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Psychiatry Research 245 (2016) 297302

Contents lists available at ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Factorial validity of the Childhood Trauma Questionnaire in Italian


psychiatric patients
Marco Innamorati a, Denise Erbuto b, Paola Venturini b, Francesca Fagioli c, Federica Ricci b,
David Lester d, Mario Amore e, Paolo Girardi b, Maurizio Pompili b,n
a
Department of Human Sciences, European University of Rome, Rome, Italy
b
Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Sapienza University of Rome,
Rome, Italy
c
Mental Health Department, ASL RME, Rome, Italy
d
Stockton University, Galloway, NJ, United States
e
Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy

art ic l e i nf o a b s t r a c t

Article history: Early adverse experiences are associated with neurobiological changes and these may underlie the in-
Received 23 May 2016 creased risk of psychopathology. The Childhood Trauma Questionnaire (CTQ-SF) is the most commonly
Received in revised form used instrument for assessing childhood maltreatment. Thus, the aim of our study was to investigate the
4 August 2016
factorial validity of an Italian version of the CTQ-SF in a sample of psychiatric inpatients by means of
Accepted 14 August 2016
conrmatory and exploratory factor analyses. The sample was composed of 471 psychiatric in-patients
Available online 16 August 2016
and out-patients (206 males and 265 females) aged 1680 years (mean age34.4 years [SD 16.3])
consecutively admitted to two psychiatric departments. All patients were administered the Italian ver-
sion of the CTQ-SF. We tested ve different factor models which lacked good t, while the exploratory
factor analysis supported the adequacy of a solution with three factors (Emotional Neglect/Abuse, Sexual
Abuse, Physical Neglect/Abuse). The three factors had satisfactory internal consistency (ordinal Cronbach
alphas 40.90). Our study supports results from previous research indicating the lack of structural in-
variance of the CTQ-SF in cross-cultural adaptations of the test, and the fact that, when measuring dif-
ferent types of childhood maltreatment, the difference between abuse and neglect may be not valid.
& 2016 Elsevier Ireland Ltd. All rights reserved.

1. Introduction abuse, was associated with diurnal cortisol regulation (Kuhlman


et al., 2015). The situation was different when the children had to
Research has suggested that early adverse experiences may be face an acute stress (cold pressure task). In this situation, exposure
associated with neurobiological changes in children and adults, to physical abuse was positively associated with a steeper accel-
and these may underlie the increased risk of psychopathology eration of cortisol toward a peak, while exposure to emotional
(Heim and Nemeroff, 2001; Baumeister et al., 2016). Furthermore, abuse was associated with a slower deceleration of cortisol during
several studies suggest that different types of childhood adverse the recovery phase, suggesting that youths exposed to emotional
experience may be differentially associated with different patterns abuse exhibited elevated cortisol levels longer than their peers.
of physiological reactivity to stress and psychopathological tra- Finally, the three types of trauma were not independently asso-
jectories (Heins et al., 2011; van Veen et al., 2013; Huh et al., 2014; ciated with the cortisol awakening response. Heins et al. (2011), in
Kuhlman et al., 2015). For example, Kuhlman et al. (2015) tried to a sample of patients diagnosed with a psychotic disorder, reported
characterize the unique associations between exposure to differ- that childhood abuse, more than childhood neglect, was associated
ent types of childhood maltreatment (physical and emotional with positive psychotic symptoms within the rst 10 years of their
abuse, and non-intentional trauma) and HPA-axis functioning, in illness, while childhood neglect, more than abuse, was associated
121 121 youths aged 916 years old, the authors found that non- with general psychopathology. van Veen et al. (2013) investigated
intentional trauma exposure, but not physical and emotional whether different types of adversities (childhood life events,
childhood trauma, and recent life events) may have different ef-
n
fects on general distress, anhedonic depression, and anxiety
Corresponding author at: Department of Neurosciences, Mental Health and
Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Via di Grottarossa
arousal. In 2615 individuals from the Netherlands Study of De-
1035/1039, 00189 Rome, Italy. pression and Anxiety (NESDA), the authors found that, in-
E-mail address: maurizio.pompili@uniroma1.it (M. Pompili). dependent of diagnostic groups, emotional neglect was

