PONTIFICAL CATHOLIC UNIVERSITY OF CHILE

FACULTY OF SOCIAL SCIENCES

SCHOOL OF PSYCHOLOGY

Initial validation of the 'Childhood Trauma Questionnaire-Short Form' version

Spanish in Chile

ANA PAULA DOMÍNGUEZ SILOS

Guide Professor: Alex Behn Berliner, PhD

Thesis presented to the School of Psychology of the Pontifical Catholic University of

Chile to obtain the academic degree of Master in Clinical Psychology

June, 2018
Santiago, Chile
PONTIFICAL CATHOLIC UNIVERSITY OF CHILE

FACULTY OF SOCIAL SCIENCES

SCHOOL OF PSYCHOLOGY

Initial validation of the 'Childhood Trauma Questionnaire-Short Form' version

Spanish in Chile

ANA PAULA DOMÍNGUEZ SILOS

Guiding Professor: Alex Behn Berliner, PhD

Thesis presented to the School of Psychology of the Pontifical Catholic University of

Chile to obtain the academic degree of Master in Clinical Psychology

2
To God.

To my parents, Rolando and Cape.

3
THANKS

To my parents, Rolando and Cape,

for supporting me and trusting in each of my decisions.

To my brothers, Mariana, Rolando and José Pablo,

to always be, even if it's thousands of kilometers away.

To my psychologist, Enrique,

for accompanying and guiding me on this journey, both academically and personally.

To my thesis advisor, Alex,

for the trust, for sharing their passion for research and help
uninterested.

At the Pontifical Catholic University of Chile,

for allowing me to be part of your institution and the knowledge granted.

A Psicomédica Clinical & Research Group,

for opening the doors for me and their contribution to make this study possible.

To CONACYT and COPOCYT,

for trusting me to represent Mexico abroad and for your support

economic.

To my friends,
for listening to me, distracting me, concentrating me, and entertaining me throughout the process.

4
Index

1. Summary......................................................7

2. Introduction...............................................................8

3.Article…………………………....………………………………………….....10
3.1. Summary……………………………………………………………………10
3.2. Introduction……………………………………………………………...…12
3.3. Method........................................................................18

3.3.1. Participants....................................................18

3.3.2. Instruments………………………………………18
3.3.3. Procedure..........................................................20

3.3.4. Data analysis…………………....…………………………….…20

3.4. Result…………………………………………………………………...22
3.5. Discussion..........................................................27

3.6. References............................................................31

4. Annexes………………………………………………………………………..…38
4.1. Informed Consent…………………………………………………38
4.2. Instruments.........................................................40

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Table of Contents
Table 1: Demographic Characteristics of the
patients………………………………………………………….…………………..…..18
2. Table 2: Goodness of fit indices for the one-factor model solution
five factors…………………………………………………………………………...23
3. Table 3: Means, Standard Deviations, Factor Loadings…………………….... 23
4. Table 4: Correlations between the scales of the CTQ-SF……………………………..25
5. Table 5: Kendall's tau correlations between the CTQ-SF scales and the instrument
Marshall
6. Table 6: Test-Retest Correlations by Scales…………………………………...27
Table 7: Current validation results compared to validations
previous.........................................................29

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Summary
In recent years, evidence has shown the relevance of
early adverse experiences, both in the physical and mental health of individuals.
The findings have indicated that the presence of these experiences has an impact on the
development, the complexity and severity of certain pathologies. Therefore, it is relevant
continue investigating around early adversity experiences, for which
It is necessary to have reliable and valid instrumentation.
The present study aimed to evaluate whether the functioning
psychometric of the 'Childhood Trauma Questionnaire-Short Form' (CTQ-SF)
instrument for measuring early adverse events, which has been validated and
translated in Spain (Hernández, et al, 2012) is maintained in a sample of population
Chilean. The sample consisted of 280 patients attending a center of
outpatient care in Santiago de Chile, who were invited to participate
voluntarily in the research. The participants completed the instruments
CTQ-SF and Marshall, and 20 of them completed the instruments again in a
an interval of approximately three months (test-retest). After the collection of
data, a confirmatory factor analysis was conducted to examine the factorial structure
of the instrument and the correlations of the subscales of both instruments were
calculated with Kendall's tau. The Spanish version of the CTQ-SF applied in Chile showed

appropriate psychometric properties and a good adaptation of the five model

factors. Based on all of the above, it is concluded that the results obtained in the study
they provide initial support for the reliability and validity of the CTQ-SF validation
Spanish in a Chilean population.

Palabras clave:validación, instrumento, trauma, negligencia, abuso.

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Introduction
It is of great interest to highlight the relevance of adverse experiences.
early (EAT). Based on the literature, EAT constitutes a factor
predictor of mental illnesses such as; depression, bipolar disorder, substance abuse
substances, post-traumatic stress disorder, and physical health diseases:
diabetes, cardiovascular disease, and asthma, among others (Nemeroff, 2016). Therefore,
It is necessary to have the appropriate instrumentation to, on one hand, explore
the incidence of EAT and on the other hand to investigate the relationship between
eating disorders and their negative impact on both physical and mental health.

