Psychometric Properties of Turkish Version of Childhood Trauma Questionnaire among Adolescents with Gender Differences

doi:10.4236/psych.2012.310138

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Psychology

2012. Vol.3, No.10, 916-922

Published Online October 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.310138

916

Psychometric Properties of Turkish Version of

Childhood Trauma Questionnaire among

Adolescents with Gender Differences

Ayse Rezan Cecen-Erogul

Mugla University, Mugla, Turkey

Email: [email protected]

Received July 8th, 2012; revised August 9th, 2012; accepted September 12th, 2012

The aim of this study was to investigate the psychometric properties of the Turkish version of Childhood

Trauma Questionnaire (CTQ) and its subscales among adolescents. The participants consisted of 1275

high school students (14 - 19 years) with a mean age of 16.33 (SD = 1.01). The confirmatory factor

analysis has revealed that CTQ has three subscale (physical abuse, emotional abuse, sexual abuse). Cron-

bach’s alpha for the total scale was .91, for physical abuse .84, for emotional abuse .89, for sexaul

abuse .70. The test-retest correlation coefficient for the total score (n = 65) was .81, for physical abuse .82,

for emotional abuse .80, and sexual abuse .75 at 3 weeks indicating adequate reliability. Discriminant va-

lidity was satisfactory. The results of the study have shown that the Turkish version of CTQ psychomet-

rically sound among high school students.

Keywords: Childhood Trauma Questionnaire; Validity; Reliability; Adolescents

Introduction

Child maltreatment is a serious threat to children’s physical

and psychological well-being (Damashek, Balachova, & Bon-

ner, 2011). Child maltreatment can result in significant long-

term emotional and behavioral consequences, including post-

traumatic stress disorder (e.g., Dubner & Motta, 1999), aggres-

sion and anger (Shields, Cicchetti, & Ryan, 1994; Korkut, 2011;

Taner & Gokler, 2004; Chapple, Tyler, & Bersani, 2005),

school difficulties (Erickson & Egeland, 2002), depression

(Boney-McCoy & Finkelhor, 1996), social difficulties (Man-

narino & Cohen, 1996), criminal behavior (Gelles & Straus,

1990), low life satisfaction (Korkut, 2012) and self esteem

(Bagley, Bolitho, & Mallick, 2001; Baldry, 2003; Durmuşoğlu

& Doğru, 2006; Korkut, 2012) and long-term health problems

(Anda et al., 2006). Physical child abuse refers to acts that

cause pain and permanent or temporary damage to the child’s

physical functions, such as bruises, burns, head injuries, frac-

tures, or internal injuries (Kolko, 1996). Forms of physical

abuse include hitting, kicking, burning with a cigarette, shaking

by the hair, and strangling. The research have shown that

physical abuse related to lack of social skills, low self esteem

and anger management problems (Kaplan, Pelcovitz, & La-

bruna, 1999; Nurcombe, 2000; Ystgaard, Hestetun, Loeb, &

Mehlum, 2004).

Abuse often causes a permanent physical injury, such as a

scar or a neurological defect. Along with physical injuries, the

following long-term affects may occur. The child adopts a vio-

lent behavioral pattern, or fear, anger, and distrust are provoked

in the child (Lynch, 1988; Lewis, 1992; Kolko, 1996). Emo-

tional abuse refers to cases where the child is criticized, terror-

ized, degraded, ridiculed, or isolated (Hart, Brassard, & Karlson,

1996). Emotional abuse also occurs when the caregivers do not

approve of or understand the child’s activities or thoughts. Ac-

cording to Hart, Brassard, & Karlson, (1996) this kind of pas-

sive emotional disapproval of the child is the most harmful

form of violence, because it is impossible for the child to de-

velop a positive self-image. All types of abuse, such as corporal

punishment, involve emotional abuse (Hart & Brassard, 1991;

Hart, Brassard, & Karlson, 1996). Sexual abuse refers to

physical abuse directed at the child’s genitals and sexual char-

acteristics, actual or attempted sexual intercourse, or any other

sexual act that violates the child’s physical integrity. Sexual

abuse also involves leading children into sexual behavior that

does not correspond to their age and developmental level, sub-

jecting children to sexual stimuli, or using them as performers

in obscene publications (Berliner & Elliott, 1996). Epidemiol-

ogical studies estimate that 27% of females and 16% of males

experience at least one episode of sexual abuse during their

childhood or adolescence (Timnik, 1985; Finkelhor, Hotaling,

Lewis, & Smith, 1990).

