Chapter 3
The psychological adjustment of adult survivors of institutional abuse in Ireland Report submitted to the Commission to Inquire into Child Abuse1


Executive summary

3.01The present report describes a research project which was commissioned by the Commission to Inquire into Child Abuse (hereafter referred to as CICA).

3.02In 2005 and 2006, 247 adult survivors of institutional abuse in industrial and reformatory schools recruited through CICA were interviewed. Other witnesses to the Commission who reported institutional abuse in other institutions and out-of-home care settings were not included in this study. There were approximately equal numbers of men and women who were about 60 years of age, and who had entered institutions run by nuns or religious brothers due to family adversity or petty criminality.

3.03Participants had spent, on average, about 5 years living with their families before entering institutions and about 10 years living in institutions. More than 90% had experienced institutional physical and emotional child abuse and about half, institutional child sexual abuse. Just over a third of those who had memories of having lived with their families reported family-based child abuse or neglect.

3.04All participants had experienced one or more significant life problems with mental health problems, unemployment and substance use being the most common. More than four fifths of participants had an insecure adult attachment style, indicative of having problems making and maintaining satisfying intimate relationships.

3.05About four fifths of participants at some point in their life had had a psychological disorder including anxiety, mood, substance use and personality disorders. The overall rates of psychological disorders among survivors of institutional living, for most disorders, were double those found in normal community populations in Europe and North America.

3.06Participants with multiple co-morbid psychological disorders had experienced more institutional abuse and showed poorer adult psychological adjustment than those with fewer disorders. Those with no diagnoses were the best adjusted as adults. Subgroups selected by specific diagnosis showed an intermediate level of adult psychological adjustment between these extremes.

3.07In the analysis of groups of participants who had spent different amounts of time in institutions and entered under different circumstances, the most poorly adjusted as adults were not those who had spent longest living in institutions (more than 12 years), but rather, those who had spent less time in institutions (under 11 years), entered institutions through the courts and reported institutional sexual abuse, in addition to physical abuse within their families.

3.08The psychological processes of traumatization and re-enactment of abuse on self and others were associated with multiple difficulties in adult life and a history of institutional abuse, but not family-based child abuse.

3.09Having spent more time living within a family context in childhood and using positive coping strategies such as planning, developing skills and developing a social support network in adulthood were associated with a good quality of life.

3.10This study had three main limitations: (1) there was a high exclusion rate and a low response rate; (2) there was no control group; and (3) the study used a crossectional, not a longitudinal design. There were also three strengths: (1) it was the largest study of its kind conducted to date; (2) an extensive reliable and valid interview protocol was used; (3) interviews were conducted by qualified psychologists. These strengths and weaknesses allow confidence to be placed in the associations found between indices of childhood institutional abuse and adult adjustment. However, they limit the strength with which causal statements may be made about institutional abuse and adult adjustment. They also limit the confidence with which statements may be made about the generalizability of the findings. Our informed judgement, in which we have a moderate degree of confidence, is that the abusive experiences caused the adult adjustment problems. But of course, we are cautious about making a definitive statement in this regard.

3.11The first recommendation is that legislation, policies, practices and procedures be regularly reviewed and revised to maximize protection of children and adolescents in institutional care in Ireland from all forms of abuse and neglect.

3.12The second recommendation is that evidence-based psychological treatment continue to be made available to adult survivors of Irish institutional abuse.

3.13The third recommendation is that staff at centres which provide psychological treatment for adult survivors of Irish institutional abuse have regular continuing professional education and training to keep them abreast of developments in the field of evidence-based treatment of survivors of childhood trauma.

3.14The fourth recommendation is that research be conducted to evaluate the effectiveness of psychological treatment for adult survivors of institutional abuse.

Acknowledgments

3.15This project involved the co-operation of a large number of people. Thanks to all who contributed. Some deserve special mention.

3.16Thanks to Christine Buckley at Aisling in Dublin for her advice and support. Thanks to colleagues at interview venues in Ireland and the UK for generously offering their premises as interview sites: Mr. Philip Moore, Director of Counselling, Harbour Counselling Service, Penrose Quay, Cork; Mr. Noel Barry, Right of Place, Lower Glanmire Road, Cork; the London-Irish Centre, Camden Square, London; Professor Peter McGeorge, School of Psychology, University of Aberdeen, Scotland; Professor Penny Renwick, Director of School of Health, Psychology and Social Care, Manchester Metropolitan University, UK; Professor David Shanks Department of Psychology, UCL, London, UK.

3.17Thanks to directors of counselling services in Ireland and the UK for provision of support for participants requiring counselling: Ms. Isolde Blau, Director of Counselling, Laragh Counselling Service, Dublin; Ms. Rachel Mooney, Director of Counselling, AVOCA Counselling Service, Dublin; Ms. Marion Rackard, Director of Counselling, Alba Counselling Service, Newbridge, Co. Kildare; Ms. Theresa Flacke, Director of Counselling, Woodquay Centre Counselling Service, Galway; Ms. Noreen Harrington, Director of Counselling, Limerick; Mr. Philip Moore, Director of Counselling, Harbour Counselling Service, Cork; Ms. Fiona Ward, Director of Counselling, Rian Counselling Service, Meath. Mr. Gerard O’Neill, Director of Counselling, COMHAR, Adult Counselling Service, Waterford; Mr. Tom McGrath, Director of Counselling, Sligo; and ICAP Immigrant Counselling and Psychotherapy, London and Birmingham.

3.18Thanks to the interviewing team for the ethical and sensitive way in which they conducted demanding interviews: Carmel Howard, HDipPsych; Susan Gavin, BA; Philomena Crotty, HDipPsych; Anne Donnelan, HDipPsych; Tara Davis, MLitt; Aongus McGrane, HDipPsych; Mimi Tatlow, HDipPsych; Dervalla Mannion, HDipPsych; Barbara Hernon, BA; Maria Mannion, HDipPsych; Su Yin Yap, BA; Eimear McMahon, HDipPsych; Aoife McCann, HDipPsych; Evita O’Malley, HDipPsych; Mairead Dowling, HDipPsych; Marie McGrath, BA; Mary Keating, BA; Eoin O’Connell, MLitt; Faye Scanlan, BA; Lynsey O’Keeffe, BA; Elaine Smith, PhD; Lucy Smith, MA; Brid O’Donoghue, BA; and Julie Grace, BA.

3.19Thanks to the interview co-odinating team for careful scheduling of all interviews in Ireland and the UK: Megan White, BA and Kevin Tierney, BA. Thanks to the data analysis team Roisín Flanagan, MSc; Mark Fitzpatrick, MSc; Edel Flanagan, MSc; and also to Dr Mark Shevlin and Dr Barbara Dooley for their expert input on data analysis. Thanks to Dr Jonathon Egan for liaison with the national Counselling Centre network and to Margaret Daly, MPsychSc for providing interviewer support.

3.20Special thanks to Muriel Keegan, MA, for project co-ordination and administration.

3.21Thanks to colleagues at CICA especially Fred Lowe for their support throughout the project.

3.22Finally our gratitude goes to all 247 participants who contributed generously to the project and without whose co-operation it could not have been conducted.

Alan Carr

June 2006

Acknowledgment to participants from the interviewing team

3.23We, the interviewers, would like to thank the many courageous individuals who took part in this study.

3.24We were deeply moved, inspired and humbled by our contact with you.

3.25We recognise the personal cost to so many of you in taking part in this project. In coming forward to tell your stories, you knew you ran the risk of re-awakening emotional pain. However your desire that your experiences be heard and recorded was stronger. We acknowledge the generosity in your decision to take part in this project so that future generations of children might be protected from the horrors you had endured.

3.26Although we spent only a few hours with you, meeting with you and listening to your stories was a moving and enriching experience for all of us. We felt privileged and honoured that you trusted us with such intensely personal and private experiences. You told us of the isolation and loneliness you experienced as young children, of the hardships you endured, of abuse and violence – often sadistic and brutal- at emotional, psychological, physical and spiritual levels.

3.27At times it was heartbreaking to listen to the stories you told. We grieved for your childhoods and we grieved that, for many of you, the legacy of your early experiences continue to affect your relationships, your work and your social lives.

3.28But more than anything we were moved and inspired by the power of the human spirit you demonstrated in the face of the terrible adversities you suffered. Alongside your pain, anger and sadness was an inner strength and resilience that clearly sustained you and that allowed many of you to move on beyond your suffering.

3.29We offer you our gratitude, respect and admiration.

The Interviewing Team

June 2006

Part 1 Introduction

Summary of Part 1

3.30A number of tentative conclusions may be drawn from the cursory literature review in Part 1. Negative childhood experiences may lead to significant adult adjustment problems. These include psychological and personality disorders, relationship and parenting problems, occupational and health difficulties, self-harm and an impoverished quality of life. The negative effects of such early adversity is probably strongly related to the variety, severity, frequency, and duration of negative experiences. The long-term outcomes of negative childhood experiences may be mediated by critical psychological processes including traumatization, betrayal, disrespect for authority, stigmatization, powerlessness, avoidance of reminders of trauma and re-enactment of negative experiences on self or others. If the negative childhood experiences occur within the context of a religious institution, religious disengagement may also occur. The negative effects of adversity may be attenuated by the use of functional coping strategies such as developing social support, mastering skills, and effectively planning escape from adversity. In contrast, the adverse effects of negative experiences may be exacerbated by the use of dysfunctional coping strategies such as overcompliance, excessive opposition, or substance abuse.

Opening comments

3.31This report presents the results of a research study which investigated the adult adjustment of people who had negative childhood experiences while living in institutions in Ireland. A key aim of the study was to profile subgroups of adult survivors of institutional child abuse on historical and psychological variables with a view to detecting associations between recollections of institutional living and current adjustment.

3.32In Part 2 the methodology used in the study is described. The overall characteristics of the sample are presented in Part 3. In Part 4 profiles of subgroups of participants with different histories of institutional living and institutional abuse are presented. Part 5 contains a description of profiles of participants with different patterns of psychological disorders. In Part 6 the focus is on psychological processes associated with institutional abuse and related coping strategies. Conclusions and recommendations are given in Part 7. In this, the first Part, a summary of relevant national and international literature in the field is given.

What is known about the long term impact of child abuse and institutional living?

3.33Within an Irish context no major studies of the effects of living in an institution in childhood on adult adjustment have been conducted. Only one major study of the characteristics of children and adolescents living in institutions in Ireland in the 60s has been completed. In Appendix F of Justice Eileen Kennedy’s (1970) Reformatory and Industrial School System’s Report, Professor Fechín O’Doherty concluded from a survey of over 300 participants aged 6-15 years that rates of learning difficulties and intellectual disability were higher in reformatories and industrial schools than in the normal population.

3.34A number of areas of the international and national scientific literature are relevant to the research project described in the present report. These include the

What follows is a summary of key findings in each of these areas.

Long-term effect of child abuse

3.35The international research literature on the long-term effects of child abuse and neglect indicates that it affects functioning in a wide range of areas (Berliner & Elliott, 2002; Carr, 2006a; Carr & O’Reilly, 2004; Kolko, 2002; NCCANI & NAIC, 2004; Wekerle & Wolfe, 2003). These include:

3.36The Sexual Abuse and Violence in Ireland (SAVI) report on a nationally representative survey of over 3,000 adults in 2002 confirmed that in Ireland, for a sizeable minority of survivors, child sexual abuse leads to significant mental health problems including post-traumatic stress disorder (McGee, Garavan, deBarra, Byrne, and Conroy, 2002).

Differential effects of the extent of abuse

3.37Attempts to identify the unique effects of different types of maltreatment (physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) have not yielded a clear pattern. In contrast the investigation of the effects of the extent of abuse clearly indicates that the variety, severity, frequency, and duration of abuse affects adjustment (Berliner & Elliott, 2002; Carr, 2006a; Kolko, 2002; NCCANI & NAIC, 2004; Wekerle & Wolfe, 2003). Poorer adjustment is associated with

Effects of institutional rearing

3.38The scientific literature on the effects of institutional living, abuse and neglect is sparse (Gallagher, 1999; Gilligan, 2000; Powers et al., 1990; Rutter et al., 1990; Rutter et al., 2001; Wolfe et al., 2006). In the short-term, institutional rearing has profound effects on cognitive and social development and some of these difficulties do not resolve when youngsters are placed for adoption. Children reared in institutions from birth until 2 years and then adopted, at 4 and 6 years showed impaired cognitive development, attachment problems, inattention and overactivity, and quasi-autistic features (Rutter et al., 2001). Wolfe et al. (2006) found that 88% of a group of 76 Canadian adult survivors of institutional abuse, at some point in their lives, suffered from a psychological disorder (as defined in the fourth edition of the American Psychiatric Association Diagnostic and Statistical Manual (DSM IV, American Psychiatric Association, 2000). PTSD, other anxiety disorders, depression and alcohol abuse were the most common disorders. The international literature on the long-term effects of being reared in an institution has shown that compared with children reared in families, those reared in institutions had poorer adjustment (Rutter et al., 1990; Rutter, 2002). This was shown by

Processes mediating the long-term effects of child abuse

3.39The long-term outcomes of child abuse are probably mediated by psychological processes (Wolfe et al., 2003), particularly the following:

Clerical abuse

3.40The small international research literature on clerical abuse indicates that this may have a detrimental effect on spirituality and lead to a disengagement from religious and spiritual beliefs and practices. This includes a loss of faith in God and organized religion; abandonment of the practice of private prayer; and withdrawal from public religious rituals such as mass attendance (e.g. Bottoms et al., 1995; Farrell & Taylor, 2000; Fater & Mullaney, 2000; McLaughlin, 1994, Rossetti, 1997; Wolfe et al., 2006). This may be conceptualized as an aspect of disrespect for authority (mentioned above) uniquely associated with clerical abuse.

3.41In Ireland, a small qualitative study of 22 survivors of clerical abuse is contained in the Time to Listen Report on Confronting Child Sexual Abuse by Catholic Clergy (Goode, McGee & O’Boyle, 2003). Some but not all, survivors in this study experienced anxiety, depression, suicidal ideation, intimacy difficulties, family relationship problems, a decline in confidence in the Church and loss of faith. These findings are consistent with those from international studies.

Functional and dysfunctional coping strategies

3.42The international scientific literature on stress, coping, risk and resilience in children exposed to early childhood adversity suggests that children may engage in functional and dysfunctional coping strategies to deal with adversity including the process of institutional rearing and institutional abuse (Luthar, 2003; Rutter et al., 1990). Functional coping strategies, which may protect children from the negative impact of abuse, include

3.43Social support refers to developing socially supportive relationships which make enduring abuse more tolerable. Skill mastery involves having positive experiences in which academic, sporting, musical or technical skills are developed and refined, usually within the context of mentoring relationships with teachers who foster such achievement. Planning skills refer to short and long-term planning to avoid abuse and escape from adversity. In the short-term this may mean organizing each day to keep away from abusers and have basic needs met. In the long-term it involves making an active and reasoned vocational choice, and choice of marital or co-habiting partner. Active vocational choice means deciding what sort of work one might be good at and then trying to find such work rather than drifting into various jobs opportunistically. Active choice of partner means knowing a partner for more than 6 months before deciding that they are suitable for a long-term relationship, rather than impulsively entering a long-term relationship. A supportive marital relationship refers to developing a relationship with a non-deviant, marital partner in whom the person can confide. Spiritual support involves deriving a sense of support from religious practices such as praying or talking with priests.

3.44Dysfunctional coping strategies may include either fully complying with the abusive regime or aggressively opposing it without due regard to the risks of further abuse entailed by this. Excessive consumption of alcohol, drugs and food are other potentially dysfunctional coping strategies.

Conclusions

3.45From this cursory review, a number of tentative conclusions may be drawn. Negative childhood experiences may lead to significant adult adjustment problems including psychological disorders and an impoverished quality of life. The negative effects of such early adversity is probably strongly related to the variety, severity, frequency, and duration of negative experiences. The long-term outcomes of negative childhood experiences may be mediated by critical psychological processes for example, traumatization and re-enactment of negative experiences on self or others. If the negative childhood experiences occur within the context of a religious institution, religious disengagement may also occur. The negative effects of adversity may be attenuated by the use of functional coping strategies such as developing social support or mastering skills. In contrast, the adverse effects of negative experiences may be exacerbated by the use of dysfunctional coping strategies such as overcompliance or avoidance. These conclusions are summarized in the model presented in Figure 1.1.

Figure 1.1. A model of the effects of childhood institutional abuse on adult adjustment.

Part 2 Methodology

Summary of Part 2

3.46The overarching aim of the present study was to profile subgroups of adult survivors of institutional child abuse on demographic, historical and psychological variables with a view to detecting associations between recollections of institutional living and current adjustment. In particular the aim was to profile subgroups of survivors defined by (1) the number of years spent in an institution and the circumstances under which admission occurred; (2) the worst type of institutional abuse experienced; and (3) the number and type of psychological disorders displayed. An additional aim was to develop a way to assess psychological processes and coping strategies associated with institutional abuse, and establish the correlates of these processes and coping strategies.

3.47Between May 2005 and February 2006 just under 250 adult survivors of institutional living recruited through CICA were interviewed in Ireland and the UK by a team which included 29 trained interviewers, all of whom had degrees in psychology. The overall exclusion rate was 26% (326 of 1267); the participation rate was 20% (246 of 1267); and the response rate for the study was 26% (246 of 941). (This low response is not unusual. A response rate of 9% was obtained in the Time to Listen Report on Confronting Child Sexual Abuse by Catholic Clergy (Goode, McGee & O’Boyle, 2003)).

3.48The sample of participants interviewed was not representative of all CICA attenders, or indeed of adult survivors of institutional living. It is probable that participants were better adjusted than CICA attenders who did not take part because the old and the ill were excluded. The interview protocol covered demographic characteristics, history of family and institutional living, recollections of child abuse within the family and institutions, psychological processes associated with institutional life, coping strategies used to deal with institutional life, current trauma symptoms, current and past diagnoses of psychological and personality disorders, relationships with partners and children, adult attachment style, main life problems, current quality of life, and global level of functioning. Interviews were conducted in an ethical way that safeguarded participants’ wellbeing. Data were managed in a way to safeguard participants’ anonymity.

Aims of the study

3.49Survivors of institutional living who have attended CICA are by no means a homogeneous group. They may be classified in a variety of ways. For example, they may be classified by historical factors such as the number of years they have spent in an institution, the circumstances under which they were admitted and the type of institutional abuse they experienced. They may also be classified by their current psychological status, for example, by the number and type of psychological disorders they display. The overarching aim of the present study was to investigate this variability shown by groups of adult survivors of institutional living with a view to profiling these groups and detecting associations between recollections of child abuse and current adjustment.

3.50In the first instance we set out to profile subgroups of participants with different histories of institutional living, specifically:

3.51In profiling subgroups our interest was in the status of these groups on historical and demographic factors, recollections of child abuse, psychological disorders, trauma symptoms, life problems, quality of life, global functioning, current family relationships, and attachment style. The main hypothesis suggested by the literature review was that people who had spent more time living in an institution would show poorer adjustment that those who had spent only a brief period living in an institution.

3.52Next, we aimed to profile subgroups of participants with different histories of institutional abuse, specifically those whose worst abusive experience was multiple forms of severe abuse, versus those who identified their worst experience as involving a single form of abuse: physical, sexual or emotional.

3.53The third aim was to profile subgroups of participants with different numbers and types of psychological disorders.

3.54The fourth aim of the study was to develop a way to assess psychological processes and coping strategies associated with institutional abuse, and investigate the relationships between these processes and coping strategies on the one hand, and past abuse and current adjustment on the other.

3.55To achieve these aims, the methodology described in this Part was used. A project team was established. An assessment protocol was developed. Participants were recruited into the study by CICA and the research team. Interviewers engaged participants in interviews using the assessment protocol. Data from the protocol were analysed by computer using statistical procedures appropriate to address the aims of the study outlined above. Procedures were built into the methodology to safeguarded the welfare of participants. These procedures were consistent with the ethics code of the Psychological Society of Ireland and the research plan was approved by the UCD human research ethics committee. This Part contains a detailed description of these research methods. Data analysis and results are presented in subsequent Parts.

Time frame

3.56This research project was planned between January and April 2005. Data were collected between May 2005 and February 2006, and the report was produced between March and June 2006.

Research team

3.57The research team included

Project director and administrator

3.58Professor Alan Carr, PhD, Director of the Doctoral programme in Clinical psychology UCD, was the Principal Investigator and Project Director. Muriel Keegan, MA, Administrator for the Doctoral Programme in Clinical Psychology was the Project administrator. She managed communication within the project team and between the team, CICA and participants. She also administered project finances and arranged document production.

Three clinical psychology postgraduates

3.59Mark Fitzpatrick, BA, MSc, DipCounsPsych; Edel Flanagan, BA, MSc, and Roisín Flanagan, BA, MSc, all of whom were doctoral postgraduates in clinical psychology at UCD trained, supervised and supported a team of interviewers (mentioned below). They conducted a portion of the interviews. They also checked all interview protocols for completeness, conducted data entry, managed data analysis, and tabulated statistical results. In addition, at the time of writing this report, each of these three postgraduates are in the process of writing doctoral theses and articles for publication in peer reviewed journals based on analyses of specific aspects of the data set arising form the project. All three postgraduates are members of cohorts of 10 candidates selected bi-annually from over 150 applicants to the UCD doctoral programme in clinical psychology. They are highly qualified, having masters degrees in psychology, and a significant amount of clinical experienced and training.

Interview organizers

3.60Kevin Tierney, BA (Hons Psych) and Megan White BA (Hons Psych) organized and scheduled interviews linking with participants, the interview team, and contact people at the various regional interview sites. They also offered back-up support to interviewers in meeting and greeting participants at UCD where this was appropriate.

Panel of interviewers

3.61Interviews were conducted by a panel of 29 interviewers which included the three clinical psychology postgraduates, the two interview organizers and the following 24 interviewers: 1. Carmel Howard, HDipPsych; 2. Susan Gavin, BA ; 3. Philomena Crotty, HDipPsych; 4. Anne Donnelan, HDipPsych; 5. Tara Davis, MLitt; 6. Aongus McGrane, HDipPsych; 7. Mimi Tatlow, HDipPsych; 8. Dervalla Mannion, HDipPsych; 9. Barbara Hernon, BA; 10. Maria Mannion, HDipPsych; 11. Su Yin Yap, BA; 12. Eimear McMahon, HDipPsych; 13. Aoife McCann, HDipPsych; 14. Evita O’Malley, HDipPsych; 15. Mairead Dowling, HDipPsych; 16. Marie McGrath, BA; 17. Mary Keating, BA; 18. Eoin O’Connell, MLitt; 19. Faye Scanlan, BA; 20. Lynsey O’Keeffe, BA; 21. Elaine Smith, PhD; 22. Lucy Smith, MA; 23. Brid O’Donoghue, BA; and 24. Julie Grace, BA. All interviewers had an honours degree in psychology or a higher diploma in psychology and were eligible for graduate membership of the Psychological Society of Ireland. All interviewers were trained in administering the interview protocol by the clinical psychology postgraduates, who in turn were trained by the project director.

