District Hospital Trauma Survivor Mental Health Screening Language Concordance and Post-Traumatic Stress Disorder Disclosure Among Congolese Survivors: A Multilevel Analysis of Interpreter Mediation Fidelity

District hospitals in eastern Democratic Republic of the Congo serve trauma survivors whose languages rarely match those of the clinicians who screen them, and interpreter mediation is the routine but unexamined hinge on which post-traumatic stress disorder disclosure turns. The framework distinguishes four fidelity dimensions of mediated trauma screening: semantic accuracy, emotional prosody, role boundary maintenance, and disclosure safety. It proposes that the effect of language concordance on disclosure is not a fixed quantity but a cross-level interaction whose magnitude depends on interpreter fidelity, and it derives testable propositions about the conditions under which mediated screening either approximates or systematically distorts direct-language screening. The dominant policy response of expanding interpreter availability without measuring fidelity misallocates resources, because fidelity rather than presence is the binding constraint on valid disclosure. Implications for screening protocol design, interpreter training, and the interpretation of routine screening data in linguistically plural district hospitals are specified, together with the boundary conditions under which the framework should not be expected to hold.