METHODOLOGICAL  ISSUES

                IN  DEVELOPMENTAL  TRAUMA  RESEARCH

• <RETROSPECTIVE   vs   PROSPECTIVE   ASSESSMENT

  • It is important to acknowledge that the assessment of childhood trauma based on retrospective self-report may be susceptible to distortion and/or inflation (McNally, 2003).
         McNally, R. J. (2003). Remembering Trauma. Cambridge, MA. Belknap Press/Harvard University.

  • A study conducted by Shaffer et al (2008)    [LINK]   (paper freely available)   is consistent with that of Brewin et al (2007) cited below and has further demonstrated the variability in the incidence rates of maltreatment and the psychological outcomes that result from utilizing different methods of identification. In their study, while the maximal number of maltreatment cases was identified by using a combination of all available identification methods, the prospective method was the single most comprehensive method for identifying the most cases of childhood physical abuse, sexual abuse, and neglect. Those who were identified as maltreated by a combination of both prospective and self-report methods experienced the greatest number of incidences of maltreatment (i.e., 49% of this group experienced more than one type of maltreatment) and displayed the most emotional and behavioral problems in late adolescence (i.e., 74% met diagnostic criteria for a clinical disorder).

    Shaffer and collegues argue that their findings stress that practitioners must be continually sensitive to possible abuse histories among their clients, seeking out information from multiple sources whenever feasible. Additionally, the potential effects of abuse disclosure on pre-existing or developing psychopathology should be considered.

  • Kate Scott and colleagues (2012), of New Zealand's Otago University, and member of the longterm developmental study in Christchurch, has examined the relationship between childhood maltreatment and DSM-IV adult mental disorders, and in particular compared prospective and retrospective findings    [LINK],    and found that childhood maltreatment was associated with elevated odds of mood, anxiety and drug disorders (odds ratios =2.1–4.1), with no difference in association strength between prospective and retrospective groups. Prospectively ascertained maltreatment predicted unfavourable depression course involving early onset, chronicity and impairment. Drug misuse was similarly predicted (and likely alcohol abuse, though the design did not permit clear answers regarding this). It was these researchers conclusion that prospectively and retrospectively assessed maltreatment elevated the risk of psychopathology to a similar degree, with prospectively ascertained maltreatment predicting a more unfavourable depression course

  • Another study relevant to evaluating retrospective versus prospective reports of outcomes of childhood abuse is that of Hauser and colleagues looking at FMS - Fibromyalgia Syndrome (Hauser et al 2012 -- see my post included here [LINK]. Biological, psychological and social factors are presumed to interact in the predisposing to, triggering and perpetuating FMS-symptoms. This study gives further evidence that childhood sexual abuse may constitute one (not obligatory) predisposition to FMS. Prospective designs, although cumber-some, are needed to clarify the causal mechanisms that can account for observed associations between reports of past sexual abuse and the presence of FMS. The Hauser et al study demonstrates that patients diagnosed with FMS can differ in various dimensions: Many, but not all FMS-patients report childhood adversities and many, but not all FMS-patients are depressed. A recent study (Loevinger et al 2012 [LINK])defined by cluster analysis a subgroup of FMS-patients distinguished by a history of childhood maltreatment, hypocortisolism and reports of the most pain and disability . The definition of distinct FMS-subgroups is necessary to evaluate most appropriate treatment strategies. The same may be said concerning the role of effects of childhood maltreatment in other disorders.

  • The study by Nickerson and colleagues "Prospective investigation of mental health following sexual assault"    [LINK] provides a valuable example of how prospective studies can contribute to developments in clinical practice.

    In this study, participants were 126 women who had been sexually assaulted in the previous 4 weeks. It was found, using lower level mediation analyses, that changes in PTSD symptoms had a greater impact on changes in depression and anxiety than vice versa. Changes in PTSD symptoms contributed more to changes in scores on measures of depression and anxiety than changes in scores on measures of depression and anxiety contributed to changes in measures of PTSD when time since trauma was considered.

    The finding highlights the role of PTSD symptoms in influencing subsequent change in other psychological symptoms. The authors discuss their findings in the context of models detailing the trajectory of psychological disorders following trauma, and clinical implications are considered.  The results suggest that symptoms of depression and anxiety develop secondarily to PTSD in trauma survivors. It appears that, not only does PTSD often manifest prior to other psychological disorders as suggested by other studies, but that changes in PTSD symptoms strongly influence changes in comorbid anxiety and depression.

    The researchers go on to argue that, in terms of clinical practice implications, it may be most beneficial to first target PTSD symptoms in individuals with comorbid PTSD / depression / anxiety diagnoses in the months following a traumatic event, rather than symptoms of anxiety or depression.

    Of particular relevance to the primary focus of this site, there are limitations associated with this study. It only examined psychological symptoms in the acute period following sexual assault, rather than long-term interrelationships between psychological symptoms. Further, only female sexual assault survivors were examined, which limits the generalizability of the findings. However, the study represents the first prospective investigation of the relationship between changes in PTSD and comorbid symptoms of depression and anxiety in women who have been recently sexually assaulted.

    The findings underscore the importance of change in PTSD symptoms in influencing subsequent change in symptoms of depression and anxiety, and highlight the potential overall psychological benefits of first targeting symptoms of PTSD in the acute period following sexual assault.

• SOURCE   OF   DATA

  • Much research on the effects of childhood abuse and trauma is based on self-report data. In addition, the inherent subjectivity of retrospective self-reported abuse is especially important to acknowledge. However, research has indicated that individuals are more likely to under-report than over-report their history of childhood abuse (Brewin, 2007). [LINK]. This has also been found by Brown et al (2007) in another study looking at adult chronic depression    [LINK].

  • In a large sample of outpatients with depressive and anxiety disorders and healthy controls, the current affective state did not moderate the association between retrospective self-reported CEM and lifetime affective disorder, indicating that a recall of CEM is not critically affected by current mood state (Spinhoven et al., 2010) [LINK]

  • Given the greater demands for evidence for criminal offence, it is likely that prevalence rates for childhood abuse are likely to be lower if based on police records than for rates based on the less stringent criteria of community or social service agencies. -- (This has been found, though I currently find the source).