Project consultants

3.62Dr Barbara Dooley, PhD, Director of Postgraduate Research and Head of the School of Psychology at UCD and Dr Mark Shevlin, PhD, Senior Lecturer, School of Psychology, University of Ulster provided statistical consultancy to the project. Dr Jonathon Egan, M Psych Sc, PsyD, Director of NCS Arches Counselling Service, National Health Executive, liaised between the project team and the directors of the network of National Counselling Service centres around the country. He advised on how best to arrange counselling for those participants who required referral to the NCS following participation in the study. He also advised on how to make the interviewing process as user-friendly and minimally distressing as possible. Margaret Daly, MPsychSc, Lecturer in Psychology UCD, provided interviewer support consultancy to the project.

Participants

3.63247 adult survivors of institutional abuse in industrial and reformatory schools participated in this study. All but one had attended the Commission to Inquire into Child Abuse (CICA). The one non-CICA attender, was the sibling of a person who attended CICA. Both siblings came to the interview centre together and asked that each be interviewed and that data from both be included in the study. For ethical reasons, an exception was made in this one case and the data from this non-CICA attender has been included in the analysis.

3.64Of the 246 CICA attenders, 175 were recruited from the confidential committee and 71 from the investigation committee. 126 were living and interviewed in Ireland. 120 were living and interviewed in the UK.

3.65The path of recruitment and attrition for both the confidential and investigation committees is presented in Figure 2.1. The 175 confidential committee attenders were recruited in the following way. 1086 people had attended the confidential committee when recruitment into the research study began in 2005. Of these 1086, 775 reported abuse in industrial and reformatory schools and 311 reported abuse in other institutional and out of home care settings such as children’s homes, residential institutions for children with special needs, hospitals, national and secondary schools and foster care. Of the 775 who reported institutional abuse in industrial and reformatory schools, 571 were invited to participate in the research study. Invitations were not sent to 204 cases who met at least one of the following criteria: whereabouts unknown; resident outside Ireland and UK; previously stated they did not want to participate in research project; previously stated they did not want to be contacted by CICA; known to be deceased; or known to be in poor health or to have a significant disability. Of the 571 cases invited, 347 replied, and 224 did not. Of those that did not, 9 invitations were returned as unknown at address and 2 were returned without any identifying details. Of the 347 who replied, 225 agreed to participate and 122 declined the invitation. Of the 225 who agree to participate, 175 attended interviews and 50 did not.

3.66The 71 investigation committee attenders were recruited in the following way. The investigation committee had heard, or had scheduled to hear, or had interviewed, or had scheduled for interview 492 complainants prior to December 2005. Of these 492 complainants, invitations were sent to 370 between July and November 2005. These 370 complainants were within the remit of the research project; were resident in Ireland or UK or contactable through a solicitor; had decided to remain with the investigation committee; and were not likely to submit additional evidence to the investigation committee hearings after December 2005. Of the 370 complainants, the investigation committee received 110 positive replies. Of the 110 replies, 11 were not forwarded to the research team because they were not resident in Ireland or UK; were not proceeding with the investigation committee; or had indicated they did not wish to take part in the research project. Of the 99 who agreed to participate, 71 attended interviews and 28 did not. The path of recruitment and attrition for the combined confidential and investigation committees is presented in Figure 2.2.

3.67The overall exclusion rate was 26%. 326 of 1267 potential participants who attended CICA and reported abuse were excluded from the study for various reasons such as living outside Ireland and the UK, being untraceable, being too ill or disabled to participate, and not wishing to take part in the study.

3.68Approximately 20% of CICA attenders participated in this study. Out of a total pool of 1267 people who attended either of CICAs committees and reported institutional abuse, 246 completed interviews. This group were clearly not a representative sample of CICA attenders, or of the total population of adult survivors of institutional living of whom CICA attenders form a subgroup. Our sample is not representative of the very ill, those who live outside Ireland and the UK, those who were untraceable, and those who did not wish to participate in the study. It is probable that the group who participated in the study were better adjusted than those who did not take part.

3.69The response rate for the study was 26%. Out of a pool of 941 people invited for interview, 246 were actually interviewed.

Assessment interview

3.70Participants were interviewed with a standard assessment protocol which is contained in appendix 1. This protocol covered the following domains

3.71The protocol included the following instruments:

A description of each of these instruments is given below.

Demographic and historical questionnaire

3.72The DHQ was used to obtain information on age, gender, education, occupational status, marital status, parental status, children, socioeconomic status, and dates and circumstances of entering and leaving institutional care.

Institutional abuse scale

3.73The 13 item IAS covered items unique to institutional settings and predominantly involving emotional abuse. The items were identified during pilot testing of the original interview protocol, when participants indicated that the Childhood Trauma Questionnaire did not cover areas unique to the institutional setting. These items cover fear of unpredictable punishment; being told that the self and parents are bad; that the parents no longer love the child; separation from siblings; having clothes and treasured possessions taken away; and the experience of having hope taken away. The reliability of the instrument was confirmed in the present study and reliability data are contained in Table 3.11.

Childhood Trauma Questionnaire

3.74The CTQ is a 28-item self-report inventory that provides a reliable and valid assessment of current recollection of the overall pattern of childhood abuse and neglect (Bernstein & Fink,1998). It yields scores for five maltreatment scales: (1) physical abuse, (2) sexual abuse, (3) emotional abuse, (4) physical neglect, and (5) emotional neglect. Also included is a 3 item minimization and denial scale for detecting false-negative trauma reports. CTQ scores for any case can be compared to norms from more than 2,200 males and females from seven different clinical and community samples, representing a broad range of ages, socioeconomic status and different racial and ethnic groups. In the present study cut-off scores for the CTQ were based on norms developed in a large community study of 1007 18-65 year old men and women in Memphis, USA (Scher et al., 2001). The CTQ has good test-retest reliability and scores from it are very stable over time. It has good convergent and divergent validity with trauma histories from other measures. It is highly sensitive to identifying individuals with verified histories of abuse. In the present study participants completed two versions of the CTQ, one to evaluate their recollections of abuse within their families (if they spent any time in their families as children) and one to evaluate their recollections of abuse while living in an institution.

Most severe forms of physical and sexual abuse

3.75For the SPSA participants were asked to recall the most severe forms of physical and sexual abuse to which they were subjected in both their families and institutions and these were rated on scales derived from Slep and Heyman’s severity rating system (2004). In each instance they were asked to indicate the frequency and duration of this most severe form of physical and sexual abuse and the age at which it began. Retrospective reports of such events tend to be more valid than those of events open to greater interpretation. In a review of 8 studies of the validity of retrospective reports of abuse, Hardt and Rutter (2004) found a substantial rate of false negatives among adult reports of major adverse experiences in childhood that allowed a reasonable operationalisation (such as most severe events). Thus, retrospective reports of clearly describable episodes of child abuse are a conservative index of abuse in adult survivors. In the studies Hardt and Rutter reviewed, validity was assessed by means of comparisons with contemporaneous, prospectively obtained, court or clinic or research records; by agreement between retrospective reports of two siblings; and by the examination of possible bias with respect to differences between retrospective and prospective reports in their correlates and consequences. Hardt and Rutter (2004) in a further review of 6 studies found that over periods of at least 6 months, adult retrospective reports of child abuse showed good test-retest reliability. These results justify the use retrospective reports of abuse in the current study. The reliability of the institution version of the SPSA was confirmed in the present study, but the family version of the SPSA had low reliability, so cautious interpretation of the family version is warranted. Reliability data are contained in Table 3.11.

Institutional Abuse Processes and Coping Inventory

3.76The 58 item IAPCI was designed specifically for this study to evaluate psychological processes and coping strategies associated with the experience of institutional abuse and later life difficulties. The following processes were covered in a series of rational scales: (1) traumatization, (2) betrayal, (3) disrespect of authority, (4) religious disengagement, (5) stigmatization, (6) powerlessness, (7) avoidance, and (8) re-enactment. The following functional coping strategies were covered: (1) social support, (2) skill mastery, (3) planning; and (4) spiritual support. The inventory also assessed these dysfunctional coping strategies: (1) overcomplying; (2) aggressively opposing, and (3) substance abuse. Five point response formats were used for all items ranging from 1=never true to 5=very often true. In the present study two versions the IACPI were used. The first inquired about processes and coping strategies used while living in an institution and the second inquired about the same processes and coping strategies in the person’s present life.

3.77The factorial structure and reliability of the IAPCI were evaluated in the present study and this is described in Part 6. Six factors scales with moderate to good reliability were developed. The scales were (1) traumatization which assesses negative emotions arising from abuse, betrayal and loss of trust, stigmatization, shame, guilt, and disrespect of authority; (2) re-enactment which assesses re-enactment of abuse, powerlessness, coping by opposing and coping by using alcohol and drugs; (3) spiritual disengagement which assesses disengagement from religious practice and not using spiritual coping strategies; (4) positive coping which assesses coping through planning, skill mastery and social support; (5) coping by complying which assesses coping by complying with the wishes of people in authority; and (6) avoidant coping which assesses coping by avoiding thoughts and situations associated with abuse.

Personal strengths

3.78Participants’ views of their personal strengths and resources that have helped them to cope with life’s challenges were evaluated with three items. These were included at the end of the interview so that participants closed the interview with an awareness of their strengths rather than their deficits.

Structured Clinical Interview for Axis I Disorders of DSM IV

3.79The SCID I (First et al., 1996) is a reliable and valid semistructured interview for assessing psychological disorders listed in the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR, APA, 2000). In this study the modules for assessing anxiety, mood and substance use disorders were used, since previous studies suggest that these are the main psychological disorders shown by adult survivors of child abuse. The anxiety disorders module yields diagnoses for posttraumatic stress disorder, panic disorder with and without agoraphobia, agoraphobia, social phobia, specific phobias, obsessive compulsive disorder, and generalized anxiety disorder. The mood disorders module yields diagnoses for major depression and dysthymia. The substance use module yields diagnoses for alcohol and other substance dependence and abuse disorders. The presence of both current disorders and past (or lifetime) disorders were assessed. Diagnoses were reliably made with inter-rater reliabilities between .77 and 1.00 as shown in Table 3.7.

Structured Clinical Interview for DSM IV Personality Disorders

3.80The SCID II is a reliable and valid semistructured interview for assessing all DSM-IV-TR axis II personality disorders (First et al., 1997). In this study the modules for antisocial, borderline, avoidant and dependent personality disorders were used, since previous studies suggest that these are the main personality disorders associated with adult survival of child abuse. With the SCID II, only current (but not past) personality disorders were assessed. Diagnoses were reliably made with inter-rater reliabilities between .96 and 1.00 as shown in Table 3.7.

Trauma symptom Inventory

3.81The 100 item TSI is a reliable and valid instrument which evaluates posttraumatic symptomatology (Briere,1996). A four point response format was used for all items from 0 = never to 3 = often. The TSI yields scores for three validity scales and ten clinical scales. The three validity scales are: (1) response level which assesses a tendency toward defensiveness or a need to appear unusually symptom-free; (2) atypical response which assesses attempts to appear very dysfunctional; and (3) inconsistent response which reflects a random response set or difficulty understanding items. The clinical scales are (1) anxious arousal; (2) depression; (3) anger and irritability; (4) intrusive experiences which assesses PTSD symptoms such as flashbacks, nightmares, and intrusive thoughts; (5) defensive avoidance of cues that remind the person of trauma ; (6) dissociation which covers depersonalization, out-of-body experiences, and psychic numbing; (7) sexual concerns which covers distress associated with sexual dissatisfaction, sexual dysfunction, and unwanted sexual thoughts or feelings; (8) dysfunctional sexual behaviour ; (9) impaired self-reference which covers identity confusion; and (10) tension reduction behaviour which covers self-harm, and anger control problems. Sex- and age-normed T scores are provided for all 13 scales. These allow statements to be made about the percentage of cases that scored outside the normal range compared with specific reference groups.

Life problem checklist

3.82The LPC is a 14 item list constructed for the present study. It provided a rapid survey of key problem areas including unemployment, homelessness, frequent illness, frequent hospitalization for physical and mental health problems, psychological disorders, substance use, self-harm, anger control in close relationships and criminality. The reliability of the instrument was confirmed in the present study and reliability data are contained in Table 3.11.

World Health Organization Quality of Life 100 UK Version

3.83The WHOQOL is a reliable and valid instrument which yields an overall quality of life score along with scores for 6 domains and 24 facets (Skevington, 2005). Four items are included for each facet, as well as four general items covering overall QOL and health, and there are 2 items unique to the UK version of the instrument, producing a total of 102 items. All items were rated on five point scales. The domains are physical well-being; psychological well-being; level of independence; quality of social relationships; quality of the environment; and quality of spiritual life. The 24 facets are classified by domain. The following facets fall within the physical well-being domain: (1) pain and discomfort, (2) energy and fatigue, and (3) sleep and rest. The following facets fall within the psychological well-being domain: (4) positive feelings, (5) thinking, learning, memory and concentration, (6) self-esteem, (7) bodily image and appearance, and (8) negative feelings. These facets fall within the level of independence domain: (9) mobility, (10) activities of daily living, (11) dependence on medication or treatments, and (12) work capacity. The domain of social relationships contains the following facets: (13) personal relationships, (14) social support, and (15) sexual activity. The environment domain contains these facets: (16) physical safety and security, (17) home environment, (18) financial resources, (19) accessibility and quality of health and social care, (20) opportunities for acquiring new information and skills, (21) participation in and opportunities for recreation/ leisure activities, (22) physical environment (pollution/noise/traffic/climate), and (23) transport. The spiritual domain contains the single facet of spirituality. The reliability of the instrument was confirmed in the present study and reliability data are contained in Table 3.11.

Global assessment of functioning

3.84The GAF is a reliable and valid rating scale for recording a global judgement about a person’s overall psychological, social, and occupational functioning, excluding impairment due to physical or environmental factors following a semi-structured interview (Luborsky, 1962). It is included in DSM-IV-TR as the Axis V assessment and forms part of the SCID. In the present study interviewers gave a single rating from 1–100. The scale was divided into ten ranges of functioning, but intermediate scores were given when applicable.

Kansas Marital Satisfaction Scale

3.85The 3 item KMS assesses perceptions of the quality of marital or long-term cohabiting relationships (Schumm et al., 1986). Seven point response formats were used for the three items ranging from 1=extremely dissatisfied to 7=extremely satisfied. The items assess satisfaction with one’s partner and the relationship as a whole. Despite its brevity, the KMS has been shown to correlate highly with other more extensive measures of marital satisfaction.

Kansas Parenting Satisfaction Scale

3.86The 3 item KPS assesses parents’ perceptions of the quality of their relationship with their children (James et al., 1985). Seven point response formats were used for the three items ranging from 1=extremely dissatisfied to 7=extremely satisfied. The items assess satisfaction with one’s children, the parenting process and overall parent-child relationships. Despite its brevity, the KPS has been shown to correlate highly with other more extensive measures of parenting satisfaction.

Experiences in Close Relationships scale

3.87The 36-item ECRI is a reliable and valid instrument for assessing adult romantic attachment style and yields scores on interpersonal anxiety and interpersonal avoidance dimensions (Brennan et al., 1998). On the basis of scores on these two dimensions, using an SPSS algorithm, cases may be assigned to one of four adult attachment style categories: secure, fearful, dismissive and preoccupied. Cases with low anxiety and avoidance scores are classified as having a secure attachment style. People with this attachment style tend to make and maintain stable relationships with adult romantic partners, while those with the other three styles typically have relationship difficulties. Cases with both high anxiety and avoidance scores are classified as having a fearful attachment style. Cases with high interpersonal anxiety and low avoidance scores are classified as having a preoccupied attachment style. Interpersonal anxiety leads these people to consistently demand excessive proximity and closeness from their partners. Cases with high interpersonal avoidance and low anxiety scores are classified as having a dismissive attachment style. Such people insist on excessive emotional distance without experiencing interpersonal anxiety. Seven point response formats are used for all items ranging from 1=disagree strongly to 7=agree strongly. The ECRI was developed from a pool of over 600 items identified in a review of 14 self-report measures of adult attachment. The avoidance and anxiety factors were identified by factor analyses, so there is evidence for the construct validity of the scale.

Procedure

3.88Specific procedures were used for

Recruiting participants

3.89The CICA confidential and investigation committees invited all those who had reported institutional abuse and attended these committees prior to December 2005 to participate in the study, with some exceptions. Those resident outside Ireland or the UK, those too ill to participate, and those who indicated that they did not wish to participate were excluded (along with a small number of cases deemed unsuitable for other reasons specified in the ‘Participants’ section above). Confidential committee attenders were contacted personally and investigation committee attenders were contacted through their solicitors. Between June and December 2005, CICA provided the research team at UCD with lists of participants, who had agreed in writing to be contacted by the research team.

3.90The interview organizer contacted each participant, described what participating in a research interview would involve and offered an interview, using the recruitment script in Appendix 2.

Pilot testing the interview protocol

3.91The 3 clinical psychology postgraduates pilot-tested and fine-tuned the optimal way for conducting interviews with 3 participants prior to interviewer training. The pilot testing informed the way in which the panel of interviewers were trained.

Interviewer training, supervision and support

3.92The three clinical psychology postgraduates under the supervision of the project director developed and delivered an interviewer training programme to the panel of interviewers. The programme involved coaching interviewers in meeting participants; taking them to the interview room; explaining the rationale for the study; obtaining informed consent; developing rapport; conducting interviews; offering breaks and refreshments; adhering to the interview protocol; checking interviews for completeness; managing client distress; informing clients about how to contact NCS or ICAP counsellors; and parting from clients in an appropriate way with the reminder that a follow-up contact would be made. Part of the training programme involved viewing videotapes about how to rate the SCID I and II when making DSM IV diagnoses. The three postgraduates also met as required with members of the panel of interviewers during the data collection period to offer supervision and support.

Interviewing process

3.93Interviews were conducted by the team of 29 interviewers who each conducted between 1 and 30 interviews. Interviews were conducted at 35 sites, 12 in Ireland and 23 in the UK. The sites included university psychology departments, counselling and survivor support centres, and hotels. In addition 14 cases were interviewed in their homes, 2 in Ireland and 12 in the UK. For all interviews (excluding home visits), participants met interviewers at designated meeting points arranged with the interview organizer. Interviewers identified themselves by carrying a white card with INTERVIEWER written on it, so that participants did not have to identify themselves to reception staff. This preserved the anonymity of participants. Participants were greeted warmly and escorted to interview rooms. Interviewers again explained the way the interview would be conducted and the overall context of the study. It was mentioned that the study was being conducted by a team from University College Dublin at the invitation of the Commission to Inquire into Child Abuse; that it would involve an interview of about 2 hours duration; that participation was voluntary; that the interview would be fully confidential; that participants could withdraw from the study at any time; and that they might be invited to participate in a follow-up interview. Participants then were invited to sign the consent form at the top of the interview protocol. The interviewer then worked through the interview questions in the sequence specified in the protocol.

3.94Where participants wanted to deviate from the protocol and discuss specific issues in details, interviewers said the following script: ‘ I understand that this is something you need to discuss. However, for this study we both have to follow the questions in this questionnaire. But, if you need to talk further about this issues, we can advise you how to contact a counsellor in your area who specializes in helping survivors of institutional living address these sorts of issues.’

3.95Where participants became distressed or tired, interviewers said this script: ‘I can see that you are distressed/tired. Would you like to take a break for a few minutes?’ Clients were offered water, soft drinks, tea or coffee during these breaks and during interviews.

3.96The final set of questions in the interview were about personal strengths and resources. This allowed clients to focus on positive aspects of their lives and contributed to eliciting a positive mood as the interviews ended. At the conclusion of each interview, interviewers thanked participants, informed them that the independent report of the results of the study of survivors of institutional living would be submitted to the Commission to Inquire into Child Abuse and referred to in the final Report of the Commission to Inquire Into Child Abuse, to which they would have access. They were also informed that as a routine procedure all participants would be given a leaflet on how to contact a counsellor as described below under ethical issues. Participants were also given an opportunity to add further comments or ask questions. In addition they were offered the option of receiving a call in a few days to check that they were ok and that there was nothing further that they wish to add or ask at that point. This provided a way of maintaining contact with participants who may have found the interview distressing. Almost all participants availed of this offer.

Interrater reliability interviews

3.97Inter-rater reliability of all scales was evaluated by conducting interviews with 52 participants in which 2 interviewers were present and each completed independent protocols for the same set of 52 cases. Data from pairs of independently completed interview protocols were analysed to evaluate the inter-rater reliability of the scales and items in the protocols. When inviting participants to engage in the inter-rater reliability study, interviewers said at the outset of the interview ‘There will be three of us in this meeting (indicating the 2 interviewers and the participant). Each of us will be keeping a record of the interview, but only I will be talking with you.’ The 52 cases involved in the reliability study constituted part of the overall sample of 247 cases.

Ethical issues

3.98The study was designed to comply with the code of ethics of the Psychological Society of Ireland. In addition, ethical approval for the study was obtained through the Human Research Ethics Committee at University College Dublin.

3.99Every effort was made to insure that the research interviews were carried out in a way that was minimally distressing for participants. However, for some candidates answering questions about traumatic events and life problems was distressing. All candidates were informed at the outset of the interview that they could take breaks during the interview to reduce distress, or leave the interview altogether at any time if it became too distressing. All participants were given the leaflet in Appendix 2 containing the addresses and telephone numbers of the National Counselling Service (NCS) national network of counselling centres and contact details for the Immigrant Counselling and Psychotherapy service (ICAP) in the UK. They were advised to contact their regional office at any time if they required counselling for abuse-related issues including those arising from the research interview. Dr Jonathon Egan, Director of the NCS Midland Office, was a consultant to the proposed research project. He briefed colleagues in all NCS centres about the study, and was available to provide information on its possible impact on participants, and the appropriate NCS response to study participants who contacted the NCS following participation in the study. In the UK Teresa Gallagher, Director of ICAP was contacted for advice on referrals to ICAP centres in the UK. Over the 6 months of data collection fewer than 5% of participants required referral for counselling.