The Childhood Trauma Questionnaire (CTQ) is a self-report

questionnaire that retrospectively assesses childhood abuse

experiences among adolescents and adults. Items were con-

structed based on a review of the child abuse literature. In an

early investigation of the responses of 286 drug- or alco-

hol-dependent patients to a 70-item version of the CTQ, Bern-

stein et al. (1994) reported that the results of yielded four fac-

tors: physical and emotional abuse, emotional neglect, sexual

abuse, and physical neglect. In this study cronbach alpha

changed between .79 - .94. In a later investigation of 398 ado-

lescents admitted to an inpatient psychiatric hospital. Bernstein

and colleagues (Bernstein, Ahluvalia, Pogge, & Handelsman,

1997) reported five factor solution in which physical and emo-

tional abuse split into separate factors. Confirmatory analyses

of this five-factor solution have been conducted subsequently,

with results supporting the appropriateness of this solution

A. R. CECEN-EROGUL

across adult substance abusers, adolescent psychiatric inpatients,

and female HMO members (Bernstein & Fink, 1998). Addi-

tionally, the CTQ has demonstrated convergent validity with

both a clinician-rated interview of childhood abuse and thera-

pists’ ratings of abuse (Bernstein et al., 1997; Bernstein & Fink,

1998; Fink, Bernstein, Handelsman, Foote, & Lovejoy, 1995).

Reliability of the CTQ is also encouraging. Test-retest reliabil-

ities ranging from .79 to .86 over an average of 4 months sug-

gest that the CTQ may be resistant to reporting biases because

of transient mood states as well as longer term psychopathology.

Moreover, the CTQ has demonstrated internal consistency reli-

ability across a range of samples, with reliability coefficients

ranging from a median of .66 for the physical neglect subscale

to a median of .92 for the sexual abuse subscale (Bernstein &

Fink, 1998).

In Turkey Aslan & Alpaslan (1999) adapted CTQ into Turk-

ish among university students (age range between 17 - 25; n =

744) but their sample did not include adolescents who attend

high school. Aslan & Alpaslan reported that the results of factor

analysis yielded three factor solution (40-item): physical abuse

(16-item), emotional abuse and neglect (19-item) and sexual

abuse (5-item). The internal consistency of the scale for total

scale .96, for physical abuse .94, for emotional abuse .95 and

for sexual abuse .94. The criterion validity of the CTQ has

shown significant correlations between CTQ and Beck Depre-

sion Inventory, Spielberger Trait Anxiety Scale, Dissociative

Experiences Scale, Toronto Alexithmia Scale.

In the light of literature, there is no research related to child-

hood trauma questionnaire validity and reliability on adoles-

cent’s population. Thus, the aim of this article is to investigate

the psychometric properties of the Turkish version of Child-

hood Trauma Questionnaire (CTQ) and its subscales among

adolescents. These properties include factor structure, internal

consistency, test-retest reliability, inter-correlations of sub-

scales and divergent and convergent validity. In addition on the

same data gender differences were also investigated in respect

of physical, emotional and sexual abuse.

Method

Participants

The study involved a community sample of 1275 adolescents

(14 - 19 years) with a mean age of 16.33 (SD = 1.01). The par-

ticipants comprised 693 (54%) girls and 582 (46%) boys from

different public high schools which represented middle socio-

economic status according to Adana, Gaziantep and Mardin

Province National Education Directory statistic service. The

participants composed of 501 (39%) high school students from

Adana, 324 (25%) Gaziantep and 450 (35%) Mardin. All stu-

dents were volunteered for complete the questionnaires.

Measurement

The Childhood Trauma Questionnaire

(CTQ; Bernstain et al., 1994) CTQ is a screening tool to de-

tect persons with experiences of childhood abuse and neglect.

The original CTQ 70-item and the items are scored on five

point scale from never (1) to everytime (5). The higher score

indicating higher abuse experiences. Aslan & Alpaslan (1999)

adapted CTQ into Turkish on the sample of university students.

