Personality Assessment Screener,Childhood Abuse,and Adult Partner Violence in African American Women Using Primary Care

Abstract

This study assessed the relationship between psychopathology with the Personality Assessment Screener (PAS) and childhood physical and sexual abuse and adult physical and sexual partner violence in a primary care sample of 98 urban-dwelling African American women. Patients completed the PAS, the Childhood Trauma Questionnaire, and the Conflict Tactics Scale. The PAS total score significantly correlated with all measures of childhood and adult abuse. Stepwise regression analyses revealed that PAS element scores of Suicidal Thinking and Hostile Control significantly predicted a history of childhood physical abuse; Suicidal Thinking, Hostile Control, and Acting Out significantly predicted a history of childhood sexual abuse; Suicidal Thinking, Negative Affect, and Alienation significantly predicted current adult partner physical violence; and Psychotic Features, Alcohol Problems, and Anger Control significantly predicted current adult sexual partner violence. The PAS appears to be a useful measure for fast-paced primary care settings for identifying patients who need a more thorough assessment for abuse.

Keywords

Personality Assessment Screener childhood sexual abuse childhood physical abuse partner violence

Violent victimization of women is a serious public health problem (Sharps & Campbell, 1999) that is frequently encountered in primary care practices (Nelson, Bougatsos, & Blazina, 2012), especially among low-income women (Moracco, Runyan, Bowling, & Earp, 2007; Taft, Bryant-Davis, Woodward, Tillman, & Jones, 2000). There is a need for brief measures that can alert psychologists, physicians, and other health care providers working in urban primary care settings to emotional distress, psychopathology, and abuse in their patients. The Personality Assessment Screener (PAS; Morey, 1997) is a 22-item self-report questionnaire designed to provide rapid screening of psychological distress and psychopathology. The PAS has shown promise as a stand-alone measure for fast-paced urban primary care settings for assessing anxiety, depression, and alcohol abuse (Porcerelli, Kurtz, Cogan, Markova, & Mickens, 2012). To the best of our knowledge, there are no studies comparing the PAS with measures of child abuse and current partner violence. Therefore, this study will assess the relationship between psychopathology with PAS element (subscale) scores and childhood physical and sexual abuse and adult physical and sexual partner violence (past year) in a sample of urban-dwelling African American women using a university-based primary care clinic.

Method

Participants and Procedures

As part of a larger study of women’s health (Porcerelli, Cogan, Markova, Murdoch, & Porcerelli, 2010), 98 African American women from an urban university-based primary care clinic participated. The women had a mean age of 34.33 (SD = 9.41), 55 (56%) had a high school diploma or less, 82 (84%) had an annual household income of less than $20,000, and 81 (83%) were single, separated, divorced, or widowed. All participants were Medicaid insured or Medicaid eligible.

Patients were recruited from the waiting room of the clinic by a receptionist. Doctoral and master-level research assistants obtained written consents from all participants and administered self-report and interview measures. Only self-report data involving the PAS, abuse, and partner violence measures are reported here. An $80 honorarium was given to all participants who completed the study. The study was approved by the Wayne State University and Michigan Department of Community Health Institutional Review Boards.

Measures

Childhood Abuse

The Physical and Sexual Abuse subscales from the Childhood Trauma Questionnaire–Short Form (CTQ-SF; Bernstein et al., 2003) were included in this study. The CTQ-SF is a 28-item self-report measure that retrospectively evaluates maltreatment during childhood on a 5-point Likert-type scale (0 = never true to 4 = very often true). Adequate reliability and validity of the CTQ-SF has been reported by Bernstein, Ahluvalia, Pogge, and Handelsman (1997). Internal consistency (alpha coefficients) for this study for the Physical Abuse (five items) and Sexual Abuse (five items) subscales were .86 and .95, respectively.