Data management

3.100Hardcopies of interview protocols were stored in locked filing cabinets in the School of Psychology at UCD. Each protocol contained a case number. Data from each protocol identified by case number, but not the participants name were entered into an SPSS data file by the team of 3 postgraduates and interview organizer. This master SPSS data file was held on three laptop computers and each of the three Postgraduates had responsibility for these laptops. They each undertook specific data analysis tasks.

3.101The entries in the data file followed the order in the assessment protocol. The variable names were those specified in the left column (e.g. D1, D2, D3....KMS1, KMS2, KMS3, E1, E2 etc.). The variable values for each case were the numbers associated with the responses to each question, marked in ink on the protocol. When the data file was complete, the ranges of all variables were checked to detect errors such as double keying. Missing data points were identified and a rational approach to manual mean substitution was used for missing data, where possible. For ‘reverse scored’ items from multi-item scales, ‘recode’ SPSS commands were used to reverse the direction of scoring. ‘Compute’ SPSS commands were used to calculate multi-item scale scores.

Conclusions

3.102The aim of the present study was to profile subgroups of adult survivors of institutional child abuse on demographic, historical and psychological variables with a view to detecting associations between recollections of institutional living and current adjustment. In particular the aim was to profile subgroups of survivors defined by (1) the number of years spent in an institution and the circumstances under which admission occurred; (2) the worst type of institutional abuse experienced; and (3) the number and type of psychological disorders they displayed. An additional aim was to develop a way to assess psychological processes and coping strategies associated with institutional abuse, and establish the correlates of these processes and coping strategies. Between May 2005 and February 2006 just under 250 adult survivors of institutional living recruited through CICA were interviewed in Ireland and the UK by a team which included 29 trained interviewers, all of whom had degrees in psychology. The overall exclusion rate was 26% (326 of 1267). The participation rate was 20% (246 of 1267). The response rate was 26% (246 of 941). The sample of participants interviewed was not representative of all CICA attenders, or indeed of adult survivors of institutional living. It is probable that participants were better adjusted than CICA attenders who did not take part because the old and the ill were excluded. The interview protocol covered a range of areas related to current adjustment and past history. Interviews were conducted in an ethical way that safeguarded participants’ wellbeing. Data were managed in a way to safeguard participants’ anonymity.

Figure 2.1. The path of recruitment and attrition for participants from the CICA confidential and investigation committees

Part 3 Characteristics of the sample

Summary of Part 3

3.103The 247 participants in this study included roughly equal numbers of men and women of about 60 years of age, who had entered institutions run by nuns or religious brothers due to family adversity or petty criminality. The majority were of lower socioeconomic status and low educational attainment. The majority had been or were currently married or in long-term relationships, with a high rate of relationship stability. Most married participants had children, with three children being the average, and most brought up their own children.

3.104On the institutional version of the Childhood Trauma Questionnaire, more than 90% of participants were classified as having experienced institutional physical and emotional child abuse and about half as having experienced institutional child sexual abuse. More than 90% were classified as having experienced physical and emotional neglect within institutions.

3.105For about 40% of participants, severe physical abuse was the worst thing that happened to them in an institution. For a further third it was humiliation and degradation. For 16% it was sexual abuse and for about a tenth it was combined physical and sexual abuse. On average, worst institutional abusive experiences began at about 9 years and lasted for 5 about years.

3.106On the family version of the Childhood Trauma Questionnaire just over a third of those who had memories of having lived with their families reported family-based child abuse or neglect.

3.107All participants had experienced one or more significant life problems. Mental health problems, unemployment and substance use were the three most common difficulties.

3.108Self-reliance, optimism, work and skills were the most frequently reported sources of personal strength and factors that helped participants face life challenges.

3.109About four fifths of participants at some point in their life had had a psychological disorder and only a fifth had never had any psychological disorder. Anxiety disorders were the most common, followed by mood disorders, followed by substance use disorders. Personality disorders were the least common. The overall rates of psychological disorders among survivors of institutional living in the present study, were far higher, and in most cases double those found in normal community populations in major international epidemiological studies

3.110The majority of participants showed clinically significant posttraumatic symptomatology on the Trauma Symptom Inventory, indicative of continuing posttraumatic adjustment difficulties.

3.111On the Experiences in Close Relationships Inventory more than four fifths of participants were classified as having an insecure adult attachment style, indicative of having problems making and maintaining satisfying intimate relationships. A fearful attachment style characterized by high interpersonal anxiety and avoidance was by far the most common. Less than a fifth of cases were classified as having a secure adult attachment style,

3.112Institutional sexual abuse was found to be associated with current post-traumatic symptomatology and major life problems.

3.113Male and female participants had different profiles. Male participants spent longer living with their families before entering institutions and fewer years in institutions. More entered institutions run by religious brothers or priests for petty crime and left because their sentence was over, while more females lived in institutions run by nuns. Male participants achieved a higher SES than females and more had children who spent time living separately form them with the child’s other parent. While their worst abusive experiences began at an older age for male participants, they reported more institutional sexual abuse. While significantly more female participants had lifetime diagnoses of panic disorder with agoraphobia, significantly more male participants had lifetime diagnoses of alcohol and substance use disorders, especially alcohol dependence. Male participants had significantly higher numbers of life problems, but also higher levels of global functioning and marital satisfaction than females.

3.114Participants under and over 59 years of age (the median age for the sample) had distinct profiles. More older participants left their institutions because they were too old to stay on and more were now retired. They had longer relationships with their current partners and were older when their first children were born. Younger participants reported greater institutional, physical, sexual and emotional abuse. More had current anxiety, mood and personality disorders, especially PTSD, generalized anxiety disorder and avoidant personality disorder. Younger participants had more trauma symptoms, adult life problems, a lower quality of life and lower level of global functioning compared with older participants.

3.115Participants from the confidential and investigation committees had distinct profiles. Participants from the confidential committee had spent fewer years with their families before entering an institution and more years in institutions run by nuns. More entered because they were illegitimate and left because they were too old to stay on. They were younger when their worst experiences began. More had maintained stable long-term relationships with their partners and provided their own children with a stable family in which to grow up. More participants from the investigation committee entered intuitions run by religious brothers or priests through the courts for petty crime and left because their sentences were over. They reported greater institutional sexual abuse than participants from the confidential committee. More participants from the investigation committee had a current diagnosis of major depression.

Introduction

3.116The overall characteristics of the sample of 247 participants is presented in this Part under the following headings:

Historical characteristics

Demographic characteristics

History of abuse

Life problems

Strengths

Psychological disorders

Trauma symptoms on the Trauma Symptom Inventory

Adult attachment styles

Reliability of multi-item scales

Correlations between indices of abuse and adjustment

Factors associated with age, gender and CICA committee attended

Historical characteristics

3.117Historical characteristics are summarized in Table 3.1. Participants had spent an average of 5.4 years living with their families before entering an institution and on average spent 10 years living in an institution. Participants reported entering institutions for various reasons including their parents being unable to look after them (42.1%), petty crime (23.5%), illegitimacy (19.43%), and parental death (14.17%). Participants gave the following reasons for leaving institutions: I was too old to stay on (71.25%), my family wanted to take me home (13.76%), my sentence was over (7.69%), I ran away (3.23%), and the institution closed down (1.61%). About half (49%) of participants had lived in institutions managed by nuns. Just under at third (31.17%) had lived in institutions managed by religious brothers or priests. About a fifth (19.83%) had lived in both types of institutions. The majority of participants were happy to leave institutions (61.5%) or had mixed feelings (34%).

Demographic characteristics

3.118Demographic characteristics are summarized in Table 3.2. The sample included almost equal numbers of males (54.7%) and females (45.3%), with a mean age of 60 years.

Current Socio-economic Status

3.119Participants were predominantly of lower socio-economic status (SES) with 24% unemployed; 15.4% unskilled manual workers; 28% semiskilled manual workers; and 12% skilled manual worker. Only 3.2% were non-manual workers. Only 3.65% were in lower professional and managerial posts, and only 0.4% had higher professional or managerial appointments. 34% of participants were retired.

Highest Socio-economic Status

3.120Since leaving school the highest socio-economic status achieved by most participants was at the lower end of the spectrum. For 42% the highest status achieved was unskilled manual work; for 25.1% is was semiskilled manual work; and for 12.6% it was skilled manual work. Since leaving school a far smaller proportion had achieved high socio-economic status. Only 8.5% had worked in non-manual jobs. Only 6.1% had worked in lower professional and managerial posts and only 0.8% had achieved higher professional or managerial appointments.

Education

3.121With respect to education, 49% had never passed any state, college or university examination. 25% had passed the Primary Certificate Examination which is usually taken at about 12 years of age at the end of primary school education. 6.1% had passed the Intermediate Certificate Examination, which it usually taken at about 15 or 16 years of age, midway through secondary school. Only 5.3% had passed the Leaving Certificate Examination, which it usually taken at about 18 years of age, and marks the completion of secondary school education. Only 3.2% had a bachelors level university degree.

Marital status

3.122With respect to marital status, 39.7% were married in their first relationship. 9.3% were married in their second relationship. 8.9% were widowed and 11.3% had never married. 19% were single and separated or divorced from their first marital or cohabiting partner. 4.5% were single and separated or divorced from second or later partner.

Stability of long term relationships

3.123With respect to the stability of long-term romantic or marital relationships, 34.6% of the 217 participants who had long term relationships were still in these relationships. 36.4% reported that they had been in one long-term relationship that had ended. 17.1% had ended two long-term relationships. 12% reported that they had been in 3 or more long-term relationships that had ended. For the 134 participants who were currently in long-term relationships or marriages, the average duration of these relationships was 31.1 years.

Children’s living arrangements

3.124For the 212 participants with children, the average number of children was 3.38, and the average age when these participants had their first child was 25.53 years. For 76.8% of these participants, their children had lived with them while they were growing up. For 13%, the children spent sometime living with the other parent. For 2.8% the children spent some time living with relatives. Only 4.7% of parents reported that their children spent some time living in care and only 2.4% had put a child up for adoption.

History of abuse

3.125Participants’ history of child abuse within institutions and families is summarized in Table 3.3.

Institution version of the Childhood Trauma Questionnaire

3.126On the total scale of the institution version of the Childhood Trauma Questionnaire (CTQ) 99.2% of cases were classified as having experienced child abuse, with most cases experiencing multiple forms of child abuse and neglect. On the CTQ subscales, 97.2% were classified as having been physically abused; 47% as having been sexually abused; 94.7% as having been emotionally abused; 97.6% as having been physically neglected and 95.1% as having been emotionally neglected. For the CTQ scales, the following cut-off scores were used in classifying cases as abused: emotional abuse 13, emotional neglect 14, physical abuse 11, physical neglect 10, sexual abuse 9, and overall CTQ child abuse score 52. These cut-off scores were two standard deviations above the mean for combined male and female normative community samples (Scher, Stein, Asmundson, McCreary & Forde, 2001).

Institutional Abuse Scale

3.127On the institutional abuse scale cases were classified as having experienced specific forms of abuse, particular to living in an institution, if participants rated items as often true or very true. 92.3% reported that they were punished unfairly by their carers. 88.7% reported that they were terrified of their carers. 88.3% reported that they could never predict when they would be punished by their carers. 85% noted that their carers tried to break them. 80.1% noted that their carers tried to take away their hope. 75.7% said that their carers told them that they were bad . 64.7% said that their carers took away their own clothes. 47% mentioned that their carers separated them from their siblings. 43% noted that their carers said their mothers were bad. 38% said that their carers destroyed their treasured possessions such as pictures, teddy bears, and mementoes. 30.4% reported that their carers told them that their mothers did not love them. 26.4% mentioned that their carers said that their fathers were bad and 21% reported that their carers told them that their fathers did not love them.

Most severe form of physical institutional abuse

3.128All participants reported that they had experienced physical abuse, serious enough to mention in answer to questions about the most severe form of physical institutional abuse they had experienced. (This is close to the 97.2% rate of physical abuse obtained on the institution version of the CTQ, a normed psychometric instrument.) 42.1% reported that being assaulted to lead to medical attention was the most severe form of physical institutional abuse to which they had been exposed. For 30% it was being hit to leave bruises; for 20.6 % it was being assaulted to lead to cuts; and for 5.7% it was being hit without being bruised. 46.6% reported that the most severe form of physical institutional abuse occurred more than 100 times. 23.9% mentioned that the most severe form of physical institutional abuse occurred 11-100 times. For 19.6% it occurred 2-10 times and for 9.7% it occurred only once. The average age when the most severe form of physical institutional abuse began was 8.5 years and the average duration was 6.7 years.

Most severe form of sexual institutional abuse

3.12950.6% of participants reported that they had experienced sexual abuse, serious enough to mention in answer to questions about the most severe form of sexual institutional abuse they had experienced. (This is close to the 47% rate of sexual abuse obtained on the institution version of the CTQ, a normed psychometric instrument.) 21.5% reported that fondling and masturbation was the most severe form of sexual institutional abuse they had experienced. For 18.6% it was oral, anal or vaginal penetration. For 6.9% it was attempted oral, anal or vaginal penetration. For 3.2% it was non-contact sex, for example, exposure. 16.6% reported that the most severe form of sexual institutional abuse occurred more than 2-10 times. 14.2 % mentioned that the most severe form of sexual institutional abuse occurred 11-100 times. For 10.5% it occurred only once and for 9.3% it occurred more than 100 times. The average age when the most severe form of sexual institutional abuse began was 10.73 years and the average duration was 2.83 years.

Worst thing that ever happened in an institution

3.130Answers to the open-ended question ‘What was the worst thing that happened to you in the institution?’ were classified into four thematically salient groups, with inter-rater agreement of over 90% for the classification of a sample of 10% of all statements. The statements from 247 participants, classified into four thematic categories, are presented in Table 3.4. For 40.1% of participants, severe physical abuse was the worst thing that happened to them in an institution. For 34.4% it was humiliation and degradation. For 16.2%, it was sexual abuse and for 9.3%, the worst thing that happened in an institution was severe combined physical and sexual abuse. Participants reported that their worst experiences began, on average, at 9.1 years and lasted, on average, for 5.3 years.

Family version of the Childhood Trauma Questionnaire

3.131121 participants had lived with their family and had sufficient memories of that time to complete the family version of the Childhood Trauma Questionnaire (CTQ). On the total scale of the family version of the CTQ 38% of these 121 cases were classified as having experienced child abuse. On the CTQ subscales, 26.4% were classified as having been physically abused; 8.3% as having been sexually abused; 20.7% as having been emotionally abused; 47.9% as having been physically neglected; and 28.9% as having been emotionally neglected. These rates are considerably lower than the rates of institutional abuse given by the institutional version of the CTQ reported above, most of which were above 90%.

Most severe form of physical abuse in the family

3.13244 participants reported that they had experienced physical abuse, serious enough to mention in answer to questions about the most severe from of physical abuse they had experienced within the family. 44 is 36%, or just over a third, of the group of 121 who had sufficient memory of living with their families to answer detailed questions about this period of their lives. Expressed as percentages of 121, 18.18% reported that being hit to leave bruises was the most severe form of physical abuse to which they had been exposed within the family. For 9% it was being assaulted to lead to medical attention; for 5.78% it was being hit without being bruised; and for 3.3% it was being assaulted to lead to cuts. Expressed as percentages of 121, 14.05% reported that the most severe form of physical abuse within the family occurred 11-100 times. 11.57 % mentioned that the most severe form of physical abuse within the family occurred 2-10 times, and for 10.74% it occurred more than 100 times. The average age when the most severe form of physical abuse within the family began was 7.29 years and the average duration was 5.2 years.

Most severe form of sexual abuse within the family

3.13314 participants reported that they had experienced sexual abuse, serious enough to mention in answer to questions about the most severe form of sexual abuse they had experienced within the family. 14 is 11.57%, or just over a tenth, of the group of 121 who had sufficient memory of living with their families to answer detailed questions about this period of their lives. Expressed as percentages of 121, 5.78% reported that fondling and masturbation was the most severe sexual abuse they had experienced within the family. For 4.13% it was oral, anal or vaginal penetration. For 1.65% it was attempted oral, anal or vaginal penetration. 4.13% reported that the most severe form of sexual abuse within the family occurred only once. 3.3 % mentioned that the most severe form of sexual abuse within the family occurred more than 100 times. For a further 3.3% it occurred 11-100 times. The average age when the most severe form of sexual abuse within the family began was 8.55 years and the average duration was 4.48 years.

Life problems

3.134All participants had experienced one or more significant life problems. Mental health problems (74.1%), unemployment (51.8%) and substance use (38.1%) were the three most common difficulties occurring in a third to three quarters of cases. Less common problems included frequent illness (29.6%), frequent hospitalisation for physical health problems (28.3%), anger control in intimate relationships (25.9%), non-violent crime (22.3%) and homelessness (21.1%). Less than a fifth of cases had problems in the following areas: self-harm (17.8%), anger control with children (13.4%), incarceration for non-violent crime (13.4%), hospitalisation for mental health problems (13%), violent crime (10.1%), and incarceration for violent crime (7.3%). The inter-rater reliability kappa coefficient for each of the life problems was above .7 indicating that the problems were reliably measured.

Strengths

3.135To assess participants perception of their own strengths they were asked - where does your strength come from?; what has helped you most in facing life challenges?; and what is the thing that means most to you in your life? A summary of responses to these questions is given in Table 3.6. Participants’ self-reliance, optimism, work and skills collectively were the most frequently reported sources of personal strength (59.3%) and factors that helped participants face life challenges (58%). Their relationships with their partners and / or family were the most commonly cited things that meant most to participants in their lives (70.2%). This was also the second most common source of strength (16.19%) along with their relationship with God or a spiritual force (16.19%). Their relationships with their partners and /or family was also the second most common factor that helped them face life challenges (25.5%). Relationship with God or a spiritual force and relationship with a friend including other survivors were cited by less than 11% of participants as factors that helped them face life challenges and things that meant most to them in their lives.

Psychological disorders

3.136Anxiety, mood and alcohol or substance use disorders were assessed with the Clinical version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I, First, Spitzer, Gibbon & Williams, 1996). Avoidant, antisocial, borderline and dependent personality disorders were assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II, First, Spitzer, Gibbon & Williams, 1997). The inter-rater reliability kappa coefficient for each of the diagnostic categories assessed was above .7 indicating that the diagnoses were reliably made (Cohen, 1960).

Overall rates of psychological disorders in survivors of institutional living

3.13781.78% of participants at some point in their life had met the diagnostic criteria for an anxiety, mood, alcohol or substance use, or personality disorder. 18.21% (or 45 participants) had never had any psychological disorder.

3.138With respect to DSM IV Axis I disorders, 64.8% of participants had at some point in their lifetime met the diagnostic criteria for a diagnosis of an anxiety, mood, alcohol or substance use disorder. 51.4% met the diagnostic criteria for a diagnosis of an anxiety, mood, or alcohol or substance use disorder when they were interviewed. With respect to DSM IV Axis II disorders, 30.4% had a personality disorder when interviewed.

3.139From Table 3.7 it may be seen that for combined current and lifetime diagnoses, anxiety disorders were the most common (current: 44.9%, lifetime: 34.4%); followed by mood disorders (current: 26.7%, lifetime: 36%); followed by substance use disorders (current: 4.9%, lifetime: 35.2%); with the rate of personality disorders being the lowest of all broad categories of diagnoses (30.4%). (Only current and not lifetime diagnoses of personality disorders may be made.)

Comparison with rates of psychological disorders in the community

3.140The overall rates of psychological disorders among survivors of institutional living in the present study, were far higher than those found in major international epidemiological studies of normal community populations conducted in Europe, the USA and the UK, summarized in Table 3.8 (Alonso et al., 2004; Grant et al., 2004; Kessler, Berglund et al., 2005; Kessler, Chiu et al., 2005; Singleton et al., 2001; Torgersen et al., 2001). The prevalence of current anxiety, mood and personality disorders among survivors of institutional living was more than twice that found in normal European, North American or British populations. The prevalence of lifetime diagnoses of anxiety, mood, and substance use among survivors of institutional living exceeded those found in normal European, North American or British populations by between 5 and 30%.

Anxiety disorders

3.141From Table 3.7 it may be seen that for anxiety disorders the three most common conditions were social phobia (current: 19.8%, lifetime: 10.9%); generalized anxiety disorder (current: 17%, lifetime: 6.9%); and posttraumatic stress disorder (current: 16.6%, lifetime: 8.5%). Other anxiety disorders were less prevalent.

Mood disorders

3.142From Table 3.7 it may be seen that for mood disorders the current (26.7%) and lifetime (36%) prevalence rates for major depression were higher than the rate of current dysthymia (11.3%). (Only current and not lifetime diagnoses of dysthymia may be made.)

Alcohol or substance use disorders

3.143From Table 3.7 it may be seen that for alcohol or substance use disorders 27.1% had a lifetime diagnosis of alcohol dependence and 7.7% for a lifetime diagnosis of alcohol abuse. Prevalence rates for all other current and lifetime substance use diagnoses were below 5%.

Personality disorders

3.144From Table 3.7 it may be seen that 21% of participants had avoidant personality disorder. 6.9% had antisocial personality disorder. 5.7% had borderline personality disorder and only 1.6% had dependent personality disorder.

Trauma symptoms on the trauma symptom inventory

3.145Cases were classified as showing clinically significant trauma symptoms if they scored two standard deviations above the mean for the normative sample described in Briere’s (1996) manual for the Trauma Symptom Inventory (TSI). A summary of the rates of cases showing clinically significant trauma symptoms on the TSI is given in Table 3.9. More than half of all participants showed clinically significant levels of avoidance of reminders of early trauma (59.9%) and intrusive experiences such as flashbacks (55.9%). Between a third and almost a half had clinically significant problems with impaired self-reference (46.2%), dissociation (44.1%), depression (41.7%), anxious arousal (38.5%) and maladaptive tension reduction (35.2%). For less than a third, anger (32%), sexual concerns (23.9%) and sexual dysfunction (12.6%) were clinically significant problems.

Adult attachment styles

3.146Cases were classified as falling into four adult attachment style categories using the Experiences in Close Relationships Inventory, SPSS algorithm described in Brennan, Clark, & Shaver’s (1998) chapter: Self-report measures of adult attachment: An integrative overview. A summary of the numbers of cases falling into the four categories is given in Table 3.10. Using this system, only 16.59% of cases were classified as having a secure adult attachment style, with the remaining 83.41% of cases having an insecure adult attachment style. A fearful adult attachment style, characterized by high interpersonal anxiety and avoidance was by far the most common insecure style, with 44.12% of participants being classified in this way. 26.72% had dismissive, and 12.55% had preoccupied adult attachment styles. A dismissive style is characterized by low interpersonal anxiety, but a high level of interpersonal avoidance, whereas a preoccupied style is characterized by high interpersonal anxiety and a low level of interpersonal avoidance.