Aslan & Alpaslan (1999) reported that Turkish version of CTQ

has three factor that physical abuse (e.g., “I was punished with

a belt, a board, a cord, or some other hard object”), emotional

abuse and neglect (e.g., “People in my family called me things

like ‘stupid’, ‘lazy’, or ‘ugly’”) and sexual abuse (e.g.,

“Someone tried to touch me in a sexual way, or tried to make

me touch them”) with the 40-item. They also reported the CTQ

has good internal consistency (for all scale .90, for physical

abuse .89, emotional abuse and neglect .89, sexual abuse .90)

and the criterion validity. In this study Aslan and Alpaslan 40-

item CTQ scale was tested among adolescents.

State-Trait Anger Expression Inventory

(STAXI; Spielberger et al., 1983) The STAXI which was

developed by Spielberger, Jacobs, Russell, and Craine (1983)

was used to determine anger levels expressed by people. The

scale was translated and adapted into Turkish by Ozer (1994).

The first 10 items of the scale measure trait anger (e.g., “I have

a fiery temper”) the other 24 items point out individuals’ anger

expression styles that anger in (e.g., “I boil inside but don’t

show it”), anger-out (e.g., “I control my urge to express my

angry feelings”) anger control (e.g., “I take a deep breath and

relax”). The scale is a 4-point Likert type scale. Ozer (1994)

reported that the scale has good validity and reliability. The

internal consistency coefficients of the scale were found to

be .79 for trait anger dimension, .84 for anger control, .78 for

anger-out and .62 for anger control (Ozer, 1994). Higher scores

on trait anger indicate higher anger levels; higher scores on the

anger-in subscale indicate higher levels of suppressed anger;

higher scores on the anger-out subscale indicate easier anger

expression, and higher scores on the anger-control subscale

indicate better anger control.

Rosenberg Self-Esteem Scale

(RSES; Rosenberg, 1965) The RSES was developed by

Rosenberg (1965) and adapted into Turkish samples by Cuha-

daroglu (1986). A 10-item (e.g., “I feel that I am a person of

worth, at least on an equal plane with others”) brief RSES re-

fers to the global self-worth of individuals, rating on a 4-point

liker type scale (1 = strongly disagree to 4 = strongly agree).

Higher scores on the scale items indicate higher levels of

self-esteem. Cuhadaroglu reported that the self-esteem scale is

valid and reliable. The cronbach alpha of the scale .76 and

test-retest reliability coefficients of .71 during a 4-week period

on the Turkish version.

The Satisfaction with Life Scale

(SWLS; Diener et al., 1985) SWLS developed by Diener et

al. (1985) and adapted to Turkish by Köker (1991) was used.

The SWLS measures global life satisfaction and consists of 5

items (e.g., “The conditions of my life are excellent”) of which

the values are evaluated according to 7 scores (1 = strongly

disagree, 7 = strongly agree). According to the results of the

validity and reliability study of the scale, the scale has good

validity and reliability. Köker (1991) reported that an internal

consistency coefficient for the Turkish version of this scale

was .80 the test retest reliability was r = .85 and item total cor-

relations varied between .71 and .80. Higher scores of the scale

indicate higher life satisfaction (Köker, 1991).

A. R. CECEN-EROGUL

Procedure

For this study mainly permission was granted from Province

of National Education Adana, Gaziantep, Mardin and approved

by the Regional Educational Research Committee for research

ethics in schools. The schools which represent middle SES in

the sample were selected basis on Ministry of National Educa-

tion statistics. Additional permission was granted from the pub-

lic school principals. The consent form was declared and the

purpose of the study was explained to all students in the class-

room setting. It was observed that all students accepted to be

volunteer for this study. All students in the classroom com-

pleted the questionnaire, on a grade basis. The instructions were

read to all children. Children and adolescents were supervised

during administration of the questionnaire. Assistance was also

available to participants however answers were not influenced

by the examiner.

Statistical Analyses

Data from the sample were used to examine factor structure

previously identified three factors by Aslan and Alpaslan

(1999), internal consistency, test-retest reliability, convergent

and divergent validity on the sample of high school students. In

order to examine the factor structure, confirmatory factor

analysis with USLMV estimation using Mplus 5.21 (Muthen &

Muthen, 2009) was conducted. To investigate sex differences

ANOVAs were carried on the data.

