5 1 First, the Impact of Event Scale was chosen for the study because '

it is a traditional measure associated with specific traumatic

events and experiences. It measures intrusion, 7 items, and % avoidance, 8 items (Horowitz et al, 1979) . The IES-15 is scored ^ from never (0) to frequently (5) in odd numbered increments (O-l-

3-5) . A benefit of the instrument was that it had been used with diverse samples. These included, for example, subjects involved in intrusive surgery, disaster rescue work and occupational

rescue work (see Appendix VII for details of these symptoms “ scores).

The IES-15 was also chosen because it closely relates to the

definition of PTSD in DSM-IIIR, measuring intrusion symptoms - - bad dreams and waves of strong feelings - that are consistent

with B of the DSM-IIIR criteria. Avoidance symptoms indicate denial-based coping strategies and include avoiding discussion of the incident, emotional numbness and an avoidance of events

similar to, or evocative of, traumata. This conforms with the ' dissociational aspect(s) of criteria C in DSM-IIIR, and the

2. Second, the Hospital Anxiety and Depression Scale, or HAD Scale (14 items) , was chosen for the study because it measures more underlying pathology: anxiety and depression. This scale is based upon psychiatric interviews ratings (Zigmond and Snaith, 1983). The means of scoring are 0-1-2-3. Symptoms of anxiety include tension, irrational fear and restlessness.

The HAD-14 scale was chosen because the above are consistent with criteria D1 in DSM-IIIR. Depression symptoms include lethargy, worry and inability to concentrate. These are consistent with criteria C. As anxiety and depression occur in mild forms, the recommended threshold in the HAD-Scale is at 10/11, for each factor. Scores above 10/11 are said to differentiate 'normal' populations from 'caseness' (1980; 365). Caseness indicates the need for professional intervention such as counselling.

3. Third, the HSCL-21 is a list of 21 elements related to general pathology. This is broken down to performance difficulties, 7 items, somatic distress, 7 items, and general feelings of distress, 7 items. Given the physical nature of fire-fighting, indeed all emergency service work, this scale was chosen because two of its sub-factors relate to the physical reactions, or sequelae, implied by the occupational experience of the emergency services.

Experiences such as 'trouble in remembering things' relate to Cl of DSM-III ('Markedly diminished interest in one or more significant activities') and also D4 ('Memory impairment or trouble concentrating'); these are classified as performance difficulties. 'Muscle soreness' and 'a lump in your throat' are indicative of somatic distress and relate to D2 ('sleep disturbance'). General feelings of distress, such as 'feeling blue' and 'feelings being easily hurt' are analogous to depression, thus relating to criteria C in DSM-IIIR.

In addition to the above reasons - that the questionnaire instruments sought to measure both traumatic reactivity and general pathology - the questionnaire instruments were also chosen because they had been previously used in similar, emergency service work. The IES-15, as mentioned, is a traditional measure of traumatic reactivity (see Appendix VII for a review of normative data). The HAD-14 had been used in research in police officers exposed to the Piper Alpha disaster (Alexander & Wells, 1991). The HSCL-21 had been used in a certain form with disaster rescue workers (Taylor & Fraser, 1982) . Whilst the purpose in this thesis is not to compare with a normative data base, this suggested an element of precedence to the instruments; specifically, they had been used in previous emergency service or closely related research work.

Before moving on to the important question of translating questionnaire instruments, following is a summary of the questionnaire instruments used, their benefits and the sub-scales:

IES-15. Impact of Event Scale, Horowitz et al, 1979.

Key benefits; Widely used in emergency service work, existence of normative data base, relates to DSM-IIIR criteria on intrusive imagery

Sub-scale 1 :.Intrusion. Elements include 'bad dreams related to the event' and 'difficulty in falling asleep because of images or thoughts related to the event'

Sub-scale 2: Avoidance. Elements include 'banishing from memories' and 'avoiding talking about it'

HAD-14. Hospital Anxiety & Depression Scale, Zigmond & Snaith, 1987.

Key benefits : Previously used in some UK emergency service work, relates to DSM-IIIR criteria on anxiety and depression Sub-scale 1: Anxiety. Elements include 'feeling tense' and

'feeling restless'

Sub-scale 2: Depression. Elements include 'losing interest in appearance' and 'ability to laugh'

HSCL-21. Hopkins Symptom Check-list, Green et al, 1988.

Key benefits: Previously used in Australian disaster rescue work, relates to DSM-IIIR criteria on depression, acknowledges the physically demanding nature of emergency service work

Sub-,.s.q.al,e 1; EsxJ.ojaïiaa,s.e diff.iq.wlLias. • Elements include 'difficulty in speaking' and 'carelessness'

Suh -acale 2j Somatic distress. Elements include 'muscle soreness' and 'hot or cold spells'

Sub-scale— 3; General failings of distress . Elements include 'feelings being easily hurt' and 'feeling lonely' (Note; closely related to 'depression')

The use of audited questionnaire translation

Questionnaire translation is one central issue to cross-cultural research. Collecting self-report data in multi-lingual context (as here in Japanese, Chinese and English) must acknowledge each language has a set of phrases and words which do not, or cannot, translate verbatim (Newmark, 1988). This chapter reviews these and other methodological issues which are important to the future study of work-trauma in different cultural settings. Where possible the approach is prescriptive, although inevitably there is some description of the methods used in this study.

Newmark (1988) notes there is, as yet, no formal translation theory to guide practitioners. The result is a necessity for ad hoc processes and methods (1988: 161). Researchers need to be aware of his suggestions about translation. He argues faults tend to occur at

■■I two main levels. A semantic fault occurs when an original word is ^

mis-translated. Thus, for example, 'once' may be translated as |

Ï

'never' or 'frequently' as 'all the time'. This is usually resolved

i

by a process of re-editing or re-translation. In most instances d

i

translators are attentive to such details and faults are unlikely to M occur in this area (1988: 158). To this we add that during data 3 analysis abnormal entries can be detected by using tally functions. _|

An implication fault is more serious and occurs in two ways. | The first fault actually lies in psychological implications a i] 1 respondent takes from the actual fact of the translated material 4

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