Reliability of multi-item scales

3.147Multi-item scales were used to assess participants’ recollections of abuse and a number of aspects of current functioning. These scales were used in correlational analyses reported below, and in other analyses reported in the next Part. Before these analyses were conducted, the reliability of the scales was evaluated. Internal consistency reliability was evaluated with Cronbach’s (1951) alpha and inter-rater reliability was assessed using the split-half method, treating ratings by each rater as two halves of the same scale. The ranges, means, standard deviations and reliability coefficients for the scales used in the correlational and later analyses are summarized in Table 3.11.

3.148With three exceptions, internal consistency and inter-rater reliability co-efficients close to or greater than .7 were obtained, indicating that scales had acceptable levels of reliability. The exceptional scales deserve mention. The total and severe physical abuse scales of the family version of the Severe Physical and Sexual abuse yielded internal consistency reliability co-efficients of .27 and .26 respectively; and the severe sexual abuse scale of the family version of the Severe Physical and Sexual abuse yielded an inter-rater reliability co-efficient of .53. These co-efficients indicate that these scales were relatively unreliable, and so results from them should be interpreted cautiously.

Correlations between indices of abuse and adjustment

3.149Pearson product-moment correlations were computed between indices of institutional living and institutional and family-based child abuse on the one hand, and indices of adjustment on the other. These analyses are summarized in Table 3.12. In these analyses, the indices of institutional living and abuse were: the number of years spent living in an institution; the total score on the Institutional Abuse Scale (IAS); the total, physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect scale scores of the institution and family versions of the Childhood Trauma Questionnaire (CTQ); and the total, severe physical and severe sexual abuse scale scores of the institution and family versions of the Severe Physical and Sexual Abuse scale (SPSA). In these analyses the indices of adjustment were: total number of current and lifetime psychological disorders; the total score on the Life Problems Checklist (LPC); the score on the Global Assessment of Functioning (GAF) scale; the total score on the Trauma Symptom Inventory (TSI); Socio economic status (SES); the number of failed marital or cohabiting relationships in a participants life; the total score on the Kansas Marital Satisfaction scale (KMS); scores on the interpersonal anxiety and avoidance scales of the Experiences in Close Relationships Inventory (ECRI); the total score on the Kansas Parent Satisfaction scale; and the total score on the World health Organization Quality of Life Scale.

3.150To avoid type 1 error (accepting spurious correlations as significant) and to identify correlations in which variables shared at least 9% of the variance, only correlations with an absolute value of .3 or greater and significant at p<.01 were interpreted as significant and meaningful.

3.151There were two important sets of findings. First, correlations larger than .3 and significant at p<.01 occurred between the total trauma symptoms score on the TSI on the one hand and the following indices of abuse on the other: the total (r=.38), sexual (r=.35), and emotional abuse (r=.32) scales of the institution version of the CTQ; and the total (r=.34) and severe sexual institutional abuse (r=32) scales of the institution version of the SPSA. These correlations show that participants who reported greater numbers of trauma symptoms also reported greater institutional sexual and emotional abuse.

3.152The second set of findings was that correlations larger than .3 and significant at p<.01 occurred between the total problems score on the LPC on the one hand and the following indices of abuse on the other: the sexual abuse scale of the institutional version of the CTQ (r=.39); the severe institutional sexual abuse scale of the institution version of the SPSA (r=.36); and the total (r=.32) and severe family physical abuse (r=.34) scales of the family version of the SPSA. However, correlations between the LPC and the scales from the family version of the SPSA must be interpreted cautiously because of the low reliability of the total and severe physical abuse scales of the family version of the SPSA. These correlations show that participants who reported greater numbers of life problems in adulthood also reported greater institutional sexual abuse, and severe family-based physical abuse (although this finding is tentative).

Factors associated with age, gender and CICA committee attended

3.153To identify factors associated with age, gender and CICA committee attended, three sets of analyses were conducted. In the first of these, 135 males participants were compared with 112 female participants on all main variables. In the second analysis, 134 older participants whose age fell above the median age for all 247 participants were compared with 113 younger participants. In the third analysis, 175 participants who had attended the confidential committee were compared with 71 who attended the investigative committee. In each of these sets of analyses, to evaluate the statistical significance of intergroup differences, chi square tests were conducted for categorical variables and t-test were used for continuous variables. In all of these tests, p values were set conservatively at p<.01 to reduce the probability of type 1 error (misinterpreting spurious group differences as significant). In a further attempt to control for type 1 error, for continuous variables, where possible multivariate analyses of variance (MANOVAs) were conducted on groups of conceptually related variables, and only if the results of MANOVAs were significant were t-tests on individual variables conducted. For the TSI and the WHOQOL, which are multiscale instruments, unless the pattern of subscale scores differed greatly from that of total scores, for brevity, only analyses of total scores are reported. To facilitate interpretation of profiles of tabulated means, all psychological variables on continuous scales were transformed to T-scores (with means of 50 and standard deviations of 10) before analyses were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. In the interests of brevity only statistically significant results from these three sets of analyses are tabulated and reported.

Comparison of male and female participants

3.154135 males participants were compared with 112 female participants on all main variables. From Table 3.13 it may be seen that there were statistically significant differences between male and female participants on the following historical and demographic variables: years spent living with the family before entering an institution, years spent in an institution, reason for entering and leaving an institution, institution management, age when worst experiences began, highest socioeconomic status (SES) attained since leaving school, and their own children’s living arrangements. Male participants spent longer living with their families before entering institutions; they spent fewer years in institutions; more entered institutions for petty crime; more left because their sentences were over; more lived in institutions managed by religious brothers and priests (not nuns); their worst experiences began at an older age; they achieved a higher SES; and more had children who spent time living separately from them with the child’s other parent.

3.155From Table 3.14 it may be seen that that there were statistically significant differences between male and female participants in their recollections of child abuse on the following variables: the sexual and emotional abuse subscales of the institution version of the CTQ; the severe physical and sexual abuse scales of the institutional version of the SPSA. These results show that male participants reported more institutional sexual abuse than female participants, while females reported more emotional and physical abuse.

3.156From Table 3.15 it may be seen that while significantly more female participants had lifetime diagnoses of panic disorder with agoraphobia, significantly more male participants had lifetime diagnoses of alcohol and substance use disorders, especially alcohol dependence.

3.157From Table 3.16 it may be seen that male participants had significantly higher numbers of life problems, but also higher levels of global functioning and marital satisfaction than females.

Comparison of younger and older participants

3.158134 older participants whose age fell at or above the median age of 59 for all 247 participants were compared with 113 younger participants on all main variables. From Table 3.17 it may be seen that there were statistically significant differences between older and younger participants on the following historical and demographic variables: reason for leaving the institution, current socio-economic status, duration of relationship with current partner, and age when first child was born. More older participants left their institutions because they were too old to stay on; more were retired; they had longer relationships with their current partners; and were older when their first children were born.

3.159From Table 3.18 it may be seen that there were statistically significant differences between older and younger participants in their recollections of child abuse on the following variables: the total score on the IAS; the emotional abuse scale of the institutional version of the CTQ; and the total, severe physical and severe sexual abuse scales of the institution version of the SPSA. Younger participants reported greater institutional, physical, sexual and emotional abuse. Younger and older participants did not differ in their recollections of family-based abuse.

3.160From Table 3.19 it may be seen that significantly more younger participants had current anxiety, mood and personality disorders. With regard to specific disorders, rates of PTSD, generalized anxiety disorder and avoidant personality disorder were significantly higher among younger participants.

3.161From Table 3.20 it may be seen that younger participants had significantly more trauma symptoms on the TSI, and more life problems in adulthood on the LPC. They also had a significantly lower quality of life on the WHOQOL 100 UK and a lower level of global functioning on the GAF.

Comparison of participants from the confidential and investigative committees

3.162175 participants who had attended the confidential committee were compared with 71 who attended the investigative committee. From Table 3.21 it may be seen that there were statistically significant differences between participants from the confidential and investigation committees on the following historical and demographic variables: number of years spent living with the family before entering an institution; years spent in an institution; reasons for entering and leaving an institution; institution management; age when worst experiences began; number of long term relationships or marriages that have ended; and participants’ own children’s current living arrangements. Participants from the confidential committee had spent fewer years with their families before entering an institution; they spent more years in an institution; more entered because they were illegitimate and left because they were too old to stay on; more lived in institutions managed by nuns; they were younger when their worst experiences began; more had maintained stable long term relationships with their partners; and more had provided their own children with care when they were growing up. More participants from the investigative committee entered institutions through the courts for petty crime and left because their sentences were over, and more lived in institutions run by religious brothers or priests.

3.163From Table 3.22 it may be seen that there were statistically significant differences between participants from the confidential and investigative committees in their recollections of child abuse on the following variables: the total and sexual abuse scale of the institution version of the CTQ, and the severe sexual abuse scale of the institution version of the SPSA. Participants from the investigative committee reported greater institutional sexual abuse than participants from the confidential committee.

3.164Significantly more participants from the investigative committee had a current diagnosis of major depression (Investigative Committee=25.4%, Confidential Committee=11.4%, Chi Square (df=1, N=247)=7.5, p<.01).

Conclusions

3.165The 247 participants in this study included roughly equal numbers of men and women of about 60 years of age, who had entered institutions run by nuns or religious brothers due to family adversity or petty criminality. The majority were married with children and of lower socioeconomic status and low educational attainment. More than 90% of participants were classified as having experienced institutional physical and emotional child abuse and about half as having experienced institutional child sexual abuse. Just over a third of those who had memories of having lived with their families reported family-based child abuse or neglect. All participants had experienced one or more significant life problems. About four fifths of participants at some point in their lives had had a psychological disorder and this rate of psychological disorders was far higher than in normal community populations. The majority of participants showed post-traumatic symptoms and an insecure adult attachment style. Institutional sexual abuse was found to be associated with current post-traumatic symptomatology and major life problems. Male and female, and younger and older participants had different profiles as had participants from the confidential and investigation committees.

Table 3.1. Historical characteristics

Variable Categories Values
Years with family before entering an institution (N=246) M 5.40
SD 4.55
Years in an institution (N=247) M 10.03
SD 5.21
Reason for entering an institution (N=247)
Parents could not provide care f 104.00
% 42.10
Petty crime f 58.00
% 23.50
Illegitimate f 48.00
% 19.43
Parent died f 35.00
% 14.17
Unknown or other f 2.00
% 0.80
Reason for leaving the institution (N=247)
Too old to stay on f 176.00
% 71.25
Family wanted to take him / her home f 34.00
% 13.76
Sentence was over f 19.00
% 7.69
Ran away f 8.00
% 3.23
The institution closed down f 4.00
% 1.61
Unknown or other f 6.00
% 2.42
Institution management (N=247)
Nuns f 121.00
% 49.00
Religious brothers or priests f 77.00
% 31.17
Nuns and religious brothers or priests f 49.00
% 19.83
Were you happy to leave the institution? (N=247)
Yes f 152.00
% 61.50
Mixed feelings f 84.00
% 34.00
No f 11.00
% 4.50

Note: For each variable with multiple categories, the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places.

Table 3.2. Demographic characteristics

Variable Categories Values
Gender (N=247) Male f 135.00
% 54.70
Female f 112.00
% 45.30
Age (N=247) M 60.05
SD 8.33
Current socio-economic status (SES) (N=241)
Unemployed f 60.00
% 24.30
Unskilled manual f 38.00
% 15.40
Semi-skilled manual and farmers owning less than 30 acres f 28.00
% 11.30
Skilled manual and farmers owning 30-49 acres f 12.00
% 4.90
Other non-manual and farmers owning 50-99 acres f 8.00
% 3.20
Lower professional and l managerial; farmers owning 100-199 acres f 9.00
% 3.65
Higher professional and managerial; farmers owning 200 acres f 1.00
% 0.40
Retired f 85.00
% 34.40
Highest SES attained since leaving school (N=235)
Unskilled manual f 104.00
% 42.10
Semi-skilled manual and farmers owning less than 30 acres f 62.00
% 25.10
Skilled manual and farmers owning 30-49 acres f 31.00
% 12.60
Other non-manual and farmers owning 50-99 acres f 21.00
% 8.50
Lower professional and managerial; farmers owning 100-199 acres f 15.00
% 6.10
Higher professional and managerial; farmers owning 200 acres f 2.00
% 0.80
Education: Highest exam passed (N=244)
None f 121.00
% 49.00
Junior school exam in 5th or 6th class (e.g. primary cert) f 62.00
% 25.10
Mid high school exam (e.g. Inter or junior cert) f 15.00
% 6.10
Leaving cert f 13.00
% 5.30
Certificate or diploma or apprenticeship exam f 25.00
% 10.10
Primary degree (e.g. BA) f 8.00
% 3.20
Marital status (N=245)
Married in first long term relationship f 98.00
% 39.70
Married in second or later marriage f 23.00
% 9.30
Cohabiting in first long term relationship f 2.00
% 0.80
Cohabiting in second or later long term relationship f 14.00
% 5.70
Single and widowed f 22.00
% 8.90
Single and never married or cohabited f 28.00
% 11.30
Single and divorced from first married partner f 24.00
% 9.70
Single and separated from first cohabiting partner f 6.00
% 2.40
Single and separated from first marital partner f 17.00
% 6.90
Single and separated or divorced from second or later partner f 11.00
% 4.50
Number of long term relationships or marriages that have ended (N=217)
No relationship has ended f 75.00
% 34.60
1 relationship f 79.00
% 36.40
2 relationships f 37.00
% 17.10
3 relationships f 13.00
% 6.00
4 or more relationships f 13.00
% 6.00
Duration of relationship with current partner (N=134) M 31.10
SD 10.73
Number of children (N=212) M 3.38
SD 1.92
Age when had first Child (N=207) M 25.53
SD 5.56
Children’s living arrangements (N=211)
Always lived with respondent f 162.00
% 76.80
Spent some time living with their other parent f 28.00
% 13.30
Spent some time living with their relatives f 6.00
% 2.80
Spent some time living in care f 10.00
% 4.70
Children put up for adoption f 5.00
% 2.40

Note: For each variable with multiple categories, the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Socio-economic status (SES) was assessed with O’Hare, A., Whelan, C.T., & Commins, P. (1991). The development of an Irish census-based social class scale. The Economic and Social Review, 22, 135-156. The percentages in long term relationships or marriages that have ended was based on the number of cases who had had any marriages or long-term relationships (N=217). The mean duration of relationship with current partner was based on the number of participants who were married or cohabiting (N=134). The mean number of children (N=212), mean age when had first child (N=207) and percentage of children in each of the children’s living arrangements (N=211) categories were based on cases with children only for whom relevant data were reported.

Table 3.3. History of abuse

Variable Scales, items or categories f %
INSTITUTIONAL CHILD ABUSE (N=247)
CTQ-Institution Total child abuse 245.00 99.20
Physical abuse 240.00 97.20
Sexual abuse 116.00 47.00
Emotional abuse 234.00 94.70
Physical neglect 241.00 97.60
Emotional neglect 235.00 95.10
Institutional abuse scale (N=247)
I was punished unfairly by my carers 228.00 92.30
I was terrified of my carers 219.00 88.70
I could never predict when I would be punished by my carers 218.00 88.30
My carers tried to break me 210.00 85.00
My carers tried to take away my hope 198.00 80.10
My carers told me I was bad 187.00 75.70
My carers took away my own clothes 160.00 64.70
My carers separated me from my brother(s) or sister(s) 116.00 47.00
My carers said my mother was bad 106.00 43.00
My carers destroyed my treasured possessions (pictures, teddy bears, mementoes etc) 94.00
38.00
My carers told me my mother did not love me 75.00 30.40
My carers said my father was bad 65.00 26.40
My carers told me my father did not love me 54.00 21.00
Most severe physical institutional abuse (N=247)
Being assaulted to lead to medical attention 104.00 42.10
Being hit to leave bruises 74.00 30.00
Being assaulted to lead to cuts 51.00 20.60
Being hit without being bruised 15.00 6.00
None 3.00 1.30
Frequency of most severe form of physical institutional abuse (N=247)
More than 100 times 115.00 46.60
11-100 times 59.00 23.90
2-10 times 46.00 18.60
Once 24.00 9.70
Never 3.00 1.20
Age when most severe form of physical institutional abuse began (N=233)
M 8.50
SD 3.72
Duration of most severe form of physical institutional abuse (N=229)
M 6.74
SD 4.42
Most severe form of sexual institutional abuse (N=246)
None 122.00 49.40
Contact (fondling and masturbation) 53.00 21.50
Penetration (oral, anal or vaginal sex) 46.00 18.60
Attempted penetration (oral, anal or vaginal sex) 17.00 6.90
Non-Contact (flashing, exposure)
8.00 3.20
Frequency of most severe form of sexual institutional abuse (N=247)
Never 122.00 49.40
2-10 times 41.00 16.60
11-100 times 35.00 14.20
Once 26.00 10.50
More than 100 times 23.00 9.72
Age when most severe form of sexual institutional abuse began (N=122)
M 10.73
SD 2.87
Duration of most severe form of sexual institutional abuse (N=111)
M 2.83
SD 2.99
Worst thing that ever happened to you in an institution (N=247)
Severe physical abuse 99.00 40.10
Severe humiliation and degradation 85.00 34.40
Severe sexual abuse 40.00 16.20
Severe physical and sexual abuse 23.00 9.30
Age when worst thing in an institution began (N=237)
M 9.18
SD 3.65
Duration of worst thing in an institution (N=225)
M 5.33
SD 4.66
CHILD ABUSE IN THE FAMILY
CTQ-family (N=121) Total child abuse 46.00 38.00
Physical abuse 32.00 26.40
Sexual abuse 10.00 8.30
Emotional abuse 25.00 20.70
Physical neglect 58.00 47.90
Emotional neglect 35.00 28.90
Most severe physical abuse in the family (N=121)
Being hit to leave bruises 22.00 18.18
Being assaulted to lead to medical attention 11.00 9.00
Being hit without being bruised 7.00 5.78
Being assaulted to lead to cuts 4.00 3.30
Frequency of most severe form of physical abuse in the family (N=121)
11-100 times 17.00 14.05
2-10 times 14.00 11.57
More than 100 times 13.00 10.74
Age when most severe form of physical abuse in the family began (N=41)
M 7.29
SD 2.80
Duration of most severe form of physical abuse in the family (N=42)
M 5.20
SD 4.13
Most severe sexual abuse in the family (N=121)
Contact (fondling and masturbation) 7.00 5.78
Penetration (oral, anal or vaginal sex) 5.00 4.13
Attempted penetration (oral, anal or vaginal sex) 2.00 1.65
Frequency of most severe form of sexual abuse in the family (N=121)
Once 5.00 4.13
More than 100 times 4.00 3.30
11-100 times 4.00 3.30
Age when most severe form of sexual abuse in the family began (N=11)
M 8.55
SD 2.46
Duration of most sever form of sexual abuse in the family (N=11)
M 4.48
SD 4.08

Note: CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). For the CTQ scales, the following cut-off scores were used in classifying cases as abused: emotional abuse: 13; emotional neglect: 14; physical abuse: 11; physical neglect: 10; sexual abuse: 9; and overall CTQ child abuse score: 52. These cut-off scores are two standard deviations above the mean for combined male and female normative samples reported in Scher, C., Stein, M., Asmundson, G., McCreary, D. & Forde, D. (2001). The Childhood Trauma Questionnaire in a Community Sample: Psychometric properties and normative data. Journal of Traumatic Stress, 14 (4), 843- 857. On the institutional abuse scale items, cases were classified as having experienced the abuse specified in the item if they were rated as often true or very true. For both institutional and family versions of the CTQ, categories and for the items on the institutional abuse scale, percentages sum to more than 100%. For ‘most severe form of physical abuse’ and ‘frequency of most severe form of physical abuse,’ percentages in 5 categories for each question sum to about 100. For ‘most severe form of sexual abuse’ and ‘frequency of most severe form of sexual abuse’ percentages in 5 categories for each question sum to about 100. Minor deviations from 100 are due to rounding of decimals to two places. For the ‘worst thing that ever happened’, verbatim responses were classified into 4 categories and percentages in these 4 categories sum to about 100.

