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====== Childhood Trauma (CTQ) ======

Adult [[start|Lifelines]] participants underwent the [[https://www.cdc.gov/me-cfs/pdfs/wichita-data-access/ctq-doc.pdf|Childhood Trauma Questionnaire]] (CTQ) short-form, a self-report instrument covering 28 items, to rate the severity of traumas experienced in their childhood ([[sections|section]]: [[mental health]]). 

===== Background =====
The physical health consequences of psychosocial adversities may be as substantial as the mental health consequences. A multinational study in 10 countries showed that childhood psychosocial adversities and early-onset mental disorders have independent, broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life, including heart disease, asthma, diabetes mellitus, arthritis, chronic spinal pain, and chronic headache ((Scott KM et al. (2011). Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen Psychiatry 68(8):838-44)).\\ 
Another multinational study showed a higher effect on myocardial infarction for psychosocial stress (OR 2.67) than for hypertension (OR 1.91), diabetes (OR 2.37) or an unhealthy lifestyle ((Yusuf S et al. (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. INTERHEART Study Investigators. Lancet 364(9438):937-52)).\\ 
Traumatic childhood events (TCEs) also constitute a key environmental exposure that should be studied in gene-environment interaction studies. It was recently shown that a variant in the MTHFR gene confers a higher risk for recurrence of depression in combination with exposure to TCEs ((Lok A et al. (2013). Interaction between the MTHFR C677T polymorphism and traumatic childhood events predicts depression. Transl Psychiatry. 30;3:e288)).  

===== Scoring =====

The CTQ includes 5 domains with 5 questions each:
  * emotional abuse (DCTQ 3, 8, 14, 18, 25) 
  * emotional neglect (DCTQ 5, 7, 13, 19, 28)
  * physical abuse (DCTQ 9, 11, 12, 15, 17)
  * physical neglect (DCTQ 1, 2, 4, 6, 26)
  * sexual abuse (DCTQ 20, 21, 23, 24, 27)
Additionally there are 3 questions on a minimization/denial scale (DCTQ 10, 16, 22).\\
Particiants are asked in how far the statements applies to their childhood on a 5-point [[https://en.wikipedia.org/wiki/Likert_scale|Likert scale]] with the following options: 1 Never true, 2 Rarely true, 3 Sometimes true, 4 Often true, 5 Very often true.

The CTQ has been validated in terms of psychometric test properties in various populations ((Bernstein DP, Fink L, Handelsman L, Lovejoy M, Wenzel K, Sapareto E, Gurriero J. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994; 151: 1132-1136))((Roy CA, Perry JC (2004). Instruments for the assessment of childhood trauma in adults. J Nerv Ment Dis. 192(5):343-51))((Thombs BD et al. (2009). A validation study of the Dutch Childhood Trauma Questionnaire-Short Form: factor structure, reliability, and known-groups validity. Child Abuse Negl 33(8):518-23)).\\ 

