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Re: Assessing Maltreatment Status
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<font size=3>In addition to Ben's thoughtful comments, you might look at
the following article that was just published in JAMA - shows that asking
youth about suicide is not distressing:<br><br>
<b>Evaluating Iatrogenic Risk of Youth Suicide Screening Programs
<br><br>
A Randomized Controlled Trial <br><br>
</b>Madelyn S. Gould, PhD, MPH; Frank A. Marrocco, PhD; Marjorie
Kleinman, MS; John Graham Thomas, BS; Katherine Mostkoff, CSW; Jean Cote,
CSW; Mark Davies, MPH <br><br>
<i>JAMA.</i> 2005;293:1635-1643. <br><br>
<b>Context </b> Universal screening for mental health problems<sup>
</sup>and suicide risk is at the forefront of the national agenda<sup> </sup>for youth suicide prevention, yet no study has directly addressed<sup> </sup>the potential harm of suicide screening.<sup> <br><br>
</sup><b>Objective </b> To examine whether asking about suicidal ideation<sup> </sup>or behavior during a screening program creates distress or increases<sup> </sup>suicidal ideation among high school students generally or among<sup> </sup>high-risk students reporting depressive symptoms, substance<sup> </sup>use problems, or suicide attempts.<sup> <br><br>
</sup><b>Design, Setting, and Participants </b> A randomized controlled<sup> </sup>study conducted within the context of a 2-day screening strategy.<sup> </sup>Participants were 2342 students in 6 high schools in New York<sup> </sup>State in 2002-2004. Classes were randomized to an experimental<sup> </sup>group (n = 1172), which received the first survey<sup> </sup>with suicide questions, or to a control group (n = 1170),<sup> </sup>which did not receive suicide questions.<sup> <br><br>
</sup><b>Main Outcome Measures </b> Distress measured at the end of<sup> </sup>the first survey and at the beginning of the second survey 2<sup> </sup>days after the first measured on the Profile of Mood States<sup> </sup>adolescent version (POMS-A) instrument. Suicidal ideation assessed<sup> </sup>in the second survey.<sup> <br><br>
</sup><b>Results </b> Experimental and control groups did not differ<sup> </sup>on distress levels immediately after the first survey (mean<sup> </sup>[SD] POMS-A score, 5.5 [9.7] in the experimental group and 5.1<sup> </sup>[10.0] in the control group; <i>P</i> = .66) or 2 days later<sup> </sup>(mean [SD] POMS-A score, 4.3 [9.0] in the experimental group<sup> </sup>and 3.9 [9.4] in the control group; <i>P</i> = .41), nor<sup> </sup>did rates of depressive feelings differ (13.3% and 11.0%, respectively;<sup> </sup><i>P</i> = .19). Students exposed to suicide questions were<sup> </sup>no more likely to report suicidal ideation after the survey<sup> </sup>than unexposed students (4.7% and 3.9%, respectively; <i>P</i> = .49).<sup> </sup>High-risk students (defined as those with depression symptoms,<sup> </sup>substance use problems, or any previous suicide attempt) in<sup> </sup>the experimental group were neither more suicidal nor distressed<sup> </sup>than high-risk youth in the control group; on the contrary,<sup> </sup>depressed students and previous suicide attempters in the experimental<sup> </sup>group appeared less distressed (<i>P</i> = .01) and suicidal<sup> </sup>(<i>P</i> = .02), respectively, than high-risk control students.<sup> <br><br>
</sup><b>Conclusions </b> No evidence of iatrogenic effects of suicide<sup> </sup>screening emerged. Screening in high schools is a safe component<sup> </sup>of youth suicide prevention efforts.<sup> <br><br>
</sup> <br><br>
<br>
At 10:27 AM 4/11/2005, you wrote:<br>
<blockquote type=cite class=cite cite>Marion,<br><br>
This is a common concern among professionals and IRB's who are not familiar with trauma research. In general, there is little evidence that simply asking questions about participants' victimization history in a controlled research environment has much of an impact. In our work alone we have conducted victimization and trauma surveys with nearly 30,000 participants from both community and clinical samples of adults and children, asking behaviorally specific questions about very sensitive issues such as sexual assault, physical abuse, witnessing domestic violence, substance use, delinquent behavior, sucicidality, and psychiatric disorders. In these surveys we always have a debriefing period after the survey proper where we ask about distress due to the topics discussed and the questions. If they report any distress, they are offered a call back from a counselor or a local referral. In all of these surveys, participants sometimes report being somewhat uncomfortable with some of the quesions. But the number that report any significant level of distress is very small. In a survey of 4,000 people, we find that on average 8-12 participants will require call backs. Nearly all of these are participants who are depressed at the time of the interview, may be suicidal, and are not currently seeing therapist. This percentage is consistent with epidemiological reports of the incidence of suicidal thoughts. Of course participating in the interview did not cause the depression, it detected it. Therefore, at least in debriefing interviews, after over 30,000 interviews a handful of participants have reported distress due to the interview.<br><br>