Table 3.4. Statements of ‘worst thing’ that happened to participants while living in an institution

Severe physical and sexual abuse
Abused sexually by older boys (but not by brothers). Emotional and physical abuse by the brothers
Stripped naked by a nun and beaten with a stick and given no supper and humiliated
After running away having my hair cut off to a very short length and was made to stand naked to be beaten by nun in front of other people
I was raped and severely beaten by a male carer
Sexual abuse and beatings
At 6 I was raped by nun and at 10 I was hit with a poker on head by nun
When I told nuns about being molested by ambulance driver, I was stripped naked and whipped by four nuns to "get the devil out of you".
Sexual abuse, beatings, and no treatment for illness
Beatings, brutality, sexual abuse, starvation and the general abuse
Sexual abuse and physical abuse combined
Sexual and physical abuse, no education, and not enough food.
Sexually abuse and being beaten
Sexual and physical abuse and living in fear
Sexual abuse and the physical beatings
Forced oral sex and beatings
Being beaten and anally raped
A brother tried to rape me but did not succeed, so I was beaten instead
Taken from bed and made to walk around naked with other boys whilst brothers used their canes and flicked at their penis’
Scalded by accident and sexually interfered with
Oral sex and being beaten if I refused
Tied to a cross and raped whilst others masturbated at the side
Sexual abuse, beatings and living in fear
Beatings and sexual abuse
Severe physical abuse
I was polishing the floor and a nun placed her foot on my back so I was pushed to the floor. I was locked in a dark room.
Being beaten by nuns when I tried to protect sister from beating
When my carers believed me and 3 others were leaving the institution, they gave me severe physical punishment and took activities away from 200 other boys for 10 weeks, but blamed this on me. The boys were allowed to abuse me often for this.
Having to empty the toilets and being lifted off the ground by my sideburns
Put in bath of Jays fluid with 3 others
They used to make my sisters beat me
Badly physically beaten and humiliated
Having my head submerged in dirty water in the laundry repeatedly by a nun
Being beaten regularly
Burst eardrum because of a beatings and loneliness
Physical abuse and segregation from other children for no reason
A severe beating by two nuns for a trivial misdemeanour until I was bleeding
Being beaten for wetting the bed and allocated to do worst work like cleaning potties and minding children
Tied to a bed and physically abused by three carers
Being physically beaten by a paid employee and left unconscious
I was beaten and hospitalised by the head brother and not allowed to go to my fathers funeral in case my bruises were seen; also the head brother threatened to killed me
Being accused of sexually interfering with other boys and being beaten until made to write down the names of boys I had touched. In the end I wrote down two names to stop the torture
They made me change my surname and beat me until I accepted it. They took my identity from me. The put me through mental torture which is still with me now. They separated me from my sister and sent her to another institution.
Being physically beaten by nuns and referred to as a number. My head was pushed under water in the bath. The nuns threw food into a group of children and I would have to struggle to get some food.
Beatings not getting a proper education
Being told at 6.30pm on way to bed that would be beaten next morning at 6.30am. It was torture waiting for it.
Beatings with shoe horn
Being beaten
One brutal beating at 12 or13 years old; and being left for long periods of time facing the wall
A very severe beating with wooden curtain pole, the hunger and the cold
Being stripped and thrown into nettles and sleeping with pigs for a week
Beatings
Constant physical abuse which made me terrified all the time
A violent physical beating
I was left hanging out of a window for hours with finger stuck in it, and was guaranteed to be beaten everyday
Beatings
Beaten for wetting bed and humiliated in front of others. I was forced to stand in dormitory for hours at a time
Everything was the worst: physical abuse and mental torture
Not being fed one day and then being beaten on the table in the dining hall
Beatings
Being beaten with wooden clothes hangers by the nuns
Beatings and name-calling
Having my hair cut off in spite and being beaten on the floor
I got beaten twice because I stole a sandwich,
Beatings and verbal abuse
Being locked in a furnace room and left, bitten by rats, found by coal delivery man, removed, washed in cold water, bites cleaned and them put back there
Being punished when tired and no-one listening to me about the abuse
I was punished a lot for running away, beaten with strap, and had my head shaved a few times
Being beaten in my underwear in the large washroom by prefects
Starving and beatings like a concentration camp. There were so many worst things. Everyday was a nightmare.
Severe beatings and taking away of our dignity "scamping" .
The hidings and the appalling hygiene
The beatings, the lack of education and not being fed properly
Having my neck sliced in an attempt to treat a growth on neck> This was not medical treatment, it was cruel.
My hair was cut short as punishment and I was beaten very badly in front of everyone when I came home late
Being beaten by an older girl who was in charge. I was hit all over mainly on the legs, and this caused welts
We were all lined up naked and slapped in the face a lot. We all had to drink water from toilets and were all washed in same dirty bath water
Receiving a severe beatings and witnessing my younger brother returning from a severe beating
Being beaten with a cane and strap; being separated me from my family
Being beaten naked and flogged so hard that marks remained for months afterwards
Extreme physical abuse leading to a burst ear drum and receiving no medical attention for days
Severe physical abuse and feelings of helplessness
Lashing; name calling (the name ‘good for nothing’ is still with me today); starving while watching pets being fed
Being beaten by a lay night-watchman 60 times until I wet myself because I was awake and being beaten by a brother on the bare backside. He bruised and battered me.
Physical abuse by the brothers and the lay night-watchman
Physical abuse and eating from the rabbit huts
Punished for stealing apples by being hit with a belt and having my hair cut
Physical and mental abuse. Being beaten every day by brothers and older boys.
The physical beatings, the emotional abuse, and no opportunity for learning or education.
The brothers tied to flog me to death
Physical abuse, my trousers were taken down and I was beaten on bare skin
Being beaten until knocked out and my head split. Having my finger placed in boiling water until all feeling was lost; the finger swelled up, skin wore away, and the nail fell off
Emotional and physical abuse; being placed there for no reason; the removal of all emotion from me
Beatings and starvations
Being thrown and ducked in scalding hot baths; being taken to hospital and anaesthetised with ether when getting my tonsils out. I have awful memories of feeling like being smothered with ether, similar to being ducked in the bath; I came as near death as you can imagine
On my second day I was badly kicked, and beaten with fists and belts
Physical abuse
Being whipped and humiliated in front of the other children
Kicked and beaten after running away
Beatings
Beaten severely
Being abused; once my tongue was almost cut out
Constant beatings; I was forced to sit on potty until my rectal muscle popped out
Beaten by nuns with cat-o-nine-tails that left deep cuts
Beaten and scared with hurley
Kicked down the stairs
I was badly beaten and witnessed extreme beatings
Beaten till my hands bled
Beatings
I was beaten whilst naked, pushed down stairs and broke my foot
Being beaten and ridiculed
Being beaten with hosepipe and fear of further beatings
Beaten so bad that I had to stay in bed for a week
Being strangled by a brother
Hunger and being slapped
Badly beaten after running away
Bad beatings
Being hit on my back by a brother and sustaining a life long injury
I was beaten in the shower naked, and not allowed to say goodbye when leaving
Whipping
Beaten until I had bones broken
Being stripped and flogged and locked in room for 2-3 weeks
Beaten
Severe sexual abuse
Sexual abuse — molested at night
Sexual abuse
Oral and anal sexual abuse on one occasion
Molested and masturbation
Rape
Sexual abuse and made to feel so insecure
Sexual abuse, starvation and secrecy in an institution that wasn’t fit for habitation
Gang-rape
Sexual assault
Sexually molested by a priest visiting the institution on 6-8 occasions
The day I entered the institution another boy tried to sexually assault me
Sexual abuse perpetrated by gardeners, a social worker and other male convent employees
Sexual abuse
Being left out in the cold one winter and staying out near the boiler where older boys who had been sent by the courts tried to molest him and I had to fight them off
A brother sexually abused me
Child sexual abuse by older boys (not the brothers)
Sexual abuse
Sexual abuse
Raped by a brother
Sexually abused in a toilet twice, and mental abuse, shown horror movies.
Sexual abuse and witnessing violence. I had a rubber hoses stuck up me and I had to watch my carers beating the youngest most vulnerable children.
Sexual abuse
Being raped by the director of the school
Rape
Being raped by Christian Brothers
Being asked by other students to abuse younger child sexually as an initiation right
Touched in a sexual way in bed at night by a Brother
Raped
Molested every week by brothers and older boys
Anal penetration by a Christian Brother
Sexual abuse
I was raped
Sexual abuse and rape
Raped by a brother
Rape
Sexually assaulted
Sexual abuse
Rape
Rape
Sexual Abuse
Severe emotional abuse
When my mother first came to visit after 6 months, she cried lots at how much weight I and all the kids had lost. She cried lots saying ‘I didn’t put ye here’
Watching other boys who had just been beaten for wetting the bed coming out of the office in pain, hearing the crying and seeing other boys trying to help
Having to go into church and kiss a dead man in his coffin
Father prevented from seeing me
They told my brothers I had died. I was hit for crying in response and told to stop
Not being loved
Neglect. Craving love but getting none
After a disagreement with a nun, my long hair was cut off in my sleep as they knew I loved it
Living in fear
Being painted with a paint brush
The night I entered the institution, my clothes and teddy thrown away
Getting chilblains frostbite, and sores so deep I could see my bones on my hand from working in the fields was worse than the beatings
The fear, starvation and hard labour
Deprived of chance to go to my grandmother’s funeral
The first day I was told my mother didn’t want me
Humiliation of being sent to school with wet sheets wrapped around me after bed wetting incident
Being force fed and held down
Seeing a young boy die. He was 12 years old, beaten by brothers on landing and fell over banister
Told to say I was the devil and had to wear a "devil’s tongue" hat
Unfair way I and the others were treated. The fear – I was always afraid
I had my identity taken away. I was known by a number only.
Having pubic hair shaved off and a nun telling people about it at dinner . She said "I shaved the monkey".
I can take any abuse, but the worst thing was having no one. Seeing other kids going out with their families and not knowing why I had no one. I was lied to: told that my parents were dead. I only found out in my 50’s that they were alive
I could stand the beating, The worst thing was the mental abuse: being put in there in the first place and not understanding why
Put in a bath of cold water
I was humiliated when the teacher of sixth class insulted me because of my father arguing with the head of industrial school
At age nine I was sent to pluck turkeys in a coal shed in the cold and had freezing fingers
The worst thing was the emotional removal of self: it still has a huge effect on my life
Lack of education: Not being taught how to read or write. That’s the most hurtful thing
Having soiled sheets put over my head for one hour when I wet the bed at night
It was threatened that my father would lock me in a mental institution if I didn’t stop causing trouble
Punishment was meted out repeatedly for the same misdemeanour. Constantly being threatened with punishment.
Getting an artificial limb without my or my mother’s consent. I was the only child in the institution with a physical disability and I felt marked out.
Nightmares due to living with constant uncertainty and unpredictability
Listening to them talking badly about my mother and being taunted about my physical appearance. I was called "four eyes"
Loneliness at Christmas time
Public humiliation about my mother being unmarried
Loss of finger through gangrene due to lack of medical attention. She loved to play the piano and this meant loss of hope to become a music teacher
Poor hygiene and not being informed or provided with information or sanitation
Looking at younger kids being beaten
We were children and we did so much hard work. We were up at six o’clock in the morning. We have no childhood memories. We knew no better
Just being there was the worst thing and the humiliation especially
Being a celiac was never detected, because the nuns were not educated enough to know about the disease
The worst thing was the overall effect of breaking my spirit; the violence; and the constant blanket of terror
The constant fear. I was called into the office and told my mother had died. I actually felt relief that it wasn’t a punishment
The leg of a chair was pressed against my temple for interrupting the teacher at the blackboard when I asked to go to the toilet
Feeling alone and unloved
I was afraid to tell the nuns I had a sore on my leg. They found out and cut my hair off.
Witnessed my sister being whipped until she bled, then made to kneel in refectory for 3 months
Being locked in a cupboard in the attic
The emotional abuse was worse than the physical abuse and its effects have stuck since then
My leg was badly burnt and I was kept hidden in a room for 5 weeks without any medical treatment. I was ill with mumps and not allowed stay in bed. I had to get up for Holy Communion. Witnessing physical abuse of other children. Watching their heads being shaved. Being hungry.
Psychological trauma of living in fear most of the time
The worst thing was the sense of being an orphan and being incarcerated and criminalised: the monotony; the ball-aching mind-aching hopelessness
Being locked in a coal-shed three times
I hated being in the band and hated the priest in charge
I found a little girl dead in her bed after they’d gone for a walk and the girl hadn’t been feeling up to it. The lack of sex-education was terrible, I didn’t know what was happening when period started. The coldness at night.
Feeling like a ’nobody’ and that everyone was better. Always feeling insecure.
Constantly being told I was worthless and shouldn’t have been born. Being called a ’dying cat’.
Seeing a woman with intellectual disabilities having her baby taken away from her
Fear of every thing. Fear of God. Fear of the Christian Bros. Fear that I would go to hell.
I overheard someone say that my mother had died the night before. When I asked about it I was ignored and dismissed. My friend was beaten so badly for wetting the bed that I watched her die. I was constantly starving. I had to bribe my carers with bread so I wasn’t beaten.
Emotional abuse. I was never allowed to show my feelings
Being put in a lower streamed class
Having cold baths in the morning
Being taken away from my friends and moved around between four institutions
Being locked in a cattle shed in the dark
I was put naked into a coffin as punishment
Chained in front of whole convent 26 times for marking paintwork
Not being able to go home at Christmas when the other boys did
Feeling of being alone and having no one
Being made to use a bucket for toilet and having no toilet paper
I was put in a cellar to peel potatoes for three days after wetting myself
Seeing my brother being beaten
It was all bad
Witnessing another boy drown and no one showing concern for him or the dead boy
Being taken into the office and told my foster mother had died and then immediately sent away again
Fear of being punished
Getting BCG injection 3 times. I had a very bad pain in my arm and was on a bed trolley
I was left all night on landing, It was a very frightening experience
The worst thing was going into and institution and leaving my family
I was left alone in the school yard for up to 10 hours
The worst thing was, they took away my dignity
The lack of food. The feeling of being unsafe and de-valued
The worst thing was when they got me to hold out brothers hand whilst they slapped it

Note: N=247. There were 23 cases where the worst thing reported was severe physical and sexual abuse; 99 cases where it was severe physical abuse; 40 cases where it was severe sexual abuse; and 85 cases where it was severe emotional abuse. Statements were classified as severe physical abuse if the person reported physical violence, beating, slapping, or being physically injured, but not having medical attention withheld. Statements were classified as severe sexual abuse if the person reported the words sexual abuse or mentioned rape; genital, anal or oral sex; masturbation; or other coercive sexual activities involving either staff or older pupils. Statements were classified as severe physical and sexual abuse if they involved both severe physical abuse and severe sexual abuse as defined earlier. Statements of actions involving humiliation, degradation, severe lack of care, withholding medical treatment, witnessing the traumatization of other pupils and adverse experiences that were not clearly classifiable as severe sexual or physical abuse were classified as severe emotional abuse. Inter-rater agreement greater than 90% was achieved for a sample of 10% of statements.

Table 3.5. Life problems

Life problems Frequency % Inter-rater reliability
Kappa
Mental health problems
183 74.10 1.00
Unemployment
128 51.80 1.00
Substance use
94 38.10 1.00
Frequent illness
73 29.60 0.95
Frequent hospitalisation for physical health
70 28.30 0.95
Anger control in intimate relationships
64 25.90 1.00
Non-violent crime
55 22.30 1.00
Homelessness
52 21.10 1.00
Self-harm
44 17.80 0.81
Anger control with children
33 13.40 1.00
Incarceration for non-violent crime
33 13.40 1.00
Hospitalisation for mental health problems
32 13.00 1.00
Violent crime
25 10.10 1.00
Incarceration for violent crime
18 7.30 1.00

Note: N=247. Life problems do not represent mutually exclusive categories and so percentages sum to more than100%. Inter-rater reliability was assessed on 52 cases with Kappa (Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37-46). The inter-rater reliability kappa coefficient for each of the life problems was above .7 indicating that the problems were reliably measured.

Table 3.6. Strengths

Where does your strength come from? What has helped you most in facing life challenges? What is the thing that means most to you in your life?
(N=243) (N=243) (N=242)
Self-reliance, my optimism, my work, and my skills f 144.00 141.00 53.00
% 59.30 58.00 21.80
Relationship with current partner / family f 40.00 63.00 170.00
% 16.50 25.90 70.20
Relationship with God or spiritual force f 40.00 25.00 7.00
% 16.50 10.30 2.90
Relationship with a friend including other survivors f 19.00 14.00 12.00
% 7.80 5.80 5.00

Table 3.7. Psychological disorders

Frequency % Inter-rater reliability
Kappa
Any current or lifetime anxiety, mood, substance use or personality disorders 202 81.78
Any anxiety, mood or substance use disorder
Any lifetime disorder 160 64.80 0.95
Any current disorder 127 51.40 0.84
Anxiety disorders
Any lifetime anxiety disorder 85 34.40 0.95
Any current anxiety disorder 111 44.90 0.88
Social phobia, lifetime 27 10.90 1.00
Social phobia , current 49 19.80 1.00
Generalized anxiety disorder, lifetime 17 6.90 1.00
Generalized anxiety disorder , current 42 17.00 0.77
Posttraumatic stress disorder, lifetime 21 8.50 0.85
Posttraumatic stress disorder, current 41 16.60 0.86
Panic disorder without agoraphobia, lifetime 22 8.90 1.00
Panic disorder without agoraphobia, current 16 6.50 1.00
Panic disorder with agoraphobia, lifetime 16 6.50 1.00
Panic disorder with agoraphobia, current 18 7.30 1.00
Agoraphobia without panic disorder, lifetime 1 0.40 1.00
Agoraphobia without panic disorder, current
8 3.20 1.00
Specific phobia, lifetime 10 4.00 1.00
Specific phobia, current 25 10.10 0.91
Obsessive compulsive disorder, lifetime 9 3.60 1.00
Obsessive compulsive disorder, current 8 3.20 1.00
Mood Disorders
Any lifetime mood disorder 89 36.00 1.00
Any current mood disorder 66 26.70 1.00
Major depression, lifetime 89 36.00 1.00
Major depression, current 38 15.40 1.00
Dysthymia 28 11.30 1.00
Alcohol or substance use disorders
Any lifetime alcohol and substance use disorder 87 35.20 1.00
Any current alcohol or substance use disorder 12 4.9 1.00
Alcohol dependence, lifetime 67 27.10 1.00
Alcohol dependence, current 9 3.60 1.00
Alcohol abuse, lifetime 19 7.70 1.00
Alcohol abuse, current 1 0.40 1.00
Other substance dependence, lifetime 8 3.20 1.00
Other substance dependence, current 3 1.20 1.00
Other substance abuse, lifetime 2 0.80 1.00
Other substance abuse, current 0 0.00 1.00
Personality disorders
Any personality disorder 75 30.40 0.96
Avoidant personality disorder 52 21.10 0.96
Antisocial personality disorder 17 6.90 1.00
Borderline personality disorder 14 5.70 1.00
Dependent personality disorder 4 1.60 1.00

Note: N=247. Mood, anxiety and substance use disorders were assessed with the SCID-I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, DC: American Psychiatric Press). Personality disorders were assessed with the SCID-II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Psychological disorders do not represent mutually exclusive categories and so percentages sum to more than 100%. With N=52, the inter-rater reliability kappa coefficient for each of the diagnostic categories assessed was above .7 indicating that the diagnoses were reliably made (Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37-46).

Table 3.8. Rates of psychological disorders among survivors of institutional living compared with rates in normal community samples in Europe, UK and USA.

CICA Europe USA UK
Anxiety disorders
Any lifetime Anxiety disorder 34.40 13.60 28.80
Any current anxiety disorder 44.90 6.00 18.10 7.97
Mood Disorders
Any lifetime mood disorder 36.00 14.00 20.80
Any current mood disorder 26.70 4.20 9.50 2.58
Substance induced disorders
Any lifetime alcohol and substance use disorder 35.20 5.20 14.60
Any current alcohol or substance use disorder 4.9 1.00 3.80
Personality disorders
Any personality disorder 30.40 13.10 14.79 4.00

Note. European current (1 year) and lifetime prevalence rates for anxiety mood and substance use disorders are from Alonso, J., Angermeyer, M., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., de Girolamo, G., de Graaf, R., Demyttenaere, K., Gasquet, I., Haro, J.M., Katz, S., Kessler, R.C., Kovess, V., Lépine, J.P., Ormel, J., Polidori, G., Vilagut, G. (2004). Prevalence of Mental Disorders in Europe: Results from the European Study of Epidemiology of Mental Disorders (ESEMeD) Project. Acta Psychiatrica Scandninavica, 109 (suppl 420), 21-27. USA current (1 year) prevalence rates are from Kessler, R., Chiu, W., Demler, O. & Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 617-627. USA lifetime prevalence rates are from Kessler, R., Berglund, P., Demler, O., Jin, R. & Walters, E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62(6), 593-602. USA prevalence rates of personality disorders are from Grant, B., Hasin, D., Stinson, F., Dawson, D., Chou, S. & Ruan, W. J. et al. (2004). Prevalence, correlates, and disability of personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 65, 948-58. UK current (1 week ) prevalence rates are from Singleton, N., Bumpstead, R., O’Brien, M., Lee, A. & Meltzer, H. (2001). Psychiatric Morbidity Among Adults Living in Private Households, 2000. London, UK: Stationary Office. The European prevalence rate for personality disorders is based on a study in Norway: Torgersen, S., Kringlen, E. & Cramer, V. (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry, 58, 590-596.

Table 3.9. Trauma symptoms on the Trauma Symptom Inventory

Trauma symptoms Frequency %
Avoidance
148 59.90
Intrusive experiences
138 55.90
Impaired self-reference
114 46.20
Dissociation
109 44.10
Depression
103 41.70
Anxious arousal
95 38.50
Maladaptive tension reduction
87 35.20
Anger
79 32.00
Sexual concerns
59 23.90
Sexual dysfunction
31 12.60

Note: N=247. Cases were classified as showing trauma symptoms if they scored 2 standard deviations above the mean for the normative sample. The following cut-offs were derived from the normative sample described in Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources: Anxious arousal: 15; Depression:14; Anger: 16; Intrusive experiences: 14; Avoidance: 16; Dissociation: 12; Sexual concerns: 9; Sexual dysfunction: 5; Impaired self-reference: 12; and Maladaptive tension reduction behaviour: 5. Trauma symptoms do not represent mutually exclusive categories and so percentages within and across groups sum to more than 100%.

Table 3.10. Attachment patterns on the Experiences in close relationships inventory

Adult Attachment style Frequency %
Fearful
109 44.12
Dismissive
66 26.72
Secure
41 16.59
Preoccupied
31 12.55

Note: N=247. Cases were classified as falling into the four attachment style categories using the Experiences in Close Relationships Inventory, SPSS algorithm in Brennan, K., Clark, C., & Shaver, P. (1998). Self-report measure of adult attachment: An integrative overview. In J. Simpson & W. Rholes (Eds.), Attachment Theory and Close Relationships (pp. 46-76). New York: Guilford Press. The four attachment categories are mutually exclusive, so percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places.

