4. Method

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          Sample of Studies


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          Coding the Studies


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          Psychological Correlates of CSA


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          Statistical Analysis


Sample of Studies

Studies were obtained by conducting computerized database searches of

  • PsycLIT from 1974 to 1995,
  • Sociofile from 1974 to 1995,
  • PsycInfo from 1967 to 1995,
  • Dissertation Abstracts International up to 1995, and
  • ERIC from 1966 to 1995.
  • Key terms entered for these databases were

  • adjustment or effect or effects,
  • college or undergraduate or undergraduates, and
  • sex abuse or sexual abuse or child and adult and sexual.
  • Studies that we already knew were also included. Reference lists of all obtained studies were read to locate additional studies.

    To be included, studies must either have used samples exclusively of college students, or, if noncollege subjects were also included, then results of measures of college students had to be reported separately.

    For inclusion in analyses of psychological correlates of CSA, studies had to

  • (a) include a control group that contained no students with CSA experiences;
  • (b) use a distinct CSA group, rather than a general "abused" group that could include participants without a history of CSA;
  • (c) report on at least one of the 18 symptoms described below; and
  • (d) provide sufficient data to compute one or more effect sizes.
  • Studies not including reports of psychological correlates were included if they contained data on reactions to CSA, either retrospectively recalled or current reflections; these data had to be classifiable into mutually exclusive negative, neutral, or positive categories. Studies were also included if they contained data on self-reported effects of CSA.

    As in other meta-analyses (e.g., Jumper, 1995 ; Oliver & Hyde, 1993 ), a single study could report data for more than one sample.

    Fromuth and Burkhart (1989) examined two male student samples - one from the Midwest and another from the Southeast-and reported separate statistics for these two samples. These samples were thus treated as distinct.

    Further, male and female samples within a single study were treated as distinct when results were reported separately for them (cf. Rind & Tromovitch, 1997 ); this was done to examine gender differences.

    Many studies reported more than one result, using different measures, for the same psychological correlate

    (e.g., a depression result from the Beck Depression Inventory and another from the Symptom Checklist).

    In these cases, effect sizes ( r s) were computed for each result and were then averaged using Fisher Z transformations to obtain a single mean effect size. This practice has been used in other meta-analyses (e.g., Erel & Burman, 1995 ) and has been recommended by Rosenthal (1984) .

    The mean effect size thus computed for a given sample for a particular psychological correlate constituted a "symptom-level" effect size.

    Finally, numerous studies reported results for more than one type of psychological correlate from a single sample (e.g., anxiety and depression). As in other meta-analyses (e.g., Neumann et al., 1996 ), we treated multiple different correlates in two ways.

    First, we computed for each sample with multiple different psychological correlates a "sample-level" effect size by averaging the symptom-level effect sizes from that sample using Fisher Z transformations. We later conducted a meta-analysis on these sample-level effect sizes.

    Second, we analyzed different psychological correlates (i.e., symptoms) separately in a series of symptom-level meta-analyses.

    Applying the above criteria produced 59 usable studies (see the Appendix ), consisting of

  • 36 published studies,
  • 21 unpublished dissertations, and
  • 2 unpublished master's theses.
  • These studies yielded

  • 70 independent samples for estimating prevalence rates,
  • 54 independent samples for computing 54 sample-level and 214 symptom-level effect sizes,
  • 21 independent samples that provided retrospectively recalled reaction data,
  • 10 independent samples that provided data on current reflections, and
  • 11 independent samples that provided data on self-reported effects.
  • Prevalence rates were based on 35,703 participants (13,704 men and 21,999 women).

    Effect size data for psychological correlates were based on 15,824 participants

  • (3,254 men from 18 samples and
  • 12,570 women from 40 samples)
  • - actual numbers of participants are somewhat higher than these because one study, not included in the above totals ( Haugaard & Emery, 1989 ), failed to provide exact sample sizes for men and women.

    Reaction and self-reported effects data were based on 3,136 participants

  • (783 men from 13 samples and
  • 2,353 women from 14 samples)
  • -actual numbers of participants are somewhat higher because one study, not included in the above totals ( Schultz & Jones, 1983 ), failed to report exact sample sizes for men and women.

