Abstract
The typical reliance on self-report questionnaires in retrospective case-control studies of childhood abuse and psychotic disorders has been criticised, due to the potential for recall bias associated with, amongst other factors, cognitive impairments and detachment from reality, among individuals with psychosis. One way to establish if any substantial bias may exist is to examine whether the concordance of reports of childhood abuse established from retrospective self-report methods versus more comprehensive interviewer-rated assessments differ between individuals with psychosis and controls. Data from the Childhood Adversity and Psychosis (CAPsy) study were used to examine the accuracy, strength of agreement, and convergent validity of two distinct retrospective measures of childhood abuse: a self-report questionnaire (the Childhood Trauma Questionnaire; CTQ) and a comprehensive interview (the Childhood Experiences of Care and Abuse schedule; CECA). In a sample of 234 cases with first-episode psychosis and 293 controls, we found no strong evidence that the validity of the two measures differed between cases and controls. For reports of sexual and emotional abuse, we found fair levels of agreement between CECA and CTQ ratings in both groups (kappa coefficients 0.43–0.53), moderate to high sensitivity and specificity, and reasonably high convergent validity (tetrachoric correlations of 0.78–0.80). For physical abuse, convergent validity was slightly lower in cases compared with controls. Both measures can be used in future studies to retrospectively assess associations between childhood abuse and psychotic phenomena, but time-permitting, the CECA is preferable as it provides additional important contextual details of abuse exposure.
Highlights
A large body of research has consistently reported that childhood abuse, along with other forms of maltreatment, is associated with an increased risk of psychosis (Matheson et al, 2013; Morgan and Gayer-Anderson, 2016; Varese et al, 2012)
The reverse was observed for physical abuse (19% when measured by the Childhood Trauma Questionnaire (CTQ), 28% for the Childhood Experience of Care and Abuse (CECA) interview)
When the CECA ratings of abuse were used as the criterion, the area under the receiver operating characteristic (ROC) curve revealed that the CTQ had varying levels of discriminating ability for different forms of abuse: i.e., poor for physical abuse among cases (AUC 0.69), fair for physical abuse among controls (AUC 0.72), and good for sexual abuse and emotional abuse among cases and controls
Summary
A large body of research has consistently reported that childhood abuse (e.g. physical, sexual or emotional), along with other forms of maltreatment, is associated with an increased risk of psychosis (Matheson et al, 2013; Morgan and Gayer-Anderson, 2016; Varese et al, 2012). Bias will occur if the validity of recall varies by outcome status (i.e., presence of psychosis or not). It may be, for example, that recall is less accurate among those with a psychotic disorder because of cognitive impairments (Saykin et al, 1991), depressed mood (Colman et al, 2016), delusional beliefs and detachment from reality
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