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Cultural Sensitivity in Screening Adults for a History of Childhood Abuse: Evidence from a Community Sample

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Background

A number of practice guidelines and recommendations call for the assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening questions, however, has not been examined.

Objective

To assess whether questions that inquire about childhood abuse history function differently for black and white patients.

Design

Cross-sectional telephone surveys in 1997 and 2003.

Subjects

Randomly sampled adults from Memphis, Tenn (1997, N = 832; 2003, N = 967).

Measurements

Physical, emotional, and sexual abuse scales of the Childhood Trauma Questionnaire–Short Form (CTQ-SF). Standardized mean difference technique for differential item functioning to assess for possible bias in CTQ-SF items.

Results

Controlling for total physical abuse scale scores, black respondents were significantly (P < .01) more likely than white respondents to report that they had been punished with a hard object during their childhood, but less likely to report having being hit so hard that it left marks, have been hit so hard that someone noticed, or to believe they had been physically abused.

Conclusions

Inquiries that do not explicitly differentiate physical punishment from physical abuse may not be useful for black respondents because they tend to identify black respondents who report fewer clearly abusive experiences than comparable white respondents. Although untested in this study, one possible explanation is that physical discipline may be used more frequently and may play a different role among black families than among white families. These results underline the importance of attending to cultural factors in clinical history taking about childhood abuse histories.

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References

  1. Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57(suppl 1):108–45.

    Article  PubMed  Google Scholar 

  2. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. JAMA 2003;290:2487–8

  3. Health Resources and Services Administration Bureau of Health Professions, U.S. Department of Health and Human Services. Bureau of Health Professions: Other definitions of cultural competence. Accessed December 21, 2005.

  4. Springer KW, Sheridan J, Kuo D, Carnes M. The long-term health outcomes of childhood abuse. An overview and a call to action. J Gen Intern Med. 2003;18(10):864–70.

    Article  PubMed  Google Scholar 

  5. McCauley J, Kern DE, Kolodner K, Dill L, Schroeder AF, DeChant HK, et al. Clinical characteristics of women with a history of childhood abuse: unhealed wounds. JAMA. 1997;277(17):1362–8.

    Article  PubMed  CAS  Google Scholar 

  6. Scher CD, Forde DR, McQuaid JR, Stein MB. Prevalence and demographic correlates of childhood maltreatment in an adult community sample. Child Abuse Negl. 2004;28(2):167–80.

    Article  PubMed  Google Scholar 

  7. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med. 1998;14(4):245–58.

    Article  PubMed  CAS  Google Scholar 

  8. MacMillan HL, Fleming JE, Streiner DL, Lin E, Boyle MH, Jamieson E, et al. Childhood abuse and lifetime psychopathology in a community sample. Am J Psychiatry. 2001;158(11):1878–83.

    Article  PubMed  CAS  Google Scholar 

  9. Molnar BE, Buka SL, Kessler RC. Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. Am J Public Health. 2001;91(5):753–60.

    PubMed  CAS  Google Scholar 

  10. Wise LA, Zierler S, Krieger N, Harlow BL. Adult onset of major depressive disorder in relation to early life violent victimisation: a case-control study. Lancet. 2001;358(9285):881–7.

    Article  PubMed  CAS  Google Scholar 

  11. Brown J, Cohen P, Johnson JG, Smailes EM. Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. J Am Acad Child Adolesc Psychiatry. 1999;38(12):1490–6.

    Article  PubMed  CAS  Google Scholar 

  12. Kendler KS, Bulik CM, Silberg J, Hettema JM, Myers J, Prescott CA. Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry. 2000;57(10):953–9.

    Article  PubMed  CAS  Google Scholar 

  13. Goodwin RD, Hoven CW, Murison R, Hotopf M. Association between childhood physical abuse and gastrointestinal disorders and migraine in adulthood. Am J Public Health. 2003;93(7):1065–7.

    Article  PubMed  Google Scholar 

  14. Drossman DA, Talley NJ, Leserman J, Olden KW, Barreiro MA. Sexual and physical abuse and gastrointestinal illness. Review and recommendations. Ann Intern Med. 1995;123(10):782–94.

    PubMed  CAS  Google Scholar 

  15. Walker EA, Keegan D, Gardner G, Sullivan M, Bernstein D, Katon WJ. Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect. Psychosom Med. 1997;59(6):572–7.

    PubMed  CAS  Google Scholar 

  16. Green CR, Flowe-Valencia H, Rosenblum L, Tait AR. The role of childhood and adulthood abuse among women presenting for chronic pain management. Clin J Pain. 2001;17(4):359–64.

    Article  PubMed  CAS  Google Scholar 

  17. Walker EA, Gelfand A, Katon WJ, Koss MP, Von Korff M, Bernstein D, et al. Adult health status of women with histories of childhood abuse and neglect. Am J Med. 1999;107(4):332–9.

    Article  PubMed  CAS  Google Scholar 

  18. Springs FE, Friedrich WN. Health risk behaviors and medical sequelae of childhood sexual abuse. Mayo Clin Proc. 1992;67(6):527–32.

    PubMed  CAS  Google Scholar 

  19. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–58.

    Article  PubMed  CAS  Google Scholar 

  20. Walker EA, Unutzer J, Rutter C, Gelfand A, Saunders K, VonKorff M, et al. Costs of health care use by women HMO members with a history of childhood abuse and neglect. Arch Gen Psychiatry. 1999;56(7):609–13.

    Article  PubMed  CAS  Google Scholar 

  21. Fiddler M, Jackson J, Kapur N, Wells A, Creed F. Childhood adversity and frequent medical consultations. Gen Hosp Psychiatry. 2004;26(5):367–77.

