Adaptation of The Ukrainian Version of The Combat Exposure Scale (CES-UA)

Keywords: combat exposure intensity, adaptation, multigroup confirmatory factor analysis, measurement invariance, convergent and discriminant validity, psychometric properties, life satisfaction

Abstract

Objective. The objective of this study was to adapt the original Combat Exposure Scale (CES; Keane et al., 1989) into the Ukrainian language, translated as the Combat Exposure Scale–Ukrainian version (CES-UA), for use in psychological practice with active-duty service members, veterans, and individuals with combat experience. This scale is a widely used self-report tool for assessing combat-related situations. Despite its international value, a validated Ukrainian version was lacking. Given the urgent psychological needs of military personnel amid Russia’s full-scale invasion of Ukraine, this gap required immediate attention.

Methods. The CES was translated and culturally adapted into Ukrainian using a forward–backward method involving a professional translator, bilingual veterans, and university faculty. Psychometric testing included 513 male service members (436 online, 77 paper). Data analysis was conducted in R (R Core Team, 2024) and RStudio (Posit, 2024).

Results. Confirmatory factor analysis confirmed the unidimensional structure of the Ukrainian version of the Combat Exposure Scale (CES-UA). Most fit indices demonstrated an excellent level of correspondence between the theoretical model and the empirical data (CFI = 0.999, TLI = 0.998, SRMR = 0.034).

Subsequent evaluation of the model confirmed its key psychometric characteristics. As a result, multiple statistical methods confirmed that the CES-UA demonstrates high reliability (α = 0.91, ordinal α = 0.95, ω = 0.93, CR = 0.94), supported convergent validity (AVE = 0.729), discriminant validity (HTMT = 0.046), and measurement invariance across age groups.

Conclusion. The Ukrainian version of the Combat Exposure Scale (CES-UA) is a reliable and valid instrument and is recommended for use with Ukrainian-speaking military personnel and veterans in both clinical practice and scientific research.

Downloads

Download data is not yet available.

References

Olefir, V., & Bosniuk, V. (2024). Adaptation of Ukrainian version of the Satisfaction With Life Scale by E. Diener. Nauka i osvita – Science and Education, (2), 64– 72. (In Ukranian). https://doi.org/10.24195/2414-4665-2024-2-9

Ackerman, A. (2022). The effect of combat exposure on sexually transmitted diseases. Economics & Human Biology, 46, 101142. https://doi.org/10.1016/j.ehb.2022.101142

Bandalos, D. L. (2018). Measurement theory and applications for the social sciences. Guilford Press.

Bao, H.-W.-S. (2023). bruceR: Broadly useful convenient and efficient R functions (Version 0.7.0) [R package]. CRAN. https://doi.org/10.32614/CRAN.package.bruceR

Bryan, C. J., Cukrowicz, K. C., West, C. L., & Morrow, C. E. (2010). Combat experience and the acquired capability for suicide. Journal of Clinical Psychology, 66(10), 1044–1056. https://doi.org/10.1002/jclp.20703

Carvalho, T., Cunha, M., Pinto-Gouveia, J., & da Motta, C. (2015). Development of the combat distress scale of the combat experiences questionnaire (CEQ). Journal of Affective Disorders, 174, 602–610. https://doi.org/10.1016/j.jad.2014.11.054

Carvalho, T., Pinto-Gouveia, J., Cunha, M., & da Motta, C. (2014). Development of exposure to combat severity scale of the combat experiences questionnaire (CEQ). Journal of Anxiety Disorders, 28(8), 938–946. https://doi.org/10.1016/j.janxdis.2014.09.024

Chen, F. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14(3), 464–504. https://doi.org/10.1080/10705510701301834

Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 9(2), 233–255. https://doi.org/10.1207/S15328007SEM0902_5

DeVellis, R. F. (2016). Scale development: Theory and applications (4th ed.). Thousand Oaks, CA: SAGE Publications.

Dunn, T. J., Baguley, T., & Brunsden, V. (2013). From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation. British Journal of Psychology, 105(3), 399–412. https://doi.org/10.1111/bjop.12046

Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9(4), 466–491. https://doi.org/10.1037/1082-989X.9.4.466

Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. https://doi.org/10.2307/3151312

Foy, D. W., Sipprelle, R. C., Rueger, D. B., & Carroll, E. M. (1984). Etiology of posttraumatic stress disorder in Vietnam veterans: Analysis of premilitary, military, and combat exposure influences. Journal of Consulting and Clinical Psychology, 52(1), 79–87. https://doi.org/10.1037/0022-006X.52.1.79

George, D. (2003). SPSS for Windows step by step: A simple guide and reference (4th ed., 11.0 update). Allyn & Bacon.