http://dx.doi.org/10.1016/j.psychres.2016.08.044
0165-1781/& 2016 Elsevier Ireland Ltd. All rights reserved.
298 M. Innamorati et al. / Psychiatry Research 245 (2016) 297302

signicantly associated with increased general distress and anhe- trauma) and on one of the two factors dened by the items po-
donic depression, while sexual abuse was signicantly associated larity (positive and negative polarity). If conrmatory factor ana-
with increased general distress and anxious arousal. lysis indicated the t of one of the competing models, we reported
To provide a reliable measure of traumatic experiences in the statistics for this model. Otherwise we planned to investigate the
childhood, Bernstein et al. (1994) developed the Childhood Trau- factorial structure of the CTQ-SF by means of exploratory factor
ma Questionnaire (CTQ), a 70-item self-report questionnaire analysis.
which assesses, retrospectively, experiences of abuse and neglect
in the childhood. The CTQ is the most commonly used ques-
tionnaire for assessing different types of childhood maltreatment 2. Methods
(DiLillo et al., 2006). The rst factor analytic studies on the CTQ
suggested a four-factor structure (Physical and Emotional Abuse, 2.1. Participants and procedure
Emotional Neglect, Sexual Abuse, and Physical Neglect) (Bernstein
et al., 1994) or a ve-factor structure (with the split of Physical and The nal sample was composed of 471 inpatients (206 males
Emotional Abuse into two separate factors) (Bernstein et al., 1997). and 265 females) consecutively admitted between 2013 and 2015
Subsequently, Bernstein et al. (2003) developed a 28-item version either to the Department of Psychiatry of the SantAndrea Uni-
of the CTQ (CTQ-SF) in order to provide more rapid screening of versity Hospital in Rome, Italy, or to the Via Plinio Adolescent
abuse and neglect histories. The CTQ-SF has 25 items measuring Psychiatric Outpatient Clinic, part of the Rome E Territorial Psy-
ve dimensions of abuse (Physical, Emotional, and Sexual Abuse) chiatric Services (see Table 1). Inclusion criteria were age of 16 and
and neglect (Emotional Neglect, and Physical Neglect), and 3 items higher and admission in the time period indicated. Exclusion cri-
included in a Minimization/Denial validity scale. In their study, the teria were the presence of major disorders of the central nervous
authors used exploratory and conrmatory factor analyses (with system (e.g., epilepsy, dementia, or Parkinson disease), and any
maximum likelihood estimators) to derive ve independent di- condition affecting the ability to take the assessment, including
mensions of abuse and neglect, but they were forced to add some delirium or denial of informed consent. Twenty-nine patients
non-hypothesized covariances among the error residuals of some (5.5%) denied their informed consent and were excluded from the
items included in the same dimension, reecting associations study. Furthermore, thirty patients (6.0%) provided missing in-
between items that are not accounted for by the latent factors formation for one to three items of the CTQ-SF and were excluded
(Bernstein et al., 2003; Thombs et al., 2007; Thombs et al., 2009). from the nal sample. Patients excluded from the study did not
To date, the ve-factor structure of the CTQ-SF has been only differ in sex and age from those included in the nal sample. The
partially conrmed in cross-cultural studies (Thombs et al., 2009; mean age of the participants in the study was 34.4 years
Hernandez et al., 2013; Karos et al., 2014). Some studies have re- (SD 16.3; Range: 1680 years). Most of the patients had been
