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

1. Abstract

The Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ) is a psychometrically validated, culturally grounded assessment instrument developed by Graham Gee, Catherine Chamberlain, and a multidisciplinary team of First Nations and non-Indigenous researchers in Australia (Gee et al., 2024). Specifically engineered to capture the nuanced psychological landscape of First Nations parents and caregivers, the ACTSQ operationalizes a dual-axis framework that concurrently assesses the manifestations of Complex Post-Traumatic Stress Disorder (CPTSD) alongside culturally embedded resources, resilience factors, and parenting capacities. Comprising 44 items administered predominantly via culturally sensitive clinical interview protocols, the instrument departs from deficit-dominated psychiatric taxonomies by contextualizing relational, historical, and intergenerational trauma within Indigenous paradigms of holistic health.

The scale encompasses five empirically substantiated factors: (1) Complex Post-Traumatic Stress Disorder Symptoms (affective dysregulation, negative self-concept, relational disturbance, and core post-traumatic intrusion and avoidance); (2) Grief, Loss, and Disconnection (loss of cultural knowledge, separation from ancestral lands, and spiritual rupture); (3) Supports and Relationships (kinship networks, parental role models, and community safety nets); (4) Sense of Self and Strengths (self-efficacy, self-acceptance, emotional regulation, and parental confidence); and (5) Cultural Connections and Resources (engagement in cultural ceremony, cultural identity continuity, and systemic coping mechanisms against racism). Psychometric evaluation across a cohort of Aboriginal and Torres Strait Islander parents (ages 18–72 years) demonstrated robust structural integrity via exploratory factor analysis (loadings > 0.30; explained variance per factor spanning 9.6% to 28.0%). Internal consistency is uniformly high, with McDonald’s omega coefficients exceeding 0.75 across all dimensions. Convergent and discriminant validity analyses showed theoretically aligned relationships with the ICD-11 Trauma Questionnaire (ITQ), confirming the ACTSQ as an indispensable instrument for perinatal, clinical, and community-led epidemiological research.

2. Keywords

Aboriginal and Torres Strait Islander health, complex post-traumatic stress disorder, CPTSD, cultural strengths, intergenerational trauma, social and emotional wellbeing, Indigenous psychometrics, parenting assessment, historical trauma, decolonizing mental health, trauma-informed care, transgenerational healing

3. Authors

The Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire was designed, validated, and published by a collaborative consortium of Indigenous and allied academic researchers across Australia:

• Graham Gee — Intergenerational Health Group, Murdoch Children’s Research Institute; Indigenous Health Equity Unit, Onemda Centre for Indigenous Health and Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
• Tess Bright — Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia.
• Amy Morgan — Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
• Carlie Atkinson — We Al-li Culturally Informed Trauma Integrated Healing, Queensland, Australia.
• Shawana Andrews — Department of Social Work, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
• Yvonne Clark — South Australian Health and Medical Research Institute (SAHMRI); School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia.
• Karen Glover — South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
• Tanja Hirvonen — Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, University of Western Australia, Perth, Western Australia, Australia.
• Elise Davis — Murdoch Children’s Research Institute, Parkville, Victoria, Australia.
• Kimberley A. Jones — Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia.
• Rachel Reilly — South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
• Fiona Mensah — Intergenerational Health Group, Murdoch Children’s Research Institute; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
• Madelyne Hudson-Buhagiar — Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia.
• Shannon K. Bennetts — Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia.
• Helen Herrman — Orygen; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
• Helen Milroy — Centre for Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, University of Western Australia, Perth, Western Australia, Australia.
• Andrew Mackinnon — Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
• Catherine Chamberlain (Corresponding Author) — Indigenous Health Equity Unit, Onemda Centre for Indigenous Health and Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia. Contact Email: [email protected].

4. Purpose

The primary clinical and epidemiological objective of the ACTSQ is to provide a culturally safe, empirically sound, and holistic instrument capable of measuring the complex sequelae of trauma while balancing symptom profiles with intrinsic, community-held strengths in Aboriginal and Torres Strait Islander parents. Historically, Western psychiatric assessment tools deployed within Indigenous contexts have suffered from significant epistemic and methodological limitations. Conventional psychometric scales—such as standard PTSD inventories designed strictly according to DSM or ICD criteria—exhibit an individualized, pathology-focused orientation. These instruments systematically fail to account for the unique historical, collective, and transgenerational trauma rooted in ongoing settler-colonial practices, the legacy of forced child removal policies (the Stolen Generations), dispossession from ancestral lands, and systemic racial discrimination in contemporary institutional systems (historical trauma).

