Scandinavian Journal of Psychology, 2018, 59, 311–318 DOI: 10.1111/sjop.

12437

Personality and Social Psychology

What is told when the story is retold? Consistency of victimization
reports in psychiatric patients
CRISTINA S. MESQUITA ^
and ANGELA C. MAIA
University of Minho, Braga, Portugal

^ C. (2018). What is told when the story is retold? Consistency of victimization reports in psychiatric patients. Scandinavian
Mesquita, C. S. & Maia, A.
Journal of Psychology, 59, 311–318.

The use of retrospective self-reports is a major methodological concern when ascertaining the occurrence of victimization experiences, with additional
concerns when assessing psychiatric patients. The test for consistency can overcome some of these concerns, increasing the confidence in the information
reported. Our aim was twofold: (1) to know the consistency of victimization reports; and (2) to test the role of changes on emotional distress in predicting
report discrepancies, in a sample of 34 adult psychiatric patients. Participants were assessed twice, with a year interval. Sexual abuse was the experience
that presented the higher level of consistency for childhood victimization, while assault with a weapon had the higher consistency level for adolescent and
adult victimization. We found that increases on emotional distress predicted report discrepancies, and more specifically, increases in the report of
victimization. Our results displayed acceptable consistency levels, suggesting some stability in the reporting of victimization over time. Considering that
inconsistencies tended either to increases and decreases in the reporting of victimization, it would be important to consider the impact of such experiences
when intervening with psychiatric patients.
Key words: Consistency, retrospective self-report, interpersonal victimization, psychiatric patients, emotional distress.
Cristina S. Mesquita, School of Psychology, University of Minho, Portugal, Campus de Gualtar, 4710-057 Braga, Portugal. E-mail: mesquitacristina@
hotmail.com

INTRODUCTION than official records as a methodology to assess victimization, as

Reliability is a major concern when using retrospective self-reports
to assess victimization. The main reasons for this concern are
related with memory accuracy, for one hand, and the willingness
to disclose a history of victimization on the other hand (Fisher,
Craig, Fearon et al., 2011; Hardt & Rutter, 2004; Hepp, Gamma,
Milos et al., 2006; Kendal-Tackett & Becker-Blease, 2004;
Langeland, Smit, Rerckelbach, deVries, Hoogendorn & Draijes,
2015; Mckinney, Harris & Caetano, 2004; Paivio, 2001). Several
studies have shown that reports of emotionally arousing events, as
interpersonal victimization, are more precise, stable and accurate
(Byrne, Hyman & Scott, 2001; Paivio, 2001; Peace & Porter,
2004; Spinhoven, Bamelis, Haringsma, Molendijk & Arntz, 2012;
van Giezen, Arensman, Spinhoven & Wotters, 2005). However,
even these experiences may be subjected to errors, bias distortion
and natural decay of the memory (Fisher et al., 2011; Hardt &
Rutter, 2004; Kremers, van Giezen, van der Does, van Dyck &
Spinhoven, 2007; van Giezen et al., 2005) with failed or
incomplete recovery (Mechanic, Resick & Griffin, 1998).
The comparison of self-reports of victimization with official
records of their occurrence, either from child protective services,
police, or medical records, is the preferential method to assess
reliability, providing an accurate measure of victimization. Yet,
frequently this strategy is compromised by the inexistence,
incompleteness or unavailability of these records, jeopardizing
this methodological option. In face of the impossibility to use
official records as a measure of reliability, the study of
consistency allows us to assess the stability of victimization self-
reports over time. As stated by Shaffer, Huston and Egeland
(2008), retrospective self-reports are not necessarily less suitable
both methodologies may provide valuable information. A
consistent report does not equal an accurate report; nevertheless,
the stability of these reports allows for a higher confidence in the
information provided. Inconsistent reports can be defined as the
failure to report the same experience(s) in different moments in
time. Discrepant reports can either lead to omissions – with a
reduction in the number of reported experiences, compared to
previous reports – or commissions – with an increased number of
victimizations being reported, compared to previous assessments
(Dube, Williamson, Thompson, Felitti & Anda, 2004; van Giezen
et al., 2005).
Self-reports’ consistency can be influenced by several factors,
including clinical factors that refer to specificities in the
functioning of individuals with psychiatric symptoms/disorders
(Alexander, Quas, Goodman et al., 2005; Dube et al., 2004;
Elliot & Briere, 1997; Epstein & Bottoms, 1998; Goldberg &
Freyd, 2008; Kremers et al., 2007; Mckinney et al., 2004; Paivio,
2001; van Giezen et al., 2005). Some authors argue that reports
of psychiatric patients are more prone to inconsistencies due to
psychopathological symptoms that affect memory and language,
cognition distortion (Paivio, 2001), delusions, hallucinations,
substance abuse and pharmacotherapy (Goodman, Thompson,
Weinfurt et al., 1999). Also, it has been suggested that psychiatric
patients may overestimate their experiences of victimization in
order to justify their current symptoms (Alexander et al., 2005;
Fisher et al., 2011; Kremers et al., 2007). In their study with 69
college students, Lalande and Bonanno (2011) found that levels
of distress felt during a victimization episode can enhance the
memory for that event, especially if the person is experiencing
emotional distress during recall.