Various instruments have been used to measure the EAT. Some were
designed to explore only one category of childhood trauma, such as sexual abuse,
while others focus on various types of trauma such as, for example: abuse
physical, verbal or psychological abuse, witnessing interpersonal violence, negligence
physical, emotional neglect and separation from significant caregivers (Roy & Perry,
2004). Within the comparative study conducted by Roy and Perry (2004) for
determine which was the best instrument to measure childhood trauma, they concluded that,
of the 21 instruments reviewed, the Childhood Trauma Questionnaire (CTQ) (Fink,
Bernstein, Handelsman, Foote & Lovejoy, 1995) stood out for having characteristics
favorable; such as the evaluation of multiple types of trauma and the presentation of
reports on psychometric properties. Likewise, the authors of the translation
and validation of the CTQ-SF in Spain, they state that the CTQ-SF (Bernstein & Fink, 1998;
Bernstein et al., 2003), is the 'Gold Standard' instrument for evaluation
retrospective of child abuse (Hernández et al., 2013).
Taking the above into account, it would be relevant to have a
instrument as mentioned above in Chile, taking into account the relevance and the
impact of early adverse experiences on people's health. For the
previously, the present study aims to determine whether the Spanish version
maintains properties of reliability, factorial structure, and validity when used
in a Chilean sample and if so, whether it requires cultural adaptation or not.
Thus, the objectives of this research are the following: 1) to evaluate whether
replicates the theoretical factorial structure through a factorial analysis

8
confirmatory; 2) analyze the Cronbach's alpha to examine internal consistency
of the items of the instrument for each scale; 3) make an estimation of
correlations between the CTQ-SF, Spanish version and the Marshall to explore validity
convergence of the instrument; and, 4) make an estimate of the correlation between the
two applications of the CTQ-SF Spanish version to the same subject, that is, test-retest,
to explore reliability.
The present report presents a structured article according to the
formal aspects of the scientific journal Psychological Therapy. The article begins with
a brief introduction to the research problem, followed by the presentation of the
method used to collect and analyze the data, as well as the results obtained.
Finally, a discussion is presented on the implications that the results have
for the validation of the instrument and clinical practice. The annexes include the
informed consent of the participants and Childhood Trauma Questionnaire-
Simple Form, in its Spanish version.

9
Initial validation of the 'Childhood Trauma Questionnaire-Short Form' version

Spanish in Chile

Summary

The present study aimed to evaluate whether the psychometric functioning of

Childhood Trauma Questionnaire-Short Form (CTQ-SF), a tool for measuring

early adverse events, which has been validated and translated in Spain (Hernández

et al., 2012), is maintained in a sample of Chilean patients. The sample was

consisting of 280 patients, who were invited to participate voluntarily in the

research, completing the CTQ-SF and Marshall instruments to examine the

convergent validity. In turn, 20 of them completed the instruments again

in an interval of approximately three months to assess temporal stability

of the instrument (test-retest). Subsequently, a factor analysis was conducted.

confirmatory and the correlations of the subscales of both instruments were

calculated with Kendall's. The Spanish version of the CTQ-SF applied in Chile showed

appropriate psychometric properties and a good fit of the five-factor model

factors. It is concluded that the results obtained in the study provide support

initial for the reliability and validity of the CTQ-SF Spanish in a Chilean population.

Palabras Claves:validación, instrumento, trauma, negligencia, abuso.

10
Abstract

The objective of this study was to evaluate the psychometric properties of the Spanish

version of the “Childhood Trauma Questionnaire- Short Form" (CTQ-SF; Hernández

et al., 2012), an instrument to measure early adverse events, in a sample of Chilean

patients. The sample consisted of 280 clinical patients, who participated in the

research, completing the CTQ-SF and Marshall trauma questionnaire to assess

convergent validity. Additionally, 20 of them completed the instruments after

approximately three months to examine temporal stability of the instrument.

Afterwards, a confirmatory factorial analysis was performed and the correlations of

the subscales of both instruments were calculated using Kendall's t. The CTQ-SF

The Spanish version in Chile showed adequate psychometric properties and a good

replication of the five-factor model. It is concluded that the results obtained in the

study are compatible with the reliability and validity of the Spanish CTQ-SF in a

Chilean population.

Keywords:validation, instrument, trauma, negligence, abuse.