Critically, standard instruments are ill-equipped to evaluate trauma during the vulnerable and pivotal developmental transition of parenthood. The perinatal and early parenting period frequently serves as a catalytic window where parents’ unresolved traumatic experiences can be reactivated, jeopardizing maternal and infant mental health, parental reflective functioning, and secure attachment. Conversely, this life transition represents a prime therapeutic window for interrupting the intergenerational transmission of trauma. Western assessment tools applied in this setting frequently run the risk of generating stigmatizing labels, exacerbating institutional surveillance, and contributing disproportionately to unwarranted child protection interventions.

The theoretical rationale underpinning the ACTSQ is anchored in the deconstruction of Western psychiatric hegemony and the implementation of a “two-eyed seeing” paradigm. The ACTSQ captures not only affective and cognitive distress, intrusions, and avoidance, but also directly assesses ancestral rupture, spiritual injury, and the profound grief associated with cultural dispossession. Crucially, the measure establishes an empirical parity between trauma and resilience. By assessing protective factors—such as kinship support systems, connection to Country, cultural continuity, self-efficacy, and racial coping strategies—the ACTSQ delivers actionable data for clinical formulations, perinatal mental health programs, infant-parent psychotherapy, and community-led parenting initiatives. In clinical practice, the tool aids clinicians in co-designing trauma-integrated healing strategies, avoiding pathologizing interpretations of normative stress, and identifying key cultural resources that buffer against distress.

5. Psychological Construct

The ACTSQ operationalizes a multidimensional psychological construct that synthesizes the diagnostic criteria of Complex Post-Traumatic Stress Disorder (CPTSD as recognized in the ICD-11) with the multidimensional holism of the Aboriginal Social and Emotional Wellbeing (SEWB) framework. The construct is articulated across five correlated yet distinct factors:

Factor 1: Complex Post-Traumatic Stress Disorder Symptoms

This dimension comprises 16 items measuring both core post-traumatic stress reactions and disturbances in self-organization (DSO). It encapsulates:

• Affective Dysregulation: Pervasive emotional volatility, heightened reactivity, difficulty soothing intense emotional states, emotional numbing, and severe psychological distress triggered by interpersonal reminders.
• Negative Self-Concept: Chronic experiences of internal shame, pervasive self-blame, existential worthlessness, and feeling damaged or broken due to adverse life events.
• Relational Disturbances: Difficulty sustaining closeness, deep-seated mistrust, avoidance of relationships, and subjective alienation from others.
• Intrusion and Hyperarousal: Involuntary reliving, vivid intrusive memories, repetitive nightmares, hypervigilance, and exaggerated startle responses.

Factor 2: Grief, Loss, and Disconnection

Encompassing 6 items, this construct reflects the unique historical, collective, and transgenerational grief experienced by Aboriginal and Torres Strait Islander peoples. Unlike uncomplicated individual bereavement, this factor captures:

• Cultural Loss: The distress associated with interrupted oral tradition, language loss, and the severance of traditional ceremonial practices.
• Disconnection from Country: Solastalgic and existential distress resulting from physical separation, land alienation, or environmental degradation of ancestral homelands.
• Spiritual Rupture: The subjective weakening of connection to spirit, Ancestors, and cultural cosmology following exposure to interpersonal violence, colonization, and historical adversity.

Factor 3: Supports and Relationships

Comprising 9 items, this relational domain evaluates the presence of functional, protective social networks within family, kinship, and broader community structures:

• Parental Role Models: Access to elders, family members, or peers demonstrating positive parenting behaviors and providing practical and emotional advice.
• Kinship and Mob Support: The availability of unconditional family acceptance, reliable child-rearing assistance, and mutual community aid.
• Interpersonal Trust and Connection: The individual’s felt capacity to form safe relational bonds versus experiencing profound interpersonal alienation and isolation.

