Psychometric Assessment of Adverse Childhood Experiences International Questionnaire (ACE-IQ) with Adults Engaging in Non-Suicidal Self-Injury
DOI:
https://doi.org/10.6092/2282-1619/mjcp-2601Keywords:
ACE, Adverse childhood experiences, Reliability, Self-harm, Validity.Abstract
Background: The current study aimed to investigate the psychometric properties of the Adverse Childhood Experiences – International Questionnaire (ACE-IQ) with individuals engaging in non-suicidal self-injury. Numerous studies have supported the association of adverse childhood experiences with non-suicidal self-injury. However, the majority of the measures used were limited to basic forms of abuse and neglect, indicating a need for the use of a more inclusive measure, such as the ACE-IQ. The psychometric properties of the measure though have only been briefly investigated with other populations, suggesting that a more thorough examination might be beneficial before its use.
Method: Two hundred eighty-four adult participants (77.5% females) with a mean age of 23.4 (SD=5.7) were recruited online via specific self-harm groups on social media platforms. Participants were asked to complete an online survey consisting of three self-report measures regarding early childhood experiences and engagement in non-suicidal self-injury.
Results: The findings of this study supported ACE-IQ’s reliability (Cronbach’s alpha = 0.854), convergent validity (r= 0.85, p<0.001 with the CTQ-SF), predictive validity (R2 = 0.12, p=0.001 of the SHI total score) and discriminant validity (F-value = 13.90, p<0.001). An exploration of the factor structure demonstrated a 5-factor solution (physical abuse, sexual abuse, emotional abuse, exposure to violence, family environment).
Conclusions: It was concluded that ACE-IQ is a reliable and valid measure to be used for research or clinical purposes with individuals engaging in non-suicidal self-injury, although further research is needed on its factor structure. Research and clinical implications are discussed.
References
Almuneef, M., Qayad, M., Aleissa, M., & Albuhairan, F. (2014). Adverse childhood experiences, chronic diseases, and risky health behaviors in Saudi Arabian adults: A pilot study. Child Abuse & Neglect, 38(11), 1787-1793. http://dx.doi.org/10.1016/j.chiabu.2014.06.003
Al-Shawi, A. F., & Lafta, R. K. (2015). Effect of adverse childhood experiences on physical health in adulthood: Results of a study conducted in Baghdad city. Journal of Family & Community Medicine, 22(2), 78-84. https://doi.org/10.4103/2230-8229.155374
Arens, A. M., Gaher, R. M., & Simons, J. S. (2012). Child maltreatment and deliberate self‐harm among college students: Testing mediation and moderation models for impulsivity. American Journal of Orthopsychiatry, 82(3), 328-337. https://doi.org/10.1111/j.1939-0025.2012.01165.x
Benedetto, L., Di Blasi, D., & Pacicca, P. (2013). Worry and meta-cognitive beliefs in childhood anxiety disorders. Mediterranean Journal of Clinical Psychology, 1(3). https://doi.org/10.6092/2282-1619/2013.1.932
Benedetto, L., & Ingrassia, M. (2015). What connections between Marital conflict and Parenting Quality? Evidence from parent’s gender in spillover effects. Mediterranean Journal of Clinical Psychology, 3(2). https://doi.org/10.6092/2282-1619/2015.3.1066
Bernstein, D. P., & Fink, L. (1998). Manual for the childhood trauma questionnaire. New York: The Psychological Corporation.
