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Implications for Clinical Practice

Brett D. Thombs, PhD; David P. Bernstein, PhD; Roy C. Ziegelstein, MD; Christine D. Scher, PhD; David R. Forde, PhD; Edward A. Walker, MD; Murray B. Stein, MD

Arch Intern Med. 2006;166:2020-2026.

Background  A number of practice guidelines and recommendations call for the assessment of childhood abuse in adult medical patients, but none specifies how best to do this. The objective of this study was to use evidence from 2 community-based population samples to evaluate abuse-screening questions that are often asked in medical clinics and to identify a small set of questions to improve screening practices.

Methods  The Childhood Trauma Questionnaire–Short Form (CTQ-SF) was administered in 2 randomized telephone interview surveys with adults aged 18 to 65 years.

Results  A total of 880 (2003 survey) and 998 (1997 survey) respondents completed the CTQ-SF in the 2 surveys. In both surveys, the rates of physical (16% and 15%), emotional (31% and 29%), and sexual (10% and 9%) abuse elicited using 3 behaviorally descriptive items in each abuse category were approximately twice the rates elicited using the explicit labeling terms physically abused (8% and 8%), emotionally abused (15% and 13%), or sexually abused (5% and 5%) (P<.001 for each). Inquiries explicitly using the labeling term abuse successfully identified a low percentage of respondents who reported behaviorally described abusive experiences for each type of abuse (34%-51%). In addition, after adjustment for the number and frequency of abusive experiences in both surveys, women were more likely than men to label themselves as explicitly abused for any abuse (odds ratio [OR], 1.7; P = .11 and OR, 2.8; P<.01), physical abuse (OR, 2.1; P = .14 and OR, 2.9; P<.01), emotional abuse (OR, 2.7; P<.01 and OR, 3.3; P<.01), and sexual abuse (OR, 3.5; P = .08 and OR, 1.5; P = .55).

Conclusion  Inquiries about childhood abuse that use broad labeling questions identify a substantially smaller number of patients than behaviorally specific questions and may be less effective in initial screening for a history of abuse.

Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Dr Thombs) and Medicine (Dr Ziegelstein), Johns Hopkins University School of Medicine, Baltimore, Md; Department of Clinical, Medical, and Experimental Psychology, University of Maastricht, Maastricht, the Netherlands (Dr Bernstein); Department of Psychology, California State University, San Bernardino (Dr Scher); Department of Criminology and Criminal Justice, University of Memphis, Memphis, Tenn (Dr Forde); Department of Psychiatry, University of Washington, Seattle (Dr Walker); Departments of Psychiatry and Family and Preventive Medicine, University of California, San Diego (Dr Stein); Psychiatry Service, Veterans Affairs San Diego Healthcare System (Dr Stein); and Department of Psychology, San Diego State University (Dr Stein). Dr Thombs is now with the Department of Psychiatry, Sir Mortimer B. Davis–Jewish General Hospital and McGill University, Montreal, Quebec. Dr Scher is now with the Department of Psychology, California State University, Fullerton.

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