Exploring Child Physical Abuse and PTSD in a Sample of Taiwanese Fourth to Eighth Graders: Prevalence and Risk Factors

目的 本研究目的在調查台灣兒童及青少年社區樣本中，兒童青少年身體虐待及其相關之創傷後壓力疾患的盛行率，並檢驗人口變項、受創者的主觀感覺、及創傷事件特徵對創傷後壓力疾患的影響。 方法 參與者年齡分佈為9-15歲。所有人均在班級團體施測情境下填答修改版的UCLA PTSD Reaction Index for DSM-IV (兒童及青少年版)，藉以調查其遭受身體虐待的頻率、發生距今時間、加害者、以及與身體虐待事件相關的創傷後壓力疾患症狀。 結果 分析結果顯示，兒童身體虐待的終身盛行率為34%，男童(38.1%)的比率高於女童(29.8%)，以父母為最常見的加害人。在曾經遭受身體虐待的樣本中，13.6%現階段仍符合創傷後壓力疾患之診斷，另外16.9%符合部分診斷。其中，性別和發展階段的差異均不顯著。危險因子的調查發現，主觀覺知威脅、遭受非父母之成人的身體虐待經驗、身體虐待之頻率、以及診斷準則A2均顯著預測創傷後壓力疾患。 討論 本研究發現台灣樣本的兒童身體虐待頻率遠高於西方族群，但其後的創傷後壓力疾患症狀卻相對較少。華人文化的教養和教育觀、以及人際衝突解決模式的影響將在文中探討。Objective: The study aimed to report the lifetime prevalence of child physical abuse (CPA) and current prevalence of full/partial PTSD following CPA in the community sample of Taiwanese fourth to eighth graders. Risk factors of PTSD, including demographic factors, victims’ subjective reactions, and event-related characteristics, were examined. Method: All participants, aged 9 to 15 years old, completed the modified version of UCLA PTSD Reaction Index for DSM-IV in class setting. The frequency, time elapsed, and perpetrators of their CPA and the following PTSD symptoms were assessed. Results: The lifetime prevalence of CPA was 34%. Males exhibited higher prevalence (38.1%) than females (29.8%). Parents were the commonest perpetrators. Of those who had experienced CPA, 13.6% and 16.9% met full and partial PTSD, respectively. No gender and grade difference was found. Perceived threat, experience of CPA by non-parent adults, CPA frequency, and criterion A2 were the major risk factors for PTSD. Discussion: CPA prevalence in Taiwan was higher than in the West, while posttraumatic symptom prevalence was lower. The influence of Chinese culture, by the ways of parenting and educational styles and strategies for coping with interpersonal conflicts, were discussed.CHAPTER 1 INTRODUCTION I Definition of Trauma 1 Child Physical Abuse 3 Definition and Issues of Measurement 3 Prevalence of CPA 5 Demographic Risk Factors of CPA 7 The Perpetrators 8 Posttraumatic Stress Disorder 11 Diagnostic Criteria for PTSD 11 Diagnosing PTSD in Children and Adolescents 13 Course of PTSD 14 Prevalence of PTSD 15 Risk Factors of PTSD 18 Risk Factors of PTSD 18 The Importance of Probing Victims'' Subjective Reactions 20 The Current Study 22HAPTER 2 METHOD 24 Participants and the Procedure 24 Measures 26 Data Analysis 28HAPTER 3 RESULTS 30 The Prevalence and Perpetrators of CPA 30 The Concordance of Objective Injury and Subjective Stressfulness of CPA 32 Prevalence of CPA-related PTSD 33 Predictors of CPA-related PTSD 37 Correlates of CPA-related PTSD 37 Predictors of CPA-related PTSD 40HAPTER 4 DISCUSSION 45 The Prevalence of CPA 45 The Victims’ Subjective Reactions to CPA 48 Correlates of Concordance of Criterion A2 and Perceived Threat 49 The Prevalence of CPA-related PTSD 51 The Risk Factors of CPA-related PTSD 54 The Frequency of CPA 55 The Criterion A2 and the Perceived Threat 55 The Relation with the Perpetrators 56HAPTER 5 CONTRIBUTIONS, LIMITATIONS, ND FUTURE DIRECTIONS 60 The Contributions 60 The Limitations 61 The Future Directions 63EFERENCES 66PPENDIX A 7