Bernstein, D. P., Fink, L., Handelsman, L., Foote, J., Lovejoy, M., Wenzel, K., Sapareto, E., & Ruggiero, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. The American Journal of Psychiatry, 151, 1132-1136. https://doi.org/10.1176/ajp.151.8.1132
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169-190. https://doi.org/10.1016/S0145-2134(02)00541-0
Bornovalova, M. A., Tull, M. T., Gratz, K. L., Levy, R., & Lejuez, C. W. (2011). Extending models of deliberate self-harm and suicide attempts to substance users: Exploring the roles of childhood abuse, posttraumatic stress, and difficulties controlling impulsive behavior when distressed. Psychological Trauma: Theory, Research, Practice, and Policy, 3(4), 349-359. https://doi.org/10.1037/a0021579
Bouzidi, H. (2018). The image of the family among the victims of rape in Algeria. Mediterranean Journal of Clinical Psychology, 6(1), 1-11. https://doi.org/10.6092/2282-1619/2018.6.1803
Buckmaster, R., McNulty, M., & Guerin, S. (2019). Family factors associated with self‐harm in adults: A systematic review. Journal of Family Therapy, 41(4), 537-558. https://doi.org/10.1111/1467-6427.12232
Chang, X., Jiang, X., Mkandarwire, T., & Shen, M. (2019). Associations between adverse childhood experiences and health outcomes in adults aged 18–59 years. PloS one, 14(2), e0211850. https://doi.org/10.1371/journal.pone.0211850
Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse & Neglect, 34(6), 454-464. https://doi.org/10.1016/j.chiabu.2009.09.020
Copeland, W. E., Wolke, D., Lereya, S. T., Shanahan, L., Worthman, C., & Costello, E. J. (2014). Childhood bullying involvement predicts low-grade systemic inflammation into adulthood. Proceedings of the National Academy of Sciences, 111(21), 7570-7575. https://doi.org/10.1073/pnas.1323641111
Costello, A. B., & Osborne, J. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research, and Evaluation, 10(1), 7. https://doi.org/10.7275/jyj1-4868
Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & behavior, 106(1), 29-39. https://doi.org/10.1016/j.physbeh.2011.08.019
Dorji, N., Dunne, M., & Deb, S. (2020). Adverse childhood experiences: association with physical and mental health conditions among older adults in Bhutan. Public health, 182, 173-178. https://doi.org/10.1016/j.puhe.2020.02.013
Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H., & Anda, R. F. (2003). The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Preventive medicine, 37(3), 268-277. https://doi.org/10.1016/S0091-7435(03)00123-3
Dwivedi, A. K., Mallawaarachchi, I., & Alvarado, L. A. (2017). Analysis of small sample size studies using nonparametric bootstrap test with pooled resampling method. Statistics in medicine, 36(14), 2187-2205. https://doi.org/10.1002/sim.7263
Egeland, B., & Carlson, E. A. (2004). Attachment and psychopathology. In L. Atkinson, & S. Goldberg (Eds.), Attachment issues in Psychopathology and Intervention (pp. 27-48). Lawrence Erlbaum Associates.
El Mhamdi, S., Lemieux, A., Ben Fredj, M., Bouanene, I., Ben Salah, A., Abroug, H., Salem, K.B., & al’Absi, M. (2018). Social and early life adversity and chronic health conditions among Tunisian adults. Translational Behavioral Medicine, 1-10. https://doi.org/10.1093/tbm/iby126
Esposito, C., Bacchini, D., & Affuso, G. (2019). Adolescent non-suicidal self-injury and its relationships with school bullying and peer rejection. Psychiatry Research, 274, 1-6. https://doi.org/10.1016/j.psychres.2019.02.018
Favazza, A. R. (1998). The coming of age of self-mutilation. The Journal of Nervous and Mental disease, 186(5), 259-268. https://doi.org/10.1097/00005053-199805000-00001
Field, A. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). London: Sage Publications.
Franzke, I., Wabnitz, P., & Catani, C. (2015). Dissociation as a mediator of the relationship between childhood trauma and nonsuicidal self-injury in females: A path analytic approach. Journal of Trauma & Dissociation, 16(3), 286-302. https://doi.org/10.1080/15299732.2015.989646
Gerdner, A., & Allgulander, C. (2009). Psychometric properties of the swedish version of the childhood trauma Questionnaire—Short form (CTQ-SF). Nordic Journal of Psychiatry, 63(2), 160-170. https://doi.org/10.1080/08039480802514366
Goodman, M. L., Martinez, K., Keiser, P. H., Gitari, S., & Seidel, S. E. (2017). Why do Kenyan children live on the streets? Evidence from a cross-section of semi-rural maternal caregivers. Child Abuse & Neglect, 63, 51-60. http://dx.doi.org/10.1016/j.chiabu.2016.10.018
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of psychopathology and behavioral assessment, 23(4), 253-263.
https://doi.org/10.1023/A:1012779403943
Gratz, K. L. (2003). Risk factors for and functions of deliberate self‐harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10(2), 192-205. https://doi.org/10.1093/clipsy/bpg022
Guérin-Marion, C., Martin, J., Lafontaine, M. F., & Bureau, J. F. (2019). Invalidating caregiving environments, specific emotion regulation deficits, and non-suicidal self-injury. Child Psychiatry & Human Development, 51(1), 39-47. https://doi.org/10.1007/s10578-019-00908-2
Ho, G. W., Chan, A. C., Chien, W. T., Bressington, D. T., & Karatzias, T. (2019). Examining patterns of adversity in Chinese young adults using the Adverse Childhood Experiences—International Questionnaire (ACE-IQ). Child Abuse & Neglect, 88, 179-188. https://doi.org/10.1016/j.chiabu.2018.11.009
Howard, R., Karatzias, T., Power, K., & Mahoney, A. (2017). From childhood trauma to self‐harm: An investigation of theoretical pathways among female prisoners. Clinical Psychology & Psychotherapy, 24(4), 942-951. https://doi.org/10.1002/cpp.2058
IBM Corp. (2017). IMB SPSS Statistics for Macintosh, Version 25.0. Armonk, NY: IMB Corp.