Table 3.11. Reliability of scales

Domain Instrument Constructs and variables No. of items in the scale Possible range Actual range M SD Internal consistency Reliability Interrater reliability
Institutional abuse
IAS (N=247) Specific Institutional abuse 13 13-65 17-65 44.46 10.82 .99 .98
CTQ-Institution (N=247) Total abuse score 25 25-125 50-124 90.81 14.81 .98 .97
Physical abuse 5 5-25 5-25 19.26 4.12 .98 .96
Sexual abuse 5 5-25 5-25 11.26 7.42 .99 .98
Emotional abuse 5 5-25 5-25 44.86 4.55 .97 .94
Physical neglect 5 5-25 8-25 17.26 3.57 .98 .97
Emotional neglect 5 5-25 9-25 19.23 3.49 .98 .98
SPSA-Institution (N=247) Total severe institutional abuse 8 0-32 0-29 14.59 5.73 .69 .98
Severe institutional physical abuse 4 0-16 0-16 10.43 3.11 .66 .97
Severe institutional sexual abuse 4 0-16 0-14 4.17 4.40 .88 .98
Family-based child abuse
CTQ-Family (N=121) Total CTQ-F score 25 25-125 32-128 54.12 19.07 .99 .99
CTQ-F Physical abuse 5 5-25 5-25 8.43 5.36 .98 .97
CTQ-F Sexual abuse 5 5-25 5-25 6.26 4.27 .99 .99
CTQ-F Emotional abuse 5 5-25 5-25 6.87 5.81 .99 .99
CTQ-F Physical neglect 5 5-25 5-25 10.48 10.40 .99 .99
CTQ-F Emotional neglect 5 5-25 5-25 10.83 6.16 .99 .99
SPSA-family (N=121) Total severe family abuse 8 0-32 0-26 4.27 6.02 .27 .90
Severe family physical abuse 4 0-16 0-14 3.49 4.82 .26 .98
Severe family sexual abuse 4 0-16 0-13 0.79 2.61 .92 .53
Trauma symptoms
TSI (N=247) Total trauma symptoms 95 0-255 1-241 94.95 50.03 .99 .99
Life Problems
LPC (N=247) Total number of life problems 14 0-14 0-12 3.66 2.80 .99 .98
Quality of Life
WHOQOL (N=247) Total WHOQOL 100 score 102 1-5 1-5 91.53 16.95 .99 .99
Global functioning
GAF (N=235) Global functioning 10 1-91 1-91 61.00 16.77 .90
Relationships
KMS (N=136) Marital satisfaction 3 0-21 3-21 17.00 4.39 1.00 1.00
KPS (N=212) Parental satisfaction 3 0-21 0-21 15.98 4.70 .99 .99
ECRI (N=247) Anxiety 18 0-122 18-122 66.86 25.26 .99 .99
Avoidance 18 0-126 20-126 74.76 27.15 .99 .99

Note. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A Retrospective Self-report. Manual. San Antonio, TX: The Psychological Cooperation.) IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. IAPCI=Institutional Abuse Processes and Coping Inventory . TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life problems chceklist. WHOQOL 100 UK= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAF=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). ECRI=Experiences in Close Relationships Inventory (Brennan, K., Clark, C., & Shaver, P. (1998). Self-report measure of adult attachment: An integrative overview. In J. Simpson & W. Rholes (Eds.), Attachment Theory and Close Relationships (pp. 46-76). New York: Guilford Press).

Table 3.12. Correlations between indices of abuse and adjustment

Instru-ment Abuse Scales Total number of current and lifetime psycho-logical disorders LPC
Total no. of life problems
GAF
Global Func-tioning
Total
trauma
symptoms on TSI
SES Number of failed relation-ships KMS
Marital satis-faction
ECRI
Anxiety
ECRI
Avoid-ance
KPS
Parental satis-faction
WHOQOL 100 UK
Total QoL
Number of years in institution .00 -.23 .01 .01 -.01 -.05 -.05 -.01 .02 -.13 -.02
IAS Specific Institutional abuse . .12 .19 -.11 .29 -.05 .01 .03 .21 .15 .15 -.14
(N=247)
CTQ-I Total institutional abuse score .15 .28 -.22 .38 -.05 .06 .00 .29 .16 .09 -.25
(N=247) Physical abuse .07 .12 -.02 .24 .04 .04 .08 .19 .06 .12 -.15
Sexual abuse .11 .39 -.15 .35 -.11 .08 -.02 .22 .10 -.06 -.19
Emotional abuse .21 .14 -.25 .32 -.07 .02 -.03 .26 .10 .13 -.20
Physical neglect -.01 .04 -.07 .15 .02 .04 .05 .18 .05 .08 -.12
Emotional neglect .07 -.02 -.19 .02 .03 -.03 -.05 .03 .19 .16 -.11
SPSA-I Total severe institutional abuse .16 .25 -.07 .34 -.16 -.01 -.02 .21 .16 .03 -.18
(N=247) Severe institutional physical ab. .13 -.06 -.01 .17 -.14 -.06 .01 .16 .16 .09 -.13
Severe institutional sexual ab. .11 .36 -.08 .32 -.11 .03 -.03 .16 .09 -.03 -.15
CTQ-F Total family abuse score .04 .24 -.11 .09 -.01 .06 .04 .04 .00 .09 -.03
(N=121) Physical abuse .06 .29 -.13 .11 .01 .09 .07 .05 -.04 .06 -.02
Sexual abuse .04 .18 -.06 .04 -.04 .16 .00 .00 .03 .09 -.00
Emotional abuse .09 .22 -.14 .13 -.03 .07 -.01 .07 .04 .05 -.08
Physical neglect -.02 .12 -.05 .05 .00 -.01 .07 .02 .00 .14 -.01
Emotional neglect .02 .22 -.12 .09 .01 .01 .03 .04 .02 .09 -.03
SPSA-F Total severe family abuse .11 .32 -.18 .17 -.08 .17 -.08 .12 .04 -.02 -.11
(N=121) Severe family physical abuse .10 .34 -.19 .18 -.04 .12 -.06 .12 .01 -.02 -.09
Severe family sexual abuse .08 .16 -.08 .08 -.12 .19 -.09 .06 .06 -.01 -.11

Note: N=247. Pearson correlations significant at p<.01 and greater than .3 are in bold. IAS=Institutional abuse scale. CTQ-I=Childhood Trauma Questionnaire, Institutional version and CTQ-F is the family version (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A Retrospective Self-report. Manual. San Antonio, TX: The Psychological Cooperation). SPSA-I =Most severe forms of physical and sexual abuse, institution version and SPSA-F is the family version. LPC=Life problems checklist. GAF=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417).TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). SES=Socio Economic Status (O’Hare, A., Whelan, C.T., & Commins, P. (1991). The development of an Irish census-based social class scale. The Economic and Social Review, 22, 135-156). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). ECRI=Experiences in Close Relationships Inventory (Brennan, K., Clark, C., & Shaver, P. (1998). Self-report measure of adult attachment: An integrative overview. In J. Simpson & W. Rholes (Eds.), Attachment Theory and Close Relationships (pp. 46-76). New York: Guilford Press). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). WHOQOL 100 UK= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath).

Table 3.13. Historical and demographic characteristics on which males and females differed significantly


Variable

Group 1
Males
Group >2
Females
Chi square
or
t
N=135 N=112
Years with family before entering an institution (N=246) M
SD
6.90
4.78
3.61
3.50
6.23***
Years spent in an institution
(N=247)
M 8.58 11.80 5.08***
SD 5.08 4.80
Reason for entering an institution
(N=247)
Illegitimate f 16.00 32.00 56.45***
% 11.90 28.80
Petty crime f 56.00 2.00
% 41.50 1.80
Parents could not provide care f 41.00 58.00
% 32.60 53.60
Parents died f 18.00 17.00
% 13.30 15.20
Unknown/Other f 1.00 1.00
% 0.70 0.90
Reason for Leaving (N=237)
Too old to stay on f 93.00 83.00 16.96***
% 71.00 80.30
Sentence was over f 18.00 1.00
% 13.70 0.90
Family wanted him/her home f 13.00 21.00
% 9.90 15.50
Ran away f 4.00 4.00
% 3.10 3.70
Institution management (N=247)
Nuns f 12.00 109.00 192.02***
% 8.90 97.30
Religious brothers or priests f 77.00 0.00
% 57.00 0.00
Nuns and religious brothers or priests f 46.00 3.00
% 34.10 2.70
Age when Worst Experiences Began (N=237) M 10.32 7.85 5.44***
SD 3.17 3.74
Highest SES attained since leaving school (N=235)
Unskilled manual f 49.00 55.00 16.34**
% 38.28 51.40
Semi-skilled manual and farmers owning < 30 acres f
%
44.00
34.37
18.00
16.82
Skilled manual and farmers owning 30-49 acres f
%
21.00
16.40
10.00
9.34
Non-manual, professional, managerial, and farmers with more than 50 acres f 14.00 24.00
% 10.93 22.42
Children’s living arrangements
(N=211)
Spent some time living with their other parent f
%
26.00
23.20
2.00
2.00
25.09***
Spent some time living with their relatives or in care f 8.00 8.00
% 7.10 8.10
Always lived with respondent f 78.00 84.00
% 69.60 84.80
Children put up for adoption f 0.00 5.00
% 0.00 5.10

Note: Group 1 contained all male participants. Group 2 contained all female participants. For each variable with multiple categories, within each group the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Percentages across rows do not sum to 100. Socio-economic status (SES) was assessed with O’Hare, A., Whelan, C.T., & Commins, P. (1991). The development of an Irish census-based social class scale. The Economic and Social Review, 22, 135-156. For continuous variables t-values are from independent t-tests. For categorical variables chi square tests were used. **p<0.01. ***p<0.001.

Table 3.14. Recollections of child abuse by males and females


Variable

Group 1
Males
Group >2
Females
t
N=135 N=112
INSTITUTIONAL ABUSE
IAS Specific institutional abuse M 49.06 51.13 1.62
(N=247) SD 9.61 10.38
CTQ-Institution Total institutional abuse M 50.96 48.84 1.67
(N=247) SD 10.41 9.40
Physical abuse M 51.11 48.65 1.94
SD 9.77 10.15
Sexual abuse M 53.01 46.38 5.60***
SD 10.35 8.24
Emotional abuse M 47.93 52.50 3.73***
SD 10.70 8.50
Physical neglect M 50.08 49.87 0.16
SD 9.85 10.24
Emotional neglect M 48.94 51.29 1.84
SD 9.45 10.55
SPSA-Institution (N=247) Total severe institutional abuse M 50.74 49.11 2.19
SD 5.32 6.42
Severe institutional physical abuse M 48.50 51.75 2.53**
SD 8.60 11.22
Severe institutional sexual abuse M 52.67 46.76 4.84***
SD 9.28 9.88

Note: Group 1 contained all male participants. Group 2 contained all female participants. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t-values are from independent samples t-tests. For the MANOVA on total subscale of the family versions of the CTQ and SPSA, F (2, 118) = 2.85, NS. For the MANOVA on the total subscale of the institution version of the CTQ, SPSA & the IAS, F (3, 243) = 4.75, p<0.01. **p<0.01; ***p<0.001.

Table 3.15. Psychological disorders in males and females


Variable
Group 1 Males
Group 2 Females
Chi square
N=135 N=112
Anxiety disorders
Panic disorder with agoraphobia, lifetime f 2.00 14.00 12.27***
% 1.50 12.50
Alcohol and substance use disorders
Any alcohol & substance use disorder, lifetime f 64.00 24.00 18.01***
% 47.40 21.40
Alcohol dependence, lifetime f 50.00 16.00 16.18***
% 37.00 14.30

Note: N=247. Group 1 contained all male participants. Group 2 contained all female participants. Diagnoses were made using the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Psychological disorders do not represent mutually exclusive categories and so percentages within and across groups sum to more than 100%.

Table 3.16. Current adjustment of males and females

Group 1
Males
Group >2
Females
t-value
N=135 N=112
Total trauma symptoms (TSI) (N=247) M 49.59 50.50 0.71
SD 10.06 9.94
Total No of life problems (LPC) (N=247) M 51.98 47.61 3.58***
SD 10.81 8.34
Total quality of life (WHOQOL) (N=247) M 51.01 48.78 1.76
SD 9.96 9.97
Global functioning (GAF) (N=235) M 51.82 47.83 3.10**
SD 9.69 9.98
Marital satisfaction (KMS) (N=136) M 55.23 46.80 4.76***
SD 8.01 11.52
Parental satisfaction (KPS) (N=212) M 47.89 50.85 1.93
SD 12.12 9.94

Note: Group 1 contained all male participants. Group 2 contained all female participants. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAS=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. **p<0.01 ***p<0.001.

Table 3.17. Historical and demographic characteristics on which older and younger participants differed significantly


Variable

Group 1
Younger
Group 2
Older
Chi square
or
t
N=113 N=134
Reason for leaving institution (N=247)
Too old to stay on f 68.00 108.00 19.93**
% 60.20 80.60
Sentence was over f 9.00 10.00
% 8.50 7.50
Family wanted him/her home f 24.00 10.00
% 21.20 7.50
Ran away f 6.00 2.00
% 5.30 1.50
Institution closed f 4.00 0.00
% 3.50 0.00
Unknown/Other f 2.00 4.00
% 1.80 3.00
Current socio-economic status (SES) (N=241)
Unemployed f 41.00 19.00 70.43***
% 36.00 14.30
Unskilled manual f 24.00 14.00
% 22.00 10.60
Semi-skilled manual / farmers owning less than 30 acres f
%
20.00
18.30
8.00
6.10
Skilled manual, non-manual professional, managerial and farmers owning more than 30 acres f
%
16.00
14.70
14.00
10.60
Retired f 8.00 77.00
% 7.30 58.30
Duration of relationship with current partner
(N=134)
M 26.02 34.97 5.24***
SD 9.01 10.36
Age when had first child (N=207) M
SD
24.38
5.47
26.52
5.46
2.82**

Note: Group 1 contained all participants all participants aged 58 years and younger (below median age). Group 2 contained all participants aged 59 or more years (above median age). For each variable with multiple categories, within each group the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Percentages across rows do not sum to 100. Socio-economic status (SES) was assessed with O’Hare, A., Whelan, C.T., & Commins, P. (1991). The development of an Irish census-based social class scale. The Economic and Social Review, 22, 135-156. For continuous variables t-values are from independent t-tests. For categorical variables chi square tests were used. **p<0.01. ***p<0.001.

Table 3.18. Recollections of child abuse in younger and older participants


Variable

Group 1
Younger
Group 2
Older
t
N=113 N=134
INSTITUTIONAL ABUSE
IAS Specific institutional abuse M 52.80 47.64 4.17***
(N=247) SD 9.37 9.93
CTQ-Institution Total institutional abuse M 51.69 48.57 2.47
(N=247) SD 9.58 10.16
Physical abuse M 50.85 49.28 1.23
SD 9.69 10.24
Sexual abuse M 51.54 48.71 2.22
SD 10.54 9.36
Emotional abuse M 52.05 48.27 3.08**
SD 8.25 11.01
Physical neglect M 50.14 49.86 0.22
SD 10.18 9.89
Emotional neglect M 50.18 49.85 0.25
SD 9.95 10.10
SPSA-Institution Total severe institutional abuse M 51.48 48.76 3.71***
(N=247) SD 6.20 5.32
Severe institutional physical abuse M 51.86 48.40 2.75**
SD 10.22 9.55
Severe institutional sexual abuse M 51.92 48.36 2.80**
SD 10.56 9.19

Note: Group 1 contained all participants all participants aged 58 years and younger (below median age). Group 2 contained all participants aged 59 or more years (above median age). CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t-values are from independent samples t-tests. For the MANOVA on total subscale of the family versions of the CTQ and SPSA, F (2, 118) = 4.06, p=0.02, but all t-tests were NS. For the MANOVA on the total subscale of the institution version of the CTQ, SPSA & the IAS, F(3, 243) = 8.90, p<0.0001. **p<0.01; ***p<0.0001.

Table 3.19. Psychological disorders in younger and older participants


Variable
Group 1 Younger
Group 2 Older
Chi square
N=113 N=134
Any anxiety, mood or substance use disorder f 71.00 57.00 10.90***
% 62.80 42.50
Anxiety disorders
Any anxiety disorder, current f 63.00 50.00 8.40**
% 55.80 37.50
Posttraumatic stress disorder, current f 27.00 14.00 8.01**
% 23.90 10.40
Generalized anxiety disorder, current f 27.00 15.00 7.01**
% 23.90 11.20
Mood disorders
Any mood disorder, current f 44.00 22.00 15.88***
% 38.90 16.40
Personality disorders
Any Personality Disorder f 46.00 28.00 11.47**
% 40.70 20.90
Avoidant Personality Disorder f 33.00 19.00 8.33**
% 29.20 14.20

Note: N=247. Group 1 contained all participants aged 58 years and younger (below median age). Group 2 contained all participants aged 59 or more years (above median age). Anxiety and mood disorders were assessed with the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press). Personality disorders were assessed with the SCID-II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Psychological disorders do not represent mutually exclusive categories and so percentages within and across groups sum to more than 100%.

Table 3.20. Current adjustment of older and younger participants

Group 1 Younger
Group 2 Older
t
N=113 N=134
Total trauma symptoms (TSI) (N=247) M 53.54 47.02 5.38***
SD 9.61 9.36
Total No of life problems (LPC) (N=247) M 52.51 47.88 3.72***
SD 10.20 9.33
Total quality of life (WHOQOL) (N=247) M 47.07 52.47 4.38***
SD 10.21 9.16
Global functioning (GAF) (N=235) M 47.60 52.00 3.44**
SD 10.09 9.50
Marital satisfaction (KMS) (N=136) M 51.65 51.73 0.04
SD 9.73 11.06
Parental satisfaction (KPS) (N=212) M 49.63 48.98 0.42
SD 10.57 11.79

Note: Group 1 contained all participants all participants aged 58 years and younger (below median age). Group 2 contained all participants aged 59 or more years (above median age). TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAF=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t values are from t-tests for independent samples. **p<0.01 ***p<0.001.

Table 3.21. Historical and demographic characteristics on which participants from the confidential and investigation committees differed significantly


Variable

Categories
Group 1
CC
Group 2
IC
Chi square
or
t
N=175 N=71
Number of years with family
before entering an institution
(N=246)
M
SD
4.60
4.10
7.38
5.03
4.11***
Years spent in an institution
(N=246)
M
SD
10.94
4.86
7.84
5.41
4.38***
Reason for entering an institution (N=245)
Illegitimate f 40.00 8.00 22.60***
% 23.10 11.30
Petty crime f 27.00 31.00
% 15.60 43.70
Parents could not provide care f 80.00 24.00
% 46.20 33.80
Parent died f 26.00 9.00
% 15.00 11.30
Reason for leaving (N=236)
Too old to stay on f 139.00 36.00 26.82***
% 82.73 52.90
Sentence was over f 7.00 12.00
% 4.16 17.60
Family wanted him/her home f 19.00 15.00
% 11.30 22.10
Ran away f 3.00 5.00
% 1.78 7.40
Institution management
(N=246)
Nuns f 105.00 16.00 31.76***
% 60.00 22.50
Religious brothers or priests f 38.00 38.00
% 21.70 53.50
Nuns and religious brothers or priests f
%
32.00
18.30
17.00
23.90
Age when worst experiences began (N=246) M
SD
8.75
3.68
10.19
3.37
2.77***
Number of long term relationships or marriages that have ended (N=216)
No relationship has ended f 61.00 164.00 10.77
% 40.10 21.90
1 relationship f 50.00 29.00
% 32.90 45.30
2 relationships f 28.00 9.00
% 18.40 15.50
3 or more relationships f 13.00 12.00
% 8.60 18.80
Children’s living arrangements (N=210)
Spent some time living with their other parent f 12.00 16.00 16.99**
% 8.00 26.70
Spent some time living with their relatives or in care f 8.00 7.00
% 5.30 11.70
Always lived with respondent f 126.00 36.00
% 84.00 60.00
Children put up for adoption f 4.00 1.00
% 2.70 1.70

Note: Group 1 contained all participants from the Confidential Committee (CC). Group 2 contained all participants from the Investigative Committee (IC). For each variable with multiple categories, within each group the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Percentages across rows do not sum to 100. Socio-economic status (SES) was assessed with O’Hare, A., Whelan, C.T., & Commins, P. (1991). The development of an Irish census-based social class scale. The Economic and Social Review, 22, 135-156. For continuous variables t-values are from independent t-tests. For categorical variables chi square tests were used. **p<0.01. ***p<0.001.

Table 3.22. Recollections of child abuse among participants who attended the confidential and investigation committees

Variable
Group 1
CC
Group 2
IC
t
N=175 N=71
INSTITUTIONAL ABUSE
IAS Specific institutional abuse M 50.01 50.11 0.07
(N=246) SD 10.28 9.32
CTQ-Institution Total institutional abuse M 49.01 52.57 2.56**
(N=246) SD 9.55 10.69
Physical abuse M 49.62 50.91 0.91
SD 9.77 10.62
Sexual abuse M 48.33 54.26 4.08***
SD 9.17 10.75
Emotional abuse M 50.17 49.71 0.33
SD 10.09 9.88
Physical neglect M 49.34 51.76 1.72
SD 10.07 9.68
Emotional neglect M 50.18 49.58 0.42
SD 10.40 9.11
SPSA-Institution Total severe institutional abuse M 49.70 50.78 1.31
(N=246) SD 5.78 6.16
Severe institutional physical abuse M 50.80 47.89 2.08
SD 9.99 9.80
Severe institutional sexual abuse M 48.75 53.19 3.23***
SD 9.92 9.48

Note: Group 1 contained all participants from the Confidential Committee (CC). Group 2 contained all participants from the Investigative Committee (IC). CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before t-tests were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. t-values are from independent samples t-tests. For the MANOVA on total subscale of the family versions of the CTQ and SPSA, F (2, 118) = 4.05, p=0.02, but all t-tests were NS. For the MANOVA on the total subscale of the institution version of the CTQ, SPSA & the IAS, F (3, 242) = 3.12, p<0.05.

Part 4 Profiles of groups with different histories

Summary of Part 4

3.166The adult survivors of institutional living who participated in this study were not a homogenous group. Four subgroups with varying histories of institutional living had distinct profiles. What follows is a summary of the profiles of the four groups from this analysis.

3.167Group 1 included those who had spent more than 12 years in an institution and entered before 5 years of age. They had spent the least time with their families (under one and a half years) and the longest time living in institutions (about fifteen years) of any of the four groups. Compared to groups 3 and 4, more were girls placed in orphanages run by nuns because they were illegitimate, or because their parents had died or could not look after them. More left because they were too old to stay on, and more had mixed feelings about leaving. More had experienced physical abuse which began at a younger age and persisted longer than in group 4. Severe emotional abuse was most commonly cited as the worst thing that happened to this group and it began at an earlier age and lasted longer than worst experiences of other groups. Compared with groups 3 and 4, this group reported fewer psychological disorders and life problems. They identified relationships with friends, self-reliance, optimism, and their work and skills as the sources of their strength.

3.168Group 2 included participants who had spent 5-11 years in institutions because of family problems. Participants in this group entered institutions run predominantly by nuns because their parents could not cope or died, and left when they were too old to stay. Compared with groups 3 and 4, more members of group 2 were female, younger when their most severe form of sexual abuse began, and more identified severe emotional abuse as the worst thing that had happened to them. Compared with group 4 more identified self-reliance, optimism, and their work and skills as the source of their strength.

3.169Group 3 included participants who had spent 5-11 years in institution and entered through the courts. Compared with groups 1 and 2, more members of this group were male, lived in institutions run by religious brothers or priests, and were survivors of institutional sexual abuse. Compared to the other three groups they identified sexual abuse as the worst thing that had happened to them, and more had experienced physical abuse within their families. Compared with groups 1 and 2, this group had more alcohol and substance use disorders, antisocial personality disorders, violent and non-violent crime, imprisonment for violent and non-violent crime, and unemployment. For this group, their self-reliance, optimism, and their work and skills were identified as the main sources of their strength in adulthood, compared with group 4.

