Cultural sensitivity in screening adults for a history of childhood abuse: evidence from a community sample.
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.


METHODS
Cross-sectional telephone surveys in 1997 and 2003.


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


METHODS
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.
Thombs
Brett D
BD
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. brett.thombs@mcgill.ca
Bennett
Wendy
W
Ziegelstein
Roy C
RC
Bernstein
David P
DP
Scher
Christine D
CD
Forde
David R
DR
D000328:Adult; D002648:Child; D002649:Child Abuse / Q000208:ethnology*; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D012111:Residence Characteristics; D012189:Retrospective Studies