Grinker, R. R., & Spiegel, J. P. (1945). The syndrome of “operational fatigue” (war neuroses) in returnees. In Men under stress (pp. 208–224). Blakiston. https://doi.org/10.1037/10784-009

Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Pearson Education.

Henseler, J., Ringle, C. M., & Sarstedt, M. (2014). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43(1), 115–135. https://doi.org/10.1007/s11747-014-0403-8

Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22. https://doi.org/10.1056/NEJMoa040603

Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

Jacobson, I. G. (2008). Alcohol use and alcohol-related problems before and after military combat deployment. JAMA, 300(6), 663–669. https://doi.org/10.1001/jama.300.6.663

Janes, G. R., Goldberg, J., Eisen, S. A., & True, W. R. (1991). Reliability and validity of a combat exposure index for Vietnam era veterans. Journal of Clinical Psychology, 47(1), 80–86. https://doi.org/10.1002/1097-4679(199101)47:1<80::aid-jclp2270470112>3.0.co;2-9

Jorgensen, T. D., Pornprasertmanit, S., Schoemann, A. M., & Rosseel, Y. (2021). semTools: Useful tools for structural equation modeling. R package version 0.5-4. https://CRAN.R-project.org/package=semTools

Kang, S., Aldwin, C. M., Choun, S., & Spiro, A. (2015). A life-span perspective on combat exposure and PTSD symptoms in later life: Findings from the VA normative aging study. The Gerontologist, 56(1), 22–32. https://doi.org/10.1093/geront/gnv120

Kardiner, A. (1941). Analysis of the symptomatology. In A. Kardiner, The traumatic neuroses of war. (pp. 68–132). National Research Council. https://doi.org/10.1037/10581-003

Keane, T. M., Fairbank, J. A., Caddell, J. M., Zimering, R. T., Taylor, K. L., & Mora, C. A. (1989). Clinical evaluation of a measure to assess combat exposure. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(1), 53–55. https://doi.org/10.1037/1040-3590.1.1.53

Kelber, M. S., Smolenski, D. J., Workman, D. E., Morgan, M. A., Garvey Wilson, A. L., Campbell, M. S., Evatt, D. P., & Belsher, B. E. (2019). Typologies of combat exposure and their effects on posttraumatic stress disorder and depression symptoms. Journal of Traumatic Stress, 32(6), 946–956. https://doi.org/10.1002/jts.22459

Kim, T. Y., Choi, J. H., Chung, H. G., & So, H. S. (2013). P.4.a.005 Reliability and validity of the Korean version of the combat exposure scale. European Neuropsychopharmacology, 23, S509–S510. https://doi.org/10.1016/S0924-977X(13)70809-5

Koenen, K. C., Stellman, J. M., Stellman, S. D., & Sommer, J. F. (2003). Risk factors for course of posttraumatic stress disorder among Vietnam veterans: A 14-year follow-up of American Legionnaires. Journal of Consulting and Clinical Psychology, 71(6), 980–986. https://doi.org/10.1037/0022-006X.71.6.980

Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1988). Contractual report of findings from the National Vietnam Veterans Readjustment Study. Volume 1: Executive summary, overview, and design. Research Triangle Institute. https://www.ptsd.va.gov/professional/articles/article-pdf/nvvrs_vol1.pdf

Li, C.-H. (2015). Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behavior Research Methods, 48(3), 936–949. https://doi.org/10.3758/s13428-015-0619-7

McDonald, R. P. (1999). Test Theory: A Unified Treatment. Psychology Press.

http://doi.org/10.4324/9781410601087

McKee, P., Budnick, C. J., Walters, K. S., & Bind, M.-A. (2024). The role of combat exposure on drinking behavior and subjective well-being: A Rubin Causal Model approach. Psychological Trauma: Theory, Research, Practice, and Policy, 16(4), 610–617. https://doi.org/10.1037/tra0001546

Myers, C. (1915). A contribution to the study of shell shock. The Lancet, 185(4772), 316–320. https://doi.org/10.1016/s0140-6736(00)52916-x

Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill.