3.170Group 4 included participants who had spent 4 or fewer years in institution. Participants in this group spent the most time with their families (more than ten and a half years) and the shortest time living in an institution (just under three years) compared with the other three groups. Most were boys placed in institutions run by religious brothers or priests because of petty crime and left because their short sentences were over, or because their families wanted them back, and few had mixed feelings about leaving. Institutional sexual abuse was the form of maltreatment that distinguished this group, and compared with groups 1 and 2, they showed more alcohol and substance use disorders, antisocial personality disorders, non-violent crime, imprisonment for non-violent crime and unemployment. Their relationships with their partners was identified as the main source of their strength in adulthood.

3.171A second analysis was conducted in which cases were classified into 4 groups defined by the type of worst abusive experiences they had suffered in institutions. What follows is a summary of the profiles of the four groups from this analysis.

3.172Group 1 included participants for whom severe sexual and physical abuse was the worst thing they had experienced. Participants in this group had experienced more physical and sexual institutional abuse than at least two of the other 3 groups (in this analysis). They had spent less time with their families before entering an institution than group 3. Like members of group 3, more had children who spent some time living separately with the child’s other parent. Compared with groups 2 and 4, more had a current diagnosis of posttraumatic stress disorder (PTSD) and multiple trauma symptoms.

3.173Group 2 included participants for whom severe physical abuse was the worst thing they had experienced. Participants in this group had the lowest educational achievement, were older than groups 1 and 3 (in this analysis), and more had put their own children up for adoption. Compared with group 3, their worst abusive experience had lasted longer. Like group 4, fewer had PTSD than groups 1 and 3, and they had fewer life problems than group 3.

3.174Group 3 included participants for whom severe sexual abuse was the worst thing they had experienced. Compared with group 4 (in this analysis), more participants in group 3 were male and were admitted through the courts to institutions run by religious brothers for petty crime. Like group 1, more had children who spent time with their other parent who lived separately compared to group 4. Also, compared to group 4, more had PTSD, multiple trauma symptoms, lifetime alcohol and substance use disorders, antisocial personality disorders and multiple life problems.

3.175Group 4 included participants for whom severe emotional abuse was the worst thing they had experienced. Compared to group 3 (in this analysis), more participants in this group were female and on average had spent the longer living in institutions run by nuns. Their worst experiences began at an earlier age than any other group and more had mixed feelings about leaving.

3.176In the analysis of groups of participants who had spent different amounts of time in institutions and entered under different circumstances, the most poorly adjusted as adults were not those who had spent longest living in institutions, but rather those who had spent a moderate amount of time in institutions and who had suffered institutional sexual abuse. In the analysis of groups of participants who reported suffering differing types of worst abusive experiences in institutions, the most poorly adjusted included those who pinpointed severe sexual abuse as the worst thing that had happened to them while living in an institution. Thus institutional sexual abuse, was associated in both analyses with a particularly poor outcome.

Questions addressed

3.177Profiles of groups with different histories of institutional living and differing histories of institutional abuse are the main focus of this Part. Survivors of institutional living who attended CICA fell into a number of discrete groups, with respect to their different histories of institutional living. There include

3.178The main question addressed in this Part is: What are the profiles of these four subgroups of cases with varying histories of institutional living with respect to historical and demographic factors, recollections of child abuse, psychological disorders, trauma symptoms, life problems, quality of life, global functioning, current family relationships, attachment style and personal strengths. The main hypothesis suggested by the literature review was that people who had spent more time living in an institution would show poorer adjustment than those who had spent only a brief period living in an institution.

3.179A subsidiary question was: What are the profiles of subgroups of participants with different histories of institutional abuse?

Statistical analysis strategy

3.180The results of analyses conducted to address these questions will be presented in two sections, corresponding to the two questions. In answering the questions addressed in this Part, the following strategy was used in all statistical analyses. For categorical variables, chi square tests were conducted with p values set conservatively at p<.01 to reduce the probability of type 1 error (misinterpreting spurious group differences as significant). Where chi square tests were significant at p<.01, group differences were interpreted as significant if standardised residuals in table cells exceeded an absolute value of 2. For continuous variables, to control for type 1 error, where possible multivariate analyses of variance (MANOVAs) were conducted on groups of conceptually related variables. Where MANOVAs were significant at p<.05, specific variables on which groups differed at a significance level of p<.01 were identified by conducting one-way analyses of variance (ANOVAs). Scheffe post-hoc comparison tests for designs with unequal cell sizes were conducted to identify significant intergroup differences in those instances where ANOVAs yielded significant F values. Dunnett’s test was used instead of Scheffe’s, where the assumption of homogeneity of variance was violated. In addition to these parametric analyses of continuous variables, in those instances where dependent variables were not normally distributed, non-parametric Kruskall Wallace tests were conducted as well as ANOVAs. If these non-parametric tests yielded results that differed from those of the ANOVAs these were reported. For continuous variables where MANOVAs were not conducted, because there were no grounds for conceptually grouping variables, to control for type 1 error, t-tests or ANOVAs were interpreted as statistically significant if p<.01. For the TSI and the WHOQOL, which are multiscale instruments, unless the pattern of subscale scores differed greatly from that of total scores, for brevity, only analyses of total scores are reported. To facilitate interpretation of profiles of tabulated means, all psychological variables on continuous scales were transformed to T-scores (with means of 50 and standard deviations of 10) before analyses were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. A full tabulation of both statistically significant and non-significant results is presented for analyses conducted to address the main question concerning cases with differing histories of institutional living. In the interests of brevity, for analyses conducted to address the subsidiary question concerning cases with differing histories of institutional living, many non-significant results were not tabulated.

History of institutional living

3.181In this section results are presented of analyses which address the question: What are the profiles of four subgroups of cases with varying histories of institutional living with respect to historical and demographic factors , recollections of child abuse, psychological disorders, trauma symptoms, life problems, quality of life, global functioning, current family relationships, attachment style and personal strengths. To address this question cases were classified into these four groups. Group 1 contained participants who spent more than 12 years in an institution and entered before 5 year of age. Participants in Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 contained participants who spent 5-11 years in an institution and placement occurred through the courts. Those in group 4 spent 4 or fewer years in institutions. There were 110 participants in group 1 (44.5%); 67 in group 2 (27.1%); 22 in group 3 (8.9%); and 48 in group 4 (19.4%).

Historical factors

3.182From Table 4.1 it may be seen that the four groups differed significantly on a range of historical factors including length of time spent with their families before entering an institution; the number of years spent in an institution; their reasons for entering and leaving an institution; the management of the institution in which they lived; and their reaction to leaving the institution.

3.183Participants in group 1 (defined as those who had spent more than 12 years in an institution and entered before five years of age) had spent the least time with their families (under one and a half years) and the longest time living in institutions (on average about fifteen years). More were placed in orphanages run by nuns because they were illegitimate, or because their parents could not look after them, or because their parents died. More left because they were too old to stay on, and more had mixed feelings about leaving. Participants in group 4 (defined as having spent four or fewer years in institution) had spent the most time with their families (on average more than ten and a half years) and the shortest time living in an institution (on average, just under three years). Most were placed in institutions run by religious brothers or priests because of petty crime and left because their short sentences were over, or because their families wanted them back and few had mixed feelings about leaving. Members of groups 2 and 3, on historical factors, had profiles which fell between those of groups 1 and 4, with group 2 being more like group 1 and group 3 being more like group 4.

Demographic characteristics

3.184From Table 4.2 it may be seen that gender was the only demographic factor on which the four groups differed significantly. Significantly more members of groups 1 and 2 were female, and significantly more members of groups 3 and 4 were male. The four groups did not differ on past or present socio-economic status, education, marital status, marital relationship stability, number of children, age at birth of first child, and children’s living arrangements.

Institutional abuse

3.185From Table 4.3 it may be seen that the four groups differed significantly on the sexual abuse scale of the institutional version of the CTQ and the total and severe physical abuse scales of the institutional version of the SPSA. On the sexual abuse scale of the institutional version of the CTQ, the mean score for group 3 was significantly greater than that for group 4, which in turn was significantly greater than that of group 1, which in turn was significantly greater than that of group 2. On the total and severe abuse scale of the institution version of the SPSA, the mean scores of for group 1 were significantly greater than those of group 4 with those of groups 2 and 3 occupying intermediate positions.

3.186From table 4.4 it may be seen that the four groups differed significantly on the ages when the most severe form of physical and sexual abuse began; the duration of the most severe form of physical abuse; the worst thing that happened to participants while living in an institution; and the age of onset and duration of the worst thing that had happened to them.

3.187From Table 4.4 it may be seen that compared with group 4, participants in group 1 were significantly younger when their most severe form of physical abuse and the worst thing that happened to them in an institution began, and the duration of these was significantly longer. On these variables the profiles of the other groups fell between those of groups 1 and 4.

3.188From Table 4.4 it may be seen that compared with groups 3 and 4 participants in groups 1 and 2 were significantly younger when their most severe form of sexual abuse began.

3.189From Table 4.4 it may be seen that compared with groups 1 and 2, significantly more members of group 3 reported that severe sexual abuse was the worst thing that happened to them in an institution. Compared to groups 3 and 4, significantly more members of groups 1 and 2 reported that severe emotional abuse was the worst thing that happened to them in an institution.

Family-based child abuse

3.190For family-based child abuse, only data from 121 members of the 137 in groups 2, 3 and 4 were available, since all members of group 1 and some members of groups 2, 3 and 4 had little recollection of the brief period of time they had spent with their parents during their early years. From Table 4.3 it may be seen that groups 2 ,3 and 4 differed significantly on the physical abuse scale of the family version of the CTQ. The mean score for group 3 was greater than that of group 2, with group 4 occupying an intermediate position between these extremes.

Psychological disorders

3.191From Table 4.5 it may be seen that the four groups differed significantly in the proportions of members who had alcohol and substance use disorders and personality disorders. Compared with groups 1 and 2, significantly more members of groups 3 and 4 had a lifetime diagnoses of alcohol dependence or a lifetime classification of any alcohol or substance use disorder. Compared with groups 1 and 2 significantly more members of 3 had an antisocial personality disorder. The four groups did not differ in rates of anxiety or mood disorders.

Current adjustment

3.192From Table 4.6 it may be seen that compared with groups 1 and 2, the average numbers of life problems were significantly higher in groups 3 and 4. Table 4.7 provides details of the specific life problems on which groups differed. From Table 4.7 it may be seen that compared with groups 1 and 2, groups 3 and 4 had significantly higher rates of substance use, non-violent crime, and incarceration for non-violent crime, while group 3 also had significantly higher rates of violent crime, incarceration for violent crime and unemployment. From Table 4.6 it may be seen that the four groups did not differ total number of trauma symptoms on the TSI, quality of life on the WHOQOL, global functioning on the GAF, marital satisfaction on the KMS or parenting satisfaction on the KPS. From Table 4.8 it may be seen that the four groups did not differ in the rates of four different adult attachment styles assessed by the ECRI.

Strengths

3.193From Table 4.9 it may be seen that the four groups differed significantly in the factors they identified as the source of their strength. Compared with groups 1 and 2, significantly more members of group 4 identified their relationships with their partners as the source of their strength. Compared with groups 2, 3 and 4, significantly more members of group 1 identified as the source of their strength relationships with friends. Compared with group 4, significantly more members of groups 1, 2 and 3 identified self-reliance, optimism, and their work and skills as the source of their strength.

Summary of profiles of groups with varying histories of institutional living

3.194Profiles of four subgroups of cases with varying histories of institutional living are summarized in Table 4.10.

3.195Group 1 included those who had spent more than 12 years in an institution and entered before 5 years of age. They had spent the least time with their families (under one and a half years) and the longest time living in institutions (about fifteen years) on any of the four groups. Compared to groups 3 and 4, more were girls placed in orphanages run by nuns because they were illegitimate, or because their parents had died or could not look after them. More left because they were too old to stay on, and more had mixed feelings about leaving. More had experienced physical abuse which began at a younger age and persisted longer than in group 4. Severe emotional abuse was most commonly cited as the worst thing that happened to this group and it began at an earlier age and lasted longer than worst experiences of other groups. Compared with groups 3 and 4, this group reported fewer psychological disorders and life problems. They identified relationships with friends, self-reliance, optimism, and their work and skills as the sources of their strength.

3.196Group 2 included participants who had spent 5-11 years in institutions because of family problems. Participants in this group entered institutions run predominantly by nuns because their parents could not cope or died, and left when they were too old to stay. Compared with groups 3 and 4, more members of group 2 were female, younger when their most severe form of sexual abuse began, and more identified severe emotional abuse as the worst thing that had happened to them. Compared with group 4 more identified self-reliance, optimism, and their work and skills as the source of their strength.

3.197Group 3 included participants who had spent 5-11 years in institution and entered through the courts. Compared with groups 1 and 2, more members of this group were male, lived in institutions run by religious brothers or priests, and were survivors of institutional sexual abuse. Compared to the other three groups they identified sexual abuse as the worst thing that had happened to them, and more had experienced physical abuse within their families. Compared with groups 1 and 2, this group had more alcohol and substance use disorders, antisocial personality disorders, violent and non-violent crime, imprisonment for violent and non-violent crime, and unemployment. For this group, their self-reliance, optimism, and their work and skills were identified as the main sources of their strength in adulthood, compared with group 4.

3.198Group 4 included participants who had spent 4 or fewer years in institution. Participants in this group spent the most time with their families (more than ten and a half years) and the shortest time living in an institution (just under three years) compared with the other three groups. Most were boys placed in institutions run by religious brothers or priests because of petty crime and left because their short sentences were over, or because their families wanted them back, and few had mixed feelings about leaving. Institutional sexual abuse was the form of maltreatment that distinguished this group, and compared with groups 1 and 2, they showed more alcohol and substance use disorders, antisocial personality disorders, non-violent crime, imprisonment for non-violent crime and unemployment. Their relationships with their partners was identified as the main source of their strength in adulthood.

History of child abuse

3.199In this section results are presented of analyses which address the question: What are the profiles of subgroups of participants with different histories of institutional abuse with respect to historical and demographic factors , recollections of child abuse, psychological disorders, trauma symptoms, life problems, quality of life, global functioning, current family relationships, attachment style and personal strengths. To address this question cases were classified into four groups on the basis of their responses to the question: What was the worst thing that happened to you in the institution? Group 1 contained 23 cases where the worst thing reported was severe physical and sexual abuse. Group 2 contained 99 cases where it was severe physical abuse. Group 3 contained 40 cases where it was severe sexual abuse. Group 4 contained 85 cases where it was severe emotional abuse. Participants’ statements were classified as severe physical abuse if they reported physical violence, beating, slapping, or being physically injured, but not having medical attention withheld. Statements were classified as severe sexual abuse if the person reported the words sexual abuse or mentioned rape; genital, anal or oral sex; masturbation; or other coercive sexual activities involving either staff or older pupils. Statements were classified as severe physical and sexual abuse if they involved both severe physical abuse and severe sexual abuse as defined earlier. Statements of actions involving humiliation, degradation, severe lack of care, withholding medical treatment, witnessing the traumatization of other pupils and adverse experiences that were not clearly classifiable as severe sexual or physical abuse were classified as severe emotional abuse. Inter-rater agreement greater than 90% was achieved for a sample of 10% of statements. Details of statements are in Table 3.4 in Part 3. For brevity many non-significant results have not been included in the tables of results arising from the comparison of the four groups who reported suffering differing types of worst types of abusive experiences in institutions.

Historical and demographic characteristics

3.200From Table 4.11 it may be seen that the four groups differed significantly on the following historical and demographic variables: gender, age, length of time with family before entering an institution, years spent in an institution, reason for entering an institution, institution management, feelings about leaving the institution, education and children’s’ living arrangements.

3.201From Table 4.11 it may be seen that participants in group 1, for whom severe physical and sexual abuse was the worst thing that happened to them in institutions, differed significantly from those in one or more of the other groups in the following respects. They were younger (being in their 50s, not their 60s) than participants in group 2 and had spent less time with their families before entering an institution than group 3. More of them had passed the primary certificate (indicating that they had achieved a higher educational level) than groups 2 and 3. Also, like members of group 3, more had children who spent some time living separately with the child’s other parent than members of group 4.

3.202From Table 4.11 it may be seen that participants in group 2, for whom severe physical abuse was the worst thing that happened to them in institutions, differed significantly from those in one or more of the other groups in the following respects. They were older than members of groups 1 and 3 (being in their 60s, not their 50s). They had a lower level of educational attainment than members of groups 1 and 4. Finally, 5.7% of participants in group 2 had put a child up for adoption whereas no members of the other three groups had done this.

3.203From Table 4.11 it may be seen that participants in group 3, for whom severe sexual abuse was the worst thing that happened to them in institutions, differed significantly from those in one or more of the other groups in the following respects. More were male compared with group 4. They were younger than group 2 (being in their 50s, not their 60s). They had spent more time with their families before entering an institution than members of the other 3 groups. Compared with group 4, they had spent fewer years in an institution; more had entered institutions through the courts for petty crime; more had been in institutions run by religious brothers and priests (but not nuns); and more were happy to leave and fewer had mixed feelings. Like members of group 2, fewer had passed their primary certificate compared with group 1. Also, like members of group 1, more had children who spent some time living separately with the child’s other parent than members of group 4.

3.204From Table 4.11 it may be seen that participants in group 4, for whom severe emotional abuse was the worst thing that happened to them in institutions, differed significantly from those in one or more of the other groups in the following respects. Compared with members of group 3, more were female; they spent more years living in institutions; fewer entered through the courts for petty crime; more lived in institutions run by nuns; and more had mixed feelings about leaving. Compared with group 2 more had achieved a higher educational qualification. Compared with groups 1 and 3, fewer had children who spent some time living separately with the child’s other parent.

Recollections of child abuse

3.205From Table 4.12 it may be seen that the four groups differed significantly on the IAS; the total, physical and sexual abuse scales of the institutional version of the CTQ; and the total and severe sexual abuse scales of the institution version of the SPSA.

3.206From Table 4.12 it may be seen that for the IAS, and the total and physical abuse scales of the institutional version of the CTQ, mean scores for group 1 were significantly higher than those of the other three groups. Those for group 4 were significantly lower than those of the other three groups. Mean scores for groups 2 and 3 occupied intermediate positions between these extremes.

3.207From Table 4.12 it may also be seen that for the sexual abuse scale of the institution version of the CTQ and the total and severe sexual abuse scales of the institution version of the SPSA, means scores for groups 1 and 3 were significantly higher than those of groups 2 and 4.

3.208From Table 4.13 it may be seen that the four groups differed on the age when the worst thing that happened to them in an institution began and the duration of these worst experiences. The mean age at which worst experiences began was significantly lower for group 4 than for the other three groups, and significantly higher for group 3, with groups 1 and 2 occupying intermediate positions between these extremes. The average duration of the worst thing that happened to participants in institutions was significantly longer for groups 2 and 4 than for group 3.

Psychological disorders

3.209From table 4.14 it may be seen that the groups differed significantly in the proportion of participants with current PTSD, any lifetime alcohol and substance use disorder, a lifetime diagnosis of alcohol dependence, and antisocial personality disorder. More members of group 3 than group 4 had each of these disorders. In addition, more members of group 1 had current PTSD compared with groups 2 and 4.

Current adjustment

3.210From table 4.15 it may be seen that the groups differed significantly in their total number of trauma symptoms on the TSI and total number of life problems on the LPC. In both areas, group 4 showed significantly better adjustment than two of the other three groups. Groups 1 and 3 had a significantly higher mean level of trauma symptoms than group 4. Group 3 had significantly more life problems than group 2, who in turn has significantly more life problems than group 4. The four groups did not differ significantly on indices of quality of life, global functioning, current family relationships, adult attachment style and personal strengths.

Summary of profiles of groups who reported suffering differing types of worst abusive experiences in institutions

3.211Profiles of these four subgroups of cases who reported suffering differing types of worst abusive experiences in institutions are summarized in Table 4.16.

3.212Summary profile of group 1 for whom severe sexual and physical abuse was the worst thing they had experienced in an institution. Participants in this group had spent less time with their families before entering an institution than the other 3 groups. Like members of group 3, more had children who spent some time living separately with the child’s other parent. Participants in group 1 had experienced more physical and sexual institutional abuse than at least two of the other 3 groups. Compared with groups 2 and 4, more had a current diagnosis of PTSD and multiple trauma symptoms.

3.213Summary profile of group 2 for whom severe physical abuse was the worst thing they had experienced in an institution. Participants in this group had the lowest educational achievement, were older than the other three groups, and more had put their own children up for adoption. Compared with the groups 1 and 3, their worst abusive experience had lasted longer. Like group 4, they showed fewer adjustment problems in adulthood compared to the other two groups.

3.214Summary profile of group 3 for whom severe sexual abuse was the worst thing they had experienced in an institution. Compared with the other three groups, more participants in group 3 were male and admitted through the courts to institutions run by religious brothers for petty crime. Like group 1, more had children who spent time with their other parent who lived separately. This group for whom severe institutional sexual abuse was their worst experience, showed the poorest adjustment as adults of all four groups. Like group 1 they showed PTSD and multiple trauma symptoms. They also had lifetime alcohol and substance use disorders and antisocial personality disorders along with multiple life problems.

3.215Summary profile of group 4 for whom severe emotional abuse was the worst thing they had experienced in an institution. Compared to the other three groups, more participants in this group were female; more had spent the longest time living in institutions; more lived in institutions run by nuns; more reported that their worst experiences began at an earlier age and lasted a longer time; and more had mixed feelings about leaving. Of the four groups, this group showed the best psychological adjustment in adulthood.

Conclusions

3.216The main question addressed in this Part concerned the profiles of subgroups of cases with varying histories of institutional living. Summary profiles of four groups of participants who had spent different amounts of time in institutions and entered under different circumstances are given in Table 4.10. A subsidiary question concerned the profiles of subgroups of participants with different histories of institutional abuse. Summary profiles of four groups of participants who reported suffering differing types of worst abusive experiences in institutions are presented in Table 4.16. A number of broad conclusions may be drawn from the analyses reported in this Part. Adult survivors of institutional living are not a homogenous group. Subgroups, defined by (1) duration of time in an institution and circumstances of entry, and (2) worst form of institutional abuse have distinctive profiles. In the analysis of groups of participants who had spent different amounts of time in institutions and entered under different circumstances, the most poorly adjusted as adults were not those who had spent longest living in institutions, but rather those who had spent a moderate amount of time in institutions and who had suffered institutional sexual abuse. In the analysis of groups of participants who reported suffering differing types of worst abusive experiences in institutions, the most poorly adjusted included those who pinpointed severe sexual abuse as the worst thing that had happened to them while living in an institution. Thus institutional sexual abuse, was associated in both analyses with a particularly poor outcome.

