Arne Gerdner

Minimization of childhood maltreatment is common and consequential: results from a large, multinational sample using the childhood trauma questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

Psychometric properties of the Swedish version of the Childhood Trauma Questionnaire - Short Form (CTQ-SF).

Childhood maltreatment is delicate to assess both in clinical work and in research. There is a need for assessment tools that can be easily administered in an ethical and non-intrusive way that meets requirements of conceptual validity for various types of maltreatment and is sensitive to levels of severity. This study explores the psychometric properties of the Swedish translation of one such tool—the Childhood Trauma Questionnaire—Short Form (CTQ-SF; Bernstein and Fink, 1998). The CTQ-SF was administered to seven samples (total n=659)—five clinical samples and two non-clinical student samples. The factor structure supports the construct validity of the global maltreatment scale, four of the five maltreatment subscales (emotional abuse, physical abuse, sexual abuse and emotional neglect) and the minimization/denial (MD) scale, but not the physical neglect (PN) subscale. All items are highly correlated with their respective subscale. The discriminant validity is satisfactory. Highly significant correlation with social desirability gives further support for the MD-scale and to the recommendation of how to apply it. Internal consistency of PN is acceptable and for all other scales satisfactory. Swedish norm groups tend to score lower than similar American norm groups on abuse scales but higher on the neglect scales. Percentiles for seven gender-specific norm groups are presented. The weaknesses of the PN-scale are discussed and new constructs are proposed. The Swedish version of the CTQ-SF has the same construct validity and internal consistency as the original, including less homogeneity of the PN scale.

Childhood abuse and neglect in severely dependent female addicts: homogeneity and reliability of a Swedish version of the Childhood Trauma Questionnaire

This study explores the psychometric characteristics of childhood experiences (‘Barndomsupplevelser’), using a Swedish translation of the 53–item version of the Childhood Trauma Questionnaire (CTQ) ...

Childhood maltreatment affects the serotonergic system in male alcohol-dependent individuals.

BACKGROUND Reduced central serotonergic neurotransmission has been demonstrated in individuals with excessive alcohol consumption and/or alcohol dependence. Childhood maltreatment has also been found to have a negative impact on central serotonergic neurotransmission. The aim of this study was to evaluate the impact of childhood maltreatment on central serotonergic dysfunction in alcohol-dependent individuals. METHODS Adult men with a diagnosis of alcohol dependence (n = 18) were recruited from outpatient treatment units for alcoholism. Central serotonergic neurotransmission was assessed by a neuroendocrine method, that is, the prolactin (PRL) response to the selective 5-HT reuptake inhibitor citalopram. Childhood maltreatment was assessed retrospectively by the Childhood Trauma Questionnaire. RESULTS Alcohol-dependent individuals with childhood experience of emotional abuse had significantly lower PRL response compared with those without such abuse (3 ± 5 and 64 ± 24 mU/l, respectively; t = 6.51, p < 0.001). Among those who reported childhood emotional abuse, 4 of 7 individuals had flat PRL responses in comparison with none in those with no report of such abuse (p < 0.01). CONCLUSIONS This is the first study to show that self-reported childhood maltreatment, in particular emotional abuse, in male alcohol-dependent individuals is associated with a quite dramatic (more than 90%) reduction in central serotonergic neurotransmission. It should, however, be noted that the number of individuals is relatively small, and the results should therefore be considered as preliminary.

Caring while living apart

Abstract In recent years, researchers have paid increasing attention to die issue of care in die new types of family and partner relationships. The aim of this study is to examine expectations and attitudes concerning care among elderly people in LAT (Living Apart Togetiier)- relationships in Sweden, that is, people who have a long-term intimate relationship, but who do not share a common home. Questionnaires were completed by 116 elderly people in LAT-relationships. Partners are ranked as the main providers of care, especially by men, but mere is considerable variation in die answers. This seems to be principally related to the degree of flexibility in this type of relationship. Some individuals see a LAT-relationship as a marriage-like relationship, while otiiers see it primarily as a type of relationship mat guarantees diem the possibility of maintaining tiieir own independent way of life.

PERSONALITY FACTORS AND DRUG OF CHOICE IN FEMALE ADDICTS WITH PSYCHIATRIC COMORBIDITY

Female addicts (N = 108) with a mean age of 37.2 were tested using the Temperament and Character Inventory (TCI) in 1996–97. In a representative sub-sample (N = 49) assessed with the Structured Clinical Interview, DSMIIIr (SCID), 82% manifested an axis-1-syndrome (lifetime), and 53% a personality disorder. Of the 108 addicts, 42 preferred alcohol, 14 heroin, 33 amphetamines, and 19 benzodiazepines. Maturity was low, but there were no differences in maturity between drug preference groups. Results indicated that those less mature were more “novelty-seeking” and “harm-avoidant”, while those maturer tended to be more persistent. Less mature persons answered less consistently. They agreed more with different items and their answers were more rare when compared to the general population. Heroin addicts were less sentimental and helpful and more aware of their own resources. Benzodiazepine and amphetamine addicts were more self-transcendent and self-forgetful. Among the relatively more mature, benzodiazepine addicts scored higher than heroin and alcohol addicts on “true” and rare answers. In conclusion, maturity and the drug of choice among female addicts were related to different TCI scales.