ported that not all the items loaded signicantly on the hy- diagnosed with a mood disorder (48.5%; 19.5% bipolar disorder-I,
pothesized dimension (Thombs et al., 2009; Karos et al., 2014), 10.2% bipolar disorder-II, and 18.8% major depressive disorder) or
while others reported different factor solution for cross-cultural psychosis (20.6%). Other diagnoses were anxiety disorders (8.6%),
versions of CTQ-SF (Gerdner and Allgulander, 2009; Grassi-Oli- personality disorders (13.2%), substance abuse (1.2%), and other
veira et al., 2014; Dudeck et al., 2015). Recently, Grassi-Oliveira DSM-IV-TR specied disorders (including eating disorders, and
et al. (2014) have suggested that the lack of structural invariance of dissociative disorders: 5.6%). Only, 2.3% of the sample had received
the CTQ-SF in cross-cultural adaptations of the questionnaire no diagnosis.
could be related to problems in the original CTQ construction and Subjectes were approached by senior fully qualied psychia-
not a weakness of the different language versions. trists and psychologists in training who informed them about the
Considering the results presented above, and the fact that Ita- aim of the study and explained how to ll-in the questionnaire.
lian versions of the CTQ-SF have been used in previous clinical
studies (Pompili et al., 2014; Imperatori et al., 2015; Imperatori Table 1
et al., 2016) without a proper investigation of their psychometric Characteristics of the sample (n 471).
properties, the aim of our study was to investigate the factorial
validity of an Italian version of the CTQ-SF in a sample of psy- Adult in- Adolescent Test Signicance
patients outpatients
chiatric inpatients as a rst step for a cross-cultural validation of (n342) (n 129)
the questionnaire. Local information on reliability and validity of a
cross-cultural adapted test is necessary to avoid the limitations Sex 0.01a
associated with a use of the instrument in an applied context Males 47.4% 34.1%
Females 52.6% 65.9%
without the availability of local reliability and validity estimates
Age M(SD) 40.99 (14.62) 17.38 (1.31) t347.72 29.25 0.001
(Gudmundsson, 2009). The lack of estimates for local reliability Diagnosis 28 159.35 0.001
and validity of a measure reduces the possibility of reliably inter- None 0.0% 7.8%
preting the ndings from studies which use this instrument and BD-I 23.5% 10.1%
the impossibility of comparing ndings from international studies. BD-II 14.2% 0.8%
MDD 17.5% 21.7%
In line with two previous studies (Grassi-Oliveira et al., 2014; Psychosis 27.8% 3.9%
Dudeck et al., 2015), we compared different models able to explain Anxiety 1.7% 24.8%
the structure of the CTQ-SF by means of conrmatory factor ana- disorders
lysis: (1) the original ve-factor model reported originally by Substance 1.3% 0.8%
abuse
Bernstein et al. (2003); (2) a ve-factor model proposed by
Other other- 6.6% 3.1%
Gerdner and Allgulander (2009), in which the items CTQ2 and wise speci-
CTQ26 of the Physical neglect subscale were allocated to the ed
Emotional neglect subscale; (3) a four-factor solution combining diagnoses
emotional and physical abuse (Lundgren et al., 2002); (4) a uni- Personality 7.3% 27.1%
disorders
dimensional model with all the items loading on a single factor
(childhood trauma); and (5) a one constructtwo method bi-factor a
One-way Fisher-exact test. BD-I = Bipolar Disorder type I; BD-II = Bipolar
model, in which each item loads on the same construct (childhood Disorder type II; MDD = Major Depressive Disorder.
M. Innamorati et al. / Psychiatry Research 245 (2016) 297302 299