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Introduction

It is essential, based on the literature, to account for the relevance of

early adverse experiences (EAT), which constitute a factor

predictor of mental illnesses such as; depression, bipolar disorder, abuse of

substances, post-traumatic stress disorder, and health conditions such as:

diabetes, cardiovascular disease, and asthma, among others (Nemeroff, 2016). Likewise,

Evidence has shown the importance of EAT in a number of markers

clinical. Some of them are: the stable interaction between early stress and genes

related to vulnerability to depression (Hornung & Heim, 2015); levels

cytogenetics in depression related to EAT (Grosse et al., 2016); stress in the

childhood and inflammatory processes in adult patients with depression (Danese et al.,

2009); adverse effects of EAT on long-term general health (Widom, DuMont, &

Czaja, 2007); deficits in the functioning of the amygdala and the hippocampus in patients

adults with EAT (Hanson et al., 2015) and increased risk of adult psychopathology

in patients with EAT, among others. (Weil et al., 2004).

Research also indicates that clinically individuals

Depressed individuals generally report more severe difficulties in childhood than those

who do not suffer from depression (Mandelli, Petrelli, & Serretti, 2015). On the other hand, the

authors (Heim and Nemeroff, 2001; Baumeister et al., 2016) found that the

early adverse experiences can be associated with neurobiological changes in

children and adults, and these can underlie the increased risk of psychopathology.

One of the most studied early adverse experiences has to do with the

interpersonal trauma that falls within the categories of psychological trauma that

proposed by Fink, Bernstain, Handelsman, Foote & Lovejoy, 1995. These categories are:

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trauma caused by natural or accidental disasters such as earthquakes or fires,

social catastrophes (war), medical traumas or personal catastrophes (rape,

physical aggression or presence of violence), conceptualizing the latter as "trauma

interpersonal.

The CTQ-SF allows for the retrospective evaluation of interpersonal traumas.

since childhood, among them, is considered child abuse. It is defined as

all forms of physical abuse, emotional mistreatment, sexual abuses, abandonment

negligent treatment or commercial or other exploitation that results in real harm or

potential to the health, survival, development or dignity of a child in the

context of a relationship of responsibility, trust, or power (Krug, Mercy,

Dahlberg & Zwi, 2002.

On the other hand, the authors of the CTQ-SF provide the following definitions.

of the types of child maltreatment. Sexual abuse was defined as contact or

sexual conduct between a child under 18 years old and an adult or an older person. The

physical abuse is defined as those bodily assaults on a child by an adult or

elderly person, who represent a risk of or resulted in an injury. Abuse

emotional is defined as those verbal assaults on the sense of worth or well-being

of a child or any humiliating or degrading behavior directed towards a child by a

adult or an elderly person. Physical neglect was defined as those acts of

part of the caregivers, who do not meet the basic physical needs of the child,

including food, housing, clothing, security, and medical care "(the supervision

parental deficiency was also included in this definition if it endangers the

child safety). Emotional neglect is defined as the inability

from caregivers to meet basic emotional and psychological needs

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of children, which include love, belonging, care, and support (Bernstein & Fink,

1998).

In this regard, a meta-analysis conducted by Nanni and colleagues (2012)

concluded that child maltreatment predicts an unfavorable situation in the course of the

depression and treatment outcomes for it. In comparison with individuals

who have not been abused, those with a history of child abuse, would run

higher risk of meeting the criteria for a depressive episode at any

moment of life, as they are also more prone to suffering vulnerabilities

cognitive and biological factors associated with greater sensitivity to stress, which in turn,

it could predispose them to an unfavorable course of disease and outcome

treatment (Nanni, Uher, and Danese, 2012).

There is great uncertainty surrounding the estimates, frequency and

the gravity of child abuse around the world. Furthermore, a large part of the violence

against children remains largely hidden and goes unreported due to fear and

stigma to the social acceptance of this type of violence (Pinheiro, 2006). At the level

Worldwide, the prevalence of child sexual abuse varies from 2% to 62%, and some of

these variations are explained by a series of methodological factors such as the

definition of abuse

(Andrews, Corry, Slade, Issakidis & Swanston, 2004). In low-income countries

high economic status, the annual prevalence of physical abuse varies from 4% to 16%, and

approximately 10% of children are neglected or emotionally abused

80 percent of this abuse is committed by parents or

caretakers, and some of the factors that lead parents to abuse their children are the

the poverty, mental health issues, low educational performance,

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the abuse of alcohol and drugs, having been mistreated as a child, and family breakdown or

violence among other family members (Butchart, Phinney, Kahane, Mian &

Furniss, 2006).

Gerdner and Allgulander (2009) assert that memories of abuse

they should be evaluated with valid and reliable instruments that meet the

following requirements: ease of application, ethical and non-intrusive management,

conceptual validation, evaluation of relevant types of abuse and sensitivity for

severe abuse. As for the sample that should be selected to validate a

instrument, the evidence shows that the most relevant studies are those that

clearly delimit the population based on the objectives of the study. The

populations must be clearly situated around their content characteristics,

place and in time (Frank & Widaman, 1995).

The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is the instrument

most used and researched to measure various forms of child abuse in adults

(Bernstein et al., 2003). In comparison with interviews and self-report scales.

available reports, the CTQ-SF does not exclusively address sexual and physical abuse,

but evaluates five types of mistreatment in a comprehensive way (Spinhoven &

Penninx, 2014). This makes it an instrument that can be used in a way

widened for scientific and/or clinical purposes in the field of adversity research

and early abuse.

