Elsevier

Psychiatry Research

Volume 272, February 2019, Pages 106-113
Psychiatry Research

Review article
Systematic review and critical appraisal of child abuse measurement instruments

https://doi.org/10.1016/j.psychres.2018.12.068Get rights and content

Highlights

  • 15% of the child abuse instruments had strong to moderate levels of evidence.

  • No instruments had adequate levels of evidence for all COSMIN criteria.

  • No single instrument is superior to all others across settings and populations.

  • Measures that capture the effects child abuse on brain development are limited.

Abstract

Child abuse is a major public health concern and a strong predictor of adult psychopathology. However, a consensus on how best to measure child abuse is not evident. This review aimed to critically appraise the methodological quality and measurement properties of published child abuse measures, examined the strength of evidence of these instruments for research use using the COnsensus-based Standards for the selection of health Measurement InstrumeNts (COSMIN) checklist and determined which measures were capable of providing information on the developmental timing of abuse. Systematic search of electronic databases identified 52 eligible instruments from 2095 studies. Only 15% (n = 8) of the instruments had strong to moderate levels of evidence for three or more of the nine COSMIN criteria. No instrument had adequate levels of evidence for all criteria, and no criteria were met by all instruments. Our results indicate there is no single instrument that is superior to all others across settings and populations. The availability of measures capable of capturing the effects of child abuse on brain development and associated behavioral phenotypes are limited. Refined instruments with a focus on capturing abuse events during development are warranted in addition to further evaluation of the psychometric properties of these instruments.

Introduction

Child abuse is a major public health concern. A recent review of a series of meta-analyses reported that prevalence rates of child abuse for self-report studies are 12.7% for sexual abuse, 22.6% for physical abuse, 6.3% for emotional abuse, 16.3% for physical neglect and 18.4% for emotional neglect (Stoltenborgh et al., 2015). Individuals who experience abuse during childhood are more likely to develop depression (Infurna et al., 2016), post-traumatic stress disorder (Breslau et al., 2014, Brewin et al., 2000), schizophrenia (McGrath et al., 2017, Varese et al., 2012), dissociative disorder (Draijer and Langeland, 1999), personality disorder (Johnson et al., 1999), substance use (Evans et al., 2017, Hamburger et al., 2008, Lo and Cheng, 2007), and suicidal behaviour (Dube et al., 2001, Stansfeld et al., 2017, Tunnard et al., 2014). The total lifetime estimated economic cost of child abuse is estimated at USD124 billion in the United States each year (Fang et al., 2012).

Despite the establishment of this potent and robust marker of psychiatric risk and proliferation of childhood abuse instruments, scientific gaps remain. First, although several reviews have evaluated child abuse measurement instruments (Burgermeister, 2007, Hulme, 2004, Roy and Perry, 2004, Satapathy et al., 2017, Strand et al., 2005), consensus on which child abuse instruments provide the best methodological quality, and measurement properties has not been achieved. Previous reviews did not conduct a systematic evaluation of the methodological quality and measurement properties of available child abuse instruments using the COnsensus-based Standards for the selection of health Measurement InstrumeNts (COSMIN) checklist (Mokkink et al., 2010). Thus, the strength of evidence for each instrument based on methodological quality, and measurement properties are largely unknown. The COSMIN initiative aims to facilitate the selection of high-quality patient-reported outcome measures for research and clinical practice and provide a comprehensive guideline for systematic review of the patient-reported outcome measures (Prinsen et al., 2018).

Second, less attention has been given to the development of psychometrically sound measures that allow for the assessment of time-dependent effects of child abuse across development. Emerging evidence has provided insight into the plasticity of the developing brain as a function of experience and has been a focus of research in recent years. Abuse during sensitive periods (e.g.: prenatal, postnatal and pubertal periods) is known to exert maximal effects on the developmental trajectory of specific brain regions (Andersen, 2003, Bale, 2015, Choi et al., 2012, Curley and Champagne, 2016, Pechtel et al., 2014, Tomoda et al., 2009, Tomoda et al., 2012). Thus, information on the timing of abuse exposure is essential in facilitating a more comprehensive description of the long-term effects of child abuse.

As such, we systematically reviewed, critically appraised, compared, and summarized the methodological quality and measurement properties of published child abuse measures using the COSMIN checklist. In addition, we assessed the strength of evidence of these measurement instruments for research use and determined which measures were capable of providing information on the developmental timing of child abuse.

Section snippets

Defining child abuse

The WHO Consultation on Child Abuse Prevention states: ‘Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power’ (World Health Organization, 1999). In this review we focussed on instruments that measure one or more of the five

Results

A total of 2095 articles were identified, screened, and assessed for eligibility resulting in 68 studies representing 52 child abuse measurement instruments (Fig. 1).

Discussion

We found a wide variation in methodology, measurement, and psychometric properties among instruments used to measure child abuse. Our findings suggest there is no single instrument that is superior to all others across settings and populations given that several criteria in the COSMIN checklist such as measurement error, criterion validity and cross-cultural validity were not evaluated or reported by most of the instruments we assessed. As such the most appropriate instrument will depend

Conclusion

Overall findings from this systematic review and critical appraisal of child abuse measurement instruments suggest no single instrument is superior to all others across settings and populations. There are a number of instruments with moderate to strong level of evidence for methodological quality and measurement properties that may be suitable for particular research questions. The present review also revealed that the availability of measures capable of capturing the effects of child abuse on

Acknowledgements

None of the funding sources played any role in the study design, analysis or interpretation of data, in the writing of the report, or in the decision to submit the paper for publication. SMS was supported by a Ministry of Higher Education Malaysia Scholarship and the National University of Malaysia. CP was supported by a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship (ID: 1105825), and a Brain and Behavior Research Foundation (NARSAD) Distinguished

Conflict of interest

No conflicts of interest to declare.

References (46)

  • A. Tomoda et al.

    Childhood sexual abuse is associated with reduced gray matter volume in visual cortex of young women

    Biol. Psychiatry

    (2009)
  • C. Tunnard et al.

    The impact of childhood adversity on suicidality and clinical course in treatment-resistant depression

    J. Affect. Disord.

    (2014)
  • S.H. Aslan et al.

    The reliability, validity and factor structure of the childhood trauma questionnaire among a group of university students

    Tur. J. Psychiatry

    (1999)
  • T.L. Bale

    Epigenetic and transgenerational reprogramming of brain development

    Nat. Rev. Neurosci.

    (2015)
  • J.D. Bremner et al.

    Psychometric properties of the early trauma inventory–self report

    J. Nerv. Ment. Dis.

    (2007)
  • N. Breslau et al.

    Childhood maltreatment, juvenile disorders and adult post-traumatic stress disorder: a prospective investigation

    Psychol. Med.

    (2014)
  • C.R. Brewin et al.

    Psychopathology and early experience: a reappraisal of retrospective reports

    Psychol. Bull.

    (1993)
  • C.R. Brewin et al.

    Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults

    J. Consult. Clin. Psychol.

    (2000)
  • D. Burgermeister

    Childhood adversity: a review of measurement instruments

    J. Nurs. Meas.

    (2007)
  • D. Daro et al.

    Creating community responsibility for child protection: possibilities and challenges

    The Future of Children/Center for the Future of Children, the David and Lucile Packard Foundation

    (2009)
  • H.C. De Vet et al.

    Measurement in Medicine: a Practical Guide

    (2011)
  • N. Draijer et al.

    Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients

    Am. J. Psychiatry

    (1999)
  • S.R. Dube et al.

    Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study

    JAMA

    (2001)
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