© 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd

^ C. Maia
312 C. S. Mesquita and A.
It is well known that psychiatric patients report high levels of
interpersonal victimization; studies have shown an association
between victimization and the subsequent development of
emotional distress and psychiatric disorders in adulthood (Cougle,
Resnick & Kilpatric, 2009; Goodman, Salyers, Mueser et al.,
2001; Horwitz, Widom, McLaughlin & White 2001; McFarlane,
Schrader, Bookless & Browne, 2006; Mueser, Salyers, Rosenberg
et al., 2004). Therefore, it is important to assess the consistency
of victimization reports in this population: as stated previously,
self-reports are frequently the only available methodology to
assess the prevalence of victimization. This knowledge has
implications for research, specifically in victimization surveys; at
a clinical level, clarifying the role of victimization experiences in
the emergence, maintenance and/or worsening of emotional
distress, and at a legal level, as inconsistent reports may
jeopardize the role of psychiatric patients as witnesses (Peace &
Porter, 2004; van Giezen et al., 2005).
Studies with psychiatric patients have found mixed results,
either indicating that victimization reports are consistent through
time, either pointing to opposite results. In their study of 229
adult psychiatric patients, Spinhoven and colleagues (2012)
intended to know the consistency for reports of sexual and
physical abuse. Participants were evaluated at Time 1, and one
year later, at Time 2. Results revealed good levels of consistency.
Forty-nine participants (21.4%) were inconsistent; from these, 25
(10.9%) made omissions, and 24 (10.5%) made commissions.
Fisher and colleagues (2011) also found results suggesting that
victimization reports are consistent. In their study with 30 adult
psychiatric patients, assessed with a seven years interval,
consistency levels for sexual and physical abuse were moderate.
Four (13.6%) participants made commissions concerning sexual
abuse, and six (20%) made omissions concerning physical abuse.
A review from van Giezen and colleagues (2005) aimed to know
the level of consistency of reports of sexual and physical abuse.
The authors found that all 37 studies had some degree of
inconsistency: irrespective to the nature of the samples, children,
adolescents, adults and adult psychiatric patients had discrepant
reports when reporting experiences of sexual and physical abuse.
It has been suggested that there may be a trend to increase the
number of victimization reported over assessments. This may be
due to underreport in initial assessments, and the effect of
rehearsal (Epstein & Bottoms, 2002; Ghetti, Goodman, Eisen, Qin
& Davis, 2002; Kremers et al., 2007; Kringsley, Gallagher,
Weathers, Kulter & Kaloupek, 2003; Odinot, Wolters & van
Giezen, 2013; Peace, Shudra, Forrester, Kasper, Harder & Porter,
2014).
The study of consistency of victimization reports in psychiatric
patients has some limitations. Existing studies tend to focus on
depressed patients (Paivio, 2001) and patients with Posttraumatic
Stress Disorder (Fisher et al., 2011; Goodman et al., 1999). At
the same time, victimization experiences also tend to be limited to
sexual and physical abuse, especially those occurred in childhood
(Fisher et al., 2011; Hardt & Rutter, 2004; van Giezen et al.,
2005), neglecting the study of consistency in other categories of
victimization, and for experiences occurred in other stages of the
lifecycle. In the previously mentioned review of van Giezen and
colleagues (2005), results showed that there was a general lack of
studies of consistency of victimization reports; the terms
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Scand J Psychol 59 (2018)
“consistency” and “accuracy” were not clearly distinguished and
were used interchangeably, along with a lack of definition of
report consistency, and finally, few studies explored the nature of
inconsistencies, with most studies failing to report omissions and
commissions.
In an attempt to overcome some of the limitations encountered in
this field, we define two aims for our study. Our first aim was to
know the consistency of victimization reports of adult psychiatric
patients, assessed twice with a 12 month interval. We assessed
consistency for experiences occurred during childhood,
adolescence and adulthood. Consistency was defined as
maintenance of the response pattern at time 2, compared to Time 1,
concerning the occurrence/non-occurrence of victimization. We
detailed the nature of inconsistencies, attending to commissions and
omissions at time 2, compared to reports at Time 1. Our second aim
was to explore the role of changes on emotional distress in
predicting report discrepancies. We hypothesized that changes on
emotional distress would predict discrepancies; specifically, an
increase in emotional distress would result in more commissions.
METHODS
Participants
Participants were 34 psychiatric patients between ages 20 and 63
years (M = 47.18, SD = 10.38), from four Portuguese psychiatric
hospitals (67.6% inpatients, 32.4% outpatients). Twenty two were
female (64.7%), and 12 were male (35.3%). To be enrolled in this
study, participants had to be receiving mental health care in a
public psychiatric hospital, as either an inpatient or an outpatient,
with a diagnosis of mental disorder according to DSM-IV.
Participants were included regardless of the diagnosis they
presented. The exclusion criteria were not understanding
Portuguese language, mental retardation, and active psychotic
symptoms.
At Time 1, two experienced researchers approached 131
participants. Of the 131 patients, 11 were not included in the
study. Six participants refused to participate, one participant felt
too disturbed to proceed, and four had no identifiable
psychopathology, leaving a final sample of 120 participants. From
those 120, 10 (8.3%) participants refused to participate at Time 2.
We expected to integrate all the 110 remaining participants at
Time 2. At Time 2, we contacted these 110 participants, asking
about how they had been feeling, and reminding them of their
participation in a second assessment. From these 110 participants:
27 (22.5%) refused to participate after their previous consent; 36
(30%) had no longer valid phone numbers and could not be
located; and 13 (10.9%) were very disturbed in the initial
conversation, leading to the decision of not proceeding with
assessment. These patients were referred to their general
practitioner and/or psychiatrist, and were not included in the
study. Additional phone calls were made the following days in
order to ensure they were receiving the care needed. The final
sample comprised 34 participants, representing 28.3% of the
original sample. There were no statistical differences between the
final sample and the original sample considering sex, age, marital
status, employment status, education level, level of victimization
and emotional distress.