Table 4.1. Historical characteristics of 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Variable Group 1 Group 2 Group 3 Group 4 Chi Square or ANOVA F Group Diffs
N=110 N=67 N=22 N=48
Years with family before M 1.41 6.57 10.05 10.71 208.35*** 4>2>1
entering an institution (N=246) SD 1.66 2.76 2.24 3.30
Years spent in an institution (N=247) M 15.05 8.34 5.89 2.84 567.22*** 1>2>3>4
SD 2.09 1.92 1.37 1.25
Reason for entering an institution
(N=245)
Illegitimate f 44.00 4.00 0.00 0.00 199.30*** 1>2,3,4
% 40.70 6.00 0.00 0.00
Petty crime f 3.00 1.00 21.00 33.00 3,4>1,2
% 2.80 1.50 95.50 68.80
Parents could not provide care f 47.00 45.00 1.00 11.00 1,2>3,4
% 43.50 67.20 4.50 22.90
Parent died f 14.00 17.00 0.00 4.00 1,2>3
% 13.00 25.40 0.00 8.30
Reason for leaving the institution
(N=247)
I was too old to stay on f 97.00 51.00 15.00 13.00 18.32*** 1,2,3>4
% 88.20 76.10 68.20 27.10
The institution closed down f 1.00 1.00 2.00 0.00 3>1,2,4
% 0.90 1.50 9.10 0.00
My short sentence was over f 1.00 2.00 3.00 13.00 4>1,2
% 0.90 3.00 13.60 27.10
My family wanted to take me home f 6.00 11.00 1.00 16.00 4>1,3
% 5.50 16.40 4.50 33.30
I ran away f 4.00 0.00 1.00 3.00 NS
% 3.60 0.00 4.50 6.30
Others f 1.00 2.00 0.00 3.00 NS
% 0.90 3.00 0.00 6.30
Institution management (N=247)
Nuns f 70.00 42.00 0.00 9.00 144.96*** 1,2>3,4
% 63.60 62.70 0.00 18.80
Religious brothers and priests f 1.00 19.00 22.00 35.00 1,2<3,4
% 0.90 28.40 100.00 72.90
Priests, religious brothers and nuns f 39.00 6.00 0.00 4.00 1>2,3,4
% 35.50 9.0 0.00 8.30
Were you happy to leave the institution (N=247)
Yes f 53.00 44.00 16.00 39.00 19.14** NS
% 48.20 65.70 72.70 81.20
Mixed feelings f 51.00 19.00 6.00 8.00 1>4
% 46.40 28.40 27.30 16.70
No f 6.00 4.00 0.00 1.00 NS
% 5.50 6.00 0.00 2.10

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in an institution. For each variable with multiple categories, within each group the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Percentages across rows do not sum to 100. For continuous variables F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. For categorical variables, where chi square tests were significant at p<.05, group differences were interpreted as significant if standardised residuals exceeded an absolute value of 2. **p<.01. ***p<.001

Table 4.2. Demographic characteristics of 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Variable Group 1 Group 2 Group 3 Group 4 Chi Square Group Diffs
N=110 N=67 N=22 N=48
Gender (N=247)
Male f 45.00 28.00 22.00 39.00 43.83*** 3,4>1,2
% 40.90 42.00 100.00 81.25
Female f 65.00 39.00 0.00 9.00 1,2>3,4
% 59.18 58.20 0.00 18.75
Age in years (N=247) M 58.59 61.11 61.82 61.27 2.32 NS
SD 7.65 8.64 9.92 8.31
Current socio-economic status (SES) (N=241)
Unemployed f 23.00 13.00 5.00 19.00 17.54 NS
% 21.50 19.70 23.80 40.40
Unskilled manual f 20.00 13.00 3.00 2.00
% 18.70 19.70 14.30 4.30
Semi-skilled manual and farmers owning less than f 14.00 6.00 3.00 5.00
30 acres % 13.10 9.10 14.30 10.60
Skilled & other non manual, farmers owning 30-200 f 16.00 7.00 0.00 7.00
acres, lower & higher managerial & professional % 15.00 10.60 0.00 14.90
Retired f 34.00 27.00 10.00 14.00
% 31.80 40.90 47.60 29.80
Highest SES attained since leaving school (N=235)
Unskilled manual f 49.00 32.00 8.00 15.00 22.95 NS
% 46.2 50.00 42.10 32.60
Semi-skilled manual and farmers owning less than f 21.00 14.00 7.00 20.00
30 acres % 19.8 21.90 36.80 43.50
Skilled & other non manual, farmers owning 30-200 f 36.00 18.00 4.00 11.00
acres, lower & higher managerial & professional % 34.00 28.10 21.10 23.90
Education: Highest exam passed (N=244)
None f 49.00 27.00 14.00 31.00 17.21 NS
% 45.40 40.30 63.60 66.00
Junior school exam in 5th or 6th class f 27.00 25.00 5.00 5.00
(e.g. primary cert) % 25.00 37.30 22.70 10.60
Intermediate or Leaving Cert. f 13.00 8.00 1.00 7.00
% 12.00 11.90 4.50 14.90
Certificate or diploma or apprenticeship exam, or f 19.00 7.00 2.00 4.00
primary degree % 17.60 10.40 9.10 8.50
Marital status (N=245)
Single and never married or cohabited f 18.00 5.00 2.00 3.00 13.45 NS
% 16.70 7.50 9.10 6.30
Single & separated/ divorced from first f 20.00 14.00 3.00 10.00
marital/cohabiting partner % 18.50 20.90 13.60 20.80
Single & separated/ divorced from 2nd/later partner f 3.00 2.00 3.00 3.00
% 2.80 3.00 13.60 6.30
Single and widowed f 11.00 7.00 2.00 2.00
% 10.20 10.40 9.10 4.20
Married/ cohabiting in 2nd or later marriage or f 16.00 11.00 3.00 7.00
long term relationship % 14.80 16.40 13.60 14.60
Married/cohabiting in first long term relationship f 40.00 28.00 9.00 23.00
% 37.00 41.80 40.90 47.90
Number of long term relationships or
marriages that have ended
(N=217)
No relationship has ended f 29.00 19.00 7.00 20.00 6.90 NS
% 32.20 30.60 35.00 44.40
1 relationship f 32.00 26.00 5.00 16.00
% 35.60 41.90 25.00 35.60
2 relationships f 19.00 10.00 4.00 4.00
% 21.10 16.10 20.00 8.90
3 relationships f 10.00 7.00 4.00 5.00
% 11.10 11.30 20.00 11.10
Duration of relationship with M 28.68 30.68 33.64 35.35 2.79 NS
current partner? (N=134) SD 10.48 12.31 10.52 7.66
Number of children (N=212) M 3.23 3.03 3.80 3.95 2.55 NS
SD 1.93 1.40 1.80 2.39
Age when had first child (N=207) M 25.38 25.61 25.86 25.52 0.05 NS
SD 5.63 5.66 6.13 5.15
Children’s living arrangements (N=211)
Spent some time living with their other parent f 9.00 5.00 8.00 6.00 17.08 NS
% 10.30 8.30 38.10 14.00
Spent some time living with their relatives or in care f 8.00 3.00 0.00 5.00
% 9.20 5.00 0.00 11.60
Always lived with respondent f 67.00 51.00 13.00 31.00
% 77.00 85.00 61.90 72.10
Children put up for adoption f 3.00 1.00 0.00 1.00
% 3.40 1.70 0.00 1.70

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in an institution. The percentages in long-term relationships or marriages that have ended were based on number of cases who had had any marriages or long-term relationships. The number in each group were: Group 1=90; Group 2=62; Group 3=20; Group 4=45. The mean duration of relationship with current partner was based on the number of participants who were married or cohabiting. The number in each group were: Group 1=56; Group 2=38; Group 3=11; Group 4=29. The mean number of children, mean age when had first child and percentage of children in each of the children’s living arrangements categories were based on cases with children only. The number in each group were: Group 1=87; Group 2=60; Group 3=21; Group 4=43. Socio-economic status (SES) was assessed with O’Hare, A., Whelan, C.T., & Commins, P. (1991). The development of an Irish census-based social class scale. The Economic and Social Review, 22, 135-156. For each variable with multiple categories, within each group the percentages sum to approximately 100. Minor deviations from 100 are due to rounding of decimals to two places. Percentages across rows do not sum to 100. For continuous variables F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. For categorical variables, where chi square tests were significant at p<.05, group differences were interpreted as significant if standardised residuals exceeded an absolute value of 2. ***p<.001.

Table 4.3. Recollections of child abuse in 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Variable
Group 1
Group 2 Group 3 Group 4 ANOVA
F
Group Diffs
N=110 N=67 N=22 N=48
INSTITUTIONAL ABUSE
IAS (N=247) Specific institutional Abuse M 48.31 58.39 50.84 50.13 2.41 NS
SD 9.63 10.35 11.36 9.23
CTQ-Institution >(N=247) Total institutional abuse score M 49.88 48.48 52.68 51.18 1.28 NS
SD 9.48 9.40 12.09 10.82
Physical abuse M 49.72 49.73 53.12 49.57 0.79 NS
SD 9.17 10.40 11.62 10.54
Sexual abuse M 49.34 47.28 56.01 52.57 5.85*** 3>4>1>2
SD 9.40 8.36 11.37 11.27
Emotional abuse M 50.89 48.85 47.85 50.58 0.98 NS
SD 9.16 11.23 13.02 8.39
Physical neglect M 51.34 48.94 48.38 49.10 1.23 NS
SD 10.00 9.93 10.98 9.59
Emotional neglect M 48.59 52.12 49.73 50.42 1.78 NS
10,84 9.54 9.54 8.53
SPSA-Institution >(N=247) Total severe institutional abuse M 51.58 48.69 50.09 48.17 5.59*** 1>4
SD 5.86 5.87 5.45 5.35
Severe institutional physical abuse M 54.26 48.91 46.72 43.19 18.37*** 1>4
SD 9.37 9.54 8.80 7.71
Severe institutional sexual abuse M 50.46 47.85 52.50 50.75 1.67 NS
SD 10.58 9.81 9.16 8.86
CHILD ABUSE IN FAMILY
CTQ-family (N=121) Total family abuse Score M 0.00 49.07 52.11 50.14 0.68 NS
SD 0.00 9.99 8.56 10.51
Physical abuse M 0.00 46.84 54.27 51.70 5.56** 3>4>2
SD 0.00 7.56 11.96 10.58
Sexual abuse M 0.00 50.98 47.05 50.12 1.13 NS
SD 0.00 11.19 0.00 10.59
Emotional abuse M 0.00 49.74 50.31 50.12 0.03 NS
SD 0.00 10.24 10.09 9.90
Physical neglect M 0.00 48.45 54.94 49.65 3.23 NS
SD 0.00 9.82 9.49 9.94
Emotional neglect M 0.00 49.51 53.12 49.23 1.18 NS
SD 0.00 9.91 11.01 9.63
SPSA-family (N=121) Total severe family abuse M 0.00 48.93 49.50 48.17 0.43 NS
SD 0.00 6.35 5.23 5.35
(N=121) Severe family physical abuse M 0.00 48.13 46.21 43.19 3.94 NS
SD 0.00 9.72 9.03 7.71
(N=121) Severe family sexual abuse M 0.00 48.93 51.54 50.74 0.75 NS
SD 0.00 10.21 8.87 8.86

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in institutions. CTQ=Childhood Trauma Questionnaire (Bernstein, D. & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report. Manual. San Antonio, TX: The Psychological Cooperation). IAS=Institutional abuse scale. SPSA=Most severe forms of physical and sexual abuse. Cautious interpretation of scores from the family version of the SPSA is warranted because of the low reliability of scores from this instrument, mentioned in Part 3 and documented in Table 3.11. To aid profiling, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before ANOVAs were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. F values are from one-way analyses of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. For the MANOVA on all subscales of the institution versions of the CTQ, SPSA & the IAS, F (24, 685) = 6.16, p<.001. For the MANOVA on all subscales of the family versions of the CTQ and SPSA, F (14, 224) = 2.66, p<.001. *p<0.05 **p<0.01 ***p<0.001. NS=Not significant.

Table 4.4. Timing of severe abuse and worst form of abuse experienced in 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Variable Group 1 Group 2 Group 3 Group 4 For Chi Square Group Diffs
N=110 N=67 N=22 N=48
INSTITUTIONAL ABUSE
Age when most severe form of physical
abuse began (N=233) M 6.51 8.56 11.05 11.80 36.61*** 1<2<4
SD 3.46 2.87 2.66 2.51
Duration of most severe form of
physical abuse (N=229) M 9.26 5.98 4.86 2.68 36.90*** 1>2>4
SD 4.41 3.40 3.31 1.32
Age when most severe form of sexual M 9.85 9.76 12.13 12.43 8.55*** 1,2<3,4
abuse began (N=122) SD 3.05 2.45 1.46 2.41
Duration of most severe form of sexual M 3.13 3.65 2.32 1.70 2.09 NS
abuse (N=111) SD 3.06 4.22 1.42 1.42
Worst thing that ever happened to you
in an institution (N=247)
Severe physical and sexual abuse (N=23) f 10.00 9.00 2.00 2.00 38.20*** NS
% 9.10 13.40 9.10 4.20
Severe physical abuse (N=99) f 45.00 18.00 9.00 25.00 NS
% 40.90 29.90 40.90 52.10
Severe sexual abuse (N=40) f 11.00 6.00 9.00 14.00 3>1,2
% 10.00 9.00 40.90 29.20
Severe emotional abuse (N= 85) f 44.00 32.00 2.00 7.00 1,2>3,4
% 40.00 47.80 9.10 14.60
Age when worst thing began (N=237) M 7.74 9.11 11.69 11.70 19.40*** 1<4
SD 3.60 3.17 1.63 3.22
Duration of worst thing (N=225) M 7.19 4.73 4.33 2.14 15.27*** 1>2,3>4
SD 5.13 4.19 3.37 1.51
CHILD ABUSE IN FAMILY
Age when most severe form of physical M 0.00 7.00 6.91 7.65 0.31 NS
abuse began (N=41) SD 0.00 2.16 1.92 3.48
Duration of most severe form of M 0.00 2.91 5.16 6.44 2.57 NS
physical abuse (N=42) SD 0.00 2.72 3.75 4.61
Age when most severe form of sexual M 8.00 8.40 0.00 8.80 0.05 NS
abuse began (N=11) SD 0.00 2.30 0.00 3.11
Duration of most severe form of sexual M 12.00 3.42 0.00 4.04 2.45 NS
Abuse (N=11) SD 0.00 2.94 0.00 4.14

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in institutions. For the ‘worst thing that ever happened’ , verbatim responses were classified into 4 categories (as shown in table 3.4) and percentages in these 4 categories sum to about 100 for each group. Percentages across rows do not sum to 100. For continuous variables F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. For categorical variables, where chi square tests were significant at p<.05, group differences were interpreted as significant if standardised residuals exceeded an absolute value of 2. ***p<.001

Table 4.5. Psychological disorders in 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Disorder Group 1 Group 2 Group 3 Group 4 Chi
Square
Group Diffs
N=110 N=67 N=22 N=48
Anxiety disorders
Any anxiety disorder, current f 51.00 30.00 11.00 20.00 0.26 NS
% 46.40 44.80 50.00 41.70
Any anxiety disorder, lifetime f 32.00 29.00 8.00 17.00 2.29 NS
% 29.10 43.30 36.40 35.40
Mood Disorders
Any mood disorder, current f 29.00 17.00 9.00 11.00 2.69 NS
% 26.40 25.40 40.90 22.90
Any mood disorder, lifetime f 40.00 25.00 6.00 18.00 0.83 NS
% 36.40 37.30 27.30 37.50
Alcohol & substance use disorders
Any alcohol or substance use disorder, current f 6.00 4.00 1.00 1.00 1.07 NS
% 5.50 6.00 4.50 2.10
Any alcohol and substance use disorder, lifetime f 27.00 20.00 13.00 28.00 23.61*** 3,4,>1,2
% 24.50 29.90 59.10 58.30
Alcohol dependence, lifetime f 16.00 17.00 10.00 23.00 23.35*** 3,4,>1.2
% 14.50 25.40 45.50 47.90
Personality disorders
Antisocial personality disorder, current f 2.00 3.00 5.00 7.00 18.07*** 3>1,2
% 1.80 4.50 22.70 14.60

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in institutions. Diagnoses were made using the SCID I (First, M., Spitzer, R., Gibbon, M., and Williams, J. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I). Washington, DC: American Psychiatric Press) and SCID II (First, M., Spitzer, R., Gibbon M., & Williams, J. (1997). Structured Clinical Interview for DSM-IV Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press). Psychological disorders do not represent mutually exclusive categories and so percentages within and across groups sum to more than 100%. Where chi square tests were significant at p<.01, group differences were interpreted as significant if standardised residuals exceeded an absolute value of 2. ***p<.001.

Table 4.6. Current adjustment of participants in 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.


Group
1
Group
2
Group
3
Group
4
ANOVA
F
Group Diffs
N=110 N=67 N=22 N=48
Total trauma symptoms (TSI) M 49.92 48.85 50.78 51.41 0.66 NS
(N=247) SD 10.00 9.99 10.80 9.74
Total No of life problems (LPC) M 48.19 47.38 57.06 54.56 10.90*** 3,4>1,2
(N=247) SD 8.78 8.64 11.85 10.69
Total quality of life (WHOQOL) M 50.01 50.41 49.61 49.60 0.08 NS
(N=247) SD 9.57 9.44 9.44 12.08
Global functioning (GAF) M 49.39 49.63 50.60 51.76 0.64 NS
(N=235) SD 9.55 10.51 9.46 10.65
Marital satisfaction (KMS) M 51.07 49.81 53.21 54.72 1.40 NS
(N=136) SD 10.52 10.85 10.31 9.69
Parental satisfaction (KPS) M 48.81 51.62 46.01 48.55 1.58 NS
(N=212) SD 11.65 8.37 10.11 13.77

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in institutions. TSI=Trauma Symptom Inventory (Briere, J. (1996). Trauma Symptom Inventory. Odessa, FL: Psychological Assessment Resources). LPC=Life Problems Checklist. WHOQOL= World Health Organization Quality of Life 100 UK (Skevington, S. (2005). World Health Organization Quality of Life 100 UK Version. Bath, UK: WHO Centre for the Study of Quality of Life, University of Bath). GAF=Global assessment of functioning scale (Luborsky, L. (1962). Clinicians’ Judgements of Mental Health. Archives of General Psychiatry, 7, 407–417). KMS=Kansas Marital Satisfaction Scale (Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., Bugaighis, M.A. (1986) Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage & the Family, 48, 381-387). KMS means and SDs are based on the number of participants who lived with partners (N=136). KPS=Kansas Parenting Satisfaction Scale (James, D. E., Schumm, W. R., Kennedy, C. E., Grigsby, C. C., Shectman, K. L., Nichols, C. W. (1985). Characteristics of the Kansas Parental Satisfaction Scale among two samples of married parents. Psychological Reports, 57, 163-169). KPS means and SDs are based on the number of participants with children (N=212). To aid profiling across variables, all variables were transformed to T-scores with means of 50 and standard deviations of 10 before ANOVAs were conducted. T-score for variable X = ((X-M)/SD)X10)+50), where X is the score of a case on variable X; M is the mean for all cases on variable X and SD is the standard deviation for all cases on variable X. F values are from one-way analysis of variance and inter-group differences are based on Scheffe post hoc tests for comparing groups with unequal Ns that were significant at p<.05. ***p<0.001. NS=Not significant.

Table 4.7. Life problems in 4 groups of participants who had spent different amounts of time in institutions and entered under different circumstances.

Variable Group 1 Group 2 Group 3 Group 4 Chi Square Group Diffs
N=110 N=67 N=22 N=48
Substance use f 32.00 20.00 13.00 29.00 19.94*** 3,4>1,2
% 29.10 29.90 59.10 60.40
Violent crime f 8.00 2.00 7.00 8.00 18.38*** 3>1,2
% 7.30 3.00 31.80 16.70
Incarceration for violent crime f 6.00 1.00 4.00 7.00 11.52*** 3>1.2
% 5.50 1.50 18.20 14.60
Non-violent crime f 16.00 7.00 12.00 20.00 32.88*** 3,4>1,2
% 14.50 10.40 54.50 41.70
Incarceration for non-violent crime f 8.00 3.00 7.00 15.00 27.84*** 3,4>1,2
% 7.30 4.50 31.80 31.30
Unemployment f 53.00 27.00 16.00 32.00 12.24** 3,4>2
% 48.20 40.30 72.20 66.70
Homelessness f 24.00 8.00 9.00 11.00 8.70 NS
% 21.80 11.90 40.90 22.90
Frequent illness f 31.00 18.00 9.00 15.00 1.76 NS
% 28.20 26.90 40.90 31.30
Frequent hospitalization for physical f 29.00 15.00 8.00 18.00 4.06 NS
Health % 26.40 22.40 36.40 37.50
Mental health f 84.00 47.00 16.00 36.00 0.88 NS
% 76.40 70.10 72.70 75.00
Self-harm f 15.00 12.00 4.00 13.00 4.13 NS
% 13.60 17.90 18.20 27.10
Hospitalization for mental health f 12.00 7.00 4.00 9.00 2.74 NS
% 10.90 10.40 18.20 18.80
Anger control in intimate relationships f 21.00 18.00 9.00 16.00 6.65 NS
% 19.10 26.90 40.90 33.30
Anger control with children f 8.00 11.00 6.00 8.00 8.20 NS
% 7.30 16.40 27.30 16.70

Note: Group 1 spent more than 12 years in an institution and entered before age 5. Group 2 spent 5-11 years in an institution and placement occurred because parents couldn’t cope or died. Group 3 spent 5-11 years in an institution and placement occurred through the courts. Group 4 spent 4 or fewer years in institutions. Life problems do not represent mutually exclusive categories and so percentages within and across groups sum to more than 100%. Where chi square tests were significant at p<.05, group differences were interpreted as significant if standardised residuals exceeded an absolute value of 2. **p<.01. ***p<.001.

1 Professor Alan Carr, PhD, Professor Alan Carr, PhD. June 2006 (revised for minor inaccuracies in December 2008).