Adult Partner Violence

The Physical Assault and Sexual Coercion subscales from the Conflict Tactics Scale–Second edition (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) were included in this study. The CTS2 is a 78-item self-report measure that assesses Negotiation, Psychological Aggression, Physical Assault, Sexual Coercion, and Injury, on an 8-point ordinal scale (0 = this has never happened to 6 = more than 20 times in the past year; 7 = occurred but not in the past year). The Physical Assault and Sexual Coercion subscales are composed of minor and severe abuse items. For data analysis, each participant’s score is converted to a 3-point scale (0 = no abuse, 1 = minor abuse, 2 = severe abuse). Adequate reliability and validity of the CTS2 has been reported by Straus et al. (1996). Internal consistency (alpha coefficients) for this study for the Physical Assault (12 items) and Sexual Coercion (7 items) subscales were .90 and .73, respectively.

Psychopathology

The PAS (Morey, 1997) is a 22-item self-report measure extracted from the Personality Assessment Inventory (PAI; Morey, 1991). A total score is used to calculate the probability that any of the subscales would be significantly elevated if the full PAI were administered. The PAS includes 10 subscales (referred to as element scores): Negative Affect, Acting Out, Health Problems, Psychotic Features, Social Withdrawal, Hostile Control, Suicidal Thinking, Alienation, Alcohol Problems, and Anger Control. The content of the 10 Element scores were identified empirically through factor analyses of the 344-item PAI (Morey, 1991). Each subscale is made up of two or three items and each is rated on a 4-point Likert-type scale (0 = false to 3 = very true). The total scores range from 0 to 66 with a recommended cutoff score of 19 or above as a positive indicator of psychopathology. Morey (1997) reported test–retest reliability for the element and total scores ranging from .66 to .92 in a community sample of adults. Creech, Evardone, Braswell, and Hopwood (2010) reported internal consistency reliability coefficients above .60 for 8 of 10 element scores. Although there have been several studies using the PAS (e.g., Hopwood & Morey, 2008), few studies have directly assessed its validity. Preliminary convergent and discriminant validity coefficients are reported in the manual comparing the PAS with various measures of personality and psychopathology. Changes in PAS element scores were reported by Lapidus, Shin, and Hutton (2001) in response to a 6-week program to support coping skills. Holden, Wasylkiw, Starzyk, Edwards, and Book (2001) reported significant correlations between the PAS Negative Affect and Social Withdrawal element scores and the Depression subscale of the Holden Psychological Screening Inventory (Holden, 1996) in a college student population. The PAS Negative Affect score predicted depression and suicide risk in a prison population (Harrison & Rogers, 2007). Creech et al. (2010) reported on the accuracy of various PAS element scores in military veterans who did and did not show elevations on the PAI. They noted that the three-item Negative Affect score demonstrated a high level of reliability and sensitivity in and of itself. Porcerelli et al. (2012) reported convergent validity of the PAS total and element scores with measures of depression, anxiety, Cluster B personality disorder symptoms, and alcohol use in a primary care sample of women.

Data Analysis

Pearson correlations were used for PAS element and total score correlations with measures of childhood abuse and adult partner violence. Stepwise multiple regression analyses were calculated with PAS element scores predicting types of childhood and adult abuse.

Results and Discussion

The PAS total score and two PAS element scores (Acting Out and Suicidal Thinking) significantly correlated with all four measures of childhood abuse and adult partner violence. However, PAS total score elevations can occur for a variety of reasons. Thus, stepwise regression analyses were performed to address shared variance between the element scores and to determine which element scores were most associated with types of violence in our female primary care patients (Table 1). Stepwise multiple regression analyses were performed to identify the PAS element scores that best predicted each type of abuse (Table 2). Suicidal Thinking and Hostile Control element scores significantly predicted a history of childhood physical abuse (p < .001), and together they explained 17% of the variance. Suicidal Thinking, Hostile Control, and Acting Out significantly predicted a history of childhood sexual abuse (p < .001), and together they explained 19% of the variance. Psychotic Features, Alcohol Problems, and Anger Control significantly predicted current adult physical partner violence (p < .001), and together they explained 29% of the variance. And last, Suicidal Thinking, Negative Affect, and Alienation, significantly predicted adult sexual partner violence (p < .001), and together they explained 24% of the variance.

Table 1.