Scand J Psychol 59 (2018)
Procedure
To conduct this study, we contacted 11 psychiatric hospitals from
the North region of Portugal. Four of them consent to be enrolled
in the study. We sought approval from the National Commission
of Data Protection, and from the Ethics Committees of Psychiatric
Hospitals and obtained approval to assess inpatients and
outpatients. After approval, patients were approached. For
inpatients, the chief nurse made the first contact with patients who
met the inclusion criteria and introduced the researcher.
Outpatients were approached on scheduled appointment days;
their psychiatrist presented the researcher, who proceeded to
present the study. After this presentation, patients who agreed to
participate signed an informed consent. Patients were also asked if
they were willing to be contacted one year later. Those who
agreed to be enrolled at Time 2 gave additional consent and
provided a phone number, either a landline or a mobile phone.
Participation was voluntary.
Time 1 assessments were conducted in a quiet room in
psychiatric hospitals, where the patients could feel comfortable
and at ease. Confidentiality was ensured for all participants
enrolled. Data were collected between July of 2013 and January
of 2014. Data for Time 2 were collected between July of 2014
and January of 2015, with an interval of 12 months between
assessments. The consent provided by the Ethics Committees did
not allow us to schedule additional assessments in the psychiatric
hospitals’ facilities. For that reason, Time 2 assessments were
made via telephone. Participants were contacted, asked follow-up
questions about their current mental health state, if they
remembered about the study they were enrolled in, and asked
about suitable dates for the assessment. On the scheduled days
participants answered the Brief Symptom Inventory (BSI) and
Lifetime Trauma and Victimization History (LTVH) checklist.
Several follow-up phone calls were made to ensure the
participants’ well-being.
Instruments
Socio-demographic information. A socio-demographic question-
naire was created to collect information about sex, age, marital
status, employment status and socio-economic status.
Psychological Distress. Brief Symptom Inventory (BSI,
Derogatis, 1982, Portuguese version from Canavarro, 1999) is an
instrument with 53 items that assesses the presence of
psychological distress within the previous seven days in a five
point scale. It evaluates nine symptom dimensions, allowing us to
calculate three indexes that constitute brief evaluations of
emotional distress: the Global Severity Index (GSI), the Positive
Symptoms Total (PST) and the Positive Symptom Distress Index
(PSDI). For the purpose of this study, GSI was used to represent
emotional distress. This index reflects a combined score that
weighs the intensity of the distress experienced and the number of
symptoms checked, and it is obtained summing the score of all
items, and dividing the result by the total number of answers. In
our study, Cronbach’s alpha varied between 0.62 (psychoticism)
and 0.87 (depression), at Time 1, and between 0.59
(psychoticism) and 0.85 (depression) at Time 2.
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Victimization reports in psychiatric patients 313
Interpersonal Victimization. Lifetime Trauma and Victimization
History (LTVH) is a checklist of victimization experiences, with
nine items assessing verbal abuse, threat of physical abuse/
assault, physical abuse/assault, sexual abuse, discrimination,
neglect and witnessing to victimization. For each experience,
participants are asked about the occurrence of victimization
during childhood (0 to 11 years), adolescence (12 to 17 years)
or adulthood (18 and older). Items are dichotomous; a positive
response to any item was considered as indicative of the
presence of a given victimization experience.
Statistical analyses
Data were analyzed using descriptive statistics and frequencies of
socio-demographic data, emotional distress and victimization
experiences. BSI Index Global Severity Index (GSI) for both
Time 1 and Time 2 was obtained summing the score of all items,
and dividing the result by the total number of answers. A
compute analyses was made, subtracting Time 1 GSI from Time
2 GSI, creating a measure representing changes on emotional
distress. A score of 0 illustrated a lack of change; a negative score
represented an improvement on the mental status, and a positive
score portrayed a worsening of the mental state.
Each victimization experience was computed, subtracting Time
1 score from Time 2 score, creating a measure of report
discrepancy. In this computed measure, a score of 0 represented a
consistent report. Scores of –1 reflected omissions, and scores of
1 reflected commissions, both representing inconsistent reports.
We also calculated the percentage of agreement between Time 1
and Time 2 reports for each victimization experience.
Additionally, we created a Total Victimization score, both for
Time 1 and Time 2, summing all victimization experiences for
each participant. The Total Victimization score for Time 1 was
then subtracted from the Total Victimization score for Time 2,
creating a measure of report discrepancy.
Consistency was calculated using Cohen’s kappa. According to
Gisev, Bell and Chen (2013), Sim and Wright (2005), and the
guidelines recommended by Kottner, Audige, Brorson et al.
(2011), Cohen’s kappa is the appropriate statistical method to
analyze agreement with nominal data. Results of Cohen’s kappa
were interpreted following Altman (1991): k < 0.20 – poor
agreement; k between 0.21 and 0.40 – fair agreement; k between
0.41 and 0.60 – moderate agreement; k between 0.61 and 0.80 –
good agreement; k > 0.81 – very good agreement.
Using Pearson and bisserial correlations, we tested for
associations between emotional distress and victimization report,
and emotional distress and commissions and omissions. Using a
linear regression, we tested the role of changes in emotional
distress in predicting changes on reports, commission and
omission. Changes on emotional distress (GSI Time 2 – GSI
Time 1) were entered as predictor, with discrepancies on
victimization report (Total Victimization Time 2 – Total
Victimization Time 1), commissions and omissions entered as
outcome.
Data analyzes was made with the support of the software IBM
Statistical Package for Social Science (SPSS), version 22 for
Windows (IBM, Armonk, NY).
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^ C. Maia
314 C. S. Mesquita and A. Scand J Psychol 59 (2018)

