Mapping the availability of translated versions of posttraumatic stress disorder screening questionnaires for adults: A scoping review

ABSTRACT Background: The most used questionnaires for PTSD screening in adults were developed in English. Although many of these questionnaires were translated into other languages, the procedures used to translate them and to evaluate their reliability and validity have not been consistently documented. This comprehensive scoping review aimed to compile the currently available translated and evaluated questionnaires used for PTSD screening, and highlight important gaps in the literature. Objective: This review aimed to map the availability of translated and evaluated screening questionnaires for posttraumatic stress disorder (PTSD) for adults. Methods: All peer-reviewed studies in which a PTSD screening questionnaire for adults was translated, and which reported at least one result of a qualitative and /or quantitative evaluation procedure were included. The literature was searched using Embase, MEDLINE, and APA PsycInfo, citation searches and contributions from study team members. There were no restrictions regarding the target languages of the translations. Data on the translation procedure, the qualitative evaluation, the quantitative evaluation (dimensionality of the questionnaire, reliability, and performance), and open access were extracted. Results: A total of 866 studies were screened, of which 126 were included. Collectively, 128 translations of 12 different questionnaires were found. Out of these, 105 (83.3%) studies used a forward and backward translation procedure, 120 (95.2%) assessed the reliability of the translated questionnaire, 60 (47.6%) the dimensionality, 49 (38.9%) the performance, and 42 (33.3%) used qualitative evaluation procedures. Thirty-four questionnaires (27.0%) were either freely available or accessible on request. Conclusions: The analyses conducted and the description of the methods and results varied substantially, making a quality assessment impractical. Translations into languages spoken in middle- or low-income countries were underrepresented. In addition, only a small proportion of all translated questionnaires were available. Given the need for freely accessible translations, an online repository was developed. HIGHLIGHTS We mapped the availability of translated PTSD screening questionnaires. The quality of the translation and validation processes is very heterogenous. We created a repository for translated, validated PTSD screening questionnaires.

