Elsevier

Child Abuse & Neglect

Volume 25, Issue 2, February 2001, Pages 307-312
Child Abuse & Neglect

Brief communication
Bias assessment for child abuse survey:: Factors affecting probability of response to a survey about childhood abuse

https://doi.org/10.1016/S0145-2134(00)00238-6Get rights and content

Introduction

Retrospective research into childhood sexual abuse (CSA) has been criticized for a variety of methodological deficiencies, including problems associated with rates of response Briere 1992, Wynkoop et al 1995. Less than total participation by potential respondents can affect the validity and generalizability of CSA findings in two ways. First, researchers must be concerned that they are obtaining a “true” prevalence of CSA; that those who do not participate have experienced CSA at the same rate as those who have agreed to supply information on CSA. Second, those CSA survivors who respond may systematically differ from those who do not respond to CSA surveys, resulting in biased estimates of the effects of CSA on psychosocial and health outcomes.

Competing predictions have been made concerning the motivation of CSA survivors to participate in retrospective research (Peters, Wyatt, & Finkelhor, 1986). On one hand, it has been suggested that they may be reluctant or unwilling to participate in studies of abuse because painful information must be disclosed. Alternatively, abuse survivors are theorized to be more motivated to “tell their story,” thereby increasing their representation in CSA research. Either of these possibilities would influence the prevalence rate obtained; in the first case by lowering it, and in the second, by raising it.

Related to this, concern has been raised as to whether CSA survivors who participate in research studies may evince greater or lesser psychopathology. Choice of sample is thought to influence the strength of the relation between CSA and adult psychiatric disorders. When clinical samples have been utilized, greater psychopathology has been noted in CSA survivors than when studies have been performed among non-clinical groups such as college students (Rind, Tromovitch, & Bauserman, 1998). It has been suggested that persons experiencing current problems may be more likely to remember instances of prior abuse, thereby inflating the relation between exposure to CSA and negative outcomes (Pope & Hudson, 1995). This speculation, however, has been difficult to substantiate because of the lack of information on participant refusals in retrospective CSA research.

Using data from the Adverse Childhood Experiences (ACE) study, we had a unique opportunity to assess the relation between a self-reported history of CSA and the probability of completing a questionnaire requesting additional information on adverse childhood experiences, including the experience of sexual, physical, and emotional abuse. The ACE study is being conducted among members of a large health maintenance organization (HMO) to assess the effects of childhood adversity on long-term health. We mailed a questionnaire (referred to here as the ACE questionnaire) requesting sensitive information on childhood experiences to approximately 13,000 adult HMO members who had already completed standardized health histories as part of a comprehensive physical examination. Importantly, the health history contained a dichotomous screening question about CSA, which read “Were you ever raped or molested as a child?”

Access to the responses to the CSA screening item obtained from the health history enabled us to assess (1) whether a self-reported history of CSA was associated with responding to the more detailed and sensitive ACE questionnaire; and (2) whether the strength of the relation between self-reported CSA and later health and psychosocial well-being varied between the respondents and non-respondents to the ACE questionnaire. Differences in the strength of the relation between self-reported CSA and health and psychosocial outcomes would support the presence of response bias.

Section snippets

Method

From August through November of 1995 and January through March of 1996, all persons who completed a routine medical evaluation at a preventive health clinic within a large, metropolitan HMO were sent a detailed questionnaire on their childhood background (the ACE questionnaire). An examination of utilization records indicate that 81% of HMO members aged 25 and older had undergone medical evaluations at this clinic during the 1992–1995 time frame. A more complete description of the study’s

Results

Overall, 5.9% of all HMO patients answered affirmatively to the question on CSA from the health history. Among respondents, the prevalence of CSA was 6.1%, while in the nonrespondent group it was 5.4%. Since there were demographic differences in response (see Table 1), we adjusted for these variables in our logistic regression model. Persons with a history of being raped or molested as a child were somewhat more likely to be respondents (OR = 1.4, C.I. = 1.1–1.6, p < .001), after adjustment.

The

Discussion

Analysis of respondents and nonrespondents yielded some support for the notion that CSA survivors are likely to cooperate with requests for information on these experiences. Persons who reported being raped or molested as a child were slightly more likely to respond in our sample, which could result in a minor overrepresentation in the ACE study. However, the absolute difference in the prevalence of CSA for the two groups was relatively small (6.1% vs. 5.4%). Moreover, the strength of the

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