Factor 4: Sense of Self and Strengths

Comprising 7 items, this internal resource dimension captures self-efficacy, parental self-concept, and psychological resilience:

• Self-Efficacy and Autonomy: The subjective belief that one possesses agency, self-determination, and the capacity to make sound life decisions.
• Parental Self-Compassion: Acceptance of the “good enough parent” archetype, buffering against perfectionism and trauma-associated inadequacy.
• Affective Agency and Coping: The capacity to maintain perspective, self-regulate during times of emotional turbulence, and utilize humor as a protective psychological buffer.

Factor 5: Cultural Connections and Resources

Comprising 6 items, this factor assesses externalized and internalized cultural capital:

• Community Belonging: Strong integration into one’s Indigenous community, shared collective identity, and mutual social support.
• Engagement in Cultural Practices: Active participation in traditional rituals, ceremony, time spent on Country (“going bush”), and experiential spirituality.
• Systemic Resilience: Possessing proactive cognitive and behavioral strategies to navigate, deflect, and mitigate the traumatic psychological impacts of systemic and interpersonal racism.

6. Theoretical Framework

The theoretical framework of the ACTSQ is situated at the intersection of contemporary trauma psychopathology, relational psychoanalysis, and Indigenous decolonial scholarship. Specifically, it integrates three foundational paradigms: the ICD-11 model of CPTSD, the Indigenous Social and Emotional Wellbeing (SEWB) framework, and the Theory of Historical and Intergenerational Trauma.

The ICD-11 Formulation of Complex PTSD

In the World Health Organization’s ICD-11, Complex PTSD was formally introduced as an entity distinct from classic PTSD. Rooted in the pioneering conceptualizations of Judith Herman (1992), CPTSD emerges following exposure to traumatic events that are typically chronic, repeated, or from which escape is practically impossible (e.g., childhood abuse, prolonged domestic violence, captivity). Beyond the three core symptom clusters of PTSD—(1) re-experiencing in the present, (2) avoidance of traumatic reminders, and (3) persistent sense of current threat—the diagnostic construct requires disturbances in self-organization (DSO):

• Severe and persistent affect dysregulation;
• Persistent beliefs about oneself as diminished, defeated, or worthless, accompanied by profound feelings of shame or guilt; and
• Persistent difficulties in sustaining relationships and feeling close to others.

The ACTSQ operationalizes these precise diagnostic facets, recognizing that interpersonal and relational trauma often impairs the parent’s capacity to feel psychologically safe, form secure attachments, and maintain affective equilibrium during infant caregiving.

The Social and Emotional Wellbeing (SEWB) Framework

Recognizing the limitations of Western individualistic psychiatric taxonomies, the ACTSQ embeds CPTSD within the holistic Aboriginal Social and Emotional Wellbeing (SEWB) model (Gee et al., 2014; Swan & Raphael, 1995). Within this worldview, health is not merely the absence of disease or psychological disorder; rather, it is a broad, multidimensional state that encompasses connection to Country, spirituality, ancestry, family, kinship, and community. The mind is not separated from the body, nor is the individual separated from their collective and ancestral ecosystem. Trauma disrupts these multifaceted relational bonds. Consequently, healing requires not just the reduction of negative internal affects, but the active reconnection to cultural resources, collective identity, kinship systems, and ancestral Country.

Historical, Transgenerational, and Structural Trauma Models

The instrument incorporates the seminal insights of Maria Yellow Horse Brave Heart (1998) and Eduardo Duran regarding historical trauma—defined as the cumulative, multi-layered emotional and psychological wounding across generations resulting from cataclysmic collective trauma. In the Australian context, British colonial settlement initiated systematic violence, frontier wars, the forced introduction of fatal pathogens, dispossession of territory, institutionalized racism, and government-mandated removal of Aboriginal children from their families and communities (Stolen Generations). The ACTSQ’s theoretical foundation posits that symptoms manifesting in parents are frequently transgenerational echoes of historical oppression rather than isolated internal dysfunctions. By synthesizing trauma symptomatology with cultural determinants of health, the ACTSQ reflects a paradigm shift toward decolonized psychological measurement.

7. Validity

The psychometric evaluation of the ACTSQ demonstrates comprehensive construct, convergent, and discriminant validity across rigorous empirical studies involving First Nations parents in Australia (Gee et al., 2024).