RESULTS of commission (23.5%). As for adolescent victimization, witness

Descriptive data
At Time 2, 15 participants (44.1%) reported higher levels of
emotional distress, and 19 participants (55.9%) reported lower
levels, compared to Time 1. Table 1 shows the prevalence for
each victimization experience both at Time 1 and 2. At Time 1,
Total Victimization score varied from 0 to 19 (M = 5.97, SD =
5.33), while at Time 2, it varied from 0 to 15 (M = 5.18, SD =
4.99).
Consistency of victimization self-reports
Results from consistency analyses are presented in Table 1. For
childhood victimization, kappa varied between poor (0.00,
discrimination) and moderate (0.52, sexual abuse). Agreement
varied from 61.8% (physical abuse/assault) to 91.2% (sexual
abuse and discrimination). For adolescent victimization, kappa
varied from poor (0.02, witness to victimization) to moderate
(0.44, verbal abuse). Agreement varied from 55.9% (witness to
victimization) to 94.1% (sexual abuse). As for adult victimization,
Kappa varied from fair 0(.22, witness to victimization) to
moderate (0.52, sexual abuse). Agreement varied between 64.7%
(witness to victimization) and 91.2% (sexual abuse).
Inconsistency in victimization self-reports
Table 2 presents the discrepancies of the participant’s self-reports.
For childhood and adulthood victimization, participants made
more omissions compared to their initial report at Time 1. As for
adolescent victimization, participants made the same number of
omissions and commissions.
Comparing the discrepancies across the lifecycle, reports of
childhood victimization had less omissions. Reports of adolescent
victimization had more commissions, and reports of adult
victimization had the higher level of omissions and the lower
level of commissions.
Results display the experiences more prone to inconsistencies.
For childhood victimization, verbal abuse had the highest level of
omission (23.5%), and physical abuse/assault had the higher level
to victimization had the higher level of omission (20.6%) and
commission (23.5%). Results for adult victimization revealed that
threat of physical abuse/assault, physical abuse/assault and
discrimination had the higher level of omission (20.6%), while
witness to victimization had the highest level of commission
(26.5%).
Regression model
Correlation analyses revealed a positive significant association
between emotional distress at Time 1, and victimization report at
Time 1, r = 0.38, p < 0.05. When we tested for the same
association between emotional distress and victimization report at
Time 2, results were not significant. We then tested for the
association between changes on emotional distress from Time 1 to
Time 2, and report discrepancies and found a positive significant
association, r = 0.43, p < 0.05.
The results from the linear regression model testing the role of
changes on emotional distress in predicting discrepancies in
victimization reports was statistically significant, t (1, 32) = 7.29,
p < 0.05, explaining 18.6% of the variance (adjusted R2 = 16%)
in report discrepancies. Changes on emotional distress towards an
increase of symptoms predicted more discrepancies on
victimization reports.
We found a positive significant association between changes on
emotional distress from Time 1 to Time 2 and commissions, rbp =
0.41, p < 0.05. The same association for omission was not
significant. The linear regression model testing the role of changes
on emotional distress in predicting commissions was statistically
significant, t (1, 32) = 15.86, p < 0.05, explaining 33% of the
variance (adjusted R2 = 31.1%) in report discrepancies, with
changes on emotional distress towards an increase of symptoms
predicting more commissions.
DISCUSSION
Our study intended to know the consistency of victimization
reports, and to test the role of emotional distress in predicting
changes in victimization reports, in a sample of psychiatric

Table 1. Prevalence of victimization at Time 1 and Time 2, Cohen’s kappa and percentage of agreement for each experience of victimization, in each
stage of the lifecycle

Childhood Adolescence Adulthood

N (%) N (%) N (%)