Correlations Between Personality Assessment Screener Element and Total Scores and Childhood and Adult Abuse (N = 98).

	Childhood Abuse		Adult Partner Violence
	Physical	Sexual	Physical	Sexual
Negative Affect	.15	.11	.30**	.36***
Acting Out	.28**	.33***	.22*	.29**
Health Problems	.02	.00	−.04	.05
Psychotic Features	.14	.08	.42***	.37***
Social Withdrawal	−.02	−.06	.07	.04
Hostile Control	.24*	.27**	.15	.20*
Suicidal Thinking	.36***	.33***	.29**	.39***
Alienation	.21*	.15	.18	.02
Alcohol Problems	.06	.13	.27**	.18
Anger Control	.16	.25	.31**	.31**
Total PAS	.29**	.28**	.39***	.41***

Note. PAS = Personality Assessment Screener.

p ≤ .05. **p ≤ .01. ***p ≤ .001.

Table 2.

Stepwise Multiple Regression Analyses Showing Predictions of Childhood Abuse and Adult Partner Violence by Personality Assessment Screener Element Scores.

Dependent Variables	Predictors	R ²	ΔR²	β
Childhood Abuse (Physical)	Suicidal Thinking			.33***
	Hostile Control			.19*
	Model Total	.17	.15
Childhood Abuse (Sexual)	Suicidal Thinking			.21*
	Hostile Control			.21*
	Acting Out			.21*
	Model Total	.19	.17
Adult Partner Violence (Physical)	Psychotic Features			.40***
	Alcohol Problems			.23**
	Anger Control			.19*
	Model Total	.29	.26
Adult Partner Violence (Sexual)	Suicidal Thinking			.35***
	Negative Affect			.30**
	Alienation			.20*
	Model Total	.24	.22

p < .05. **p < .01. ***p < .001.

Suicidal Thinking and Hostile Control element scores of the PAS were associated with both physical and sexual childhood abuse histories. Longitudinal studies have documented a link between childhood sexual (e.g., Fergusson, McLeod, & Horwood, 2013) and physical (Dunn, McLaughlin, Slopen, Rosand, & Smaller, 2013) abuse and suicidal ideation. The Acting Out element score, indicative of impulsivity, sensation seeking, drug use, or a combination of these behaviors (Morey, 1991), also contributed to the prediction of childhood sexual abuse.

Adult physical and sexual partner violence had different PAS predictors. The Psychotic Features score, in a nonpsychotic sample of urban women, suggests that elevated scores may suggest that the patient is a recent victim of actual persecution (i.e., physical partner violence) versus persecutory thinking seen in various paranoid conditions. For sexual partner violence, Suicidal Thinking combined with Negative Affect and Alienation scores to predict sexual partner violence. This combination of scores suggests that women who are sexually victimized by their intimate partner not only feel anxious, depressed, and potentially suicidal, they may also feel unable to discuss this type of abuse with others.

Given the length of the instrument and its ease of scoring, the PAS appears to be a useful measure for fast-paced primary care settings for identifying aspects of psychopathology and for identifying patients who need a more thorough assessment for abuse.

Strengths of this study include multiple measures of abuse. Being aware of a history of physical or sexual abuse in either childhood or adulthood help health care providers understand the nature of their patients’ complaints, injuries (Tjaden & Thoennes, 2000), and physical illnesses (Porcerelli et al., 2003). Screening instruments that help identify victims of partner violence assist health care professionals in providing safety interventions for mothers and their children. There are two limitations of the study. The sample included only African American women limiting its generalizability. The study may also lack some degree of ecological validity in which responses were given as part of a research project and not during an actual clinical encounter with their health care providers.

In conclusion, these findings suggest that additional studies with the PAS are warranted in health care clinics serving low-income urban women.

Footnotes

Authors’ Note

The article was presented as a poster at the Annual Convention of the Society for Personality Assessment, New York, NY, March 7, 2015.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported in part through federal matching funds from the Michigan Department of Community Health and Wayne State University Department of Family Medicine and Public Health Sciences (MDCH 224-23M2Q).

