acad Consult Liaison Psychiatry"},{"key":"pone.0360940.ref033","volume-title":"Mplus user\u2019s guide","author":"LK Muth\u00e9n","year":"2017","edition":"8"},{"issue":"1","key":"pone.0360940.ref034","doi-asserted-by":"crossref","first-page":"2444745","DOI":"10.1080\/20008066.2024.2444745","article-title":"The factor structure of the International Trauma Questionnaire - Heywood cases in confirmatory factor analysis","volume":"16","author":"K-I Karstoft","year":"2025","journal-title":"Eur J Psychotraumatol"},{"issue":"1","key":"pone.0360940.ref035","doi-asserted-by":"crossref","first-page":"2152929","DOI":"10.1080\/20008066.2022.2152929","article-title":"Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample","volume":"14","author":"A R\u00e1cz","year":"2023","journal-title":"Eur J Psychotraumatol"},{"issue":"6","key":"pone.0360940.ref036","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1002\/jts.22444","article-title":"Examining the discriminant validity of complex posttraumatic stress disorder and borderline personality disorder symptoms: Results From a United Kingdom population sample","volume":"32","author":"P Hyland","year":"2019","journal-title":"J Trauma Stress"},{"issue":"4","key":"pone.0360940.ref037","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1037\/1082-989X.9.4.466","article-title":"An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data","volume":"9","author":"DB Flora","year":"2004","journal-title":"Psychol Methods"},{"issue":"1","key":"pone.0360940.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives","volume":"6","author":"L Hu","year":"1999","journal-title":"Struct Equat Model: Multidiscip J"},{"issue":"1","key":"pone.0360940.ref039","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1146\/annurev-psych-121924-104021","article-title":"How do psychologists determine whether a measurement scale is good? A quarter-century of scale validation with Hu & Bentler (1999)","volume":"77","author":"D McNeish","year":"2026","journal-title":"Annu Rev Psychol"},{"issue":"1","key":"pone.0360940.ref040","doi-asserted-by":"crossref","first-page":"134","DOI":"10.2307\/1130296","article-title":"\u201cHow Big Is Big Enough?\u201d: Sample size and goodness of fit in structural equation models with latent variables","volume":"58","author":"JS Tanaka","year":"1987","journal-title":"Child Dev"},{"issue":"4","key":"pone.0360940.ref041","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1037\/tps0000176","article-title":"Ten frequently asked questions about latent class analysis","volume":"4","author":"K Nylund-Gibson","year":"2018","journal-title":"Transl Issues Psychol Sci"},{"issue":"1","key":"pone.0360940.ref042","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"JR Landis","year":"1977","journal-title":"Biometrics"},{"issue":"4","key":"pone.0360940.ref043","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1037\/rev0000418","article-title":"The memory and identity theory of ICD-11 complex posttraumatic stress disorder","volume":"130","author":"P Hyland","year":"2023","journal-title":"Psychol Rev"},{"key":"pone.0360940.ref044","doi-asserted-by":"crossref","first-page":"103055","DOI":"10.1016\/j.janxdis.2025.103055","article-title":"Memory and identity processes in ICD-11 complex posttraumatic stress disorder: Tests of a new theory","volume":"114","author":"P Hyland","year":"2025","journal-title":"J Anxiety Disord"},{"issue":"1","key":"pone.0360940.ref045","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1037\/a0021591","article-title":"Sex differences in impulsivity: A meta-analysis","volume":"137","author":"CP Cross","year":"2011","journal-title":"Psychol Bull"},{"issue":"11","key":"pone.0360940.ref046","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1016\/j.addbeh.2013.10.033","article-title":"Sex differences in impulsive action and impulsive choice","volume":"39","author":"J Weafer","year":"2014","journal-title":"Addict Behav"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360940","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:27:36Z","timestamp":1792603656000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360940"}},"subtitle":[],"editor":[{"given":"Jan Christopher","family":"Cwik","sequence":"first","affiliation":[{"name":"Hochschule Niederrhein - Campus M\u00f6nchengladbach: Hochschule Niederrhein - Campus Monchengladbach","place":["GERMANY"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360940","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]}}}