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All participants were referred to the researcher as a result of printed and/or verbal publicity on the research project disseminated by word-of-mouth or through the internet media. The following criteria for childhood sexual abuse were listed on the recruitment pamphlet (See Appendix A): (a) the abused victim was under the age of 16 at the time of the first incident, (b) the victim had experienced non-contact and/or contact sexual abuse, (c) the abuser was at least 5 years older than the victim at the time of the abuse, and (d) the victim is 16 years old or more at the time of this study.

On the basis of the above subject recruitment criteria, 28 female and 17 male survivors, aged 16 and older, were referred over a period of close to eight months, from 13 March to 1 November 2006. Eventually, a total of 22 subjects were selected (10 females and 12 males).

All 22 participants voluntarily took part in this study and received no remuneration for their participation. The demographic characteristics of these participants are discussed in Chapter 3.

As this is a mixed method approach (see Procedure below), several participants’ voices will speak from this study, as they disclosed their stories and expressed their traumas, each one contributing to an overall picture of survivorship of their past childhood sexual abuse. All the participants are identified by pseudonyms. A summary of their stories are found in Appendix B.

Instrumentation

Apart from the qualitative research aspect of this mixed method study, the quantitative research instruments administered to each participant were the following:

1. A Background Data Questionnaire,
2. The situational COPE Instrument, and
3. The Symptom Checklist-90-Revised.

The Background Data Questionnaire

This self-administered Background Data Questionnaire was used to obtain the initial demographic and background information about each participant. It included questions on sensitive sexual abuse histories and related issues that were placed towards the end of the Questionnaire (See Appendix C).

The initial 12 questions included the participants’ name, birth date, ethnicity, marital and family status, highest educational level achieved, occupational details, number of years they were married, and number of children. Religious affiliation, number of times they attended religious services each month, religiosity, were handled by questions 13 to 15.

Questions 16 to 24 dealt with the participants up till the age of 16 years old. Questions in this section included, whom the participants lived with, and if they did not live with their family during that period of time, with whom did they stay, the reason(s) they were not staying with their parents, the quality of their relationship with their principal caregiver(s), the kind of relationship their parents had, how close or distant was their family unit, with whom were they emotionally closest to, the kind of home they lived in, who made up the family unit, and the family status in terms of broad class structure.

The remaining eighteen questions (Questions 25 to 42) referred the participants back to their sexual abuse history. These questions were extracted from the “Pink Sheet – Child Sexual Abuse” segment of the Wyatt Sexual History Questionnaire (Wyatt, 1984).

Questions in this final segment included the first time they became aware of sexual matters, their initial sexual experience, its nature and frequency, perpetrator details, and the different types of abuses investigated.

The COPE Instrument

Descriptive Profile

The COPE instrument is a 60-item multidimensional situational coping style inventory (Carver, Scheier, & Weintraub, 1989) to identify the different ways in which people respond to stress. Each item, representing a single coping strategy, is rated on a 4-point Likert-type scale that ranges from “I usually don’t do this at all” (1) to “I usually do this a lot” (4), regarding the frequency with which respondents practice that coping technique.

The original measure yielded fourteen factors or scales (Carver and Scheier, 1994), viz.,

• active coping
• planning
• restraint coping
• suppression of competing activities
• seeking social support for instrumental reasons
• seeking social support for emotional reasons
• acceptance
• positive reinterpretation and growth
• turning to religion
• behavioural disengagement
• mental disengagement
• alcohol-drug disengagement
• using humour
• denial

Given the focused nature of this research paper, it was decided to combine some of the above-mentioned fourteen scales, thereby reducing the COPE variables to eight. The combinations were derived on the conceptual basis of how each item related to the other, and loadings that come from a single factor that incorporate both scales into a single scale, as concluded by Carver et al. (1989).

