Georgina Guilera

The prevalence of child sexual abuse in community and student samples: A meta-analysis☆ , ☆☆

BACKGROUND Studies conducted internationally confirm that child sexual abuse is a much more widespread problem than previously thought, with even the lowest prevalence rates including a large number of victims that need to be taken into account. OBJECTIVE To carry out a meta-analysis of the prevalence of child sexual abuse in order to establish an overall international figure. METHODS Studies were retrieved from various electronic databases. The measure of interest was the prevalence of abuse reported in each article, these values being combined via a random effects model. A detailed analysis was conducted of the effects of various moderator variables. RESULTS Sixty-five articles covering 22 countries were included. The analysis showed that 7.9% of men (7.4% without outliers) and 19.7% of women (19.2% without outliers) had suffered some form of sexual abuse prior to the age of eighteen. CONCLUSIONS The results of the present meta-analysis indicate that child sexual abuse is a serious problem in the countries analysed.

The International Epidemiology of Child Sexual Abuse: A Continuation of Finkelhor (1994).

OBJECTIVE The purpose of this paper was to compare the prevalence rates of child sexual abuse reported by [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] with those found in recent publications in order to confirm the widespread prevalence of child sexual abuse. METHODS Relevant articles about prevalence of child sexual abuse were identified through searches of computerized databases and a handsearch of Child Abuse & Neglect and the Journal of Child Sexual Abuse. RESULTS Thirty-eight independent articles were identified, corresponding to 39 prevalence studies; these articles report the prevalence of childhood sexual abuse in 21 different countries, ranging from 0 to 53% for women and 0 to 60% for men. CONCLUSIONS Comparison of the present study with that of [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] shows a similarity between prevalence distributions; there appears to be a general pattern that remains more or less constant over the years, especially in women. PRACTICE IMPLICATIONS Twelve years after the first revision study about the international prevalence of child sexual abuse, there is still a need for new data about this topic. The present study shows child sexual abuse is still a widespread problem in the society. In this research, carried out on 38 independent studies, there is new data for 21 countries over the world, being especially relevant the results obtained from other countries different from those pertaining to North America or Europe. It is important to point out the high prevalence found in most of the countries, so this information could be a new warning to make society and governments aware of this problem and undertake actions to prevent sexual abuse in childhood.

Victimization and polyvictimization of Spanish children and youth: Results from a community sample

Most research into adolescent victimization and polyvictimization has been carried out in the United States and in northern European countries. The present study aims to determine the prevalence of victimization and polyvictimization in a community sample of Spanish adolescents. The sample consisted of 1,107 youth (M=14.52, SD=1.76), 590 males and 517 females, randomly recruited from 7 secondary schools in a north-eastern region in Spain. The Spanish version of the Juvenile Victimization Questionnaire was applied, assessing 6 aggregate categories of childhood victimization (conventional crimes, caregiver, peer and sibling, witnessed and indirect, sexual, and electronic victimization). A total of 83% of adolescents reported at least 1 type of victimization during their lives, and 68.6% during the last year. Boys were generally more exposed to conventional crimes (68.0%), and girls to emotional abuse by caregivers (23.0%) and to sexual (13.9%) and electronic (17.6%) victimization during their lifetime. Age differences obtained in victimization rates for the past year confirmed that peer and sibling victimization peak in early adolescence (33.9%). Witnessing community violence was more frequent in older adolescents (34.7%). Almost 20% of the sample was considered as polyvictims (i.e., experienced 4 [corrected] or more forms of victimization). Adolescent polyvictims experienced victimization in 4 or more domains during their lifetime. This study adds new information on the epidemiology of victimization in the international context and is the first to do so from the perspective of a country in south-western Europe. It illustrates that Spanish youth experience a higher level of victimization than official records suggest, and that gender and age should be taken into account when analyzing this complex area of study.

Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S): Psychometric properties of a brief scale for cognitive evaluation in schizophrenia

OBJECTIVE The Screen for Cognitive Impairment in Psychiatry (SCIP) is a brief scale designed for detecting cognitive deficits in several psychotic and affective disorders. This study examined the psychometric properties of the Spanish version of the SCIP in a sample of outpatients suffering schizophrenia-spectrum disorders. METHODS Psychometric properties were evaluated in a sample of 126 stable patients with schizophrenia. Men and women 18 to 55 years of age were recruited from consecutive admissions to 40 psychiatric outpatient clinics in Spain and asked to complete a series of cognitive measures at baseline, as well as three versions of the SCIP separated by one week intervals. A matched sample of 39 healthy controls was also subjected to the baseline examination. The feasibility, reliability and validity of the SCIP was examined; concurrent validity was assessed by means of a complete neuropsychological battery. RESULTS Average time for SCIP administration was 16.02 (SD=5.01) minutes. Test-retest reliability intra-class correlation coefficients ranged from 0.74 to 0.90, with an internal consistency Cronbachs alpha value of 0.73. The three parallel forms of SCIP were shown to be equivalent. The SCIP scales were correlated with corresponding neuropsychological instruments, with Pearsons r between 0.38 and 0.60, p<0.01. The SCIP effectively discriminated between the patient and control samples. Factor analysis revealed one significant dimension, cognitive performance, that accounted for 49.8% of the total variance. CONCLUSIONS The Spanish version of the SCIP is a simple, brief, valid and reliable tool for detection of cognitive impairment in patients with schizophrenia by minimally trained healthcare personnel.

Polyvictimization and its relationship to symptoms of psychopathology in a southern European sample of adolescent outpatients

This study examined the relationship between accumulated experiences of victimization and symptoms of psychopathology in 132 adolescent outpatients aged 12-17 years (M=14.27; SD=1.42). The Juvenile Victimization Questionnaire and the Youth Self-Report were used to analyze polyvictimization and symptoms of psychopathology, respectively. The interviews were conducted between December 2009 and May 2012. Cluster analysis identified a subgroup of polyvictimized patients (n=17) whose general psychological impairment was significantly worse and who presented significantly more externalizing and internalizing symptoms in comparison to the rest of the sample. This difference remained significant when taking into account the clinical severity of these symptoms. These results should be taken into account when assessing and treating adolescent outpatients, for whom an adequate prognosis must be made in line with their experiences and distress. Both the self-report technique and the statistical procedure used have been shown to be suitable for identifying victimization experiences in outpatients, although this new evidence requires confirmation in future research.

Neurocognitive diagnosis and cut-off scores of the Screen for Cognitive Impairment in Psychiatry (SCIP-S).

OBJECTIVES To demonstrate the ability of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) to discriminate between cognitively-impaired individuals and those with adequate functioning in a sample of schizophrenic and bipolar patients, as well as in a control group. METHODS The SCIP-S, together with a full neuropsychological battery, was administered to three groups: patients with schizophrenia, patients diagnosed with bipolar disorder I, and controls. The battery scores were used to perform a standardization with respect to the control group and this served to determine the comparison groups (cognitively impaired versus unimpaired) for each of the subtests of the SCIP-S. A full analysis of decision validity was conducted on the basis of receiver operating characteristic curves (sensitivity and specificity, +LR and -LR, PPV and NPV). RESULTS All the subtests yielded adequate values for sensitivity and specificity with the proposed cut-off points, while the total score of the SCIP (<70) was associated with a sensitivity of 87.9 and specificity of 80.6. CONCLUSIONS The SCIP-S shows adequate decision validity as a screening tool for cognitive deficit in patients diagnosed with schizophrenia or bipolar disorder.

Clinical usefulness of the screen for cognitive impairment in psychiatry (SCIP-S) scale in patients with type I bipolar disorder

BackgroundThe relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD.MethodsAfter short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects.ResultsFeasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbachs alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity.LimitationsThe sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored.ConclusionWith minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia.