    Coding the Studies

    For each study, the following information was coded:

  • (a) all statistics, if provided, on psychological correlates of CSA, including means, standard deviations, t tests, F ratios, correlations, chi squares, degrees of freedom, and sample sizes;
  • (b) types of psychological correlates reported;
  • (c) all statistics regarding relations between moderator variables (e.g., force, penetration, frequency of CSA) and psychological correlates;
  • (d) sex of participants;
  • (e) definition of CSA, including ages that defined a "child" and an older person, whether peer experiences were included, whether CSA experiences were limited to contact sex or also included noncontact sexual experiences, and whether CSA experiences were limited to unwanted sex or also included willing sexual experiences;
  • (f) all reaction data, if provided, including both retrospectively recalled reactions to and current reflections on the CSA experiences;
  • (g) all self-reported effects data, if provided, including responses to how these experiences affected participants overall and how they affected their sex lives;
  • (h) types of family environment measures used; and
  • (i) all statistics on family environment measures, including their

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    relations with CSA and with psychological correlates.

  • Together, the three basic sets of statistics

    (differences between CSA and control participants in adjustment, differences between CSA and control participants in family environment, and the relationship between family environment and adjustment)
    were used to address the question of whether significant relationships between CSA and adjustment were spurious, attributable to the confounding variable of family environment.

    Finally, the results of all analyses using statistical control were coded

    (e.g., examining the relationship between CSA and adjustment, holding family environment factors constant).
    These data were used to directly examine whether any significant relations between CSA and psychological adjustment were spurious.

    Psychological Correlates of CSA

    Coding of the studies resulted in 18 categories of psychological correlates of CSA; several additional correlates were infrequently reported and were therefore not considered in the meta-analyses. These 18 correlates, along with the measures used to assess them in the various studies, were as follows:

      1. Alcohol problems
      - based on the Michigan Alcoholism Screening Test (MAST; Brady, Foulks, Childress, & Pertschuk, 1982 ), the alcohol subscale of the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1982 ), and investigator-authored items.

      2. Anxiety
      - based on the Anxiety subscale of the Symptom Checklist (SCL-90-R; Derogatis, Lipman, & Covi, 1973 ), the Hopkins Symptom Checklist (HSCL; Derogatis, Lipman, Rickels, Ulenhuth, & Covi, 1974 ), the Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982 ), the Trauma Symptom Checklist (TSC-33 and TSC-40; Briere & Runtz, 1989 ), the MMPI form R ( Hathaway & McKinley, 1967 ), the MCMI, the Institute of Personality and Ability Testing Anxiety Scale Questionnaire (IPAT; Krug, Scheier, & Cattell, 1976 ), the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970 ), and investigator-authored items.

      3. Depression
      - based on the Depression subscales of the SCL-90-R, the HSCL, the BSI, the TSC-33 and 40, the MMPI form R, the Hugo Short Form of the MMPI (HSF; Hugo, 1971 ), and the MCMI; depression-related items from the Clinical Analysis Questionnaire (CAQ; Cattell, 1973 ); the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961 ); and investigator-authored items.

      4. Dissociation
      - based on the Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986 ), Briere's Dissociation Scale ( Briere & Runtz, 1988b ), and the dissociation subscale from the TSC-33 and 40. This symptom indicates experiences such as depersonalization, memory loss, and not feeling like oneself.

      5. Eating disorders
      - based on the Bulimia Test (BULIT; Smith & Thelen, 1984 ), the Bulimia Diagnostic Instrument ( Nevo, 1985 ), the Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982 ), the Eating Disorder Inventory (EDI; Garner, Olmsted, & Polivy, 1983 ), and investigator-authored items.

      6. Hostility
      - based on the Hostility subscale of the SCL-90-R and the BSI. This symptom reflects thoughts, feelings, or actions that are characteristic of anger.

      7. Interpersonal sensitivity
      - based on the Interpersonal Sensitivity subscale of the SCL-90-R, HSCL, and BSI. This symptom reflects feelings of uneasiness and marked discomfort when interacting with others, as well as feelings of personal inadequacy and inferiority, especially compared with others.

