Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ)

Abstract

The Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ) is a 44-item, culturally relevant psychometric tool developed in 2024 by Gee, Chamberlain, and colleagues. Its primary function is to assess symptoms related to Complex Post-Traumatic Stress Disorder (CPTSD) and identify protective strengths among Aboriginal and Torres Strait Islander parents in Australia. The instrument was developed through a rigorous, multistage process involving scoping reviews, consultations with Elders and parents, and expert feedback, ensuring cultural appropriateness and clinical utility.

Initially comprising 88 items (28 strengths and 60 distress items), the ACTSQ was refined based on quantitative and qualitative feedback, culminating in the final 44-item structure following Exploratory Factor Analysis (EFA). The resulting scale measures five distinct factors encompassing both distress and resilience, providing a holistic view of well-being specific to this population group. Comprehensive results regarding reliability, validity, and factor structure have been reported in the academic literature.

Keywords

Colonisation, Complex Post-Traumatic Stress Disorder Symptoms, Complex Trauma Symptoms, Cultural Connections, Grief and Loss, Parenting, Sense of Self, Supports and Relationships, Indigenous People, Culturally Appropriate Tool, Aboriginal and Torres Strait Islander.

Authors

Gee, Graham, Bright, Tess, Morgan, Amy, Atkinson, Carlie, Andrews, Shawana, Clark, Yvonne, Glover, Karen, Hirvonen, Tanja, Davis, Elise, Jones, Kimberley A., Reilly, Rachel, Mensah, Fiona, Hudson-Buhagiar, Madelyne, Bennetts, Shannon K., Herrman, Helen, Milroy, Helen, Mackinnon, Andrew, Chamberlain, Catherine.

Purpose

The core purpose of the ACTSQ is to establish a valid and culturally appropriate tool for assessing psychological distress and resilience within the Aboriginal and Torres Strait Islander parental population. Prior measures often fail to adequately capture the intergenerational trauma and unique cultural protective factors relevant to this community, necessitating a specialized instrument tailored to their experiences.

Specifically, the ACTSQ provides a nuanced measure that moves beyond standard Post-Traumatic Stress Disorder (PTSD) assessment by focusing on the complex, chronic, and systemic trauma resulting partly from colonisation and historical injustice. Crucially, it simultaneously identifies inherent strengths and cultural connections that serve as protective factors promoting healing and well-being.

Construct

The ACTSQ is designed to measure the interconnected constructs of Complex Post-Traumatic Stress Disorder (CPTSD) and Complex Trauma, alongside critical protective factors. Complex Trauma refers to pervasive adverse experiences, often interpersonal and chronic, leading to severe difficulties in affect regulation, self-concept, and relationships.

The scale operationalizes these constructs across five key, empirically derived domains: Complex post-traumatic stress disorder symptoms; Grief, loss and disconnection (particularly related to culture and country); Supports and relationships; Sense of self and strengths; and Cultural connections and resources. This comprehensive, multifaceted approach acknowledges that trauma symptoms cannot be separated from cultural protective factors for this population.

Validity

The validity of the ACTSQ was established through rigorous psychometric testing, including convergent and discriminant validity analyses. Convergent validity was assessed by correlating the ACTSQ factors with the ICD-11 Trauma Questionnaire (ITQ) PTSD and CPTSD subscales.

Results indicated strong support for convergent validity: Factors 1 (CPTSD symptoms) and 2 (Grief, loss and disconnection) showed significant positive correlations with the ITQ subscales, confirming that these factors measure related distress. Conversely, Factors 3 (Supports and relationships) and 4 (Sense of self and strengths) showed appropriate negative correlations, demonstrating that greater strengths correlated with lower trauma symptoms. Factor 5 (Cultural connections and resources) showed no correlation with the ITQ subscales, supporting its distinct role as a resilience factor separate from general trauma symptomatology. Discriminant validity was also successfully demonstrated.

Reliability

Reliability analyses demonstrated the strong internal consistency and acceptable inter-rater reliability of the ACTSQ. Internal consistency, measured using McDonald’s Omega, was consistently high, exceeding the threshold of 0.75 for all five factors, indicating that items within each factor measure the intended underlying construct cohesively.

Inter-Rater Reliability (IRR), assessed using the Intraclass Correlation Coefficient (ICC), yielded fair to good results, generally ranging between 0.5 and 0.7. However, Factors 4 (Sense of self and strengths) and 5 (Cultural connections and resources) demonstrated slightly lower correlation coefficients, suggesting potential variability in how interviewers interpret or score these specific strength-based domains.

Factor Analysis

The underlying structure of the ACTSQ was confirmed using Exploratory Factor Analysis (EFA). The analysis was conducted on the initial pool of items to identify the latent structure of the questionnaire. Parallel analysis and scree plots provided clear evidence supporting a robust five-factor solution, aligning with the theoretical model of complex trauma and indigenous resilience.