% % %
T1 T2 K agreement T1 T2 K agreement T1 T2 K agreement

Verbal abuse 16 (47.1) 11 (32.4) 0.34 67.3 14 (41.2) 11 (32.4) 0.44 73.5 18 (52.9) 15 (44.1) 0.47 73.5
Threat physical 8 (23.5) 3 (8.8) 0.27 79.4 9 (26.5) 6 (17.6) 0.24 73.5 14 (41.2) 9 (26.5) 0.42 73.5
abuse/assault
Physical abuse/assault 9 (26.5) 12 (35.3) 0.11 61.8 9 (26.5) 12 (35.3) 0.25 67.6 14 (41.2) 8 (23.5) 0.48 76.5
Sexual abuse 3 (8.8) 4 (11.8) 0.52 91.2 1 (2.9) 1 (2.9) –0.03 94.1 4 (11.8) 3 (8.8) 0.52 91.2
Discrimination 3 (8.8) 0 0.00 91.2 8 (23.5) 7 (20.6) 0.41 79.4 16 (47.1) 13 (38.2) 0.35 67.6
Neglect 5 (14.7) 7 (20.6) 0.20 76.5 4 (11.8) 7 (20.6) 0.25 79.4 4 (11.8) 5 (14.7) 0.36 85.3
Witness to 10 (29.4) 7 (20.6) 0.30 73.5 11 (32.4) 12 (35.3) 0.02 55.9 8 (23.5) 14 (41.2) 0.22 64.7
victimization
Total victimization 54 44 56 56 78 67

© 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd

Scand J Psychol 59 (2018)
Table 2. Omission and commission for each victimization experience, for each stage of the lifecycle
Type of inconsistency
Childhood
N (%)
Omission Commission
Verbal abuse 8 (23.5) 3 (8.8)
Threat physical abuse/assault 6 (17.6) 3 (8.8)
Physical abuse/assault 5 (14.7) 8 (23.5)
Sexual abuse 1 (2.9) 2 (5.9)
Discrimination 3 (8.8) 0 4 (11.8)
Neglect 3 (8.8) 5 (14.7)
Witness to victimization 6 (17.6) 3 (8.8)
Total discrepancies 29 24
patients. Implications for research include a better understanding
of the limitations and challenges of data obtained through self-
reports in this group, further clarifying the potential of self-reports
as a data collection methodology. As for clinical practice, this
knowledge might allow the design of more targeted interventions
and preventive actions. Inconsistent reports raise questions about
the actual occurrence of victimization, compromising the success
of interventions targeted to address emotional issues related to this
experience, potentially compromising the success of treatments
and care. Additional implications include the role of psychiatric
patients as witnesses, as mentioned in the Introduction.
This study had a twofold aim. First, we aimed to discover the
consistency of victimization reports of adult psychiatric patients.
We assessed the consistency of experiences occurred during
childhood, adolescence and adulthood, detailing the nature of the
inconsistencies. We used Cohen’s kappa and percentage of
agreement to describe our results. We found lower kappa levels
had corresponding lower percentages of agreement, and higher
kappa levels had corresponding higher percentages of agreement
for childhood sexual abuse, adolescent witnessing to victimization
and adult witnessing to victimization and sexual abuse. Childhood
discrimination was the experience with the lower kappa score, but
presented the highest percentage of agreement. The disagreement
between measures may be explained by the nature of the statistics
used. Cohen’s kappa is sensitive to the prevalence of the attribute,
that is, the presence of victimization, and corrects for chance
agreement (Sim & Wright, 2005); thus in the absence of
childhood discrimination at Time 2, kappa scores reflect an
absence of consistency. On the other hand, the high levels of
percentage of agreement reflect the agreement for the
nonoccurrence of childhood discrimination. The same applies to
disagreement concerning adolescent experiences. Despite the fact
that the same number of participants reported sexual abuse in
