Bifulco A, Bernazzani O, Moran P M, Jacobs C
Royal Holloway, University of London, UK.
Br J Clin Psychol. 2005 Nov;44(Pt 4):563-81. doi: 10.1348/014466505X35344.
Childhood neglect and abuse, as measured by retrospective interview, is highly predictive of psychiatric disorder in adult life and has an important role in aetiological models. However, such measures are labour-intensive, costly, and thus restricted to relatively modest sample sizes. A compact self-report assessment of childhood experience is invaluable for research screening purposes and large-scale survey investigation.
A self-report questionnaire (CECA.Q) was developed to mirror an existing validated interview measure: the childhood experience of care and abuse (CECA). The questionnaire assessed lack of parental care (neglect and antipathy), parental physical abuse, and sexual abuse from any adult before age 17. A high-risk series of 179 London women were interviewed using the CECA together with the PSE psychiatric assessment, and completed the CECA.Q at later follow-up. Repeat CECA.Qs were returned for 111 women and 99 women additionally completed the parental bonding instrument (PBI; Parker, Tupling, & Brown, 1979).
Satisfactory internal scale consistency was achieved on the CECA.Q for antipathy (alpha = .81) and neglect (alpha = .80) scales. There was satisfactory test-retest for both care and abuse scales. Significant associations were found between CECA.Q scales and the parallel interview scales with cut-offs determined for high sensitivity and specificity. CECA.Q neglect and antipathy scales were also significantly related to PBI parental care. CECA.Q scales were significantly related to lifetime history of depression. Optimal cut-off scores revealed significant odds ratios (average of 2) for individual scales and depression. When indices were compiled to reflect peak severity of each type of adversity across perpetrator, odds-ratios increased (average 3). A dose-response effect was evident with the number of types of neglect/abuse and rate of lifetime depression.
The CECA.Q shows satisfactory reliability and validity as a self-report measure for adverse childhood experience. The merits of having parallel questionnaire and interview instruments for both research and clinical work are discussed.
通过回顾性访谈衡量的童年期忽视和虐待，能高度预测成年后的精神障碍，且在病因模型中具有重要作用。然而，此类测量方法耗费人力、成本高昂，因此样本量相对有限。一份简洁的童年经历自我报告评估对于研究筛查目的和大规模调查研究而言非常宝贵。
开发了一份自我报告问卷（CECA.Q），以反映现有的经过验证的访谈测量工具：童年期照料与虐待经历（CECA）。该问卷评估了缺乏父母照料（忽视和反感）、父母身体虐待以及17岁之前来自任何成年人的性虐待情况。对179名伦敦高危女性进行了访谈，使用CECA以及PSE精神评估，并在后续随访时完成CECA.Q。111名女性返还了重复的CECA.Q，另外99名女性完成了父母依恋量表（PBI；帕克、图普林和布朗，1979年）。
CECA.Q在反感量表（α = 0.81）和忽视量表（α = 0.80）上实现了令人满意的内部量表一致性。照料和虐待量表的重测结果令人满意。在CECA.Q量表与平行访谈量表之间发现了显著关联，并确定了具有高敏感性和特异性的临界值。CECA.Q忽视和反感量表也与PBI父母照料显著相关。CECA.Q量表与抑郁症的终生病史显著相关。最佳临界值显示各量表与抑郁症的显著优势比（平均为2）。当编制指数以反映每种类型逆境在施暴者中的峰值严重程度时，优势比增加（平均为3）。忽视/虐待类型数量与终生抑郁症发生率之间存在明显的剂量反应效应。
CECA.Q作为童年不良经历的自我报告测量工具，显示出令人满意的信度和效度。讨论了在研究和临床工作中同时拥有平行问卷和访谈工具的优点。