      8. Locus of control
      - based on the Locus of Control (LOC) scales by Nowicki and Duke (1974) , Coleman et al. (1966) , and Rotter (1966) . This scale measures the extent to which one feels in control of one's life.

      9. Obsessive-compulsive symptomatology
      - based on the Obsessive-Compulsive subscales of the SCL-90-R, HSCL, and BSI. This symptom is concerned with unremitting and irresistible thoughts, impulses, and actions that are ego alien or unwanted.

      10. Paranoia
      - based on the Paranoia subscales of the SCL-90-R, HSCL, BSI, MCMI, MMPI form R, HSF, and CAQ. This symptom reflects a disordered mode of thinking, consisting of thoughts involving, for example, projection, hostility, suspiciousness, grandiosity, and delusions.

      11. Phobia
      - based on the Phobic Anxiety subscales of the SCL-90-R and BSI. This symptom reflects a persistent fear response of an irrational and disproportionate nature to a specific person, place, object, or situation.

      12. Psychotic symptoms
      - based on the Psychoticism subscales of the BSI, SCL-90-R, MCMI, MMPI (form R and HSF, Sc scale), CAQ, and Tennessee Self-Concept Scale (TSCS; Fitts, 1964 ). For these measures, high scores indicate attributes such as mental confusion and delusions (i.e., first-rank symptoms of schizophrenia such as hallucinations and thought-broadcasting).

      13. Self-esteem
      - based on the TSCS, Rosenberg Self-Esteem Scale ( Rosenberg, 1965 ), Self-Ideal Discrepancy subscale of the Family Perception Grid ( Kelly, 1955 ), the Self subscales of the McPearl Belief Scale ( McCann & Pearlman, 1990 ), subscales from the Erwin Identity Scale ( Erwin & Delworth, 1980 ), and the Coopersmith Self-Esteem Inventory ( Coopersmith, 1967 ).

      14. Sexual adjustment
      - based on Finkelhor's Sexual Self-Esteem Scale ( Finkelhor, 1981 ), Reed's (1988) Romantic and Sexual Self-Esteem Survey, the Derogatis Sexual Functioning Inventory (DSFI; Derogatis & Melisaratos, 1979 ), the Psychosexual Functioning Questionnaire ( Schover, Friedman, Weiler, Heinman, & LoPiccolo, 1982 ), the Sexual Arousability Inventory ( Hoon, Hoon, & Wincze, 1976 ), subscales from the TSC-33 and 40 and the Erwin Identity Scale, and investigator-authored items.

      15. Social adjustment
      - based on the Social Support Questionnaire ( Sarason, Levine, Basham, & Sarason, 1983 ); the Interpersonal Relationship Scale ( Schlein, Guerney, & Stover, 1971 ); the Inventory of Interpersonal Problems ( Horowitz, Rosenberg, Baer, & Ureno, 1988 ); the Texas Social and Behavioral Inventory ( Helmreich & Stapp, 1974 ); the Social Adjustment Scale (SAS; Weissman & Bothwell, 1976 ); Rathus' Assertiveness Schedule ( Rathus, 1973 ); Rotter's Interpersonal Trust Scale ( Rotter, 1967 ); the Intimacy Attitude Scale ( Treadwell, 1981 ); the Intimacy Behavior Scale ( Treadwell, 1981 ); subscales from the TSCS, McPearl Belief Scale, the College Self-Expression Scale ( Galassi, DeLo, Galassi, & Bastien, 1974 ), the Student Development Task and Lifestyle Inventory ( Winston, Miller, & Prince, 1987 ), and the Miller Social Intimacy Scale (MSIS; Miller & Lefcourt, 1982 ); and investigator-authored items.

      16. Somatization
      - based on MacMillan's Health Opinion Survey ( MacMillan, 1957 ); subscales from the HSCL, TSC-33 and 40, BSI, SCL-90-R, MCMI, MMPI form R, HSF, and CAQ; and investigator-authored questions. This symptom reflects bodily related distress such as headaches and pain; it also includes gastrointestinal, respiratory, and cardiovascular complaints and complaints of sleeping problems.

