The Cambodian Somatic Symptom and Syndrome Inventory (CSSI)

Information about Measure
First Name Devon
Last Name Hinton
Affiliation Department of Psychiatry, Massachusetts General Hospital
Other means of contacting author (e.g., website,, ResearchGate)
Mental health assessment tool that was adapted/developed/validated The Cambodian Somatic Symptom and Syndrome Inventory (CSSI)
Mental health condition assessed Trauma- and stressor-related disorders
Idiom of distress included, if any Not Applicable
Lifestage of interest
Age range (age – age)
Country or countries where tool was developed/adapted/validated United States with Cambodian refugees
Language(s) of the adapted/developed/validated tool Khmer
Clinical or community sample? Clinical
Subpopulation in which tool was developed/validated (e.g., tool was developed and tested among middle-class women)? United States with Cambodian refugees at a psychiatric clinic
Development procedures Locally developed and culturally validated
If validated, what was the gold standard?
Description of other development procedures, if applicable
Cronbach’s alpha
Other information about tool (e.g., additional psychometrics [NPV, PPV, Youden’s index, diagnostic odds ratio]) For the somatic scale, the alpha was .91, and for the syndrome scale, .88, with the all the multi-item syndrome subscales having excellent internal consistency as well (all alphas > .84).
Links to development/adaptation/validation studies and/or previous studies using the tool Hinton, D. E., Alexandra Kredlow, M., Pich, V., Bui, E., & Hofmann, S. G. (2013). The relationship of PTSD to key somatic complaints and cultural syndromes among Cambodian refugees attending a psychiatric clinic: The Cambodian Somatic Symptom and Syndrome Inventory (CSSI). Transcultural Psychiatry, 50(3), 347–370.
Notes when administering the tool The CSSI is meant to be used alongside other standardized assessment tools such as the PTSD Checklist (PCL). The CSSI scale assesses somatic symptoms and cultural syndromes that are particularly salient among traumatized Cambodian population but are not assessed in the DSM-IV criteria. The CSSI items are divided into two subscales: a somatic scale (18 items) and a syndrome scale (19 items), with the syndrome scale having five subscales. The CSSI assesses how much the patient was bothered by certain somatic symptoms or syndromes in the last 4 weeks, each rated on a 0–4 Likert-type scale: 0 (not at all), 1 (a little bit), 2 (moderately), 3 (quite a bit), and 4 (extremely).
The CSSI also assesses cultural syndromes that are prominent aspects of the Cambodian response to trauma (see Table 1): somatic-focused syndromes (10 items): agoraphobia/motion-sickness-type syndromes (two items); emotion-focused syndrome (one item); a cognitive-deficit syndrome (one item); and spiritual-type syndromes (four items).