The instrument 'Childhood Trauma Questionnaire' (CTQ) was developed by

psychologist David P. Bernstain to provide a brief, reliable evaluation and

valid of a wide range of traumatic experiences in childhood (Bernstain,

The questionnaire consists of 25 clinical items and 3 validity items, which

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they evaluate 5 clinical scales: physical abuse, emotional abuse, sexual abuse, neglect

emotional and physical neglect. It has been translated into several languages such as: Italian

(Innamorati et al., 2016), German (Bader, Schafer, Schenkel, Nissen & Schwander,

2007), Norwegian (Fosse & Holen, 2002, 2006, 2007), Turkish (Ucok & Bikmaz, 2007),

French (Paquette, Laporte, Bigras & Zoccolillo, 2004), Portuguese (Grassi-Oliveira,

Stein & Pezzi, 2006), Haitian Creole (Martsolf, 2004) and Dutch (Thombs, Bernstein,

Lobbestael & Arntz, 2009). The Spanish version has been validated by Hernández and

collaborators (2013), and this is the one that will be used in the present study in order to

determine if a cultural adaptation is necessary.

The Spanish version of the CTQ-SF was validated with a population of 185 women.

hospitalized patients and outpatient patients, from various mental health centers

from the psychiatric hospital of Reus, Spain. To examine the internal consistency of

CTQ-SF, the Cronbach alpha coefficients were calculated in the total of the

sample, and these ranged from 0.66 in emotional neglect to 0.94 in sexual abuse.

The mean and the standard deviation were also calculated to describe the items.

of the CTQ-SF in a clinical population. The correlations between the scales of the CTQ-SF

were examined using Kendall and ranged from 0.29 to 0.50. The factor analysis

Confirmatory (AFC) was developed with the software EQS 6 (Bentler, 2006) for

analyze the structural validation of the 5 factors of the CTQ-SF proposed by

Bernstein et al. (2003). The results of the CFA supported the structure of the 5

factors proposed by Bernstain et al. (2003). Hernández et al. (2013) propose that

future studies should examine the test-retest reliability and convergent validity of

CTQ-SF Spanish, using corroborating data. In the studies conducted by Paivio.

& Cramer (2004), the findings included internal consistency and test-retest reliability.

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in all dimensions of abuse and neglect before and after approximately

3 months of treatment for substance dependency issues. In addition, the

CTQ demonstrated sensitivity and specificity, compared to evaluations based

in clinical interviews. It also proved to be resistant to biases

notification due to transient mood states (Christine, Stein, Mccrearyp,

& Forde, 2001).

In summary, the childhood trauma questionnaire (CTQ) is a tool

internationally accepted for the assessment of exposure to abuse in childhood

(Bernstein et al., 2003) and several studies use this instrument in different countries.

(Grassi-Oliveira et al. 2014). Therefore, the CTQ-SF has become the

most commonly used self-report questionnaire for research in different forms

of abuse and neglect during childhood (Bernstein et al., 1994; Pietrini, Lelli, Verardi,

Silvestri and Faravelli, 2010; Teicher & Parigger, 2015) and is one more tool

reliable compared to other assessment methods, such as observations

of the staff and the reports of the parents (Polanczyk et al., 2009).

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Method

Participants

The participants were 280 patients, 204 women and 76 men, all of them

consultants of an outpatient mental health center in Santiago

Chile, between 18 and 74 years old, with an average of 39.84 (13.70). Table 1 shows the

descriptive characteristics of the sample. It was defined to ensure maximum

possible statistical power for the analyses, approaching the suggested standards in the

literature (Floyd and Widaman, 1995, Fabrigar Et al., 1999). All patients

Those over 18 were invited to participate, being this the only exclusion criterion.

Table 1: Demographic characteristics of the patients.

Sample N Age Gender

Patients 280 M=39.84 Men 76

Clinicians DS=13.70 (27%)
Women 204
(73%)

Instruments

Childhood Trauma Questionnaire- Short Form (CTQ-SF; Bernstein &

Fink, 1998). The CTQ-SF is a 28-item self-report instrument for adults and

adolescents, which retrospectively assesses events of neglect and child abuse.

The CTQ-SF was developed in an initial version of 70 items by Bernstein et al.

(1994). The length of the scale was reduced from 70 to 28 items, based on an analysis

exploratory and confirmatory factor. The CTQ-SF evaluates 5 types of abuse: abuse

emotional, physical abuse, sexual abuse, emotional neglect, and physical neglect.

