# Structure and validity of the Subjective Traumatic Outlook questionnaire under conditions of continuous trauma

## TL;DR

This study validates the Subjective Traumatic Outlook questionnaire as a reliable tool for measuring trauma in populations affected by ongoing conflict.

## Contribution

The study confirms the STO's two-factor structure and diagnostic accuracy in a real-world wartime context.

## Key findings

- The STO showed a stable two-factor structure across two time points during the Israel conflict.
- The four-item STO version performed as well as the five-item version in diagnosing PTSD and complex PTSD.
- The STO demonstrated strong internal consistency and convergent validity over time in a conflict-affected population.

## Abstract

This longitudinal study examines the psychometric validity of the Subjective Traumatic Outlook (STO) questionnaire by evaluating its structural consistency and diagnostic performance in a conflict-affected context. The STO was used to measure trauma-related subjective distress at two time points following the terrorist attacks in Israel on 7 October 2023.

The primary aim of this study was to evaluate the STO as a concise and reliable assessment tool for populations affected by armed conflict.

A nationally representative sample of 4097 participants responded at T1, of whom 2005 completed the study at T2. Data were collected during the ongoing war in Israel. Participants completed the STO alongside validated measures of post-traumatic stress disorder (PTSD (PTSD Checklist for DSM-5) and International Trauma Questionnaire), depression, anxiety and adjustment disorder. Exploratory factor analyses were used to estimate one- to three-factor solutions using robust maximum likelihood estimation. Convergent validity was assessed through bivariate correlations with trauma- related measures. Receiver operating characteristic analyses were conducted to evaluate diagnostic utility for PTSD and complex PTSD per the ICD-11.

Exploratory factor analysis supported a stable two-factor structure across both waves. The STO demonstrated strong internal consistency and stable convergent validity over time. Receiver operating characteristic analyses indicated that the four-item version matched or slightly outperformed the five-item version, suggesting improved parsimony without loss of diagnostic accuracy.

The stable factor structure of the STO and its strong psychometric properties across both waves within a wartime context support its utility for large-scale screening and early detection of trauma-related distress.