Orak, U., Yildiz, M., Aydogdu, R., Koenig, H. G., & Pietrzak, R. H. (2023). The relationship between combat exposure and suicide risk in U.S. military veterans: Exploring the role of posttraumatic stress symptoms and religious coping. Journal of Affective Disorders, 341, 77–87. https://doi.org/10.1016/j.jad.2023.08.115

Peterson, A. L., Goodie, J. L., Satterfield, W. A., & Brim, W. L. (2008). Sleep disturbance during military deployment. Military Medicine, 173(3), 230–235. https://doi.org/10.7205/milmed.173.3.230

Porter, B., Hoge, C. W., Tobin, L. E., Donoho, C. J., Castro, C. A., Luxton, D. D., & Faix, D. (2018). Measuring aggregated and specific combat exposures: Associations between combat exposure measures and posttraumatic stress disorder, depression, and alcohol-related problems. Journal of Traumatic Stress, 31(2), 296–306. https://doi.org/10.1002/jts.22273

Putnick, D. L., & Bornstein, M. H. (2016). Measurement invariance conventions and reporting: The state of the art and future directions for psychological research. Developmental Review, 41, 71–90. https://doi.org/10.1016/j.dr.2016.06.004

R Core Team. (2024). R: A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org/

Rhemtulla, M., Brosseau-Liard, P. É., & Savalei, V. (2012). When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychological Methods, 17(3), 354–373. https://doi.org/10.1037/a0029315

Rivera-Rivera, N., Pérez-Pedrogo, C., Calaf, M., & Sánchez-Cardona, I. (2022). Translation, cultural adaptation, and psychometric properties of the Spanish version of the Combat Exposure Scale (CES-S) with U.S. military Spanish speaking Latino veterans living in the Caribbean: A cross-sectional preliminary data study. Psychological Trauma: Theory, Research, Practice, and Policy, 14(4), 721–727. https://doi.org/10.1037/tra0001099

Rosseel, Y. (2012). Lavaan: An R Package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02

RStudio Team. (2023). RStudio: Integrated Development Environment for R. Posit Software, PBC. https://posit.co/

Svetina, D., Rutkowski, L., & Rutkowski, D. (2019). Multiple-Group invariance with categorical outcomes using updated guidelines: An illustration using mplus and the lavaan/semtools packages. Structural Equation Modeling: A Multidisciplinary Journal, 27(1), 111–130. https://doi.org/10.1080/10705511.2019.1602776

Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–471. https://doi.org/10.1002/jts.2490090305

Unger W. S., Gould R. A., Babich M. (1998). The development of a scale to assess war-time atrocities: the War Events Scale. Journal of Traumatic Stress, 11(3), 375–383. https://doi.org/10.1023/A:1024463406656

Vandenberg, R. J., & Lance, C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3(1), 4–70. https://doi.org/10.1177/109442810031002

Vogt, D., Smith, B. N., King, L. A., King, D. W., Knight, J., & Vasterling, J. J. (2013). Deployment risk and resilience inventory-2 (DRRI-2): An updated tool for assessing psychosocial risk and resilience factors among service members and veterans. Journal of Traumatic Stress, 26(6), 710–717. https://doi.org/10.1002/jts.21868

Wells, T. S., LeardMann, C. A., Fortuna, S. O., Smith, B., Smith, T. C., Ryan, M. A. K., Boyko, E. J., & Blazer, D. (2010). A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. American Journal of Public Health, 100(1), 90–99. https://doi.org/10.2105/ajph.2008.155432

West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation models with nonnormal variables: Problems and remedies. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 56–75). Sage Publications, Inc.

Wilk, J. E., Bliese, P. D., Kim, P. Y., Thomas, J. L., McGurk, D., & Hoge, C. W. (2010). Relationship of combat experiences to alcohol misuse among U.S. soldiers returning from the Iraq war. Drug Alcohol Depend, 108(1–2), 115–121. https://doi.org/10.1016/j.drugalcdep.2009.12.003

Zumbo, B. D., Gadermann, A. M., & Zeisser, C. (2007). Ordinal versions of coefficients alpha and theta for likert rating scales. Journal of Modern Applied Statistical Methods, 6 (1), 21–29. https://doi.org/10.22237/jmasm/1177992180

Published
2025-06-30
Cited
How to Cite
Kasiianenko, D. (2025). Adaptation of The Ukrainian Version of The Combat Exposure Scale (CES-UA). Visnyk of V.N. Karazin Kharkiv National University. Series Psychology, (78), 67-76. https://doi.org/10.26565/2225-7756-2025-78-10