18
Each scale is represented by 5 items that are rated with 5 points on a scale.

Likert type, which goes from almost never true to almost always true. Three items

Additional components make up the scale to detect socially accepted responses or

false or negative trauma reports. The coefficients of internal consistency of

the English version has a range of 0.84 to 0.89 in emotional abuse, 0.81 to 0.69 in

physical abuse, 0.92 to 0.95 in sexual abuse, 0.85 to 0.91 in emotional neglect and 0.61

a 0.78 in physical negligence (Bernstein et al., 2003). The factorial structure of the 5

elements of the CTQ-SF remained the same in both the clinical and non-clinical samples

referenced. The results of the confirmatory factor analysis indicated a good

and acceptable adaptation of the 5-factor model. The CTQ-SF was translated into

Spanish and re-translated by bilingual native speakers of Spanish and English. A group of

PhD and masters in psychology and psychiatry reviewed the translation and the re-translation.

until they reached a consensus, and thus they agreed on the final version in

The coefficients of internal consistency of this version range from

0.87 en abuso emocional, 0.88 en abuso físico, 0.94 en abuso sexual, 0.83 en

emotional neglect and 0.66 in physical neglect (Hernández et al., 2012). To this

Spanish version, linguistic adaptations were made in four items (3, 4, 19, 24)

to make them understandable for the Chilean sample, corroborating by experts in

the topic, which will not affect the meaning of the item.

Marshall Trauma Scale (Marshall, Lin, Simpson, Vermes, &

Liebowitz, 2000). The Marshall Trauma Scale (Marshall et al. 2000) is a

questionnaire that determines the anamnetic recall of the occurrence of abuse

during childhood. This scale is a brief and easy-to-apply instrument whose

19
external validity has been confirmed by Cuneo et al. (2005) obtaining a coefficient

Pearson correlation of 0.88 with the Traumatic Background Interview EAT

(Perry & Herman, 1992). The scale assesses the presence (score=1) or absence

(score=0) from EAT through seven items: 1) Traumatic separation from father, mother

the caregiver for over a month 2) Experience of having suffered significant physical punishment

3) Having suffered physical harm after being punished 4) Having

witnessed physical violence between parents or caregivers 5) Alcohol or drug abuse

by a family member 6) Forced sexual contact by a relative 7)

Forced sexual contact with a non-family member.

Procedure

All patients over 18 years old attending the care center

outpatient clinics in Santiago de Chile were invited to participate in the study, before

that they would go to their medical appointment. If they agreed to participate, they were asked to read and

they will sign the informed consent, once this requirement has been fulfilled they will

I granted the CTQ-SF questionnaire and Marshall to be answered in a manner

of the auto report. With the patients who marked in the informed consent that

they had no problem being contacted again for a second application (Test-Re-

test), the same procedure was carried out three months later. The study was approved

by the Committee on Scientific Research Safety of the Pontifical University

Catholic University of Chile and by the Ethics Committee of Psicomédica.

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Data Analysis

To estimate the psychometric properties of the Spanish version of the CTQ-SF, we

four types of data analysis were conducted. First, a analysis was carried out

confirmatory factor analysis to evaluate if the factorial structure of the CTQ-SF was replicated

Spanish version using Mplus 7 software (Muthén & Muthén, 1998-2011). The

factorial solutions were analyzed with respect to the following fit indices

(1) Tucker and Lewis Index (TLI), (2) Comparative Fit Index (CFI) and

Square Root of the Error (RMSEA). These fit indices have been proposed as

reliable for analyzing factor solution using EFA (Schreiber et al., 2010).

To estimate the model fit using these indices, we use the cutoff levels.

proposed by Hu and Bentler (2009): (TLI > 0.95 CFI > 0.95, and RMSEA < 0.06).

Secondly, reliability was calculated using the alpha coefficient of

Cronbach, to examine the internal consistency of the items of the instrument for each

scale, where the SPSS software was used. This coefficient is used to evaluate

the degree of homogeneity among the items and whether the items of the same scale are

evaluating the common concept. As a general rule, to consider whether an

The instrument has good internal consistency; the alpha value must be greater than or

equal to 0.70 (Cohen, 1992). The mean and standard deviation were also calculated for

describe the items of the instrument.

As a third analysis, the convergent validity of the instrument was calculated using

the Kendall correlation between the CTQ-SF scales and the Marshall scale in its

totality. Similarly, it was deemed pertinent to analyze the correlations between the

different scales of the CTQ-SF and the items from Marshall that directly evaluate the

content of the scales.

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Finally, the correlation between the two applications of the CTQ-SF was estimated.

Spanish version to the same subject, that is, test-retest, to explore stability.

temporal of the CTQ-SF. The subsample was selected randomly, without

embargo, a 50% sample loss was observed from an initially selected sample

of 40 patients.

Results

Confirmatory factor analysis (CFA)

Before starting the factor analysis, the Kolmogorov test was applied.

Smirnov to check if the variables are normally distributed. The

test results indicated that the sample does not behave normally. It

they used, therefore, estimation procedures such as MLR.

