Psychometric properties of the Chinese version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) among undergraduates and depressive patients

Abstract

Objective

The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a self-report questionnaire that retrospectively provides screening for a history of childhood abuse and neglect, and which is widely used throughout the world. The current study aimed to examine the psychometric properties of the Chinese version of the CTQ-SF.

Methods

Participants included 3431 undergraduates from Hunan provinces and 234 depressive patients from psychological clinics. Confirmatory factor analysis was performed to examine how well the original five-factor model fit the data and the measurement equivalence of CTQ-SF across gender. Internal consistency was also evaluated.

Results

The five-factor model achieved satisfactory fit (Undergraduate sample TLI = 0.925, CFI = 0.936, RMSEA = 0.034, SRMR = 0.046; depressive sample TLI = 0.912, CFI = 0.923, RMSEA = 0.044, SRMR = 0.062). Measurement invariance of the five-factor model across gender was supported fully assuming different degrees of invariance. The CTQ-SF also showed acceptable internal consistency and good stability.

Conclusion

The current study provides that the Chinese version of the Childhood Trauma questionnaire-short form has good reliability and validity among Chinese undergraduates and depressive samples, which also indicates that the CTQ-SF is a good tool for child trauma assessment.

Introduction

Child maltreatment is defined as the physical, sexual, or psychological abuse or neglect of a child or children, especially by a parent or other caregiver. It may include any act or failure to act by a parent or other caregiver that results in actual or potential harm to a child, and can occur in a child's home or in the organizations, schools, or communities the child interacts with. Child maltreatment is a serious stress that produces a range of physiological changes which are associated with negative outcomes of behavior, mood, and social function. Studies have shown that child maltreatment is a risk factor for the development of multiple adult mental disorders, with approximately 50% of people with depression having experienced childhood trauma before the onset of illness (Heim, Newport, Mleztzko, Miller, & Hemeroff, 2008). Child maltreatment can have long-term and serious harmful effects on children's cognitive development, which may lead to adverse social and emotional reactions during child-to-adult development. In a non-clinical sample study, 40% of adolescents with a history of childhood trauma met the diagnostic criteria for depression (Famularo, Kinscherff, & Fenton, 1992). People who have experienced child maltreatment are more likely to develop psychotic, neurotic personality or mental illness symptoms after adulthood. Studies have shown that the reported rates of childhood abuse and neglect are high: in China, the reported incidence of physical abuse in 2009 of children under 18 years old was 26.6%, the incidence of emotional abuse was 19.6%, the incidence of sexual abuse was 8.7%, and the incidence of neglect was 26.0% (Gilbert et al., 2009).

The CTQ-SF (Bernstein & Fink, 1998; Bernstein et al., 2003) is a 28-item self-report questionnaire which was used to evaluate traumatic experiences in childhood, including various forms of abuse and neglect. Unlike other scales that only focus on one aspect of childhood trauma (abuse or neglect), CTQ-SF is the only one that assesses all five types of childhood maltreatment. The CTQ-SF has 28 items, including 25 clinical items and 3 validity items. The 25 clinical items are used to measure the five maltreatment constructs (five items for each subscale): physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect (Bernstein & Fink, 1998). Since its inception, the CTQ-SF has been revised and used by scholars all over the world. It has good psychometric properties and has been translated into a variety of languages and applied to different groups of people in the world. For example, the CTQ-SF has shown good reliability and validity among Norwegians in high-risk groups (Dovran et al., 2013). Both clinical and non-clinical samples have been reported to be reliable for assessing childhood experience in Swedish (Gerdner & Allgulander, 2009). Bernstein and colleagues (Bernstein, Ahluvalia, & Pogge, 1997) used principal component analysis to explore the factor structure of the CTQ-SF among adolescent psychiatric population. They found that the five-factor solution including emotional abuse、physical abuse、sexual abuse、emotional neglect and physical neglect was chosen because of its superior content and face validity. Subsequently, Bernstein and colleagues also used confirmatory factor analysis to confirm the five-factor model and they demonstrated that the five-factor model also had a good fit among adult substance abusers, adolescent psychiatric inpatients, and female HMO members. A study with 441 middle school students in China conducted that the Chinese version of CTQ-SF is a good psychometric tool for childhood abuse assessment (Zhao, Zhang, Li, & Zhao, 2005). Although some researchers have examined the psychometric properties of the CTQ-SF among Chinese populations with varying cultural backgrounds, no study has examined the psychometric properties of the CTQ-SF among depressive samples in China. Thus, the main aim of this study was to examine the psychometric properties of the CTQ-SF among depressive samples.

Prior studies have found that CTQ-SF scores reflect gender differences. One study of 210 patients (144 men, 66 women) diagnosed with a first episode of psychosis reported that man’s physical and emotional neglect was significantly higher than that of woman, and woman’s emotional abuse was significantly higher than that of man (Pruessner et al., 2018). A clinical study found that boys were significantly less likely than girls to disclose the abuse at the time it occurred, and also took significantly longer to discuss their childhood experiences later in life (Heim et al., 2008). Although many studies have confirmed that the score of CTQ-SF had significantly difference between male and female, whether CTQ-SF has measured invariance in male and female among undergraduate sample has not been confirmed in China. However, in order for the gender groups comparison of the scale to be more effective, it must be demonstrated whether it has a measurement invariance across gender. That is to say, measurement invariance is a prerequisite for comparison between groups.

Therefore, the purpose of this study was to examine the psychometric properties of the 28-item CTQ-SF in a Chinese population (including undergraduate and depressive samples), including reliability and measurement invariance across gender.