Prior to conducting the National Survey of Adolescents, a victimization survey of a nationally representative sample of 4023 American adolescents, we did a series of small pilot studies of the screening questions, asking kids not to answer them, but to give us feedback on them. As part of these pilots, we asked kids if they understood the questions, would they answer them, and did they find them offensive or distressing. In those pilots, adolescents sometimes said the questions made them a little uncomfortable, but they would answer them. No kid in these pilots reported they would be seriously distressed by answering the quesions.<br><br>
A second indicator is that in our longitudinal studies, agreement to participate in follow-up interviews has always been 95-98%. If the interviews were extraordinarily distressing, one would assume that most people would not agree to continue participation in the study. In fact, this is not the case and nearly all agree to participate. In fact, we find that victims tend to participate and complete follow-up interviews at a higher rate than those that report no history of victimization at baseline. This finding is consistent with what is found in most surveys, that participants who feel some sort of connection to the topic and think it is important, tend to stay in longitudinal studies more than those that have no interest in it. In debriefing, participants who report victimization often report they want to participate because the findings will help others with similar experiences, and that they get some satisfaction from their participation.<br><br>
So, our experience has been that while asking very difficult and sensitive questions does make some participants a little uncomfortable, there is little or no evidence that simply asking questions causes significant distress. However, good debriefing interviews should be conducted and resources should be available to respond if necessary.<br><br>
Good luck in your work.<br><br>
Ben<br><br>
Marion Burke wrote:<br><br>
<blockquote type=cite class=cite cite>Dear List serve members,</blockquote><br>
<blockquote type=cite class=cite cite>I am a graduate student at Capella University, currently finalizing my dissertation proposal that examines the differential outcomes of single versus multiple child abuse and neglect experiences. I intend to use the Comprehensive Child Maltreatment Scale (CCMS) for Adults (Higgins & McCabe, 2001) in order to assess abuse/non-abuse status in an Internet community sample. The CCMS is a retrospective self-report measure of childhood abuse and neglect experiences designed for a nonclinical population. The department chair of my specialization, who is not familiar with the child maltreatment literature, is concerned that the use of this measure may cause potential problems due to the sensitive nature of the questions. He is worried that participants may have adverse reactions to this questionnaire, and that potential legal ramifications may result. Here is where I need some input:</blockquote><br>
<blockquote type=cite class=cite cite>Does anyone have knowledge of or has had experiences with participants who had adverse reactions to questionnaires that are used to retrospectively establish maltreatment status? Does anyone have knowledge of legal consequences that resulted due to the use of such questionnaires? What precautions could be taken to reduce the likelihood of adverse reactions to sensitive questions? What options do I have to assess for abuse histories without the use of such questionnaires?<br>
</blockquote>-- <br>
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~<br>
Benjamin E. Saunders, Ph.D.<br>
National Crime Victims Research and Treatment Center<br>
Medical University of South Carolina<br>
165 Cannon Street, Box 250852 843-792-2945 Telephone<br>
Charleston, SC 29425 843-792-7146 Fax<br><br>
Visit our web site: <a href="http://www.musc.edu/cvc"; eudora="autourl">www.musc.edu/cvc</a><br>
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