AIM The World Health Organization Disability Assessment Schedule II (WHODAS II) was developed for assessing disability. This study provides data on the validity and utility of the Spanish version of the WHODAS II in a large sample of patients with schizophrenia. METHODS The sample included 352 patients with a schizophrenia spectrum disorder. They completed a comprehensive assessment battery including measures of psychopathology, functionality and quality-of-life. A sub-sample of 36 patients was retested after six months to assess its temporal stability. RESULTS Participation in society (6.3%) and Life activities (4.0%) were the domains with the highest percentage of missing data. The internal consistency (Cronbachs alpha) of the total scale was 0.94, and the test-retest stability reached an intraclass correlation coefficient of 0.92. It became apparent that the six primary factor models represent a better fit with reality than other competing models. Relationships between the WHODAS and measures of symptomatology, social and work-related functionality, and quality-of-life were in the expected direction and the scale was ultimately found to be able to differentiate among patients with different degrees of disease severity and different work status. CONCLUSIONS Assessment of disability using appropriate tools is a crucial aspect in the context of mental health and, in this regard, the Spanish version of the WHODAS II shows ample evidence of validity in patients with schizophrenia. The most important contribution of this study is that it is the first analyzing the Spanish version of the WHODAS II (36-item version) in a large sample of patients with schizophrenia.

Brief cognitive assessment instruments in schizophrenia and bipolar patients, and healthy control subjects: A comparison study between the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) and the Screen for Cognitive Impairment in Psychiatry (SCIP)

Cognitive impairment in schizophrenia and psychosis is ubiquitous and acknowledged as a core feature of clinical expression, pathophysiology, and prediction of functioning. However, assessment of cognitive functioning is excessively time-consuming in routine practice, and brief cognitive instruments specific to psychosis would be of value. Two screening tools have recently been created to address this issue, i.e., the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) and the Screen for Cognitive Impairment in Psychiatry (SCIP). The aim of this research was to examine the comparative validity of these two brief instruments in relation to a global cognitive score. 161 patients with psychosis (96 patients diagnosed with schizophrenia and 65 patients diagnosed with bipolar disorder) and 76 healthy control subjects were tested with both instruments to examine their concurrent validity relative to a more comprehensive neuropsychological assessment battery. Scores from the B-CATS and the SCIP were highly correlated in the three diagnostic groups, and both scales showed good to excellent concurrent validity relative to a Global Cognitive Composite Score (GCCS) derived from the more comprehensive examination. The SCIP-S showed better predictive value of global cognitive impairment than the B-CATS. Partial and semi-partial correlations showed slightly higher percentages of both shared and unique variance between the SCIP-S and the GCCS than between the B-CATS and the GCCS. Brief instruments for assessing cognition in schizophrenia and bipolar disorders, such as the SCIP-S and B-CATS, seem to be reliable and promising tools for use in routine clinical practice.

Poly-victimization and psychopathology among Spanish adolescents in residential care.

The aim of this study was to analyze the effect of poly-victimization on symptom severity among adolescents being cared for by the child welfare system in a southwestern European country. The sample consisted of 127 youths (62 males and 65 females) aged 12-17 years (M=14.60, SD=1.61) who were recruited from short- and long-term residential centers. The Juvenile Victimization Questionnaire (Finkelhor, Hamby, Ormrod, & Turner, 2005) and the Youth Self-Report (Achenbach & Rescorla, 2001) were used to assess interpersonal victimization experiences and psychopathology, respectively. Victim (n=68), low poly-victim (n=48), and high poly-victim (n=18) groups had comparable rates of psychopathology severity, with the exception of rule-breaking behavior, which was more severe among those with more victimization experiences (Cramers V=.342). Poly-victimization was shown to be a significant predictor of clinically severe rule-breaking behavior, thought problems, and anxiety/depression symptoms. Among victimization types, sexual and electronic victimization significantly predicted withdrawn/depressed and aggressive behavior, and attention problems, respectively. The results of this study highlight the importance of assessing a wide range of victimization experiences among adolescents in care, since poly-victimization seems to underlie the serious psychological problems these youth present.