The final eight dimensions are as follows:

• active coping (the process of taking active steps to try to remove or circumvent the stressor or to ameliorate its effects)
• restraint coping (trying to avoid becoming distracted by other events and waiting until an appropriate opportunity to act presents itself)
• seeking social support (seeking advice, assistance, or information , and getting moral support, sympathy, or understanding from others)
• reframing and acceptance (positively appraising and accepting the reality of a stressful situation in order to attempt to deal with it)
• turning to religion (the tendency to turn to religion in times of stress)
• disengagement (reducing one’s effort behaviourally and mentally to deal with the stressor)
• alcohol-drug disengagement (turning to the use of alcohol and other drugs as a way of disengaging from the stressor)
• using humour (making jokes about the stressor)

Denial was removed as a scale in a later study by Carver and Scheier (1994), due to its low reliability.

In this paper, the COPE instrument had been used in 2 formats. The COPE Work-Related instrument is a time-limited version in which respondents indicated the degree to which they actually did have each response during a particular period in the past when they experienced a stressful work-related situation (See Appendix D).

The COPE Child Sexual Abuse (CSA) instrument is also a time-limited version in which participants indicated how they were coping with their CSA situation up to the present (See Appendix E). The formats differ in their verb forms: the situational-past format relating to work stress (COPE Work-Related instrument) is past tense, while the second format (COPE CSA instrument) is present tense progressive (I am ...) or present perfect (I have been ...).

Reliability

Cronbach’s Alpha reliability was computed for each of the eight scales for the 22 participants on both COPE instruments, and the results are displayed in Table 1. The internal consistency of this instrument comes from Cronbach’s Alpha reliability coefficients, which generally are acceptably high, with all the scales on the COPE Work-Related and COPE CSA instruments registering above .75, with several scales above .80.

The disengagement scale on the COPE CSA instrument has the lowest coefficient, but respectable reliability of .68.

Test-retest reliabilities ranging from .46 to .89 on two groups of 89 and 116 students, indicated that self-reports of coping tendencies that are measured by the COPE are relatively stable (Carver et al., 1989).

The situational COPE scales do correlate in conceptually meaningful ways. One cluster that is made up of adaptive strategies, like active coping and planning, were associated with suppression of competing activities, restraint coping, positive reinterpretation and growth, and the seeking out of social support.

These were all correlated, to a lesser degree, with acceptance. A second cluster of more questionable coping mechanisms, like behavioural disengagement, mental disengagement, and alcohol and drug use were all moderately inter-correlated (Carver et al., 1989).

Not surprisingly, this latter group of coping strategies tended to be inversely correlated with the theoretically more functional strategies.

Validity

COPE has been found to exhibit strong evidence of both convergent and discriminant validity, with constructs such as hardiness, optimism, control, and self-esteem, and had good psychometric properties with alphas ranging from .45 to .92 (Carver et al., 1989).

The Symptom Checklist-90-Revised (SCL-90-R)

Descriptive Profile

The SCL-90-R (Derogatis, 1994) is a self-administered general measure of psychopathological symptoms as experienced over a one-week interval, appropriate for both adolescents and adults. The item readability equates to a Singaporean Secondary One level reading ability, that is, no younger than 13 years old.

It can be administered online, by paper and pencil, or by means of an audio-taped presentation, taking between twelve to fifteen minutes to complete.

The test manual provides normative data for four groups: non-patient adults, non-patient adolescents, psychiatric outpatients, and psychiatric patients. The measure consists of 90 items in total, each a description of a symptom that a participant rates in terms of their severity on a 5-point scale (ranging from 0 = Not at all, to 4 = Extremely), with 83 items representing nine sub-scales:

• somatization
• obsessive-compulsive
• interpersonal sensitivity
• depression
• anxiety
• hostility
• phobic anxiety
• paranoid ideation
• psychoticism

In addition to these nine symptoms’ scales, it also contains seven items which relate to appetite and sleep disturbances (Derogatis, 1994). The SCL-90-R utilizes three global distress indices:

• the Global Severity Index
• the Positive Symptom Distress Index
• the Positive Symptom Total

A high score on the Global Severity Index (GSI), which is the mean value of all the items, is the best single indicator of the current level or depth of psychological distress (Groth-Marnat, 2003). In the present study, the GSI served as the primary measure of the participant’s overall psychological status.