Findings

Multivariate tests of normality using Mplus revealed evi-

dence of marked positive skew and kurtosis in the data, with the

majority of responses clustering around low frequencies of

childhood trauma experiences. In cases where data violate

normality, estimation methods such as maximum likelihood are

unsuitable as they rely on the normality assumption. Therefore,

the data were examined using the ULSMV estimation method,

which takes into account deviations from normality (Muthen &

Muthen, 2009). Based on Aslan & Alpasan (1999) a three fac-

tor structure (physical abuse, emotional abuse and neglect, and

sexual abuse) was hypothesized analysis applied on the com-

munity sample data. Generally, TLI, and CFI values of .90 or

above reflect good fit, and values between .80 and .90 represent

adequate-to-good fit (Hu & Bentler, 1999). An RMSEA of

about .05 reflects a close fit of the model in relation to its de-

grees of freedom, whereas values as high as .08 reflect a rea-

sonable error of approximation (Byrne, 1998).

Confirmatory factor analysis applied to 40 item questionnaire

for three factor models and 5 item (11-14-20-27-28) deleted

because of the low factor loadings (below .30). Thus, after de-

leted five items, two models were tested on 35 item. In the first

model only a three factor model and in the second model three

factor second order model were tested. Both results of models

produce the same factor loadings and value of same fit indices.

Thus, three factor second order model was accepted. By using

ULSMV, consistent with Aslan and Alpaslan (1999), with all of

the following cutoff criteria for fit indices outlined by Muthen

& Muthen (2009) in either the “good” (2 = 1270.407 ; df = 557;

p < .000) Comparative Fit Index (CFI) .925, Tucker Lewis

index (TLI) .920 or “fair” Root Mean Squared Error of Ap-

proximation (RMSEA) .04 for the current sample. The results

of confirmatory factor analyses provided support for the con-

struct validity of the CTQ subscales, consisting of three clear

content factors relating to physical abuse, emotional abuse and

social abuse.

Standardized factor loadings on the predicted three factors

are presented in Table 1. The factor loadings range for physical

Table 1.

Standardized factor loadings on the predicted four factors.

Factor loadings

Predicted Factors

1 2 3

Physical Abuse 1 .65

3 .55

5 .71

6 .66

9 .69

16 .66

18 .72

21 .70

24 .69

25 .65

30 .83

33 .62

Emotional Abuse

2 .57

4 .66

7 .77

8 .69

10 .60

12 .79

13 .70

15 .65

19 .41

22 .66

23 .48

26 .53

32 .69

35 .75

36 .58

37 .59

38 .76

40 .77

Sexual Abuse

17 .63

29 .73

31 .77

34 .77

39 .85

918

A. R. CECEN-EROGUL

abuse from .55 to .83, for emotional abuse .41 to .79, for sexual

abuse .63 to .85. All subscale factor loadings are higher

than .40. Standardized factor loadings for the higher order

model are shown in Table 2. As shown in Table 2, the stan-

dardized factor loadings of each first-order factor on the higher

order factor for the model were .89 for physical abuse, .73 for

emotional abuse, .63 for sexaul abuse. The intercorrelations

between first order factors are; for physical and emotional

abuse and neglect .65, for physical and sexual abuse .56 and for

emotional abuse and neglect and sexual abuse .45 (See Table

2). The percentage of variance in the first-order factors that

could be explained by the higher order factor ranged from 40%

for sexual abuse to 79% for physical abuse.

Internal Consistency and Test-Retest Reliability

Internal consistency was calculated using the total commu-

nity sample of 1275 children and adolescents. Cronbach’s alpha

coefficient for the total scale was .91 indicating a high degree

of homogeneity among items comprising the scale. Internal

consistency of the subscales was also high, with coefficient

alphas of .84 for physical abuse, .89 for emotional abuse, .70

for sexual abuse.

Test-retest reliability was demonstrated using a subsample of

65 adolescents who were reassessed 3 weeks after the initial

administration of the questionnaire. The test-retest correlation

coefficient for the total score was .81, for physical abuse .82,

for emotional abuse .80, and sexual abuse .75 at 3 weeks indi-

cating adequate reliability. Coefficients were high across all

subscales and the total score indicating that the scale has good

temporal stability.