The purpose of screening measures is to be a brief, easy to administer instrument which reliably distinguish between individuals with and without PTSD. However, a screening measure is not designed to obtain a definitive, but only a probable diagnosis, which needs to be clinically verified. Therefore, screening measures can but do not have to comprise items corresponding to the diagnostic criteria of PTSD. In addition, they could include any item, which is predictive of a probable PTSD diagnosis and can effectively be assessed in the target scenario, in which the screening measure is assumed to be applied (for more details see Brewin, 2005). Over the last few decades, a multitude of PTSD screening questionnaires have been developed (Brewin 2005). Differences between these questionnaires include differences in diagnostic criteria sets for PTSD (e.g. as defined by the fourth or the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders; DSM-IV, DSM-5;[O'Donnell et al., 2014] or eleventh edition of the International Classification of Diseases; ICD-11), the number of items included (e.g. assessing all symptoms of PTSD (Blanchard et al., 1996) vs only a few symptoms (Connor & Davidson, 2001), different target populations (e.g. refugees [Mollica et al., 1992] or veterans [Yarvis et al., 2012]), different settings (e.g. clinic [Duek et al., 2020], or community [Kilpatrick et al., 2013]) and constructs assessed (e.g. only symptoms of PTSD [Foa et al., 1997] vs broader sequelae of trauma [Oe et al., 2020]). Many of these measures were developed in English and in high-income countries, most commonly in the United States of America. Psychological trauma, however, affects individuals all around the globe, including many who do not live in high-income countries and are not native English speakers (Benjet et al., 2016). Therefore, screening for symptoms of PTSD in these diverse settings requires either new, context-specific screening measures or translations of existing questionnaires (Beaton et al., 2000;Bullinger et al., 1998)]. In both cases, the ability of the questionnaire to reliably measure symptoms of PTSD in the specific context is essential for ensuring the clinical utility and validity of the research in which this questionnaire is utilized. Otherwise, if the measures are inadequate, this risks the misdiagnosis of PTSD, the inaccurate assessment of symptom severity, biased estimates of prevalence rates, compromised comparisons across regions or ethnic groups and unreliable results for use in meta-analyses (van de Vijver and Tanzer 2004). Furthermore, in clinical settings, unreliable screening tools may result in individuals affected by PTSD not receiving adequate treatment.
The translation of an existing questionnaire is an expensive, and time-consuming process. Historically, such translations have unfortunately often been handled ad hoc and were poorly documented and often have been inadequately evaluated (Chassany et al., 2002). Over the last decade, multiple guidelines, frameworks, and best-practice summaries that can guide the translation of questionnaires have been developed (Acquadro et al., 2008). Across all different guidelines, it is emphasized that a mere word-to-word translation of a questionnaire is insufficient to ensure reliability and validity in a target population and that cultural aspects of the target population also need to be taken into account, especially given that the trans-cultural validity of PTSD itself is a subject of ongoing debate (Hinton and Lewis-Fernández 2011;Gilmoor et al., 2019;Hall 2020). Yet, the recommended procedures differ substantially and indicate a lack of consensus regarding the procedures required to utilize a reliable translation.
Given the importance of PTSD screening questionnaires for clinicians, public health experts and researchers globally, free access to translated, accurate and reliable questionnaires is essential. Several literature reviews have discussed the availability of PTSD screening questionnaires beyond a US context (Ali et al., 2016;Beidas et al., 2015;Gagnon and Tuck (2004). Beidas and colleagues (2015) systematically reviewed the literature for freely available, validated, standardized screening questionnaires for mental disorders for adults in low-resource settings (Beidas et al., 2015). Their review also included five questionnaires assessing symptoms of PTSD in English (Beidas et al., 2015). However, they did not assess whether these questionnaires had been translated from English into other languages. In another systematic review, Ali et al., 2016) provided an overview of brief screening tools for the detection of common mental disorders, including PTSD, that were validated in low-and middle-income countries (Ali et al., 2016). Importantly, they aimed to assess the diagnostic accuracy against a recognized gold standard diagnostic interview. Regarding PTSD screening questionnaires, 13 studies investigating a total of 10 different questionnaires were identified, with some studies assessing the accuracy of a translated version, while others assessed the accuracy of the original, English version. Evaluating the diagnostic accuracy of translated screening questionnaires is not commonly done as part of the translation process. Hence, the review likely excluded many studies reporting on the translation of a PTSD screening questionnaire. In a third systematic review, Gagnon and Tuck (2004) aimed to determine the best questionnaires for assessing multiple outcomes, including PTSD, in refugee women (Gagnon and Tuck 2004). The study reported on the properties of seven different scales. Of these, the highest number of validation studies, namely 14, were reported for the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992). However, their review was limited to a specific subpopulation, namely refugee women.
Notwithstanding these reviews, a comprehensive overview of the available translated PTSD screening questionnaires for different populations is currently lacking. This is problematic for two main reasons. First, without an overview, gaps in the literature are difficult to address. Notably, a lack of translated questionnaires constitutes an important hurdle for clinicians and researchers. Furthermore, it seems likely that PTSD screening questionnaires are less available for non-English speaking populations in low-and middle-income countries than in high-income countries. This is particularly a disadvantage for trauma-affected individuals, clinicians, and researchers who do not live in high-income countries, creating further barriers to research and treatment in these contexts. Second, systematic investigations (e.g. such as a systematic review) prerequire enough available information to ensure that the research question of interest can be addressed with the current literature. Regarding translations of PTSD questionnaires, no overview of the relevant literature exists. In addition, the above outlined reviews identified few studies investigating the performance of a translated PTSD questionnaire (Ali et al., 2016) or had to forgo the reliability and validity assessment due to very heterogeneous outcome reporting (Beidas et al., 2015). Hence, the information to plan a systematic review which would answer a specific quality-related question is currently lacking and not the goal of this review.
We aim to provide a broad overview of the existing literature of PTSD screening questionnaires translated from English to other languages, as well as the evaluation process of these translations. Therefore, neither a quality appraisal of the existing translated questionnaires, nor recommendations regarding the use of specific questionnaires are goals of this scoping review (Arksey & O'Malley, 2005;Nyanchoka et al., 2019;Peters et al., 2020).