References

Bernstein

D. P.

Ahluvalia

Pogge

Handelsman

(1997). Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 340-348.

Bernstein

D. P.

Stein

J. A.

Newcomb

M. D.

Walker

Pogge

Ahluvalia

. . .Zule

(2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27, 169-190.

Creech

S. K.

Evardone

Braswell

Hopwood

C. J.

(2010). Validity of the personality assessment screener in veterans referred for psychological testing. Military Psychology, 22, 465-473.

Dunn

E. C.

McLaughlin

K. A.

Slopen

Rosand

Smaller

J. W.

(2013). Developmental timing of child maltreatment and symptoms of depression and suicidal ideation in young adults: Results from the National Longitudinal Study on Adolescent Health. Depression and Anxiety, 30, 955-964.

Fergusson

D. M.

McLeod

G. F. H.

Horwood

L. J.

(2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect, 37, 664-674.

Harrison

K. S.

Rogers

(2007). Axis I screens and suicide risk in jails: A comparative analysis. Assessment, 14, 171-180.

Holden

R. R.

(1996). Holden Psychological Screening Inventory Manual. North Tonawanda, NY: Multi-Health Systems.

Holden

R. R.

Wasylkiw

Starzyk

K. B.

Edwards

M. J.

Book

A. S.

(2001). Associations between the Holden Psychological Screening Inventory and the Personality Assessment Screener in a nonclinical sample. Psychological Reports, 88, 1005-1011.

Hopwood

C. J.

Morey

L. C.

(2008). Emotional problems suppress the relation between continuous performance and adult ADHD. Journal of Psychopathology and Behavioral Assessment, 30, 204-210.

10.

Lapidus

L. B.

Shin

S. K.

Hutton

E. M.

(2001). An evaluation of a six-week intervention designed to facilitate coping with psychological stress. Journal of Clinical Psychology, 57, 1381-1401.

11.

Moracco

K. E.

Runyan

C. W.

Bowling

J. M.

Earp

J. A. L.

(2007). Women’s experiences with violence: A national study. Women’s Health Issues, 17, 3-12.

12.

Morey

L. C.

(1991). Personality assessment inventory professional manual. Odessa, FL: Psychological Assessment Resources.

13.

Morey

L. C.

(1997). Personality Assessment Screener professional manual. Lutz, FL: Psychological Assessment Resources.

14.

Nelson

H. D.

Bougatsos

Blazina

(2012). Screening women for intimate partner violence and elderly and vulnerable adults for abuse. Rockville, MD: U.S. Preventive Services Task Force.

15.

Porcerelli

J. H.

Cogan

Markova

Murdoch

Porcerelli

(2010). Abuse, outpatient charges and utilization, and psychiatric symptoms in urban women on Medicaid. Journal of the American Board of Family Medicine, 23, 363-370.

16.

Porcerelli

J. H.

Cogan

West

P. P.

Rose

E. A.

Lambrecht

Wilson

K. E.

. . .Karana

(2003). Violent victimization of women and men: Physical and psychiatric symptoms. Journal of the American Board of Family Practice, 16, 32-39.

17.

Porcerelli

J. H.

Kurtz

J. E.

Cogan

Markova

Mickens

(2012). Personality Assessment Screener in a primary care sample of low-income urban women. Journal of Personality Assessment, 94, 262-266. doi:10.1080/00223891.2011.650304

18.

Sharps

Campbell

(1999). Health consequences for victims of violence in intimate relationships. In Arriaga

Oskamp

(Eds.), Violence in intimate partner relationships (pp. 163-180). Thousand Oaks, CA: Sage.

19.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283-316.

20.

Taft

C. T.

Bryant-Davis

Woodward

H. E.

Tillman

Jones

S. E.

(2000). Intimate partner violence against African American women: An examination of the sociocultural context. Aggression and Violent Behavior, 14, 50-58.

21.

Tjaden

Thoennes

(2000). Prevalence and consequesces of male-to-female and female-to-male intimate partner violence as measured by the National Violence Against Women Survey. Violence Against Women, 6, 142-161 .