Compulsory Commitment to Care of Substance Misusers: International Trends during 25 Years

Purpose: The study explores international trends in law on compulsory commitment to care of substance misusers (CCC), and two subtypes – civil CCC and CCC within criminal justice legislation – as well as maximum length and amount of applications of such care. Method: The time period covers more than 25 years, and a total of 104 countries and territories. The study is based on available data in three times of observation (1986, 1999 and 2009). Applications of CCC in number of cases are studied on European level for the years 2002–2006. Trends are analyzed using nonparametric tests and general linear models for repeated measures. Findings are discussed from contextual analysis. Result: There is a trend towards decrease in the number of countries worldwide having civil CCC legislation after the millennium, while CCC under criminal law has increased since the mid-1980s, resulting in some total net decrease. The shift results in longer mean duration of CCC and an increase in the number of cases sentenced. Conclusion: There is a risk that the shift from civil CCC to penal CCC implies more focus on young out-acting males in compulsory treatment and that the societal responsibility for more vulnerable persons might be neglected.

Compulsory Commitment to Care of Substance Misusers : A Worldwide Comparative Analysis of the Legislation

This study explores the worldwide use of compulsory commitment to care (CCC) at the end of the 20 th century and evaluates the implementation of WHO recommendations since the 1960s. Based on three WHO reports, the legislation of 90 countries and territories are analyzed, and types as well as predictors of such legislation are analyzed in multivariate models from country characteristics. Laws on CCC for alcohol and drug misusers are common all over the world; more than 80 percent of the countries and territories studied have such laws. The majority use civil commitment - acute or rehabilitative - in accordance with welfare logic, while a large minority still uses commitment under criminal law, based on a moral logic. Civil CCC is positively related to strong economies or having been part of the Soviet legal system. CCC under criminal law is negatively related to the same factors.

Factors associated with involuntary admissions among patients with substance use disorders and comorbidity: a cross-sectional study

BackgroundTo investigate factors associated with involuntary admissions to hospital pursuant to a social services act of patients with substance use disorder by comparing the socio-demographic characteristics, substance use, and psychiatric comorbidities with voluntarily admitted patients.MethodsThis cross-sectional study compared two groups admitted to combined substance use disorder and psychiatry wards. Sixty-five patients were involuntarily admitted pursuant to the Social Services Act and 137 were voluntarily admitted. The International Classification of Diseases and Related Health Problems was used for diagnostic purposes regarding substance use disorders, type and severity of psychiatric problems, and level of functioning. Socio-demographic variables were measured using the European Addiction Severity Index, and the Symptom Checklist-90-R instruments were used to evaluate the range of psychological problems and psychopathological symptoms. Logistic regression was performed to investigate the relationship between involuntary admissions and patients characteristics.ResultsPatients who had been involuntarily admitted were more likely to be females, had utilized public welfare services more often, presented more severe substance use patterns, and had a history of more frequent visits to physicians for somatic complaints in the last 6 months, they also had fewer comorbid mental disorders. Still, considerable burdens of comorbid substance use disorders and mental disorders were observed both among involuntary and voluntary admitted patients.ConclusionsMore attention is required for involuntarily admitted patients in order to meet the needs associated with complex and mixed disorders. In addition, treatment centers should offer diagnostic options and therapy regarding substance use, psychiatric and somatic disorders.

Neighborhood Reactions Toward Facilities for Residential Care

Abstract Although a substantial body of research on community hostility towards the establishment of human services facilities now exists, researchers as well as community practitioners have identified a need for a more naturalistic and systematic approach to the issue. As a step in that direction, this paper focuses on a nationally representative sample of facilities for residential care in Sweden, with the objective of identifying patterns of hostile NIMBY (Not In My Back Yard) reactions and institutional as well as community predictive factors. Approximately 16 percent of these facilities studied experienced NIMBY reactions. In contradiction to many previous studies, which try to explain the neighborhood reactions in terms of attitudes towards special client groups, the findings of this study indicate that the characteristics of the facility itself and of the community in which it is placed seem to be the most significant factors. The study suggests that there is also significant community support for the facilities and that interaction with the community can provide the facilities with positive resources.