The solution of a one-factor and five-factor structure was tested and

verified with the different adjustment indices proposed in the AFC literature

(Schreiber et al., 2006). Table 2 presents fitting parameters for a model

adapted for the solution of one factor and five factors. As can be seen, the

solution of a factor reports relatively low adjustment indices, the values being

in CFI and TLI lower than 0.95 which is what is expected and the RMSEA indices are below

of the limit 0.06, while the five-factor solution reports indices within

desired, with the values in CFI and TLI close to 0.95 and the RMSA index above

the limit of 0.06. In this way, it is verified that the 5-factor model is the one that

it has better adaptation and the factorial structure proposed by the authors and validated in

Previous studies are confirmed in the local sample.

22
Table 2: Goodness of fit indices for the one-factor and five-factor model solution
factors.

Model CFI TLI RMSEA

Solution of 0.926 0.916 0.052

five factors

Solution of a 0.548 0.507 0.126

factor
CFI, comparative fit index; TLI, Tucker-Lewis index; RMSA, Root

Square of the Error.

Reliability

The mean, standard deviation, and the factorial load of the scales and items of

CTQ-SF are reported in Table 3. The alpha reliability coefficient of

Cronbach ranged from 0.65 in physical neglect to 0.94 in sexual abuse. The

factorial load of Bernstein's largest sample (2003), in comparison mode

with the factorial load obtained in the study. All items obtained a load

factorial greater than or equal to 0.40 with the exception of item 1 (0.37) and 4 (0.35).

Table 3: Means, Standard Deviations, Factor Loadings.

Item Media Factorial Load

(DS) (Chile, 2018) (Bernstain, 2003) N: 625

Emotional abuse 10.5 (4.9)

.84)

3 2.2 (1.2) .69 .69

23
8 1.8 (1.2) .60 .70

14 2.2 (1.2) .85 .83

18 1.8 (1.1) .71 .82

25 2.6 (1.4) .76 .83

Physical abuse (α .88) 7.8 (4.2)

9 1.2 (0.7) .65 .63

11 1.6 (1.1) .88 .78

12 1.9 (1.2) .82 .66

15 1.8 (1.2) .89 .87

17 1.3 (0.8) .65 .72

Sexual abuse (α .94) 7.5 (4.6)

20 1.6 (1.1) .88 .90

21 1.3 (0.9) .85 .73

23 1.4 (0.9) .90 .90

24 1.6 (1.1) .84 .93

27 1.6 (1.1) .88 .92

Negligence 19.7 (4.6)

emotional (α .83)

5 (R) 3.8 (1.3) .67 .79

7 (R) 4.1 (1.1) .79 .47

13 (R) 4.0 (1.2) .55 .83

24
19 (R) 3.8 (1.2) .63 .81

28 (R) 3.9 (1.2) .81 .81

Physical negligence (α 7.6 (3.2)

.65

1 1.7 (1.2) .37 .40

2 (R) 1.9 (1.2) .76 .60

4 1.3 (0.8) .35 .51

6 1.2 (0.7) .40 .42

26 (R) 1.6 (1.0) .64 .66

Reversible item

Validity of the instrument

The correlation between the scales of the instrument was estimated, which are shown

In the following table 4. The five scales showed a significant correlation.

The sexual abuse scale shows the lowest correlations with the others.

four scales.

Table 4. Correlations between the scales of the CTQ-SF

AE AF AS NE NF

AE - .431** .224** .507** .406**

AF - .217** .343** .327**

AS - No translation .293**
needed for numbers.

NE - .473**

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NF -

Emotional Abuse

Emotional, NF: Physical Negligence.

The convergent validity of the CTQ-SF was examined in relation to the Marshall,

an instrument that measures exposure to early adversity. A high correlation between

both instruments would indicate that the CTQ-SF is valid for measuring the construct of

exposure to early adversity. The correlations between the scales of the CTQ-SF and

The total Marshall is displayed in Table 5, as well as the subscales of the Marshall.

that were defined on an ad hoc basis based on the items of Marshall that cover

items from the CTQ-SF scales.

Table 5. Kendall's tau correlations between the scales of the CTQ-SF and the instrument
Marshall

AE AF AS NE NF

Marshall Total .445** .453** .410** .395** .453**

Marshall/Sexual Abuse .219** .670** .230** .251**

Marshall/Physical Abuse .593** .183** .319** .301**

Marshall/ Emotional Negligence .275** .175** .321** .339**

Marshall/Physical Negligence .202** .171** .190** .292**

Emotional Abuse

Emotional, NF: Physical Neglect.

26
It can be observed that the specific correlations between the CTQ-SF and the

Marshalls are generally low. It is important to note that the Marshall is an instrument.

very brief, used as general screening, and therefore maintains a

reduced variability, which may reduce correlation.

Test/re-test stability

A correlation was made between the scales of the first and the second.

application of the test, the results (table 6) indicate that each scale correlated with

strong and significant way, indicating the temporary stability of the instrument.

Therefore, despite making two applications in a time interval of 3

months, the responses are similar, which speaks to the reliability of

instrument.