Review question
The objective of this scoping review is to map the global availability of evaluated non-English versions of PTSD screening questionnaires for adult populations. Our definition of a non-English version is one that has been translated from English to another language independent of whether additional steps were undertaken to adapt and evaluate a questionnaire to a target population or not. Because we aim to map the available translations of PTSD screening questionnaires and expect that few translations have undergone a formal evaluation procedure, we define evaluated questionnaires as questionnaires on which any kind of information about their translation technique as well as their accuracy is provided in a peer-reviewed journal article. Therefore, some of the included questionnaires might not be evaluated in a formal sense (e.g. performance might be only assessed by correlating the total score to another PTSD questionnaire's total score). More information about the conducted evaluation procedures will be provided for each study (see below). The aims of this review are twofold: First, to identify published, peer-reviewed PTSD screening questionnaires that were translated to at least two different languages. The decision to only cover peer-reviewed, published studies as well as to exclude questionnaires with less than two translations, was made to limit the scope of this review, to ensure its feasibility and to include a criterion reflecting the use of a given questionnaires across a minimal number of different language groups. The second aim is to map all evaluated translations of the screening questionnaires identified in step one in terms of translation techniques used, results from the qualitative and/or quantitative evaluations, and accessibility of the translated questionnaires.

Study design
The aim of a scoping review is to map existing evidence on a prespecified topic. In contrast to systematic reviews, scoping reviews are more exploratory and cover a broader spectrum of evidence (Peters et al., 2020). This scoping review will be conducted in accordance with the methodological framework for scoping reviews proposed by the Joanna Briggs Institute (Peters et al., 2015;Peters et al., 2020). This framework is based upon earlier work by Arksey and O'Malley (2005) and Levac and colleagues (Levac et al., 2010). The reporting will follow the guidance of the extension of the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' for scoping reviews (PRISMA-ScR; Tricco et al., 2018).

Consultation
Several actions were taken to ensure adequate consultation from relevant stakeholders. First, the study team was assembled specifically to include researchers with a diverse background regarding gender, profession, cultural context, and geographical location. Second, all members of the research team will consult with local and international contacts (personal and professional). Third, the project was designed to be published as a registered report. Registered reports follow a two-phase publishing model (Nosek and Lakens 2014;Nosek et al., 2018). In a first phase, the authors only submit documents outlining the importance of the question they want to investigate and a detailed study plan including information about the proposed methodological approach and study design. These documents will then be reviewed by independent peers who can suggest modifications to all aspects of the submitted documents (including the study design, the measures etc.). If the study is deemed to investigate a relevant question in an appropriate manner, an 'inprinciple acceptance' is granted meaning that the final manuscript (including the results and their discussion) will be published after the completion of the study, regardless of what the results show (Nosek et al., 2018;Simons et al., 2014). Due to this publishing model, independent peer-reviewers, will be consulted before the review will be conducted.

Review registration
The initial protocol including the appendices were revised upon the suggestions made by the reviewers during the first-phase review process. Following journal guidelines on registered reports, after the revised manuscript and the protocol were accepted 'in-principle,' the revised protocol was deposited and time-stamped here: https://osf.io/ud8hc. We used the Open Science Framework (OSF; https:// osf.io), an open-source platform maintained by the Center for Open Science, a non-profit technology organization.

