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

Journal of General Internal Medicine volume 22, pages 368–373 (2007)Cite this article

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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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

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

Authors
  1. Brett D. Thombs PhD
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  2. Wendy Bennett MD, MPH
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  3. Roy C. Ziegelstein MD
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  4. David P. Bernstein PhD
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  5. Christine D. Scher PhD
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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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KEY WORDS

  • childhood abuse
  • Childhood Trauma Questionnaire–Short Form
  • assessment