Table 6: Test-Retest Correlations by scales.

AE** AF** AS** NE NF**
AE* .698**
AF* .966**
AS* .721**
NE* .730**
NF* .500
First application
Second application

Discussion

The results of this study confirm the reliability and validity that

it has the Spanish version of the CTQ-SF in the Chilean population. The adaptation of the CTQ-SF

Spanish version (Hernández, et al., 2012) in the Chilean population showed properties

appropriate psychometrics and a good adaptation of the five-factor structure in

27
a Chilean clinical sample. The averages of the CTQ-SF scales Spanish version

In the Chilean sample it was similar to the Spanish application.

The results of the confirmatory factor analysis support the structure of

five factors proposed by Bernstain et al. (2003) and for the same reason, it does not result

it is necessary to make some modification to this model, confirming the results of

previous studies (Scher et al., 2001; Thombs et al., 2009; Spinhoven et al., 2014).

In both versions (Spanish and English) of the CTQ-SF, the neglect scale

physics showed the lowest factor loadings in the AFC (Bernstein et al., 2003;

Hernández et al., 2012). This result and the low internal consistency of this scale

they indicate that this factor is the least homogeneous.

Regarding convergent validity, the instrument used turned out not to be the

more convenient, as being a test used for initial screening it is brief and not

covers the 5 scales used in the CTQ-SF. For future studies the following

instruments that could be considered to examine convergent validity:

Maltreatment and Abuse Chronology of Exposure (MACE) (Teicher & Parigger,

2015) The childhood experience of care and abuse questionnaire (CECA.Q)

(Bifulco et al., 2015).

Despite the fact that the proposed sample for the test-retest analysis showed a

loss of 50%, due to the fact that the second contact with the patients became more complex,

significant correlations could be found. This fact constitutes a contribution

for the validation of the instrument in the Spanish translation, although it is still

It is necessary to replicate the study with a larger test-retest sample to determine

with greater confidence that the instrument has temporal stability.

28
Regarding the scale of 'physical neglect', it can be hypothesized that, due to

to be the scale with the least internal consistency, this decreases the correlation of the scale

I manage myself in the test-retest. Still, future research should take this into account.

why the 'physical negligence' scale has a lower correlation than the other scales

in the test-retest.

The three validity items (10, 16, and 22) that make up the test were not

included in the validation study, that is why future research and clinical use

they should take into account the scoring of the items to include or not from the instrument

to a subject of the investigation.

As can be seen in Table 6, when we compare our results with

the results of Bernstain et al. (2003) and Hernández et al. (2013) can be observed

that the reported values are similar in the three studies. Comparing the study

From Hernández et al., 2013, it is important to highlight that the sample obtained in the present

the study was larger and was not limited only to female patients, which contributes

greater wealth to research. Furthermore, this study evaluated the

test-retest reliability, these contributions being important in the validation of

test in the Spanish language.

Table 6: Results of the current validation compared to validations

previous

Validation N Internal Consistency (Alpha of Test

n Cronbach) Retest

AE AF AS NE NF

29
Bernstein 1399 0.84 0.81 to 0.92 to 0.85 to 0.61 If
and et al., patients a 0.86 0.95 0.91 a
2003 clinical 0.89 0.78
579
patients
non-clinical

Hernández 185 0.87 0.88 0.94 0.83 0.66 -

and others patients
2013 clinical

Sunday 280 0.84 0.88 0.94 0.83 0.65 If

ez., 2018 patients
clinical
Emotional Abuse

Emotional, NF: Physical Neglect.

The range in Bernstein et al., 2003 is from the 4 samples that were used in the study.

As main limitations of the study, it should be mentioned that the sample was

only clinical, it is important that future studies can be carried out with a sample

clinical and non-clinical comparison. Similarly, although the obtained sample was

According to the study by Hernández et al. (2013), it is proposed to conduct a study with samples

similar to the original validation by Bernstain et al. (2003). Likewise, despite

that the sample was adequate for the analysis, future studies should obtain

a more homogeneous gender sample, since 73% of the sample was female.

In summary, the Spanish CTQ-SF in the Chilean population showed a

appropriate internal consistency. Furthermore, the five-factor structure of the version

original was replicated in a clinical sample, so the results of this study

30
provide initial support for the reliability and validity of the Spanish CTQ-SF in

Chile.

Finally, the validation of this instrument represents a significant contribution to the

evaluation, diagnosis and treatment in the clinical field. Thus, it becomes

an investigative tool that can be used in future studies, in order to

provide relevant information about early adverse experiences and their

impact on physical and mental health.

31
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Attachments

LETTER OF INFORMED CONSENT

Initial Validation of the "Childhood Trauma Questionnaire-Simple Form" (CTQ-SF) Spanish version
in Chile.