Relationship with Trait-Anger Expression Styles,

Self-Esteem and Life Satisfaction Sc a l e s

The convergent and discriminant validity of the CTQ and it’s

subscales was examined using Pearson’s correlations with

self-report measures of trait anger and anger expression styles,

self esteem and life satisfaction (Table 3). The mean score on

the physical abuse was 21.18 (SD = .50; n = 450), emotional

abuse was 35.39 (SD = 9.95, n = 450), sexual abuse was 6.15

(SD = 2.36, n = 450) trait anger was 26.42 (SD = 5.88, n = 450)

while on the anger in was 17.97 (SD = 4.25, n = 450), anger out

was 17.77 (SD = 4.99, n = 450), anger control was 20.57 (SD =

4.90, n = 450), self esteem was 29.01 (SD = 5.17, n = 550), life

satisfaction was 21.0 (SD = 5.49, n = 550). All correlations

were significant in the expected direction. Theoretically it

would be expected positive correlations between physical,

emotional, sexual abuse and trait anger, anger in anger out;

negative correlations between the physical, emotional, sexual

abuse and anger control, self esteem and life satisfaction.

Gender Differences

To examine gender differences in scores on the CTQ,

ANOVAs were carried out for each subscale and the two total

scores. A Bonferroni correction was applied to avoid inflation

of the type I error rate. Means and SD for each (sub) scale are

presented in Table 4. Significant main effects for gender were

found for the emotional abuse F(1, 1275) = 13.81, p < .001;

sexual abuse, F(1, 1275) = 10.31, p < .001 except physical

abuse F (1, 1275) = 2.15, p > .05.

The means of the CTQ subscale scores indicating boys re-

ported more childhood physical, emotional and sexual abuse

Table 2.

Standardized intercorrelations between first-order factors and statistical relationships between first-order and higher order factors.

Factor 1 2 3

Standardized loading of first order

factor on higher order

% of variance explained by

higher order factor

1. PA - .89 .79

2. EA and Neg. .65 - .73 .53

4. SA .56 .45 - .63 .40

Note: PA = Physical abuse; EA and Neg. = Emotional abuse and Neglect; SA = Sexual abuse.

Table 3.

The pearson correlations results between the variables.

CTQ PA EAN SA TA AI AO AC SE LS

CTQ (total) -

Physical Abuse .77*

Emot. Abuse-Neglect .82* .46*

Sexual Abuse .44* .23* .28*

Trait Anger .41* .41* .31.* .19*

Anger In .27* .30* .18* .10* −.39*

Anger Out .23* .27* .12* .21* .54* .52*

Anger Control −23* −.18* −.20* −.20* −.34* −.12* −.43*

Self-esteem −.38* −.32* −.49* −.49* −.35* −.21* .18* .14*

Life Satisfaction −.53* −.32* −.34* −.34* −.23* −.21* −.19* .23* .40* -

Note: *p < .001.

A. R. CECEN-EROGUL

Table 4.

Gender differences on total CTQ and its subscales scores.

CTQ and Subscales Gender N X SD df F p

Girls 693 18.80 6.32 1

Boys 582 18.71 6.13 12 Physical Abuse

Total 1275 18.76 6.23 1274

.062 .804

Girls 693 32.68 11.93 1

Boys 582 34.13 11.24 12

Emotional Abuse

and Neglect

Total 1275 33.34 11.64 1274

4.948 .026*

Girls 693 5.28 2.04 1

Boys 582 5.61 2.09 12 Sexual Abuse

Total 1275 5.43 2.07 1274

8.331 .004*

Girls 693 56.76 17.10 1

Boys 582 58.47 15.92 12 CTQ (total)

Total 1275 57.54 16.59 1274

3.337 .068

Note: *p < .05.

than girls. ANOVA results shown that there were significant

effect on childhood emotional and sexual abuse according to

gender, but there was not significant effect on physical abuse

according to gender.

Discussion

The aim of this study was to investigate the psychometric

properties of the CTQ among adolescents. To investigate valid-

ity and reliability of CTQ, data was collected from 9th, 10th,

11th to 12th grade students.