adolescence in both Time 1 and 2, the low prevalence rates of this
experience (only one participant) may explain the low kappa
score alongside with the high score for percentage of agreement.
Despite the fact of Cohen’s kappa being sensitive to the
prevalence of the attribute, some victimization experiences that
had low prevalence rates had the higher Kappa scores, as
childhood and adulthood sexual abuse. This specific experience
has been classified as one of the more serious forms of
victimization (Finkelhor, Ormrod & Turner, 2009; Kirchner,
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Victimization reports in psychiatric patients 315
Adolescence Adulthood
N (%) N (%)
Omission Commission Omission Commission
6 (17.6) 3 (8.8) 6 (17.6) 3 (8.8)
6 (17.6) 3 (8.8) 7 (20.6) 2 (5.9)
4 (11.8) 7 (20.6) 7 (20.6) 1 (2.9)
1 (2.9) 1 (2.9) 2 (5.9) 1 (2.9)
3 (8.8) 7 (20.6) 4 (11.8)
2 (5.9) 5 (14.7) 2 (5.9) 3 (8.8)
7 (20.6) 8 (23.5) 3 (8.8) 9 (26.5)
30 31 34 23
Forns, Soler & Plaellas, 2014); experiences assessed as highly
negative are properly recalled, due to their distinctiveness and the
physiological and behavioral reactions associated. And as they
may endanger life, their memory must remain consistent through
time, in order to prevent their re-occurrence (Alexander et al.,
2005; Spinhoven et al., 2012). Likewise, we also found that
among the most prevalent experiences of victimization for each
stage of the lifecycle, Kappa scores varied from poor to moderate.
Although they were the most prevalent, generally, the prevalence
rates of victimization were not high. And as mentioned earlier,
low prevalence rates of the attribute can lead to a reduced kappa
score, due to chance correction (Sim & Wright, 2005). This fact,
combined with the small sample size, may account for the general
levels of Kappa found in our sample. Results from percentage of
agreement showed that higher agreement was found in less
prevalent experiences, reflecting a bias toward the agreement for
the nonoccurrence. As stated by Hardt and Rutter (2004),
psychiatric patients may be more consistent in reporting events
that did not happened.
Compared to childhood and adult victimization, reports of
adolescent victimization had the lower kappa scores and
percentages of agreement. One possible explanation is presented
by Kremers and colleagues (2007). According to the authors,
individuals with a history of victimization may elaborate general
schemes of victimization events that allow them to remember that
a given victimization occurred, but may lead to difficulties
remembering specific details. This is especially salient in
individuals that suffered from repeated victimization. Thus, the
memory concerning the occurrence of the victimization tends to
be more precise than the memory for its specific course:
participants remember the victimization, but may not be able to
correctly recall if it happened during childhood, adolescence or
adulthood (Hardt & Rutter, 2004; Peace et al., 2014; Quas,
Alexander, Goodman, Ghetti, Edelstein & Redlich, 2010; van
Giezen et al., 2005).
Examining the nature of the inconsistencies in our study, we
found that participants made more omissions, decreasing the
number of victimization experiences reported at Time 1, except
for adolescent victimization, where they made the same amount
of omissions and commissions. According to Kringsley and
colleagues (2003), there is a tendency to increase the number of
victimization experiences reported throughout repeated