      17. Suicidal ideation and behavior
      - based on the Reasons for Living Inventory ( Linehan, Goodstein, Nielsen, & Chiles, 1983 ), the Suicide Behaviors Questionnaire ( Linehan & Nielsen, 1981 ), and investigator-authored items.

      18. Wide adjustment
      - based on the General Well-Being Schedule ( McDowell & Newell, 1987 ); total or global scores from the HSCL, TSC-33 and 40, SCL-90-R, and BSI; subscales of the Comrey Personality Scales ( Comrey, 1970 ) and the TSCS; investigator-created variables derived from combining scales of standard measures; and investigator-authored items. This factor is a general measure of psychological adjustment or symptomatology and, when derived by combining items or measures, is analogous to Jumper's (1995) "psychological symptomatology" and Neumann et al.'s (1996) "general symptomatology."

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    Statistical Analyses

    The effect size used in this review was r , the Pearson correlation coefficient.

  • For CSA-psychological adjustment relations, positive r s indicated poorer adjustment for CSA participants compared to control participants.
  • For CSA-family environment relations, positive r s indicated poorer family functioning for CSA subjects.
  • For family environment-adjustment relations, positive r s indicated that poorer family functioning was associated with poorer adjustment.

    Pearson r s were also computed to assess the magnitude of the relation between various moderating variables (e.g., force) and outcome measures (i.e., psychological adjustment and self-reported reactions). Positive r s indicated that higher levels of moderators were associated with higher levels of symptoms or more negative reactions to the CSA.

    Finally, Pearson r s were computed to assess the size of the differences in reactions and self-reported effects between men and women who had CSA experiences. In this case, positive r s indicated that men reported fewer negative reactions or effects than women, or conversely, that they reported more positive reactions or effects than women.

    Formulas for calculating r were taken from Rosenthal (1984, 1995) .

    A number of studies reported results separately for different types of CSA participants

    (e.g., Collings, 1995 ; Roland, Zelhart, & Dubes, 1989 ; Sedney & Brooks, 1984 ).
    To make the effect sizes in these cases comparable to those in the majority of studies that compared participants with all types of CSA experiences with controls, we combined all CSA subgroups in a given study into a single CSA group and then compared this group with its control group (cf. Neumann et al., 1996 ). [*2]

    [*2] Combination of CSA subgroups was achieved by computing a weighted mean, and by computing the "true" variance of all CSA participants.
    The "true" variance is the value that would have resulted from computing the variance of the scores of all CSA participants irrespective of their subgrouping.

    This value was obtained by

  • (a) adding the sum of the squares of the CSA subgroups to get the within sum of squares for these subgroups,
  • (b) calculating the between-means sum of squares for the CSA subgroups,
  • (c) adding the within and between sum of squares to get the sum of squares total for the subgroups, and
  • (d) dividing the sum of squares total by the number of CSA scores minus 1.
  • Using the derived mean and variance, the CSA group was then compared with the control group.

    This procedure produced results that were comparable to those of most other studies that used one overall CSA group and was thus chosen over contrasting the means of the CSA subgroups with the control mean.

    Sample-level and symptom-level effect sizes across studies were compared and combined meta-analytically using formulas taken from Rosenthal (1984) and Shadish and Haddock (1994) .

    Combining effect sizes involved transforming r s into Fisher Z s and then weighting the Fisher Z s by the degrees of freedom ( df = N - 3) associated with their samples.

    The mean weighted Fisher Z was transformed back to a mean weighted effect size, referred to as the unbiased effect size estimate (r u).

    This metric was used to estimate the effect size in the population and is considered to be unbiased because it weighs more heavily larger samples whose effect sizes are generally considered to be more precise population estimates ( Rosenthal, 1984 ; Shadish & Haddock, 1994 ).

    Statistical significance of the effect size estimates was determined by computing their 95% confidence intervals; an interval not including zero indicated an effect size estimate was significant ( Shadish & Haddock, 1994 ).

    To establish interrater reliability for coding, Bruce Rind and Philip Tromovitch independently coded studies for psychological correlates, reactions, self-reported effects, family environment-CSA relations, family environment-adjustment relations, and results of statistical control. Interjudge agreement for these codings ranged from 85% to 100%; all disagreements were resolved by discussion.


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