Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables

Minimization of Childhood Maltreatment Is Common and Consequential: Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire.

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ's discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias-as detected by the MD subscale-has a small but significant moderating effect on the CTQ's discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables

Association between CTQ Severity Ratings and MD Total Scores.

<p>Association between CTQ Severity Ratings and MD Total Scores.</p

Taxometric Analyses of Minimization and Denial Items.

<p>Top row: left panel—average MAMBAC curve for the observed data (dark line) in comparison to simulated taxonic data (light lines representing one standard deviation above and below the mean); right panel—average MAMBAC curve for the observed data (dark line) in comparison to simulated dimensional data (light lines representing one standard deviation above and below the mean). Middle row: left panel—average MAXEIG curve for the observed data (dark line) in comparison to simulated taxonic data (light lines representing one standard deviation above and below the mean); right panel—average MAXEIG curve for the observed data (dark line) in comparison to simulated dimensional data (light lines representing one standard deviation above and below the mean). Bottom row: left panel—average L-Mode curve for the observed data (dark line) in comparison to simulated taxonic data (light lines representing one standard deviation above and below the mean); right panel—average L-Mode curve for the observed data (dark line) in comparison to simulated dimensional data (light lines representing one standard deviation above and below the mean). Inverted U-shaped graphs for the MAMBAC procedure, peaked graphs for the MAXEIG procedure, and bimodal distributions of factor scores for the L-Mode procedure are all suggestive of taxonic structure.</p

CTQ and subscale means for clinical and community samples.

<p>CTQ and subscale means for clinical and community samples.</p

Percentages of Clinical and Community Samples in CTQ Severity Quartiles.

<p>X-Axis: Quartiles of childhood maltreatment based on total CTQ scores: none, low, moderate, and severe. Y-Axis: The percentage of subjects whose CTQ scores fall into that severity quartile. Within each quartile, the bar depicted on the left represents the percentage of clinical subjects (n = 5429–5876), and the bar on the right represents the percentage of community subjects (n = 12432–12915). Notably, the largest relative percentage of community subjects was in the “none” maltreatment quartile. That trend was reversed in the “moderate” and “severe” categories, where double the percentage of subjects were in the clinical group.</p

Associations between MD Subscale Scores and Community versus Clinical Criterion.

<p>Associations between MD Subscale Scores and Community versus Clinical Criterion.</p