They participated in the study voluntarily and received no pay- may be not generalizable to other samples or to the population
ment. Each patient provided written, informed consent prior to (MacCallum et al., 1992). Nevertheless, even an exploratory factor
data collection. For patients under the age of 18 (Italian legal age), procedure is data driven and error prone, despite the fact that
consent was provided by both parents. The study protocol received optimal results may result from the correct choice of the extrac-
ethics approval from the local research ethics review board. tion and rotation methods to use and the use of tests for selecting
the number of factors to rotate (Costello and Osborne, 2005). We
2.2. Measures also decided not to use a multi-group conrmatory factor analysis
despite the fact that it could have permitted us to investigate
At entry into the study, all patients were administered the structural invariance between adolescents and adult patients. In
Italian version of the CTQ-SF. The original version of the CTQ-SF is fact, the subjects-to-variables ratio was not satisfactory for this
a 28-item self-report measure used to assess the severity of ve kind of analysis, especially when considering the small number of
different types of childhood maltreatment (Emotional Abuse EA, adolescents included in our sample.
Physical Abuse-PA, Sexual Abuse SA, Emotional Neglect EN, The conrmatory factor analysis was performed using Mplus
Physical Neglect PN). Each factor is composed of 5 items rated on 6.0 (Muthn and Muthn, 19982010). We used a Mean- and
a 5-point Likert type scale (from 1 never true to 5 very often Variance-adjusted Weighted Least Square (WLSMV) estimator
true) (Bernstein et al., 2003), plus 3 items included as a validity with a polychoric correlation matrix, after calculating Mardia's
scale. In the present study, we used an Italian adaptation of this multivariate asymmetry skewness and kurtosis statistics (Mardia,
scale. One author of the present study (DE) translated the CTQ-SF 1970). Model t was assessed using the following indices: (1) the
from the original English version and a second researcher (MI) Root Mean Square Error of Approximation (RMSEA), with values
back-translated to English. Finally, an English-speaking person, between 0.05 and 0.08 indicative of good adequacy of the model,
uent in the Italian language, supervised the procedure and and values below 0.05 indicating evidence of absolute t (Browne
amended any minor discrepancies in the nal version. and Cudek, 1993; Hu and Bentler, 1999); (2) the Comparative Fit
Index (CFI), with values greater than 0.95/0.96 indicating good t
2.3. Statistical analysis of the model; (3) the Weighted Root Mean Square Residual
(WRMR), with values of less than 1.0 indicating good t (Yu,
All the analyses were performed with the Statistical Package for 2002); and (4) the chi-square (2) test and the normed 2 (2/
the Social Sciences (SPSS) 19.0 for Windows, Mplus 6.0 (Muthn degrees of freedom). P-values for the 2 test greater than 0.05 and
and Muthn, 19982010), and the statistical software Factor v. 10.3 a normed 2 less than 2 (Tabachnick and Fidell, 2013) indicate that
(Lorezo-Seva and Ferrando, 2013). In order to carry out con- the model is an adequate t to the data, although the 2 test over-
rmatory and exploratory factor analyses independently, the rejects true models for large samples.
sample was randomly divided in two subsamples. The con- The exploratory factor analysis was performed using Factor v.
rmatory factor analysis was performed on a subsample of 271 10.3 (Lorezo-Seva and Ferrando, 2013). Polychoric correlations
patients (109 males and 162 females; mean age 34.06 years matrix and unweighted least squares (ULS) estimator were used.
[SD 15.88]), and the exploratory factor analysis on a subsample of The number of factors to retain was determined by results of the
200 patients (97 males and 103 females; mean age 34.91 years Hull method based on the RMSEA (Lorenzo-Seva, 2013). The
[SD 16.95]). The number of patients to include in each one of the Goodness of Fit Index (GFI) and root mean square of residuals
subsample was decided in order to guarantee the maximum sta- (RMSR) are reported. An acceptable model should have mean va-
tistical power possible for the analyses, approaching the standards lue of the RMSR of 0.071 or lower (Kelley, 1935; Bollen and Long,
suggested in the literature (Floyd and Widaman, 1995; Fabrigar 1993), and a GFI greater than 0.95/0.96 (Hu and Bentler, 1999). As
et al., 1999). For example, the number of two hundred participants measures of reliability, we reported ordinal Cronbach's alpha ()
was suggested as the minimum for exploratory factor analysis in (Zumbo et al., 2007). The association with sociodemographic
those situation when latent factors are not overdetermined and variables was evaluated by means of a series of t-tests and Pear-
the communalities are moderately high (Fabrigar et al., 1999), and son's r correlation coefcients.
two hundred seventy-one participants for the conrmatory factor
analysis guaranteed the suggested standard of 10 participants per
variable measured (Floyd and Widaman, 1995). The two sub- 3. Results
samples did not differ in sex (two-sided Fisher's exact test
p 0.08), mean age (t469 0.55; p 0.58), diagnosis (28 6.00; 3.1. Conrmatory factor analysis
p 0.65), and the proportions of patients enrolled from each one of
the two psychiatric centers (two-sided Fisher's exact test p 0.53). Multivariate Kurtosis was signicant in both subsamples (sub-
A conrmatory-exploratory approach is not the only that may sample 1 [n 271]: coefcient 1127.03; statistic 101.26;
be used to rene factor models. Sometimes, researchers prefer to po 0.001; subsample 2 [n 200]: coefcient 1009.45;
use modication indices in a conrmatory factor analysis frame- statistic 64.36; p o0.001), while skewness was not (subsample 1:
work for identifying localized areas of strain and poor t. However, coefcient 315.34; statistic 14,242.92; df 2925; p 1.00; sub-
this process is data driven and error prone, and the nal model sample 2: coefcient 312.21; statistic 10,406.84; df 2925;

