Research paper Evaluation of the Swedish Trauma Symptom Inventory-2 in a clinical and a student population D. Nilsson a, *, O ¨ . Dahlstro ¨m b , M. Wadsby c , K. Bergh Johannesson d a Institution for behavioral sciences and learning, department of psychology, Linko ¨ping university, SE-58183 Linko ¨ping, Sweden b Institution for behavioural sciences, department of disability research, Linko ¨ping university, SE-58183 Linko ¨ping, Sweden c Department of clinical and experimental medicine, CSAN, child and adolescent psychiatry, Linko ¨ping university, SE-58185 Linko ¨ping, Sweden d National centre for disaster psychiatry, department of neuroscience, Uppsala university, SE-75185 Uppsala, Sweden 1. Introduction Many clients seeking help at psychiatric clinics may have a history of several traumatic experiences and adverse life events (Al-Saffar, Borga, & Hallstrom, 2002; Cloitre et al., 2011). Symptoms of distress from repeated traumatic experiences can go unrevealed for a long time and may have accumulated up to the point at which a person finally requires psychiatric consultation or care. The symptoms of long-term impact of trauma may be misperceived in traumatised individuals as personality traits, personality disorders, or both (Briere, 1995, 2011). Broad-spectrum assessment instruments for identifying these conditions serve as important tools at psychiatric clinics. A commonly held view is that stressors are perceived as traumatic when the potential threat exceeds the defensive abilities of the individual, which causes overwhelming fear, anxiety and stress in certain situations (Briere & Rickards, 2007; Frueh, Grubaugh, Elhai, & Ford, 2012). More complex emotional effects after trauma can result from severe stressors that are either repetitive or prolonged, involve harm or abandonment by caregivers, or occur at vulnerable times in a person’s life (Courtois & Ford, 2009). The result can be a complexity of symptoms including not only symptoms of posttraumatic stress disorder (PTSD), such as intrusive images, avoidance of reminders and hyperarousal, but also symptoms characterised by self-regulatory disturbances (e.g. dissociation, somatic distress, relational alienation and impulsiveness) (Cloitre et al., 2009). Other common symptoms can be difficulties in relationships with other people, low self-esteem and problems associated with handling emotions and situations. These symp- toms often compromise an individual’s personality development and the basic trust in primary relationships (Courtois & Ford, 2009). Multiple types of potential trauma may be described as polytraumatisation, affecting both self-esteem and psychological distress (Nilsson, Dahlstro ¨ m, Priebe, & Svedin, 2014). The European Journal of Trauma & Dissociation xxx (2017) xxx–xxx A R T I C L E I N F O Article history: Received 12 July 2017 Received in revised form 17 October 2017 Accepted 17 October 2017 Available online xxx Keywords: Trauma Symptom Inventory-2 Adults Reliability Validity Trauma Psychiatry A B S T R A C T Introduction. – The Trauma Symptom Inventory-2 (TSI-2) is a broad-spectrum assessment instrument designed to identify symptoms that can appear in the aftermath of potentially traumatic experiences. Objective. – This study aimed to evaluate the external and internal validity of this newly reconstructed instrument. Method. – In total, 696 individuals participated in the study, including 83 psychiatric outpatients. Participants answered the TSI-2, together with a trauma history questionnaire, and other questionnaires assumed to correlate with the different scales included in the TSI-2. Results. – Validity was evaluated by correlations between the TSI-2 and the other instruments and by the differences between clinical and non-clinical populations. Reliability was calculated by testing internal consistency and test-re-test reliability. A confirmatory factor analysis (CFA) was computed to test the postulated four-factor structure. Cronbach’s alpha was found to be good and ranged from a = .77 to .91 and test-retest reliability was strong. Strong to satisfactory correlations were found between the TSI-2 and the other instruments. The student sample scored significantly lower than the clinical group on all clinical scales. Sensitivity and specificity were calculated with different cut-off scores. Conclusion. – Despite the CFA demonstrating a questionably good model of fit, most of the scales proved to be sound and the TSI-2 could be recommended as a broad-spectrum assessment instrument.  C 2017 Elsevier Masson SAS. All rights reserved. * Corresponding author. E-mail address: doris.nilsson@liu.se (D. Nilsson). G Model EJTD-48; No. of Pages 12 Please cite this article in press as: Nilsson, D., et al. Evaluation of the Swedish Trauma Symptom Inventory-2 in a clinical and a student population. European Journal of Trauma & Dissociation (2017), https://doi.org/10.1016/j.ejtd.2017.10.006 Available online at ScienceDirect www.sciencedirect.com https://doi.org/10.1016/j.ejtd.2017.10.006 2468-7499/  C 2017 Elsevier Masson SAS. All rights reserved.