Eligibility criteria
To ensure the feasibility of this review, its scope will be limited to PTSD screening questionnaires that were translated at least two different times. Two translations may include translations into different language (e.g. French, Arabic, Spanish), different versions or dialects within a given language (e.g. Levantine Arabic, Egyptian Arabic, Modern Standard Arabic), and different translations within the same language and dialect (e.g. Somali translations that differ based on translation team). Therefore, the inclusion of records is conducted in a two-step process which is shown in Figure 1 (which is an adaption of the PRISMA flow diagram; Page et al., 2021). In a first step, we will systematically search for peer-reviewed articles containing information on the translation of PTSD screening questionnaires for adults. A list with all translations for each questionnaire will be prepared. In a second step, all questionnaires for which less than two translations have been identified, will be removed prior to the data extraction. For all questionnaires that were adapted to account for revised PTSD diagnostic criteria (e.g. with one version assessing DSM-IV and a later version assessing DSM-5 criteria), the cumulative number of adaptations (across all versions of the questionnaires) will be assessed. If this cumulative number is five or higher, all versions of the questionnaires will be included in the data extraction process. The eligibility criteria for both steps are defined following the Population, Concept, Context (PCC) framework as follows: Populations: This review focuses on translations of screening questionnaires developed for adult populations (≥ 18 years). No additional restrictions are imposed for the inclusion of populations (e.g. no restrictions regarding language, gender, country of origin, study site, whether the population was an epidemiological or clinical sample etc.).
Concept: The overarching concept of interest for this review is to map the availability of translated and evaluated PTSD screening questionnaires commonly used in traumatic stress research and/or in clinical practice. The following aspects of the concept of interest are discussed in depth: (a) PTSD, (b) screening questionnaire, (c) translation and/or cultural adaptation (d) evaluation.
PTSD: For the purpose of this review, questionnaires developed to assess PTSD as defined by either the fourth, the text-revised fourth or the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, DSM-IV-TR, DSM-5; American Psychiatric Association, 2013) or the tenth or eleventh edition of the International Classification of Diseases (ICD-10, ICD-11;World Health Organization, 1992) are considered.
Screening questionnaire: In accordance with the systematic review of PTSD screening instruments for adults by Brewin, screening questionnaires were defined as consisting of less than 30 items (not including the items assessing the types of trauma experienced or witnessed (Brewin, 2005). A list outlining the questionnaires that will be included in the first step is provided in Appendix I (Supplemental data).
Translation: The translation of a questionnaire to a new population is a resource-intensive and complex process (Sousa & Rojjanasrirat, 2011). For this review, we consider all studies that include at least one translation of a PTSD screening questionnaire from English to any other language. Each new translation, independent from the number of preexisting translations into the same target language, will be counted as one translation. In contrast, studies that adapted a questionnaire to a population without translating it will be excluded from this review.
Evaluation: The translation process of a questionnaire should include an evaluation of the questionnaire's properties, including its reliability and validity (Boateng et al., 2018). For this review, only studies that report information about the translation procedure as well as results from a performance assessment are considered for inclusion. Consequently, articles that state that a questionnaire was translated, but do not report some results information regarding what translated questionnaires exist as well as the evaluation procedure they have undergone and not to answer a specific question (e.g. regarding the quality the included translations). Therefore, we will collect information about the evaluation of the translated questionnaires (e.g. whether the reliability of the questionnaire was assessed) but not the quality of the included studies (e.g. the reported sensitivity and specificity). Consequently, to cover the presumably very heterogeneous literature, we will include studies with any kind of information on the questionnaire's performance, even if this information was gained using non-standard practices.
Context: We will consider studies with no restrictions regarding the context in which they were conducted.
Types of evidence sources: Only peer-reviewed, published studies reporting quantitative and qualitative results of the evaluation of the adapted questionnaire will be considered. Such studies can include but are not limited to the following designs: epidemiological study, experimental study, and cross-sectional studies. Qualitative studies and any kind of study not reporting quantitative or qualitative results of the evaluation of the adapted questionnaire(s) will not be considered for this review.
Languages: Articles published in English, German, Spanish, French, Chinese, Filipino and Hebrew will be included.
Date range. The publication date range will not be limited. However, the definitions of PTSD considered for this review are limited to the DSM-IV, DSM-IV-TR, DSM-5, ICD-10, and ICD-11, of which the DSM-IV was introduced in 1994 and the ICD-10 in 1990.

Search strategy
Our search strategy for the identification of articles of interest rests upon four main pillars to ensure coverage of the index, but also of the grey literature. First, we will conduct a systematic search of three electronic bibliographic databases: Embase, MEDLINE, and APA PsycInfo. Second, we will search the reference list of relevant review articles (Ali et al., 2016;Beidas et al., 2015;Gagnon and Tuck 2004). Third, all members of our research team, of whom some have several decades of experience translating and adapting questionnaires, will be asked to provide articles of interest from their personal archives. Fourth, we will search PTSDpubs (formerly PILOTS), a curated database covering literature on PTSD.
The search strategy for the bibliographic databases was developed in several steps. Initially, a limited search of MEDLINE was conducted to identify relevant articles. Index terms and relevant words from the identified articles' titles and abstracts were obtained. Next, the search strategies of existing systematic reviews (Beidas et al., 2015;Boateng et al., 2018;Gagnon and Tuck 2004) were analysed. Subsequently, a search strategy was developed by three authors (JH, FS & TS), and reviewed by the remaining authors as well as by an experienced librarian. We will search Embase, MEDLINE, and APA PsycInfo; using OVID. The final search strategy is presented in Appendix II (Supplemental data).

