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关于儿童虐待发生率不断扩大的流行病学数据:德国ICAST-R在学生样本和全国家庭调查中的验证

Widening epidemiological data on the prevalence of child maltreatment: Validation of the German ICAST-R in a student sample and national household survey.

作者信息

Jarczok Marion, Lange Stephanie, Meinck Franziska, Witt Andreas, Clemens Vera, Fegert Jörg M, Jud Andreas

机构信息

Department of Child and Adolescent Psychiatry/Psychotherapy, University Medical Center Ulm, Ulm, Germany.

Department of Child and Adolescent Psychiatry/Psychotherapy, University Medical Center Ulm, Ulm, Germany; Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Ulm, Germany.

出版信息

Child Abuse Negl. 2023 Mar;137:106038. doi: 10.1016/j.chiabu.2023.106038. Epub 2023 Jan 25.

Abstract

BACKGROUND

A number of instruments for measuring child maltreatment (CM) prevalence have repeatedly been used across different countries. Although they hold the potential for providing benchmarks to tackle the gap of lacking comparability of CM prevalence across countries, contextual information about the adverse experiences such as perpetrator, chronicity, frequency, or severity are rarely covered. The ISPCAN Child Abuse Screening Tool - Retrospective (ICAST-R) covers these important dimensions. The German version increases the number of available versions to 21 different languages. Spoken by about 120 million people, German is one of the 20 most prevalent languages around the world. Moreover, the ICAST-R is intended to be used with young adults. This study further aims at adding towards the gap of psychometrics in older age groups.

METHODS

Analyses are based on both a sample of German students (n = 333) and a nationally representative household survey (n = 2515). The validation process covered six steps: (1) Analyses of missing data on single items, (2) calculation of descriptive statistics to estimate the prevalence CM as well as subjective severity and main perpetrators. (3) Structural validity of the four conceptualized subtypes of CM (neglect, physical abuse, emotional abuse and sexual abuse) was tested using confirmatory factor analyses (CFA). Next (4), equivalence testing by multigroup confirmatory factor analyses (MGCFA) on age groups was conducted within the representative sample; (5) reliability was tested by determining internal consistencies for each subscale via the McDonald's Omega, Kuder-Richardson 20 (KR-20), and Cronbach's alpha. Lastly (6), criterion validity was tested in regression models comparing depressive/anxious symptomatology for single victimization and polyvictimization.

RESULTS

The German ICAST-R yielded low missing values items in both samples. 16 % of the participants in the national household survey reported neglect, 20.3 % physical abuse, 22.2 % emotional abuse, and 8.6 % sexual abuse. Polyvictimization was prevalent with 20.6 % of subjects reporting >2 types of CM. Students in the pilot-survey reported much higher prevalence estimates than participants in the nationally representative sample. The types of CM subjectively rated as most harmful were emotional abuse and sexual abuse. In both samples, structural validity was similarly confirmed as CFA was reproducing the four conceptualized subtypes of CM with adequate fit (household survey: CFI 0.919, TLI 0.907, RMSEA 0.017, SRMR 0.046). Internal consistency achieved acceptable and comparable values for all three types of coefficients; criterion validity was established with a significant dose-response effect of CM experiences on both anxiety and depressive symptoms/diagnoses. Age dependent analyses on structural validity (MGCFA) and reliability in the household survey revealed potential weaknesses of items.

CONCLUSION

The German version of the ICAST-R both widens the possibility of international CM prevalence comparison and provides novel epidemiological data for Germany on subjective severity of CM and CM perpetrators. Even in the presence of a marked selection bias, the ICAST-R had similarly good psychometric properties in the student and nationally representative household sample. Except for issues with two items, equivalence testing was comparable across age groups.

摘要

背景

许多用于测量儿童虐待(CM)患病率的工具已在不同国家反复使用。尽管它们有可能为解决各国CM患病率缺乏可比性的差距提供基准,但关于诸如施虐者、长期性、频率或严重程度等不良经历的背景信息却很少涉及。国际预防虐待儿童协会儿童虐待筛查工具-回顾版(ICAST-R)涵盖了这些重要方面。德语版使可用版本数量增加到21种不同语言。德语是世界上20种最常用的语言之一,约有1.2亿人使用。此外,ICAST-R旨在用于年轻人。本研究进一步旨在填补老年人群体心理测量学方面的空白。

方法

分析基于德国学生样本(n = 333)和全国代表性家庭调查(n = 2515)。验证过程包括六个步骤:(1)分析单个项目的缺失数据;(2)计算描述性统计量以估计CM患病率以及主观严重程度和主要施虐者;(3)使用验证性因素分析(CFA)测试CM的四种概念化亚型(忽视、身体虐待、情感虐待和性虐待)的结构效度;接下来(4)在代表性样本中通过多组验证性因素分析(MGCFA)对年龄组进行等效性测试;(5)通过麦克唐纳欧米伽系数、库德-理查森20系数(KR-20)和克朗巴赫α系数确定每个子量表的内部一致性来测试信度;最后(6)在回归模型中测试标准效度,比较单次受害和多重受害的抑郁/焦虑症状。

结果

德语版ICAST-R在两个样本中单项缺失值较低。全国家庭调查中16%的参与者报告遭受忽视,20.3%遭受身体虐待,22.2%遭受情感虐待,8.6%遭受性虐待。多重受害很普遍,20.6%的受试者报告遭受超过两种类型的CM。试点调查中的学生报告的患病率估计值比全国代表性样本中的参与者高得多。主观上被评为最有害的CM类型是情感虐待和性虐待。在两个样本中,结构效度均得到类似确认,因为CFA以适当的拟合度再现了CM的四种概念化亚型(家庭调查:CFI 0.919,TLI 0.907,RMSEA 0.017,SRMR 0.046)。所有三种系数的内部一致性都达到了可接受且可比的值;通过CM经历对焦虑和抑郁症状/诊断的显著剂量反应效应确立了标准效度。家庭调查中对结构效度(MGCFA)和信度的年龄依赖性分析揭示了项目的潜在弱点。

结论

德语版ICAST-R既拓宽了国际CM患病率比较的可能性,又为德国提供了关于CM主观严重程度和CM施虐者的新的流行病学数据。即使存在明显的选择偏差,ICAST-R在学生样本和全国代表性家庭样本中也具有类似良好的心理测量特性。除了两个项目的问题外,各年龄组的等效性测试具有可比性。

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