^ C. Maia
316 C. S. Mesquita and A.
assessments, which is contrary to our findings. Several factors
may have contributed for our results. Contextual factors may have
influenced the reports of victimization. According to Hard and
Rutter (2004), individuals tend to attribute meaning to their
memories. It is possible that participants in our study were more
willing to report their victimization experiences at Time 1 because
of the context of assessment, the psychiatric hospital. By reporting
victimization, participants might have felt that their reports could
account for their current symptoms, thus justifying their
psychiatric care requirements (Fisher et al., 2011; Kremers et al.,
2007). Additionally, being in under psychiatric care might have
elicited feelings of distress, increasing the reports (Bonanno, Noll,
Putnam, O’Neill & Trickett, 2003). As Time 2 assessments were
carried when patients were in their homes, and with a schedule
they chose, they might have underreported, either because they did
not feel the need to justify their psychiatric care requirements,
either because the assessment was made via telephone, leading to
unwillingness to disclose (DiLillo, DeGue, Kras, Loreto-Colgan &
Nash, 2006; Hobrook, Green & Krosnick, 2003; Pridemore,
Damphousse & Moore, 2005). Furthermore, with time, participants
might minimize their experiences, no longer considering them as
victimization, and failing to report them (Alexander et al., 2005).
These hypotheses may explain the fact that adult experiences had
the higher levels of omission. On the other hand, the lowest levels
of commission concerning adult victimization may be justified by
the fact that these experiences were recent, and less prone to
memory decay or incorrect recall (Fisher et al., 2011; Kremers,
et al 2007; van Giezen et al., 2005).
Reports of adolescent victimization displayed the higher levels
of commissions. The presence of general schemes for
victimization might have led to a recollection of the victimization,
failing to correctly locate the timing of its occurrence from one
assessment to the other (Hardt & Rutter, 2004; Peace et al., 2014;
Quas et al., 2010; van Giezen et al., 2005). Finally, childhood
experiences had the lower levels of omission. These experiences
might have been repeatedly thought of and reported, thus
allowing the creation of a structured narrative, leading to more
stable reports (Peace & Porter, 2004; van Giezen et al., 2005).
Our second goal aimed to test the role of changes on emotional
distress, from Time 1 to Time 2, in predicting discrepancies on
the number of victimizations reported from Time 1 to Time 2,
further detailing the role of commissions and omissions. We
found that changes on emotional distress explained 18.6% of the
variance in discrepancies. Changes towards an increase on
emotional distress predicted an increase on report discrepancies
towards an increase in the number of victimizations reported.
These findings met those from previous studies that found
changes on emotional distress to be related to inconsistencies in
victimization reports in psychiatric patients (Fisher et al., 2011;
Kremers et al., 2007; Paivio, 2001; Spinhoven et al., 2012; van
Giezen et al., 2005), with a trend to increase the reporting of
victimization over time (Fisher et al., 2011; Kremers et al., 2007;
Paivio, 2001; Spinhoven et al., 2012; van Giezen et al., 2005).
This study has some limitations. The major limitations concern
the number of dropouts in our sample, due mostly to the
impossibility of contacting participants for the second assessment.
The size of the sample calls for caution in the interpretation of the
results, and further limits the extent of some statistical analyzes.
© 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd
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Scand J Psychol 59 (2018)
