Development and Validation of a Historical Trauma Scale: The Influence of Historical Trauma Experiences on Alcohol Use Among Indigenous Communities

Purpose: Alcohol use has become a major health concern for Taiwanese indigenous communities. Previous research indicates that historical trauma is one of several alcohol use determinants among indigenous peoples in Taiwan. Historical trauma framework underscores that contemporary indigenous health behaviors and outcomes are long reaching effects of historically traumatic events due to colonial oppression. Since the existing historical trauma research in Taiwan is qualitative and conceptual in nature, there is a need to examine the connection between historical trauma and alcohol use among indigenous communities. Making this empirical linkage requires the development of a historical trauma measure relevant to Taiwanese indigenous communities. This study describes the establishment of the Historical Trauma Experiences (HTE) and demonstrates an association of the HTE with alcohol use.

Method: Item development of the HTE was informed by the following sources: (1) existential concepts and literature review of historical trauma; (2) findings of previous qualitative interview project conducted in 2013 to explore Taiwanese indigenous people’s perspectives regarding historical traumatic events and their impacts on alcohol use. Once item development was completed, the scale was provided to both academic and cultural experts to assess face and content validity of the initial thirteen items, which was reduced to ten based on their feedback. Next, data were collected in 2015 using a quantitative survey with a convenience sample of 245 indigenous tribal members (20- 83 years) who live in a rural locale in the East Taiwan. The survey included the HTE, alcohol use and demographic questionnaire. The HTE measured the inter-generational experiences of significant historical traumatic events for Taiwanese indigenous communities. Alcohol use was measured by Chinese version of Alcohol Use Disorders Identification Test (10 items, α=.91). Statistical tests included reliability analyses (Cronbach’s alpha), exploratory factor analysis (EFA), confirmatory factor analyses (CFA) and correlational analyses to examine the factor structure and construct and predictive validations of the newly developed HTE.

Findings: EFA results indicated a three-factor solution for the HTE. However, CFA findings revealed that a two-factor model fitted the data well based on selected model fit indices (X²=33.97(df=23), p=.66; RMSEA=.047). The final model contained two subscales with seven items (α=.74). The two subscales of the HTE included: (1) disruption of land and family attachment, and (2) cultural and educational assimilation. Both HTE subscales are significantly associated with alcohol use disorder. The disruption of land and family attachment was positively associated with alcohol use disorder (z=2.66, p<.01). The cultural and educational assimilation was negatively associated with alcohol use disorder (z=-2.96, p<.01). The HTE demonstrated preliminary evidence of construct and predictive validity.

Implications/Conclusions: This study provides preliminary evidence for adequate psychometric properties of the HTE scale. Findings support historical trauma framework and demonstrates that historical trauma experiences are one of major determinants of alcohol use among indigenous communities in Taiwan. Future intervention and prevention for alcohol use among indigenous peoples should explore how to address and heal from the disruption of land and family attachment, since it is a significant determinant of alcohol use disorders among Taiwanese indigenous communities.