Source of evidence selection
Following the search, all citations identified through each pillar of the search strategy will be exported into Covidence (Veritas Health Innovation 2022). First, duplicates will be removed. Second, titles and abstracts of all remaining citations will be screened by a pair of independent reviewers against the inclusion criteria. The list with inclusion and exclusion criteria used by the reviewers is presented in Appendix III (Supplemental data). All abstracts deemed to meet inclusion criteria by at least one reviewer will be included in the review. Third, potentially relevant records will be fully retrieved. Again, a pair of reviewers will independently assess the records against the inclusion criteria. All articles deemed to meet inclusion criteria by at least one reviewer will be included in the review. Following the PRISMA-ScR guidelines (Tricco et al., 2018), the results of the search, the records inclusion process, and reasons for the exclusion of records during the full-text review will be recorded and reported. At the beginning of the evidence selection process, 25 randomly sampled records will be selected, and each will be screened by all reviewers. Afterwards, the results will be compared, and disagreements discussed. Based on this discussion, the document providing clarifications to the inclusion and exclusion criteria (Appendix III, Supplemental data) will be revised. All articles deemed to meet inclusion criteria by at least one reviewer will be included in the review.

Data extraction
The data extraction process will be guided by a data extraction form and conducted by a pair of reviewers using Covidence, adhering to the JBI Manual for Evidence (Peters et al., 2020). Any disagreements between the two reviewers during data extraction will be resolved by a third reviewer. If more than a total number of 30 studies are identified, data extraction will be conducted by one reviewer only to ensure feasibility of the review. In this case, accuracy of the extracted data they will be verified by an additional reviewer. Any disagreements will be resolved by a third reviewer.

Data of interest and data extraction form
The data of interest aimed to be extracted from individual records can be grouped into three categories: (a) Study characteristics, (b) Translation and evaluation, and (c) Access.
Study characteristics: For each record, the following data will be assessed: Study name II. DOI III.
Corresponding author's email address IV.
Year of publication V.
Source questionnaire VI.
Country of study site X.
Sample size XI.
Percentage of females Translation and evaluation: As outlined above, multiple recommendations and guidelines for the translation of existing questionnaires exist (Acquadro et al., 2008). Still, very few studies have tested how different translation processes affect the validity of the corresponding translations (e.g. Perneger et al., 1999). Therefore, we only aim to map whether some basic steps regarding the translation procedures and performance testing of the resulting questionnaires were undertaken. For this purpose, we use the following three dimensions: Translation.
Was the measure back translated? Grading: Yes or no. Description: Kind of translation procedure used (free text). I. Qualitative evaluation Was any kind of qualitative validation process reported (e.g. pilot testing of the adapted questionnaire, qualitative interviews, face validity etc.)? Grading: Any or none. Description: Kind of qualitative assessment (free text). II. Quantitative evaluation/Dimensionality Was any kind of dimensionality testing conducted (e.g. confirmatory factor analysis, bifactor modelling, measurement invariance testing, etc.)? Grading: Any or none. Description: Kind of dimensionality assessment (free text). III. Quantitative evaluation/Reliability Was any kind of reliability testing reported (e.g. internal consistency, testretest reliability etc.)? Grading: Any or none. Description: Kind of reliability assessment (free text). IV. Quantitative evaluation/Performance Was any kind of performance testing reported (e.g. diagnostic accuracy, correlation with another screening questionnaire, etc.)? Grading: Any or none. Description: Kind of performance assessment (free text).
Access. We will assess whether the source and the adapted questionnaires are freely available for clinical or research purposes. A questionnaire will be considered freely accessible, when it can either be freely accessed on the internet with a reasonable amount of effort (e.g. questionnaires only included in the supplementary materials of paywalled articles are not considered freely accessible) or can be requested from the authors with responses including the questionnaire within four weeks (also see Appendix V, Supplemental data).