The final psychometric model retained 44 items. All retained items demonstrated factor loadings greater than 0.3, with minimal problematic cross-loadings across factors. The variance explained by the individual factors ranged from 9.6% to 28%, collectively accounting for a significant portion of the variance in complex trauma and strength reporting among the study population.

Instrument

Test Type: Original Inventory/Questionnaire

Format: 44 items rated on a five-point Likert scale (0 = Not at all, 4 = A lot).

Language Available: English (developed specifically for Aboriginal and Torres Strait Islander parents in Australia).

Population Group: Aboriginal and/or Torres Strait Islander parents.

Age Group: Adults, ranging from 18–72 years.

Population Details: Respondents are Aboriginal and/or Torres Strait Islander parents residing in Australia.

Test Methodology: Psychometric evaluation included Test validity, convergent and discriminant validity, internal consistency (McDonald’s Omega), inter-rater reliability (ICC), and exploratory factor analysis.

Keywords

Complex Trauma, CPTSD, Indigenous Health, Australia, Psychometric Evaluation, Cultural Resilience, Intergenerational Trauma, Parenting Assessment, Strengths-Based Measurement, Likert Scale.

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: [email protected] (Catherine Chamberlain)

Correspondence Address: Intergenerational Health Group, Murdoch Children’s Research Institute; Indigenous Health Equity Unit, Onemda; Melbourne School of Population and Global Health, University of Melbourne; South Australian Health and Medical Research Institute (SAHMRI); Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, University of Western Australia.

Permissions & Fee and Test Year

The test items are available (Yes). The scale was developed and published in 2024. Information regarding specific permissions and fees for clinical or research use should be directed to the corresponding author, Catherine Chamberlain.

Reference’s

Gee, G., Bright, T., Morgan, A., Atkinson, C., Andrews, S., Clark, Y., Glover, K., Hirvonen, T., Davis, E., Jones, K. A., Reilly, R., Mensah, F., Hudson-Buhagiar, M., Bennetts, S. K., Herrman, H., Milroy, H., Mackinnon, A., & Chamberlain, C. (2024). Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire: Psychometric evaluation. Australian Journal of Psychology, 76(1), Article 2335917. https://doi.org/10.1080/00049530.2024.2335917

Items of the Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The ACTSQ is administered via Interview. Items are rated on a five-point Likert scale:

• 0 = Not at all
• 1 = A little bit
• 2 = Somewhat
• 3 = A fair bit
• 4 = A lot

A. Complex Post-Traumatic Stress Disorder Symptoms

• Felt as if you are reliving bad or hurtful things that have happened
• Had a memory come back that was so strong you lost yourself in that moment
• Had flashbacks of bad or hurtful things that have happened without meaning to
• Had the same bad dreams or nightmares over and over again
• Tried to avoid people, places or situations that remind you of bad or hurtful things that have happened
• Felt on guard or “on alert”
• Felt angry really easily for no reason
• Felt edgy, jumpy, frightened or nervous
• Felt like there is something wrong with you
• Felt shame from things that have happened to me
• Felt guilty for no reason
• Felt you are no good
• Felt strong emotions and had trouble managing them
• Felt numb or found it hard to feel
• Felt your feelings can be hurt very easily
• Felt cut off or distant from what’s going on around you

B. Grief, Loss, and Disconnection

• I am able to spend time on “country” or a special place that I have a connection with
• Felt like your connection to spirit or spirituality is weak
• Felt grief and loss because of losing cultural knowledge and practices
• Felt grief and loss of connection to country
• Felt like your spirit or spirituality has become weak because of bad or hurtful things that have happened
• Felt disconnected to your ancestors because of bad or hurtful things that have happened

C. Supports and Relationships

• I have role models in my life that I can learn about parenting
• I have people who listen to me and believe in me
• I feel supported by my friends/mob
• I have family that love me even when I muck up
• I have family/mob who can help me with my child
• I have people in my life that I have close relationships with
• Found it hard to have close, trusting relationships with people
• Felt really alone, even when you are with others
• Felt disconnected from people close to you, even when you know they care for you

D. Sense of Self and Strengths

• I feel like I have a say or can make choices in my life
• I feel it’s ok to be a “good enough” parent, and don’t have to be “perfect”
• I can trust myself to make good choices
• I feel ok with myself as I am
• I have done things that I am proud of
• I can manage my emotions well, even in difficult situations
• I am able to have a laugh even when things are difficult

E. Cultural Connections and Resources

• I feel like I belong in my community
• I participate in cultural practices that give me peace (such as going out bush, ceremony, community cultural events)
• Spirituality is a source of strength for me
• I have strategies to deal with racism if it happens
• I am able to maintain my Aboriginal or Torres Strait Islander identity, values and beliefs
• Not felt connected to your community