Construct Validity

Construct validity was established through a multi-stage iterative co-design methodology. Initial scale development incorporated comprehensive systematic scoping reviews, in-depth qualitative yarning circles with Aboriginal and Torres Strait Islander Elders, health practitioners, and parents, followed by expert consensus panels. The initial pool of 88 candidate items was subjected to rigorous cognitive pretesting and psychometric reduction. The resulting 44-item five-factor model evidenced strong structural integrity, accounting for extensive cumulative variance. Each factor demonstrated high substantive coherence, reflecting both psychological distress and adaptive Indigenous protective factors.

Convergent Validity

Convergent validity was evaluated by examining bivariate correlations between the ACTSQ dimensions and the standardized International Trauma Questionnaire (ITQ), which measures ICD-11 PTSD and CPTSD:

• Factor 1 (CPTSD Symptoms): Displayed robust, statistically significant positive correlations with the ITQ PTSD subscale ($r \approx 0.65$ to $0.74$, $p < 0.001$) and the ITQ CPTSD Disturbances in Self-Organization (DSO) subscale ($r \approx 0.70$ to $0.80$, $p < 0.001$).
• Factor 2 (Grief, Loss, and Disconnection): Correlated positively and significantly with ITQ trauma and DSO indices ($r \approx 0.35$ to $0.50$, $p < 0.01$), confirming that cultural and spiritual disconnection is closely tied to traumatic distress.
• Factor 3 (Supports and Relationships) & Factor 4 (Sense of Self and Strengths): Demonstrated statistically significant negative correlations with the ITQ symptom scales ($r \approx -0.25$ to $-0.45$, $p < 0.01$), indicating that relational and individual strengths act as protective buffers against CPTSD symptoms.

Discriminant Validity

Discriminant validity was established through factor intercorrelations and differential associations with external measures. Factor 5 (Cultural Connections and Resources) exhibited virtually zero or weak, non-significant correlations with the ITQ PTSD and DSO indices ($r < 0.10$, $p > 0.05$). This confirmed that cultural identity, spiritual strengths, and systemic coping mechanisms constitute an independent, orthogonal dimension of resilience that cannot be captured or inferred simply by assessing the presence or absence of Western post-traumatic symptoms.

8. Reliability

The ACTSQ has been rigorously evaluated for internal consistency and test-retest/inter-rater stability across validation cohorts.

Internal Consistency

Rather than relying exclusively on Cronbach’s alpha ($lpha$), which relies on tau-equivalence assumptions that are rarely met in multidimensional psychological inventories, the scale developers calculated McDonald’s omega ($\omega$), a more robust estimate of composite reliability. Internal consistency across all five subscales substantially surpassed standard psychometric benchmarks ($\omega > 0.70$):

• Factor 1 (CPTSD Symptoms): $\omega > 0.90$, demonstrating exceptional internal consistency and item homogeneity for the clinical symptom domain.
• Factor 2 (Grief, Loss, and Disconnection): $\omega > 0.82$, confirming strong reliability across items capturing collective and cultural bereavement.
• Factor 3 (Supports and Relationships): $\omega > 0.80$, indicating reliable measurement of relational and kinship networks.
• Factor 4 (Sense of Self and Strengths): $\omega > 0.78$, reflecting coherent assessment of self-worth, agency, and parenting adequacy.
• Factor 5 (Cultural Connections and Resources): $\omega > 0.75$, demonstrating adequate reliability for cultural participation and coping resources.

Inter-Rater Reliability

Given that the instrument is administered primarily through a semi-structured conversational interview protocol, inter-rater reliability was rigorously assessed using the Intraclass Correlation Coefficient (ICC). For Factors 1, 2, and 3, ICC values ranged between 0.50 and 0.70, indicating fair-to-good concordance across independent raters. Factors 4 and 5 yielded lower ICC estimates, an expected phenomenon attributed to the subjective, nuanced nature of cultural identity expressions and contextual parenting self-evaluations during conversational assessment.

9. Factor Analysis

The structural dimensionality of the ACTSQ was evaluated through Exploratory Factor Analysis (EFA) following extensive data collection from Aboriginal and Torres Strait Islander parents across Australia.

Extraction and Rotation Criteria

The number of underlying latent dimensions was determined using a convergence of psychometric criteria: parallel analysis, visual inspection of the scree plot, and evaluation of eigenvalues (> 1.0). Given that psychological distress, cultural experiences, and social resources naturally correlate in real-world populations, an oblique factor rotation (e.g., Promax or Oblimin) was employed, permitting latent factors to be correlated.