The results of the confirmatory factor analysis has confirmed

that the 35-item CTQ has three factor as in Aslan and Alpaslan

(1999) study. In this study findings indicated that fit indices

were satisfactory and three-factor structure of the CTQ was

supported in the current adolescents sample. This results indi-

cated that the factor structure of the CTQ in the current sample

was very similar to the earlier study results using the CTQ

(Aslan & Alpaslan, 1999). All 35-item factor loadings were .40

and above. Furthermore, intercorrelations of the three subscales

provide evidence that physical abuse, emotional abuse and

sexual abuse have a common core but are relatively different

constructs. The sexual abuse factor had the lowest intercorrela-

tion and the lowest factor loading in this sample. This is con-

sistent with previous findings that the sexual abuse factor was,

found to display the lowest intercorelation and lowest factor

loadings (Aslan & Alpaslan, 1999).

The results of internal consistency and test-retest reliability

of the CTQ was satisfactory. Internal consistency of CTQ dis-

played a high degree of homogeneity among items comprising

the scale. Test-retest reliability with a subsample of adolescents

demonstrated good test-retest reliability similarly, the stability

of scores on individual subscales was also satisfactory at three

weeks after initial testing. This indicates that the questionnaire

is a stable measure of CTQ. The CTQ and its subscales

test-retest reliability was comparable to earlier results for this

time period (Aslan & Alpaslan, 1999; Bernstein & Fink, 1998).

The convergent and divergent validity of the CTQ was satis-

factory. As expected the self-esteem scale, satisfaction with life

scale and anger control subscale were negatively associated

with all CTQ subscales and total CTQ scores. In addition as

expected direction trait anger, anger anger in and anger out

subscales were positively associated with all CTQ subscales

and total CTQ scores. Specifically, the correlations between

physical abuse, emotional abuse and sexual abuse and total

scores and the self-esteem, satisfaction with life, anger expres-

sion styles and trait anger measures were all moderate to rela-

tively high. All these results can be evidence for criterion valid-

ity of CTQ.

Finally, sex differences in mean scores were investigated on

the current sample. The total CTQ and its subscales (physical,

emotional, sexual abuse) scores were higher among boys than

girls. Although there were no significant overall difference on

the CTQ and on the physical abuse scores between males and

females, there were significant effect of gender on emotional

and sexual abuse subscales scores.

The result has shown that no significant physical abuse dif-

ference according to the gender. This result is consistent with

some previous studies in the literature (Bulut-Ateş & Çeçen-

Eroğul, 2011; Kalkan & Karadeniz-Özbek, 2011; Kaya &

Çeçen-Eroğul, 2011; Yılmaz-Irmak, 2008) but not consistent

some studies that there is a significant difference according to

gender (Bekçi, 2006; Horton & Cruise, 2001; Karaca, 2001;

Yenibaş, 2002; Ziyalar, 1993). There were significant differ-

ences on the emotional and sexual abuse scores that the male

students have higher scores on this subscales. This results sup-

port previous research findings in our country (Aslan & Al-

paslan, 1999; Bulut-Ateş & Çeçen-Eroğul, 2011; Kalkan &

Karadeniz-Özbek, 2011; Kaya & Çeçen-Eroğul, 2011) but not

support the general abuse literature in western culture, espe-

cially the research reported that sexual abuse prevelans is

higher among girls than boys (Bernstein et al., 1994; Jacobson

& Richardson, 1987). The difference might be explained by

cultural differences, in collectivist culture as in our country,

especially families tend to more protective to girls than boys.

As a reality both gender can exposure to the abuse, but further

920

A. R. CECEN-EROGUL

research is needed to clarify these findings that why boys re-

ports more childhood trauma experiences than girls.

As a results of the study, the Turkish version of CTQ has

good validity and reliability for adolescents population. The

CTQ for adolescents can be used for investigating childhood

trauma experiences. This study has some limitations. The limi-

tation of this study is that the factor structure and psychometric

properties of the measure were not evaluated in a clinical group.

It would be useful to assess its temporal stability as well as to

further evaluate its psychometric properties using more diverse

Turkish populations including clinical samples.

In conclusion, the Turkish version of childhood trauma ques-

tionnaire can be used confidently on adolescents population to

assess childhood trauma experiences.

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