Table 2
Fit indices for the competing factor models.

Model 2 (df) Normed 2 RMSEA (90%CI) CFI WRMR

*
Original ve-factor model (Bernstein et al., 2003) 656.64 (265) 2.48 0.074 (0.067/0.081) 0.92 1.40
Five-factor model proposed by Gerdner and Allgulander (2009) 633.27* (265) 2.39 0.072 (0.064/0.079) 0.93 1.35
Four-factor model (Lundgren et al., 2002) 771.50* (269) 2.87 0.083 (0.076/0.090) 0.90 1.58
One constructtwo method bi-factor model 542.95* (250) 2.17 0.066 (0.058/0.073) 0.94 1.11
One-factor model 1343.62* (275) 4.89 0.120 (0.113/0.126) 0.78 2.31

*
p o 0.001.
300 M. Innamorati et al. / Psychiatry Research 245 (2016) 297302

p 1.00). The second factor may be considered a measure of Sexual Abuse (5


In the rst subsample (n 271), no models tted the data well items from the original SA dimension, and 1 item from the original
(see Table 2), and, for the ve-factor models, MPLUS also warned PA dimension loaded on this factor), and the third factor a measure
that the residual covariance matrix (theta) was not positive de- of Physical Neglect/Abuse (3 items from the original PN dimension,
nite. Among all the models, the one constructtwo method bi- and 4 items from the original PA dimension loaded on this factor).
factor model had the best tting indices. In this model, all the The three factors correlated signicantly with one another (Pear-
items negatively worded (CTQ2, CTQ5, CTQ7, CTQ13, CTQ19, son's r: F1F2 0.22; F1F3 0.46; F2F3 0.35; p o0.001). For the
CTQ26, and CTQ28) loaded signicantly on the corresponding whole sample (n 471), ordinal Cronbach's alpha coefcients for
group factor (standardized loadings ranged from 0.36 for CTQ26 to the three dimensions of the CTQ were satisfactory (0.95, 0.99, and
0.69 for CTQ19), while six items positively worded (CTQ1, CTQ3, 0.93, respectively, for Emotional Neglect/Abuse, Sexual Abuse, and
CTQ4, CTQ8, CTQ14, and CTQ18) did not load signicantly on their Physical Neglect/Abuse). Males and females did not differ sig-
group factor (loadings ranging from  0.02 for CTQ8 to 0.20 for nicantly on Emotional Neglect/Abuse (t469  1.96, p 0.051;
CTQ1), suggesting the absence of a method effect for these items. mean score on the whole sample 21.22 [SD 8.61]) and Physical
All the items except for two (CTQ5, CTQ21) also loaded sig- Neglect/Abuse (t469  0.21, p 0.84; mean score on the whole
nicantly on the general factor (loadings ranging from 0.22 for sample 9.33 ([SD 3.90]). Sexual Abuse mean scores
CTQ26 to 0.85 for CTQ11). Finally, three thresholds (items CTQ2, (t464.15 2.43, p=0.015; mean scores of 7.51 [SD 3.38] and 8.44
CTQ19, and CTQ14) were nonsignicant. [SD 4.84], respectively, for males and females) did differ sig-
Modication indices indicated several areas of local strain ei- nicant by sex. Scores were not signicantly correlated with age
ther in the BY statements (i.e., statements dening which items (r's ranging between  0.003 and 0.06; p 40.05).
are supposed to measure latent factors; n 7), suggesting the need
for a renement of the model to permit several items to load on a
different group factor, and in the WITH statements (i.e., statements 4. Discussion
dening correlational relationships among latent factors; n 2),
suggesting the necessity for permitting correlations between the In our sample of psychiatric patients, the ve-factor model
two group factors, as well as between the negative and the general originally proposed for the CTQ-SF by Bernstein et al. (2003) did
factors. All these results suggest that some of the characteristics of not t the data. This lack of t was also true for all the competing
the bi-factor model (independence between the latent factors, all models we tested (a ve-factor model in which two items of the
items loading on a group factor and on the general factor, pre- physical neglect subscale were allocated to load on the Emotional
ferably with higher loadings on the general factor) are not met in neglect subscale, a four factor model combining emotional and
the data and the necessity for dening the structure of the CTQ-SF physical abuse, one constructtwo method bi-factor model, and a
in an exploratory way. one-factor model).
The factor structure of the questionnaire for the present sample
3.2. Exploratory factor analysis was derived by means of an exploratory factor analysis which
indicated a three-factor solution. The ve dimensions proposed by
In the verication sample (n 200), the Kaiser-Meyer-Olkin the authors of the CTQ were collapsed into fewer dimensions.
(KMO) measure of sampling adequacy ( 0.88) indicated the Almost all the items originally measuring Emotional Neglect and
adequacy of the correlation matrix for factor analysis. Exploratory Abuse were collapsed into one common dimension, with the ex-
factor analysis resulted in four factors with eigenvalues 4 1 (ei- ception of one item (Emotionally abused) originally measuring
genvalues between 11.04 and 1.27). However, the Hull method emotional abuse which loaded signicantly on two factors (Emo-
suggested retaining only the rst three factors (44.1%, 13.8%, and tional Neglect/Abuse and Sexual Abuse) and was excluded from all
5.8% of real-data variance, respectively for F1, F2, and F3). The GFI the dimensions. Seven items of the original dimensions measuring
(0.99) and the RMSR (0.054) suggested a good t for this model. physical abuse and neglect loaded signicantly on the same factor,
Factor loadings are reported in Table 3. Considering the pattern of while two items loaded on a different factor and the last item
loadings on each factor, the rst factor may be considered a (Take me to the doctor) had low loadings on all the three factors.
measure of Emotional Neglect/Abuse (4 items from the original EA Last, only Sexual Abuse remained a separate dimension of child-
dimension, 5 items from the original EN dimension, and 1 item hood trauma; all the items originally loading on the corresponding
from the original PN dimension loaded on this factor) (see Table 3). factor loaded on this factor plus one more item (Physically

