PTSD assessment in Ukrainian refugees using the PCL-5: linguistic and cultural challenges

Introduction In the aftermath of the Ukrainian full-scale invasion of Ukraine by Russia, multiple language-adapted versions of psychometric instruments have emerged to assess the mental health of near 6 million Ukrainians who sought refuge in European host countries, revealing concerning indicators of poor mental health and challenges related to inclusion behaviours (Sajjad, 2022; UN Refugee Agency, UNHCR, 2022). Since 2022, there have been several surveys ofn Ukrainian refugees., mostly concerning the displaced and not internally displaced persons, However, but these studies often lack control over the psychometric properties of the adapted versions used to assess trauma and related symptomatology (Xu et al., 2023). Recent studies focused on the mental health and well-being of refugees from Ukraine, specifically civilians, but the information gathered on trauma and pPost-tTraumatic sStress dDisorder (PTSD) Formatada: Author List;Keywords;Abstract remains unclear sparse (Buchcik et al., 2023; Costanza et al., 2022). Mental health indicators suggest a fragile well-being environment for these refugees in host countries, which is likely to worsen over time without proper PTSD evaluation (Buchcik et al., 2023; Costanza et al., 2022; Figueiredo et al., 2024; Figueiredo & Petravičiūtė, 2025; Lotzin et al., 2023). Native language-adapted and cultural-sensitive psychological assessment is crucial for efficient diagnosis and treatment of PTSD symptoms. A well-established instrument for PTSD assessment the PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013a), a 20-item self-report of PTSD symptoms according to DMS-5 criteria (American Psychiatry Association, APA, 2013). Several translations in Ukrainian and Russian have been employed amongst Ukrainian refugees. However, the accuracy and validity of these translations remains unclear. In this study, we address significant gaps in documentation and validation of translated versions of PCL-5. This study addresses the gap highlighted by Buchcik et al. (2023) regarding the limited evidence on trauma and PTSD among Ukrainian refugees, leading us to the issue of translation for accurate assessment. Our studyWe examined the translation accuracy ofs three its three adaptations of the PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013a) in two languages: a (1) Ukrainian (further referred to as UV1; Bezsheiko, 2016) and a (2) Russian (RV; Los Angeles County, Department of Mental Health) both version conducted clinically among Ukrainian refugees in Germany;, and (3) an otheranother Ukrainian adaptation (UV2; Figueiredo et al., 2024), utilized used in a research settings with Ukrainian refugees in Portugal. We employed both a qualitative and a quantitative approach using bilingual expert ratings as well as novel in this field automated linguistic similarity metrics adapted from machine translations. From these analyses, we derived recommendations for clinical practitioners and researchers. Initially, a back-translation of the two Ukrainian and one Russian versions of the PCL-5 into English was conducted using the DeepL translation program. Subsequently, corrections were made by a native Russian bilingual fluent in both Russian and Ukrainian, who ensured precise word-for-word accuracy. These corrections were refined by a bilingual psychologist proficient in Ukrainian and Russian 1.1.2 The PTSD Checklist for DSM-5 (PCL-5) Translation Processes and Associated Risks 2.1 Psychometric properties of the PCL-5 The adaptation of psychological assessment instruments, particularly in cross-cultural studies, typically involves a systematic forward-translation and back-translation process as a standard procedure for clinical and research tools (Forkus et al., 2023; Gadeberg et al., 2017; Thompson et al., 2024). Following the translation phase, the validation process is conducted in three stages: a pilot study to evaluate the instrument's linguistic properties, a main study involving administration to the target population, and test-retest reliability assessments. However, the reliability of such instruments can be compromised if the translation process is not rigorously overseen. Specifically, the lack of oversight by ethical committees specializing in the constructs being assessed may lead to deviations in translation quality, thereby affecting the validity and reliability of the instrument (Klotz et al., 2023; Leitgöb et al., 2023). The primary issue lies in the translation of the same psychometric questionnaire and the lack of cross-cultural awareness in the psychological assessment process. In this we on a used for trauma the PCL-5 for The PTSD Checklist for DSM-5 (PCL-5) been used its English version was in by Weathers et al. with several adaptations versions in for both research and clinical However, main is the of the PTSD the made in the translation of the of particularly in the of Ukrainian refugees et al., 2024; et al., 2023; et al., 2022). 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Following the translation phase, the validation process is conducted in three stages: a pilot study to evaluate the instrument's linguistic properties, a main study involving administration to the target population, and test-retest reliability assessments. However, the reliability of such instruments can be compromised if the translation process is not rigorously overseen. Specifically, the lack of oversight by expert committees may lead to deviations in translation quality, thereby affecting the validity and reliability of the instrument (Klotz et al., 2023; Leitgöb et al., 2023). 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