===== Variables =====


| **Questions English**                                                                                                   | **Questions Dutch**                                                                                                                 | **Code**                       | **Variable**  | **Assessment**  | **Age**  |
| When I was growing up I didn't have enough to eat.                                                                      | Tijdens mijn jeugd had ik niet voldoende te eten.                                                                                   | ctq_physicalneglect_adu_q_01   | DCTQ1         | [[2B]]          | 18+      |
| When I was growing up I knew that there was someone to take care of me and protect me                                   | Tijdens mijn jeugd wist ik dat er iemand was om voor me te zorgen en me te beschermen.                                              | ctq_physicalneglect_adu_q_02   | DCTQ2         | [[2B]]          | 18+      |
| When I was growing up people in my family called me things like "stupid", "lazy" or "ugly"                              | Tijdens mijn jeugd noemden mensen in mijn gezin mij dingen als ’dom’, ‘lui’ of ’lelijk’.                                            | ctq_emotionalabuse_adu_q_03    | DCTQ3         | [[2B]]          | 18+      |
| When I was growing up my parents were too drunk or high to take care of the family                                      | Tijdens mijn jeugd waren mijn ouders te dronken of stoned (onder invloed van drugs) om voor het gezin te zorgen.                    | ctq_physicalneglect_adu_q_04   | DCTQ4         | [[2B]]          | 18+      |
| When I was growing up there was someone in my family who helped me feel that I was important or special                 | Tijdens mijn jeugd was er iemand in mijn gezin die mij het gevoel gaf dat ik belangrijk en bijzonder was.                           | ctq_emotionalneglect_adu_q_05  | DCTQ5         | [[2B]]          | 18+      |
| When I was growing up I had to wear dirty clothes                                                                       | Tijdens mijn jeugd moest ik vieze kleren dragen.                                                                                    | ctq_physicalneglect_adu_q_06   | DCTQ6         | [[2B]]          | 18+      |
| When I was growing up I felt loved                                                                                      | Tijdens mijn jeugd had ik het gevoel dat er van me gehouden werd.                                                                   | ctq_emotionalneglect_adu_q_07  | DCTQ7         | [[2B]]          | 18+      |
| When I was growing up I thought that my parents wished I had never been born                                            | Tijdens mijn jeugd had ik het gevoel dat mijn ouders wensten dat ik nooit geboren was.                                              | ctq_emotionalabuse_adu_q_08    | DCTQ8         | [[2B]]          | 18+      |
| When I was growing up I got hit so hard by someone in my family that I had to see a doctor or go to the hospital        | Tijdens mijn jeugd ben ik door iemand uit mijn gezin zo hard geslagen dat ik naar een dokter of naar het ziekenhuis moest gaan.     | ctq_physicalabuse_adu_q_09     | DCTQ9         | [[2B]]          | 18+      |
| When I was growing up there was nothing I wanted to change about my family.                                             | Tijdens mijn jeugd was er niets dat ik wilde veranderen aan mijn gezin.                                                             | ctq_noabuse_adu_q_10           | DCTQ10        | [[2B]]          | 18+      |
| When I was growing up people in my family hit me so hard that it left me with bruises or marks.                         | Tijdens mijn jeugd ben ik zo hard geslagen door mensen in mijn gezin dat ik er blauwe plekken of littekens aan overhield.           | ctq_physicalabuse_adu_q_11     | DCTQ11        | [[2B]]          | 18+      |
| When I was growing up I was punished with a belt, a board, a cord, or some other hard object.                           | Tijdens mijn jeugd ben ik gestraft met een riem, een plank, een touw of een ander hard voorwerp.                                    | ctq_physicalabuse_adu_q_12     | DCTQ12        | [[2B]]          | 18+      |
| When I was growing up people in my family looked out for each other.                                                    | Tijdens mijn jeugd kwamen mijn gezinsleden voor elkaar op.                                                                          | ctq_emotionalneglect_adu_q_13  | DCTQ13        | [[2B]]          | 18+      |
| When I was growing up people in my family said hurtful or insulting things to me.                                       | Tijdens mijn jeugd zeiden mensen in mijn gezin kwetsende of beledigende dingen tegen me.                                            | ctq_emotionalabuse_adu_q_14    | DCTQ14        | [[2B]]          | 18+      |
| When I was growing up I believe that I was physically abused.                                                           | Tijdens mijn jeugd geloof ik lichamelijk mishandeld te zijn geweest.                                                                | ctq_physicalabuse_adu_q_15     | DCTQ15        | [[2B]]          | 18+      |
| When I was growing up I had the perfect childhood.                                                                      | Tijdens mijn jeugd had ik de perfecte jeugd.                                                                                        | ctq_noabuse_adu_q_16           | DCTQ16        | [[2B]]          | 18+      |
| When I was growing up I got hit or beaten so badly that it was noticed by someone like a teacher, neighbor, or doctor.  | Tijdens mijn jeugd ben ik zo hard geslagen dat het opgemerkt werd door iemand zoals een leraar, een van de buren, of een dokter.    | ctq_physicalabuse_adu_q_17     | DCTQ17        | [[2B]]          | 18+      |
| When I was growing up I felt that someone in my family hated me.                                                        | Tijdens mijn jeugd had ik het gevoel dat iemand in mijn gezin me haatte.                                                            | ctq_emotionalabuse_adu_q_18    | DCTQ18        | [[2B]]          | 18+      |
| When I was growing up people in my family felt close to each other.                                                     | Tijdens mijn jeugd voelden de leden van mijn gezin zich met elkaar verbonden.                                                       | ctq_emotionalneglect_adu_q_19  | DCTQ19        | [[2B]]          | 18+      |
| When I was growing up someone tried to touch me in a sexual way, or tried to make me touch them.                        | Tijdens mijn jeugd probeerde iemand mij op een seksuele manier te betasten, of mij ertoe te brengen hem of haar te betasten.        | ctq_sexualabuse_adu_q_20       | DCTQ20        | [[2B]]          | 18+      |
| When I was growing up someone threatened to hurt me or tell lies about me unless I did something sexual with them.      | Tijdens mijn jeugd dreigde iemand me pijn te doen of leugens over me te vertellen als ik niet iets seksueels met hem of haar deed.  | ctq_sexualabuse_adu_q_21       | DCTQ21        | [[2B]]          | 18+      |
| When I was growing up I had the best family in the world.                                                               | Tijdens mijn jeugd groeide ik op in het best denkbare gezin.                                                                        | ctq_noabuse_adu_q_22           | DCTQ22        | [[2B]]          | 18+      |
| When I was growing up someone tried to make me do sexual things or watch sexual things.                                 | Tijdens mijn jeugd wilde iemand mij seksuele dingen laten doen of mij naar seksuele dingen laten kijken.                            | ctq_sexualabuse_adu_q_23       | DCTQ23        | [[2B]]          | 18+      |
| When I was growing up someone molested me.                                                                              | Tijdens mijn jeugd ben ik door iemand gemolesteerd.                                                                                 | ctq_sexualabuse_adu_q_24       | DCTQ24        | [[2B]]          | 18+      |
| When I was growing up I believe that I was emotionally abused.                                                          | Tijdens mijn jeugd geloof ik emotioneel mishandeld te zijn geweest.                                                                 | ctq_emotionalabuse_adu_q_25    | DCTQ25        | [[2B]]          | 18+      |
| When I was growing up there was someone to take me to the doctor if I needed it.                                        | Tijdens mijn jeugd was er iemand die me naar de dokter bracht als dat nodig was.                                                    | ctq_physicalneglect_adu_q_26   | DCTQ26        | [[2B]]          | 18+      |
| When I was growing up I believe that I was sexually abused.                                                             | Tijdens mijn jeugd geloof ik seksueel misbruikt te zijn geweest.                                                                    | ctq_sexualabuse_adu_q_27       | DCTQ27        | [[2B]]          | 18+      |
| When I was growing up my family was a source of strength and support.                                                   | Tijdens mijn jeugd was mijn gezin een bron van kracht en ondersteuning.                                                             | ctq_emotionalneglect_adu_q_28  | DCTQ28        | [[2B]]          | 18+      |