Factor Loadings and Variance Explained

The exploratory factor analysis definitively supported a robust five-factor solution. The final 44-item questionnaire retained items based on strict structural criteria:

• Primary factor loadings exceeding 0.30 (with the majority of items loading above 0.45);
• Minimal cross-loadings (< 0.20 difference on secondary dimensions);
• No isolated single-item factors or uninterpretable residual constructs.

The individual factors accounted for meaningful proportions of variance in the item matrix, ranging from 9.6% to 28.0% per factor. The largest proportion of variance was explained by the CPTSD symptom dimension, followed by the relational support and cultural disconnection factors. This structural balance provides empirical proof that Indigenous psychological functioning is dual-faceted, requiring distinct evaluation of clinical symptomatology and cultural-relational resources.

10. Instrument / Measurement Tool

• Instrument Name: Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ)
• Test Type: Dual-axis multidimensional inventory / Clinical diagnostic screening questionnaire
• Target Population: Aboriginal and/or Torres Strait Islander parents and caregivers (validated with adults aged 18 to 72 years)
• Item Count: 44 items (reduced from an initial 88-item research prototype)
• Administration Format: Culturally responsive interview format (“yarning-based” clinical assessment) or supervised self-report questionnaire
• Response Scale: 5-point Likert-type scale scored from 0 to 4:
  • 0 = Not at all
  • 1 = A little bit
  • 2 = Somewhat
  • 3 = A fair bit
  • 4 = A lot
• Subscale Breakdown:
  • Factor 1: Complex Post-Traumatic Stress Disorder Symptoms — 16 items
  • Factor 2: Grief, Loss, and Disconnection — 6 items
  • Factor 3: Supports and Relationships — 9 items
  • Factor 4: Sense of Self and Strengths — 7 items
  • Factor 5: Cultural Connections and Resources — 6 items
• Scoring and Interpretation Procedures:
  • Subscale scores are calculated by summing the response weights within each factor. Alternatively, mean item scores (range 0.0 to 4.0) can be calculated to preserve scale comparability.
  • Trauma Dimensions (Factors 1 and 2): Higher scores denote severe CPTSD symptomatology, complex affective dysregulation, profound negative self-concept, and extensive historical/cultural disconnection.
  • Strength Dimensions (Factors 3, 4, and 5): Higher scores denote elevated protective relational scaffolding, robust parenting confidence, emotional agency, and strong cultural-spiritual resources.
  • Dual-Axis Clinical Profile: Assessment outputs should never be collapsed into a single aggregate deficit score. Clinicians must map the balance between distress and resilience to inform trauma-informed care and parenting interventions.

11. Permissions & Fee and Test Year

The Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire was published in 2024. The tool was developed through publicly funded research under the auspices of the Murdoch Children’s Research Institute, the University of Melbourne, and partner Aboriginal community organizations.

In accordance with Indigenous data sovereignty and ethical research guidelines established by the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS), the ACTSQ is intended for culturally safe clinical, perinatal, and community-led research applications. While academic publications describing the instrument are accessible via peer-reviewed literature, clinicians, healthcare organizations, and researchers seeking to deploy or adapt the tool must adhere to culturally informed protocols and obtain permission from the primary research team. Inquiries regarding formal usage, training modules, clinical scoring guides, and licensing should be directed to the corresponding author, Professor Catherine Chamberlain ([email protected]).

12. References

Brave Heart, M. Y. H. (1998). The return to the sacred path: Healing the historical trauma and historical unresolved grief response among the Lakota through a psychoeducational group intervention. Smith College Studies in Social Work, 68(3), 287–305. https://doi.org/10.1080/00377319809517532

Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138(6), 536–546. https://doi.org/10.1111/acps.12956

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

Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander social and emotional wellbeing. In P. Dudgeon, H. Milroy, & R. Walker (Eds.), Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed., pp. 55–68). Commonwealth of Australia.

Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. https://doi.org/10.1002/jts.2490050305

Swan, P., & Raphael, B. (1995). Ways forward: National consultancy report on Aboriginal and Torres Strait Islander mental health. Australian Government Publishing Service.

World Health Organization. (2018). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/

13. Items of the Scale