Kazeem, O. T. (2015). A validation of the adverse childhood experiences scale in Nigeria. Research on Humanities and Social Sciences, 5(11), 18-23. https://www.iiste.org/Journals/index.php/RHSS/article/view/23421
Kidman, R., Smith, D., Piccolo, L. R., & Kohler, H. P. (2019). Psychometric evaluation of the Adverse Childhood Experience International Questionnaire (ACE-IQ) in Malawian adolescents. Child Abuse & Neglect, 92, 139-145. https://doi.org/10.1016/j.chiabu.2019.03.015
Kim, D., Bae, H., Han, C., Oh, H. Y., & MacDonald, K. (2013). Psychometric properties of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in Korean patients with schizophrenia. Schizophrenia Research, 144(1-3), 93-98. http://dx.doi.org/10.1016/j.schres.2012.12.020
Kim, Y. H. (2017). Associations of adverse childhood experiences with depression and alcohol abuse among Korean college students. Child Abuse & Neglect, 67, 338-348. http://dx.doi.org/10.1016/j.chiabu.2017.03.009
Leonardi, V., Caracciolo, M., & Mallamace, D. (2013). Attachment and alexithymia: the role of emotions from the affective deprivation towards illness. Mediterranean Journal of Clinical Psychology, 1(3). https://doi.org/10.6092/2282-1619/2013.1.947
Liu, R. T., Scopelliti, K. M., Pittman, S. K., & Zamora, A. S. (2018). Childhood maltreatment and non-suicidal self-injury: A systematic review and meta-analysis. The Lancet Psychiatry, 5(1), 51-64. https://doi.org/10.1016/S2215-0366(17)30469-8
Maier, H. E., & Lachman, M. E. (2000). Consequences of early parental loss and separation for health and well-being in midlife. International Journal of Behavioral Development, 24(2), 183-189. https://doi.org/10.1080/016502500383304
Mall, S., Mortier, P., Taljaard, L., Roos, J., Stein, D. J., & Lochner, C. (2018). The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university. BMC Psychiatry, 18(1), 63. https://doi.org/10.1186/s12888-017-1583-9
Marx, C. M., Tibubos, A. N., Brähler, E., & Beutel, M. E. (2020). Experienced childhood maltreatment in a sample of pedophiles: comparisons with patients of a psychosomatic outpatient clinic and the general population. The Journal of Sexual Medicine, 17(5), 985-993. https://doi.org/10.1016/j.jsxm.2020.01.019
McLaughlin, K. A. (2016). Future directions in childhood adversity and youth psychopathology. Journal of Clinical Child & Adolescent Psychology, 45(3), 361-382. https://doi.org/10.1080/15374416.2015.1110823
Merrick, M. T., Ports, K. A., Ford, D. C., Afifi, T. O., Gershoff, E. T., & Grogan-Kaylor, A. (2017). Unpacking the impact of adverse childhood experiences on adult mental health. Child Abuse & Neglect, 69, 10-19. https://doi.org/10.1016/j.chiabu.2017.03.016
Midolo, L. R., Santoro, G., Ferrante, E., Pellegriti, P., Russo, S., Costanzo, A., & Schimmenti, A. (2020). Childhood trauma, attachment and psychopathology: A correlation network approach. Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2418
Quinn, M., Caldara, G., Collins, K., Owens, H., Ozodiegwu, I., Loudermilk, E., & Stinson, J. D. (2018). Methods for understanding childhood trauma: Modifying the adverse childhood experiences international questionnaire for cultural competency. International Journal of Public Health, 63(1), 149-151. https://doi.org/10.1007/s00038-017-1058-2
Rosenblat, J. D., Mansur, R. B., Brietzke, E., Kennedy, S. H., Carvalho, A. F., Lee, Y., Subramaniapillai, M., Muzina, D.J., Dale, R., Tamura, J.K., Lui, L. M., Park, C., Phan, L., Tuineag, R.M., & Mclntyre, R.S. (2020). Association of history of adverse childhood experiences with irritable bowel syndrome (IBS) in individuals with mood disorders. Psychiatry Research, (288), 112967. https://doi.org/10.1016/j.psychres.2020.112967
Samia, P., Premji, S., Tavangar, F., Yim, I. S., Wanyonyi, S., Merali, M., Musana, W., Omuse G., Forcheh, N., Dosani, A., Letourneau, N. & MIGHT Consortium (2020). Adverse childhood experiences and changing levels of psychosocial distress scores across pregnancy in Kenyan women. International journal of environmental research and public health, 17(10), 3401. https://doi.org/10.3390/ijerph17103401
