Tips on reviewing sexual abuse studies
Sexual abuse a powerful risk factor
There are many biomedical and socio-behavioral studies that include questions about childhood sexual abuse since this is a major risk factor for a variety of illnesses.
"Childhood sexual abuse is the single most powerful risk factor for any kind of psychopathology," says Frederick A. Ernst, PhD, professor of psychology in the department of psychology and anthropology at the University of Texas Pan America. Ernst is the principal investigator of the study on childhood sexual abuse.
"There is a long laundry list of diagnoses that are at higher risk if a person reports having been sexually abused as a child," he adds. "And I can't think of a behavioral event or phenomenon that is a more powerful risk factor than sexual abuse as a child."
This is why researchers studying substance abuse problems, criminal activity, domestic abuse, HIV and hepatitis C infection, depression, personality disorders, and other issues often will include questions about participants' history of sexual abuse.
"If we start tiptoeing and sidestepping this issue because we're afraid it will traumatize respondents, then we're doing a gross disservice to the investigation and understanding of how childhood sexual abuse plays itself out later in adult life," Ernst says.
Based on Ernst's research into participants' feelings about being asked questions regarding their sexual histories, he offers this advice:
Offer warnings: Investigators could give participants multiple written warnings before they see and answer sensitive questions.
Here are some examples of warnings that Ernst and co-investigators have used:
"Many of the questions on the survey deal with sensitive or taboo topics, such as cheating, sexual behavior, and racism."1
"Given that the survey questions deal with some sensitive topics, you may be uncomfortable answering certain questions."
"If any questions cause you psychological distress, you should talk to the researcher who can provide you with some resources for further assistance."
Another disclaimer could be stated as the following: "If you are feeling any discomfort that would cause you to opt out, please do not answer any questions that follow," Ernst suggests.
Limit questions about details: One issue IRBs might consider regarding sexual abuse histories in studies is how much detail is being asked. If the study is assessing another social-behavioral issue and is asking about childhood sexual abuse because it might be a factor, then it likely isn't necessary to ask for specific details about the abuse, Ernst says.
"Most of the literature is addressing whether or not you are revictimizing these subjects by asking them questions about a traumatic event," he explains. "Our research and most of the research out there suggest the answer is 'No,' as long as you are not asking for significant detail."
If a research study requests significant detail about the type of sexual abuse and frequency then the IRB would need to examine whether or not the benefits of the study outweigh the discomfort experienced by the subject, Ernst adds.
The rule of thumb is asking how much detail is being requested.
"How much are you asking someone to revisit a very personally embarrassing, at the very least, and possibly traumatic experience, at the worst, for the sake of research?" Ernst says.
If the research question asks for a simple "yes" or "no" answer, then it probably is something the IRB could approve, Ernst suggests.
"If the researcher is delving into specifics and very detailed aspects of that experience, especially about penetration then IRBs have to very carefully examine what will be gained from the research and whether it's worth the discomfort these people are being put through," he adds.
"This research area is a hornet's nest, fraught with problems," Ernst says. "It's real easy to avoid you just don't address it but then you are missing and under-investigating the single most powerful risk factor for adult psychopathology."
Reference
- Benham G, Croyle K, Ernst F. Ethical implications of asking sensitive questions. Poster presented at PRIM&R's 2009 Advancing Ethical Research Conference, held Nov. 14-16, 2009, in Nashville, TN. Poster: 15.
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