Cultural sensitivity in screening adults for a history of childhood abuse: evidence from a community sample

A number of practice guidelines and recommendations call for the assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening questions, however, has not been examined. OBJECTIVE: To assess whether questions that inquire about childhood abuse history function differently for black and white patients. DESIGN., Cross-sectional telephone surveys in 1997 and 2003. SUBJECTS: Randomly sampled adults from Memphis, Tenn (1997, N=832; 2003, N=967). MEASUREMENTS: Physical, emotional, and sexual abuse scales of the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Standardized mean difference technique for differential item functioning to assess for possible bias in CTQ-SF items. RESULTS: Controlling for total physical abuse scale scores, black respondents were significantly (P <.01) more likely than white respondents to report that they had been punished with a hard object during their childhood, but less likely to report having being hit so hard that it left marks, have been hit so hard that someone noticed, or to believe they had been physically abused. CONCLUSIONS: Inquiries that do not explicitly differentiate physical punishment from physical abuse may not be useful for black respondents because they tend to identify black respondents who report fewer clearly abusive experiences than comparable white respondents. Although untested in this study, one possible explanation is that physical discipline may be used more frequently and may play a different role among black families than among white families. These results underline the importance of attending to cultural factors in clinical-history taking about childhood abuse histories.