I.
Is the adapted questionnaire freely accessible? II.
Grading: Yes or no. III.
Description: Kind of access (free text).
A draft of the extraction form is provided in Appendix IV (Supplemental data). The data extraction form will be implemented with instructions into Covidence. The data extraction process will be piloted using five randomly selected full-text records which will be assessed by the involved data extraction reviewers. Disagreements will be discussed, and the extraction form will be revised as necessary with any resulting modifications explicitly stated in the resulting scoping review.

Deviations from the protocol
We report one deviation from the protocol. The search terms outlined in the protocol to be used in Embase and APA PsycInfo were missing an additional specifier included in the search terms for MEDLINE. Thus, we expanded the preregistered search terms (instead of 'exp posttraumatic stress disorder' they also included 'or (ptsd or posttraumatic stress or post traumatic stress or trauma or traumatic) mp.') for these two databases to increase consistency across all searched databases. However, this deviation only broadened the search criteria and did therefore not jeopardize the preregister aim of this scoping review.

Study selection
The flow through the study selection process is shown in Figure 1. We identified 822 studies using our search  strategy. An additional 32 studies were found by citation searching, and 12 were sent to us by colleagues. Thereof, 740 studies were excluded during the screening process, leaving 126 studies for extraction. The full screening details, including causes for exclusion, are shown in Figure 1. Interrater reliability for each of the three pairs of reviewers who reviewed titles, abstract, and fulltexts was between fair and substantial (Cohen's κ 0.28,0.58,and 0.61,respectively).

Translation, evaluations and availability
Eighty-three per cent (n = 105) of studies described using a forward and back translation procedure.
Regarding the evaluation of translated questionnaires, 95.2% of studies (n = 120) used quantitative reliability analyses (e.g. internal consistency, test-retest reliability, inter-rater reliability, etc.), 47.6% (n = 60) used quantitative dimensionality evaluations (e.g. confirmatory factor analysis, bifactor modelling, measurement invariance testing), 38.9% (n = 49) used quantitative performance analyses (e.g. diagnostic  accuracy, correlation with another screening questionnaire) and 33.3% (n = 42) used qualitative methods (e.g. pilot testing of the adapted questionnaire, qualitative interviews, face validity). Regarding the availability of the translated questionnaires, 17 (13.5%) questionnaires are freely available online, 5 (4.0%) were made freely available online by their authors after being contacted by the study team, and in 12 (9.5%) cases the authors stated that they are willing to share the questionnaires upon request. We were unable to obtain 92 (73.0%) of all questionnaires for different reasons (e.g. the authors declined or did not respond to our request). For a more detailed description of the results see Table 1 and the Supplementary Materials.