Reliability

The reliability of the SCL-90-R has consistently been good. Internal consistency coefficients for the nine symptom dimensions were quite satisfactory. Based on 103 psychiatric patients and 209 ‘symptomatic volunteers’, they ranged from .79 for paranoid ideation to .90 for depression (Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988), and from .77 for psychoticism to .90 for depression (Derogatis, Rickels, & Rock, 1976), respectively.

The test-retest reliability in the Horowitz et al. (1988) sample yielded coefficients that had been shown to be adequate, ranged from .68 for somatization to .83 for paranoid ideation, even though the elapsed time between assessments was ten weeks, while the coefficients reported by Derogatis at al. (1976), all were between the range of .80 and .90, with reassessment from the initial evaluation one week later of the 94 heterogeneous psychiatric outpatients prior to their first therapy session.

Cronbach’s Alpha reliability was computed for each of the SCL-90-R’s dimension for the 22 participants in this study, and the results are displayed in Table 2, with reliability ranging from .71 for phobic anxiety to .91 for depression.

Validity

The SCL-90-R demonstrated acceptable levels of invariance for all nine symptom dimensions across the gender parameter, with respectable levels of agreement (.60 to .85) between males’ and females’ structural definitions on eight of the nine scales, and a moderate level of agreement (.51) on the paranoid ideation scale (Derogatis, 1994).

Research assessing the sensitivity and specificity for various disorders has been generally supportive. The SCL-90-R detected relevant bulimic symptoms with a sensitivity of 72% and specificity of 91%, and psychological difficulties related to diabetes with 72% sensitivity and 87% specificity (Pevelar & Fairburn, 1990).

Furthermore, Starcevic, Bogojevic, & Marinkovic (2000) established a high sensitivity of 89% and specificity of 97% on the hostility, paranoid ideation, somatization, and obsessive-compulsive scales in their detection of Clusters A and B Personality Disorders.

Derogatis et al. (1976) compared scores from the SCL-90-R with scores from the Minnesota Multiphasic Personality Inventory (MMPI,) and derived highly acceptable levels of convergent-discriminant validity on all the former dimensions, except for the obsessive-compulsive scale, which has no directly comparable scale on the MMPI.

Schmitz, Kruse, Heckrath, Alberti, & Tress (1999) found that the SCL-90-R’s anxiety and depression subscales showed acceptable concurrent validity for the diagnostic groups and it appears to be a useful tool for identifying mental disorders in primary care practice and for research.

The SCL90-R was chosen as a measure of symptomatic distress resulting from childhood sexual abuse by several researchers to profile abused survivors. Williamson, Borduin, and Howe (1991) used the SCL-90-R to measure the degree of clinical distress among a group of physically and sexually abused adolescents.

Swett, Surrey, and Cohen (1990) studied 125 adult psychiatric outpatients with histories of physical and sexual abuse. Both studies concluded that survivors’ SCL-90-R profiles were significantly higher than those without such histories. Bryer, Nelson, Miller, and Krol (1987) studied the childhood abuse histories of 66 female psychiatric inpatients and linked their scores to the SCL-90-R, and through discriminant function analysis, they were able to correctly assign 72% of the patients on the basis of the SCL-90-R.

Relevant material of my postgraduate thesis will be summarized in this blog over the coming weeks. Appendices, statistical tables, and bibliographical details are excluded.

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Coram Deo — before the face of God. This blog reflects on Scripture, world events, science, music, psychology, and the human mind — always through the lens of Christian faith. All of life is lived before the face of God.