Ana Paula Domínguez Silos

You have been invited to participate in the studyInitial Validation of Childhood Trauma
Spanish version of the Simple Questionnaire Form (CTQ-SF) in ChileAna Paula Domínguez Silos
Master's student at the Catholic University of Chile. The purpose of this letter is to assist you.
to make the decision to participate in this research.

What is the purpose of this research?

The objective of this study is to validate in Chile an instrument that assesses trauma experiences.
what they could have experienced in their childhood.

What does their participation consist of?

You will participate in the research by completing two questionnaires about early experiences that
may have experienced during his childhood. The first will consist of 28 questions and the second of
7 questions, both with the same theme.

How long will their participation last?

You will answer both questionnaires, administered by the principal investigator, which take
to be completed within a maximum of 20 minutes. These questionnaires will be completed before moving on to your
medical hour; in a box in the same facilities. There will be two evaluation instances, in
where participation will be the same and in the same place, if you agree, you could be
contacted 2 months later for a second application, this being only a possibility since,
You will not necessarily be contacted.

What risks do you face by participating?

Some of the questions you will be asked may evoke memories of experiences.
that may cause feelings of stress or anxiety, if so please let the researcher know
about what is happening and if necessary the application will be suspended.

What benefits can their participation have?

Your participation in the research is of great importance to the researchers and professionals.
of Health in Chile, by participating, I would be benefiting the population that consults as
you, to what with this new instrument help professionals identify the complexity of
pathologies and thus provide a better work plan for the consulting population.

What happens to the information and data you provide?

Researchers will maintain CONFIDENTIALITY regarding any information obtained
In this study, this data will be for the exclusive use of this research and once it is completed
analysis, the data will be destroyed. We remind you that the information you provide in
this questionnaire is confidential and will be conducted in an anonymized manner.

39
¿Es obligación participar? ¿Puede arrepentirse después de participar?
You are NOT obligated in any way to participate in this study. If you agree to participate,
You can stop doing it at any time without any repercussions.

Who can they contact to learn more about this study or if they have questions?

If you have any questions about this research, you can contact Ana Paula.
Domínguez, a Master's student in Clinical Psychology at the Catholic University of Chile.
His phone number is +56 9 45622233 and his email is [email protected]. If you have any
consult or concern regarding your rights as a participant in this study, you can
contact theEthical Scientific Committee of Social Sciences, Arts and Humanities. President:
María Elena Gronemeyer. [email protected]
I HAVE HAD THE OPPORTUNITY TO READ THIS CONSENT STATEMENT
INFORMED, TO ASK QUESTIONS ABOUT THE RESEARCH PROJECT, AND I ACCEPT
PARTICIPATE IN THIS PROJECT.

Signature of the Participant Date

participant_name

Signature of the Researcher Date

(Signatures in duplicate: one copy for the participant and another for the researcher)

I consent to being contacted again for a second application of the instrument:

If ___ No ___

40
Childhood Trauma Scale
Questionnaire, CTQ-SF

Age: Sex:

Instructions: This questionnaire addresses experiences you may have had during your childhood or
adolescence. For each question, check the box that best suits you. Although some
Questions refer to intimate and personal topics, it is important to answer honestly.

When I was little Never Rarely A A Almost

y/o adolescent: sometimes often always

I didn't have enough

for eating

I felt cared for and

protected

3. Some members
from my family to me
they called him 'fool',
loose or ugly

My parents were
too drunk or
"drugged" for
take care of the family

Someone of mine
family made me feel
important or special

I had to get dressed

with dirty clothes

I felt loved

I thought that my
parents did not want that
would have been born

41
They hit me so
strong that I had to go to the
doctor or to the hospital

10. I have not wanted

change family

11. Some member of

my family hit me
so strong that it me
left marks or
bruises

12. They punished me with

a belt, a stick,
a rope or another
blunt object

13. The members of

my family took care of
one another

Members of my
my family insulted me or
they said things that made me
they were hurting

I think I have been

physically abused

When I was little Never Rarely A A Almost

y/o adolescent: often always

I have had a
perfect childhood

They hit me so
strong that someone arrived
to note the marks (e.g.
a teacher, a neighbor
or a doctor)

42
I felt that someone
from my family to me
I hated

19. The members of

my family felt
close to each other

20. Someone tried

touch me or made me
make touchings
sexual

21. Someone me
threatened to do me
damage if I didn't do something
sexual act with him or her

22. I had the best

family of the world

Someone forced me
to engage in sexual acts or
made me see such acts

I have been a victim of

sexual harassment

I think I suffered
psychological abuse

There was someone who

she took me to the doctor if
I needed it

27. I think they have

abused by me
sexually

28. My family was a

security source and
support

43
Trauma Scale: Marshall YES NO

Traumatic separation from the father, mother, or primary caregiver due to

more than a month

Experience of having suffered significant physical punishment

Being left with physical harm after having been punished

Having witnessed physical violence between parents or caregivers

Alcohol or drug abuse by a family member

Forced sexual contact by a relative

Forced sexual contact with a non-family member

44