Discussion
The objective of this scoping review was to map the global availability of translations of evaluated PTSD screening questionnaires for adult populations. This was achieved by (1) identifying published, peer-reviewed screening questionnaires that were translated in at least two different languages, and (2) mapping these questionnaires across translation techniques, qualitative and quantitative evaluation procedures, and accessibility of translated questionnaires. This scoping review identified 12 PTSD screening questionnaires that had undergone at least two translations and evaluations from English into another language.
The breadth of the questionnaires identified in this review covers definitions of PTSD according to the DSM-IV, the DSM-5, and the ICD-11. While the 12 questionnaires identified in this review represent a broad sample of PTSD screening questionnaires, if this list is limited to current definitions (i.e. DSM-5 or ICD-11), many fewer questionnaires were identified (specifically HTQ-5, PDS-5, PCL-5, ITQ). The target languages included in this review highlight the diversity of translations and gaps to be addressed. The most frequent translations comprised targeted languages such as Arabic, Spanish, Chinese, German, Korean, and French. While these are dominant languages spoken in multiple countries, they tend to represent the dominant languages spoken in high income countries, and/or the language of the most dominant migrant groups that reside in those countries. The over-representation of high-income countries in target languages is reflected when viewing the geographic locations in which these studies were conducted. These include the USA, China, Germany, and Korea, while relatively fewer studies were conducted in parts of Africa, South America, Eastern Europe, Southeast Asia, and the Middle East. These findings are not surprising, given that most research funding comes from high income countries. However, for clinicians and researchers residing in low-and middle-income countries, the lack of available non-English screening questionnaires poses major challenges (e.g. when accurate PTSD screening is needed to make important decisions regarding triaging patients or allocating resources). While most of the world's population resides in lower-and middleincome countries, mental health resources in these contexts are limited (Saxena et al., 2007). Amplifying this problem, is that only a small fraction (n = 34, 27.0%) of all identified questionnaires are freely available online or upon request from the developers. These inequities in research funding and resources may exacerbate the disparity in global mental health and mental health research. More global partnerships are needed to provide valid translations of PTSD screening questionnaires to reduce this gap.
The utility of translated PTSD screening questionnaires is highly dependent upon the quality of the translation. In this review, most studies reported using forward and blind-back translation procedures, according to best practice (Acquadro et al., 2008). However, the reporting on this process, such as the qualifications of the translators, how discrepancies were reconciled and/or the use of expert panels to review the final translation, varied substantially across different studies. In many instances, it was unclear if the translation process was conducted by the authors themselves, or was completed in an alternate study. Indeed, the lack of descriptions around translation processes precludes a more systematic review of the literature. Greater transparency and more standardized documentation of the translation process will be important to establish, as the utility of screeners is dependent upon linguistic accuracy. Equally important in the translation process is the evaluation of the translated questionnaire. The most frequently reported evaluation in this scoping review was quantitative reliability analyses. In most cases this was using Cronbach's alpha, with only a few studies implanting methods such as test-retest analyses. Less than 40% of studies evaluated the diagnostic performance of the translated questionnaire. It is also worth noting that less than 34% of studies reported qualitative methods which includes basic practices such as investigating the face validity of the questionnaire. Given that direct translations may often not convey the appropriate information, utilizing and reporting this form of evaluation is crucial for ensuring that meaning is retained, rather than only relying on statistical methods. These results indicate that there was substantial variability regarding the reported evaluation procedures. It is worth noting that 132 studies were excluded during screening because they did not include any form of evaluation. Guidelines are needed on baseline evaluation requirements for translation use, in addition to more studies in which the primary aim is to evaluate the diagnostic utility of translated questionnaires.
While the translation and evaluation process of PTSD screening questionnaires can be costly and burdensome (Acquadro et al., 2008), this burden could be alleviated by making translations freely available for research and clinical use. For example, given that permission has been obtained from the authors of the original questionnaire, translated versions could be published alongside the article describing the translation and evaluation procedures. To disseminate the results from this review and increase access for clinicians and researchers, we created a website (https:// tobiasrspiller.github.io/PTSD-Screener-Repo/) that provides global access to translated PTSD screening questionnaires. On this website, questionnaires can be downloaded or requested from the developers and the relevant studies are linked so that the developers can be credited appropriately. Moreover, the website also highlights gaps in the literature.
While this review aimed to map the availability of translated and evaluated PTSD screening questionnaires, some limitations should be noted. First, it was not the aim of this review to provide a quality assessment of each translated questionnaire. Information around translation is often lacking, precluding an assessment of this kind. Similarly, the review does not make recommendations on psychometric validity of the questionnaire. Rather, the aim was to present an overview in order to provide information for researchers and clinicians to make their own decisions. Second, to ensure feasibility of the review we planned to exclude all questionnaires that were translated only once. Following this preregistered protocol, we excluded the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), the only questionnaire for which we found less than two translations. This cut-off was partially arbitrary, as was the list of the included questionnaires, both not covering all existing questionnaires and translations. Future studies should aim to map these uncovered gaps, for example, questionnaires that were developed in a language other than English. Finally, this study only examined English questionaries that were translated into a target language. Therefore, there may have been non-English PTSD questionnaires that have been developed, which were outside the scope of this review.
To conclude, while the results identified 12 translated PTSD questionnaires, more transparency is needed around translation processes, and more rigorous evaluation methods are needed to ensure the utility of these measures in clinical and research contexts. Furthermore, more investment is needed in developing high quality translations of PTSD screening questionnaires in countries and language groups that have thus far been neglected. As the majority of existing translations were not accessible, more avenues for freely accessible translations of PTSD questionnaires are urgently needed. Making translations available in an online repository will hopefully help eliminate the need for duplicate translations and create space for more rigorous validation studies to be made widely available.

Disclosure statement
No potential conflict of interest was reported by the authors.