Table 3
Factor loadings after normalized Promax rotation for the CTQ items (n 200).

Items Emotional Neglect/Abuse Sexual Abuse Physical Neglect/Abuse Items Emotional Neglect/Abuse Sexual Abuse Physical Neglect/Abuse

CTQ1PN  0.16 0.28 0.42 CTQ15PA 0.03 0.71 0.10


CTQ2*PN 0.67 0.09 0.03 CTQ17PA 0.17 0.21 0.60
CTQ3EA 0.45 0.02 0.26 CTQ18EA 0.60 0.15 0.07
CTQ4PN 0.18 0.09 0.73 CTQ19*EN 0.78  0.07  0.29
CTQ5*EN 0.56  0.08 0.11 CTQ20SA 0.01 0.97  0.12
CTQ6PN  0.18 0.26 0.62 CTQ21SA  0.07 0.78 0.23
CTQ7*EN 0.74  0.16 0.20 CTQ23SA  0.15 0.73 0.24
CTQ8EA 0.49 0.21 0.10 CTQ24SA 0.02 0.92  0.05
CTQ9PA 0.16  0.04 0.78 CTQ25EA 0.42 0.49  0.07
CTQ11PA 0.28 0.01 0.67 CTQ26*PN 0.39 0.24 0.02
CTQ12PA 0.12  0.15 0.83 CTQ27SA 0.002 1.00  0.11
CTQ13*EN 0.81  0.18  0.02 CTQ28*EN 0.90 0.04  0.20
CTQ14EA 0.61 0.06 0.18