    Article  PubMed  Google Scholar 

  22. Fall M, Baranowski AP, Fowler CJ, Lepinard V, Malone-Lee JG, Messelink EJ, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2004;46(6):681–9.

    Article  PubMed  CAS  Google Scholar 

  23. ACOG Committee on Practice Bulletins–Gynecology. ACOG Practice Bulletin No. 51. Chronic pelvic pain. Obstet Gynecol. 2004;103(3):589–605.

    Google Scholar 

  24. American Gastroenterology Association. American Gastroenterological Association medical position statement: irritable bowel syndrome. Gastroenterology. 2002;123(6):2105–7.

    Article  Google Scholar 

  25. Dill DL, Chu JA, Grob MC, Eisen SV. The reliability of abuse history reports: a comparison of two inquiry formats. Compr Psychiatry. 1991;32(2):166–9.

    Article  PubMed  CAS  Google Scholar 

  26. Fricker AE, Smith DW, Davis JL, Hanson RF. Effects of context and question type on endorsement of childhood sexual abuse. J Trauma Stress. 2003;16(3):265–8.

    Article  PubMed  Google Scholar 

  27. Hui CH, Triandis HC. Measurement in cross-cultural psychology: a review and comparison of strategies. J Cross-Cult Psychol. 1985;16(2):131–152.

    Article  Google Scholar 

  28. Poortinga, YH. Equivalence of cross-cultural data: an overview of basic issues. Int J Psychol. 1989;24(6):737–756.

    Google Scholar 

  29. Day RD, Peterson GW, McCracken C. Predicting spanking of younger and older children by mothers and fathers. J Marriage Fam. 1998;60(1):79–94.

    Article  Google Scholar 

  30. Wissow LS. Ethnicity, income, and parenting contexts of physical punishment in a national sample of families with young children. Child Maltreatment. 2001;6(2):118–29.

    Article  PubMed  CAS  Google Scholar 

  31. Straus MA, Stewart JH. Corporal punishment by American parents: national data on prevalence, chronicity, severity, and duration, in relation to child and family characteristics. Clin Child Fam Psychol Rev. 1999;2(2):55–70.

    Article  PubMed  CAS  Google Scholar 

  32. Lansford JE, Deater-Deckard K, Dodge KA, Bates JE, Pettit GS. Ethnic differences in the link between physical discipline and later adolescent externalizing behaviors. J Child Psychol Psychiatry. 2004;45(4):801–12.

    Article  PubMed  Google Scholar 

  33. Deater-Deckard K, Dodge KA, Bates JE, Pettit GS. Physical discipline among African American and European American mothers: links to children’s externalizing behaviors. Dev Psychol. 1996;32(6):1065–72.

    Article  Google Scholar 

  34. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27(2):169–90.

    Article  PubMed  Google Scholar 

  35. Bernstein DP, Fink L. Childhood Trauma Questionnaire: A retrospective self-report manual. San Antonio, TX: The Psychological Corporation; 1998.

  36. Zwick R, Thayer DT. Evaluating the magnitude of differential item functioning in polytomous items. J Educ Behav Stat. 1996;21(3):187–201.

    Google Scholar 

  37. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

    Google Scholar 

  38. Whaley AL. Sociocultural differences in the developmental consequences of the use of physical discipline during childhood for African Americans. Cult Divers Ment Health. 2000;6(1):5–12.

    CAS  Google Scholar 

  39. American Psychological Association. Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. 2002.

  40. Martin J, Anderson J, Romans S, Mullen P, O’Shea M. Asking about child sexual abuse: methodological implications of a two stage survey. Child Abuse Negl. 1993;17(3):383–92.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Funding for the project was obtained by Dr. Forde from the Memphis Shelby Crime Commission. Dr. Ziegelstein is supported by the Miller Family Scholar Program. The authors are grateful to Ms. Cheri Smith of the Harrison Medical Library of the Johns Hopkins Bayview Medical Center for her assistance in this research.

Dr. Scher is now a member of the Department of Psychology, California State University, Fullerton, CA, USA.

Dr. Thombs is now a member of the Department of Psychiatry, McGill University, Montreal, QC, Canada.

Potential Financial Conflicts of Interest

Dr. Bernstein is the author of the Childhood Trauma Questionnaire, which is published by the Psychological Corporation.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Brett D. Thombs PhD

  2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Wendy Bennett MD, MPH & Roy C. Ziegelstein MD

  3. Department of Clinical, Medical, and Experimental Psychopathology, University of Maastricht, Maastricht, The Netherlands

    David P. Bernstein PhD

  4. Department of Psychology, California State University, San Bernardino, CA, USA

    Christine D. Scher PhD

  5. Department of Criminology and Criminal Justice, University of Memphis, Memphis, TN, USA

    David R. Forde PhD

  6. Department of Psychiatry, McGill University and Sir Mortimer B. Davis–Jewish General Hospital, Institute of Community and Family Psychiatry, 4333 Cote Ste Catherine Road, Montreal, QC, H3T 1E4, Canada

    Brett D. Thombs PhD

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  1. Brett D. Thombs PhD
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  2. Wendy Bennett MD, MPH
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  6. David R. Forde PhD
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Correspondence to Brett D. Thombs PhD.

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Thombs, B.D., Bennett, W., Ziegelstein, R.C. et al. Cultural Sensitivity in Screening Adults for a History of Childhood Abuse: Evidence from a Community Sample. J GEN INTERN MED 22, 368–373 (2007). https://doi.org/10.1007/s11606-006-0026-y

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