Despite this limitation, it is noteworthy that some relevant studies
in this field had samples similar in size (Fisher et al., 2011;
Goodman et al., 1999; Paivio, 2001), thus providing this study
with value. Another limitation concerns the failure to control for
additional victimization experiences that might have occurred
between assessments. It is possible that further victimization
occurred and might have been reported, increasing the
inconsistency in our findings. In future studies, we will consider
victimization that occurred during the time frame between
assessments. Furthermore, it is possible that the sensitive nature of
the information required might have interfered with disclosure in
either Time 1, 2 or both, especially if the perpetrator was a family
member or someone close to the participant (Goodman-Brown,
Edelstein, Goodman, Jones & Gordon, 2003; Hegarty & Tafta,
2001; Ullman, 2002). According to Langeland and colleagues
(2015), the quality of the reports of victimization may be
influenced not only by factors pertaining to memory, but also by
reluctance in disclosing the experiences. Another limitation
concerns the conditions in which assessment were made, which
were not kept constant. Due to external constraints, namely rules
and procedures of each psychiatric institutions, we were not able
to conduct Time 2 assessments in the same setting as the Time 1
assessment, leading to changes not only in the context of
assessment (psychiatric hospital vs home) but also in the method
of assessment (in person vs via telephone). It is possible that both
these changes may have played a role in the content of the
reports.
Despite these limitations, our work brings some novelty to the
study of consistency of victimization reports. This study was
conducted with psychiatric patients, thought to be more
vulnerable to memory errors and distortion due to psychiatric
symptoms. We found acceptable levels of consistency suggesting
that self-reports may be useful in ascertaining the occurrence of
interpersonal victimiation in psychiatric patients. As symptoms of
emotional distress predict discrepancies in victimization reports,
particularly towards an increase in reporting, caution must be used
when considering the presence of victimization in this population
(van Giezen et al., 2005). This has practical implications. At a
clinical level, psychiatric patients with victimization require
intervention to integrate these experiences. In order for the
intervention to succeed, health care providers need to have
confidence in patients’ reports. It is important to make thorough
and repeated assessments, through the use of different methods
(Peace & Porter, 2004), in order to prevent failure of interventions
(Ewing, Levy & Boamah-Wiafe, 2014; Neger & Prinz, 2015;
Waldmand-Levi, Finzi-Dottan & Waintraub, 2015), particularly
due to the fact that the prevalence of interpersonal victimization
is high in this population (Fitzgerald, DeCastella, Filia, Benitez &
Kulkarni, 2005; Horwitz et al., 2001; Meade, Kershaw, Hansen
& Sikkema, 2009; Scott, 2007; Silver, Arseneault, Langley, Caspi
& Moffitt, 2005; Swanson, Swartz, Essock et al., 2002).
Implications at the legal level highlight the need for assessments
of the mental health of potential witnesses, as their reports of
victimization may be influenced by symptoms of emotional
distress (Peace & Porter, 2004; van Giezen et al., 2005). The
confidence in the reports provided by the witness impacts on
conviction rates, further preventing additional victimization for
the self and other potential victims.
 14679450, 2018, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/sjop.12437 by Cochrane Portugal, Wiley Online Library on [10/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Scand J Psychol 59 (2018) Victimization reports in psychiatric patients 317

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