*Items reversed; In bold items included in each factors. Original dimensions: EA Emotional Abuse; PA Physical Abuse; SASexual Abuse; ENEmotional Neglect;
PN Physical Neglect.
M. Innamorati et al. / Psychiatry Research 245 (2016) 297302 301

abused) originally loading on the Physical Abuse dimension. invariance of the CTQ-SF should be assessed in future studies
The lack of t of the original ve-factor model is not new in the across diagnoses, although Spinhoven et al. (2014) found structure
research. For example, Villano et al. (2004) examined the factor invariance of the CTQSF across the presence of anxiety and/or
structure of the CTQ-SF in a sample of 171 female street-based sex depressive disorder, while Bernstein et al. (2003) reported mea-
workers and reported a poor-t for the original ve-factor model, surement invariance among substance-abusing patients, adoles-
whereas a four-factor solution best represented the data. The au- cent psychiatric inpatients, and community controls. In conclusion,
thors also reported several cross-loadings of items on more than our study may be considered only a rst necessary step in the
one factor and hypothesized that abuse and neglect were not two process of the cross-cultural validation of the CTQ-SF.
conceptually distinct constructs in their sample. This observation
is also true for our sample, where two out of the three dimensions
in the factor analysis had loadings from items assessing either 5. Conclusions
abuse or neglect. However, the results from Villano et al.'s (2004)
study may also be related to the fact that, in their study, the CTQ- Our results indicate that, when measuring different type of
SF was administered face-to-face. childhood maltreatment, the difference between abuse and ne-
The lack of t of the original ve-factor model has been also glect may be not clear. Future studies are needed to assess the
reported by several other studies (Thombs et al., 2009; Hernandez measurement invariance of the Italian version of the CTQ-SF across
et al., 2013; Karos et al., 2014). Grassi-Oliveira et al. (2014) sug- sex and type of sample, and to investigate further the validity of
gested that the lack of structural invariance of the CTQ-SF in cross- this measure. Nevertheless, the CTQ-SF may be used by re-
cultural adaptations of the questionnaire could be related to pro- searchers investigating the association between different types of
blems in the original CTQ construction. childhood maltreatment and psychopathology or reactivity to
Supporting the validity of the three-factor solution in the pre- stress. The CTQ-SF may be also useful for clinicians. It could be
sent study, all three dimensions had satisfactory internal con- used for assessing the severity of a history of childhood mal-
sistency (ordinal Cronbach alpha 4 0.90), in line with what some treatment in order to identify patients with potentially worse
authors consider desirable (Nunnally and Bernstein, 1994). psychopathology and outcomes. However, considering the differ-
Nevertheless, this is the rst study on the CTQ-SF which used a ent factor structure reported for the Italian CTQ-SF and the ab-
Cronbach's alpha coefcient corrected for ordinal measures, while sence of research supporting the use of a specic cutoff for clas-
previous studies using the standard Cronbach's alpha coefcient sifying individuals who have experienced maltreatment versus
indicated problems with the homogeneity in content of the items those who have experienced none or little maltreatment, the CTQ-
included in the physical neglect dimension (Karos et al., 2014). SF should not be used at the present time for diagnostic or
In our sample, males and females did not differ in their scores screening purposes.
on Emotional Neglect/Abuse and Physical Neglect/Abuse, but they
did differ in their Sexual Abuse mean scores. Differences on the
CTQ-SF between males and females have been reported in the Disclosure of potential conicts of interest
past. For example, differences between females and males are
reported in the manual of the CTQ-SF for all ve dimensions of All the authors declare no conict of interest.
maltreatment in a sample of adolescent psychiatric inpatients
(Bernstein and Fink, 1998). Pompili et al. (2014), in a sample of 163
Italian psychiatric inpatients, reported gender differences, but only Ethical approval
for emotional abuse scores. Thombs et al. (2007), assessing mea-
surement equivalence of the CTQ-SF across sex and race in a All procedures performed in studies involving human partici-
sample of drug-abusing adults, reported that the intercept pants were in accordance with the ethical standards of the in-
equivalence for three items (emotionally abused, wear dirty stitutional and/or national research committee and with the 1964
clothes, and physically abused) was not supported, indicating Helsinki declaration and its later amendments or comparable
that men and women had different scores on these items. Speci- ethical standards.
cally, women reported higher scores for the two items measuring
abuse, one of which (physically abused) loaded on the factor
Sexual Abuse in our sample. Furthermore, the structural invariance Informed consent
across males and females has been questioned in the past. For
example, Wright et al. (2001) investigated the factor structure of Informed consent was obtained from all individual participants
the CTQ-SF in 916 university students, and reported that their included in the study.
results support a different factor structure for males (a ve-factor
model with the deletion of two items and with some cross-load-
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