Sansone, R. A., Wiederman, M. W., & Sansone, L. A. (1998). The self‐harm inventory (SHI): Development of a scale for identifying self‐destructive behaviors and borderline personality disorder. Journal of Clinical Psychology, 54(7), 973-983. https://doi.org/10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H
Seery, M. D., Holman, E. A., & Silver, R. C. (2010). Whatever does not kill us: cumulative lifetime adversity, vulnerability, and resilience. Journal of Personality and Social Psychology, 99(6), 1025-1041. https://doi.org/10.1037/a0021344
Serafini, G., Canepa, G., Adavastro, G., Nebbia, J., Belvederi Murri, M., Erbuto, D., Pocai, B., Fiorillo, A., Pompili, M., Flouri, E., & Amore, M. (2017). The relationship between childhood maltreatment and non-suicidal self-injury: A systematic review. Frontiers in Psychiatry, 8, 149. https://doi.org/10.3389/fpsyt.2017.00149
Soares, A. L. G., Howe, L. D., Matijasevich, A., Wehrmeister, F. C., Menezes, A. M., & Gonçalves, H. (2016). Adverse childhood experiences: Prevalence and related factors in adolescents of a Brazilian birth cohort. Child Abuse & Neglect, 51, 21-30. http://dx.doi.org/10.1016/j.chiabu.2015.11.017
Stone, A. A., Bachrach, C. A., Jobe, J. B., Kurtzman, H. S., & Cain, V. S. (Eds.). (1999). The science of self-report: Implications for research and practice. USA: Psychology Press.
Subramaniam, M., Abdin, E., Seow, E., Vaingankar, J. A., Shafie, S., Shahwan, S., Lim, M., Fung, D., James, L., Verma, S., & Chong, S. A. (2020). Prevalence, socio-demographic correlates and associations of adverse childhood experiences with mental illnesses: results from the Singapore Mental Health Study. Child Abuse & Neglect, 103, 104447. https://doi.org/10.1016/j.chiabu.2020.104447
Takizawa, R., Maughan, B., & Arseneault, L. (2014). Adult health outcomes of childhood bullying victimization: evidence from a five-decade longitudinal British birth cohort. American Journal of Psychiatry, 171(7), 777-784. https://doi.org/10.1176/appi.ajp.2014.13101401
Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2, 53-55. https://doi.org/10.5116/ijme.4dfb.8dfd
Thomas, R., Siliquini, R., Hillegers, M. H., & Jansen, P. W. (2020). The association of adverse life events with children's emotional overeating and restrained eating in a population‐based cohort. International Journal of Eating Disorders, 53(10), 1709-1718. https://doi.org/10.1002/eat.23351
Tran, Q. A., Dunne, M. P., Vo, T. V., & Luu, N. H. (2015). Adverse childhood experiences and the health of university students in eight provinces of Vietnam. Asia Pacific Journal of Public Health, 27(8_suppl), 26S-32S. https://doi.org/10.1177/1010539515589812
Trujillo, N. P., & Servaty-Seib, H. (2018). Parental Absence and Non-Suicidal Self-Injury: Social Support, Social Constraints and Sense-Making. Journal of Child and Family Studies, 27(5), 1449-1459. https://doi.org/10.1007/s10826-017-0976-1
van der Feltz-Cornelis, C. M., Potters, E. C., van Dam, A., Koorndijk, R. P., & Elfeddali, I. (2019). Adverse Childhood Experiences (ACE) in outpatients with anxiety and depressive disorders and their association with psychiatric and somatic comorbidity and revictimization. Cross-sectional observational study. Journal of Affective Disorders, 246, 458-464. https://doi.org/10.1016/j.jad.2018.12.096
World Health Organization (WHO; 2018). Adverse Childhood Experiences International Questionnaire (ACE-IQ). Geneva: WHO, 2018. Retrieved on 25th of March 2019 from: https://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/en/
Yong, A. G., & Pearce, S. (2013). A beginner’s guide to factor analysis: Focusing on exploratory factor analysis. Tutorials in Quantitative Methods for Psychology, 9(2), 79-94. https://doi.org/10.20982/tqmp.09.2.p079
Zhang, J., Tang, B. W., Liu, M. W., Yuan, S., Yu, H. J., Zhang, R., Huang, X., Nzala, S.H., Chikoya, M, Wang, P. & He, Q. Q. (2020). Association of Adverse Childhood Experiences with Health Risk Behaviors Among College Students in Zambia. International Journal of Behavioral Medicine, 27, 400-405. https://doi.org/10.1007/s12529-020-09863-y
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