ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Tamadoni Asef Abad   S. (1)
Hejjazi   S.A. (*2)
Masoudi   Sh. (3)
Fotovvat   A. (2)






(*2) Legal Medicine Research Center, Iranian Legal Medicine Organization, Tehran, Iran
(1) Department of Family Counseling, Quchan Branch, Azad University, Quchan, Iran
(3) Department of Counseling & Psychology, Quchan Branch, Azad University, Quchan , Iran

Correspondence

Address: General Department of Forensic Medicine of Khorasan Razavi, Sanabad St., Khaki Bridge Crossroads, Khorasan Razavi, Iran Postal Code: 9138615916
Phone: +98 (51) 8454400
Fax: +98 (51) 8454400
arya_hedjazi@yahoo.com

Article History

Received:  September  3, 2020
Accepted:  September 15, 2020
ePublished:  September 20, 2020

BRIEF TEXT


…[1]. Stockholm syndrome is a psychological response. It occurs when hostages or abuse victims bond with their captors or abusers during captivity [2].

Emotional bonds may lead to intimacy between the hostages and their capture over time. However, this bond is considered illogical because of the high risks to the victim [3]. …[4-8]. Research has shown that for many women, abuse and violence are associated with attachment and stability in relationships even after separation from the abusive husband and partner [9]. ...[10-12]. Graham et al. in 1995 developed a scale to identify reactions associated with the Stockholm syndrome, and the original version had 49 items, which was reduced to 24 items in later research [13]. ...[14-21].

This study aimed to investigate the factor structure, validity, and reliability of SSS in Iranian women victims of spousal violence.

The present study is a cross-sectional descriptive-survey study.

This study was performed from October to March 2017 on all women (n=2110) suffering from spousal abuse and referring to the legal medicine centers in Mashhad city.

Three hundred sixty women were selected using the available sampling method and using the general rule of sampling knowledge in factor analysis (the number of subjects should always be more than the number of questionnaire items) based on Stevens theory [22].

Demographic information questionnaires and the SSS and Revised Adult Attachment Scale (RAAS) were used for data collection as follows: - Demographic information questionnaires: this questionnaire was designed in order to collect basic information about the participants such as age, level of education, duration of the marriage, number of children, the reason for not getting a divorce, number of visits to the legal medicine center, occupation, economic status, frequency of sexual partners per month, type of domestic violence and betrayal. - SS scale: The initial assumptions of this scale were selected based on their severity of Stockholm syndrome in the initial studies. ...[23]. …[19]. George confirmed the structure's validity and the three-factor structure of the scale using heuristic factor analysis [19]. In a study confirming the convergent validity and factor structure of the Mexican sample scale, Rizo-Martinez et al. reported its reliability for the whole scale, core dimensions, damage, and love in 0.84 0.94, 0.90, and 0.89, respectively [9]. - RAAS questionnaire: The RAAS questionnaire was used to assess the simultaneous validity of SSS. The adult attachment scale includes self-assessment of developing relationship skills and self-description of developing attachment relationships than attachment styles which Colin and Reed compiled in 1990 [24]. ...[25]. Pakdaman et al. in a study, while confirming the validity of the scale structure through the correlation of subscales with each other, evaluated its reliability using Cronbach's alpha and retest method for the proximity component by 0.81 and 0.82, dependence by 0.78, 0.80, and anxiety by 0.85 and 0.83 [26]. In a study, Teymouri Asefichi et al. obtained scale reliability through Cronbach's alpha test for the components of closeness, dependence, and anxiety in 0.73, 0.68, and 0.74 level, respectively [27]. To evaluate the questionnaire's content and face validity in both source and target languages, it is recommended to use the forward-backward method as a guide for intercultural adaptation [28]. Therefore, the translation and equivalence of the Stockholm Syndrome Questionnaire with Iranian culture were conducted based on this method, which includes translation steps, reverse translation, and the English version's comparison with the Persian version. The questionnaire was first translated from English to Persian by two bilingual experts to evaluate the scale's content and face validity. In this step, 2 Persian translations independent of SSS were obtained. Then, two translations and their recorded equations were reviewed and considering all the options for equivalence of words or terms, a Persian version of the scale was prepared. Then, the Persian version was translated into English by a bilingual expert, and finally, its conceptual similarity with the original version was confirmed by two previous bilingual experts. In the present study, the terms of spouse or husband were chosen instead of the sexual partner not to be contrary to the Iranian culture, and cases of informal marriages and similar individuals do not enter the research. Finally, a Persian version of the questionnaires with favorable quality was prepared. The content validity ratio (CVR) and content validity index (CVI) was used to evaluate the questionnaire's content validity. To determine the CVR, the questionnaire was sent to 10 experts, and they were asked to review each question on a 3-part scale (necessary, useful but not necessary, and not necessary). The Lushe table [29] was used to interpret the CVR, which was calculated more than 0.75 for all items. To assess the CVI, three criteria of simplicity, specificity (relevance), and clarity were examined separately in a 4-point Likert scale (1: unrelated, 2: somewhat related, 3: related, and 4: completely related) for each of the items. Each item was accepted based on a score higher than 0.80, and finally, the content validity of SSS was confirmed. After obtaining ethical approval from the Legal Medicine Organization, the purpose of research for the subjects was explained to observe with ethical considerations, and their written consent was obtained. The necessary guidance on how to complete the questionnaires was provided, and the questions and ambiguities of the participants were removed. The SSS structure's validity was evaluated using exploratory factor analysis and the principal component method used by the varimax rotation. The simultaneous validity of SSS was calculated using the RAAS questionnaire. The reliability of the scale was calculated using the retest method and Cronbach's alpha coefficient. Data were analyzed using SPSS 26 software.

The demographic information of 360 participants has been presented in Table 1.Among the Stockholm syndrome dimensions, the core component had the highest mean, and the love dependency component had the lowest mean. Indices of skewness and kurtosis also showed that the data distribution for the total score of Stockholm syndrome and its dimensions was in the normal range of 2% (Table 2).The value of the Kaiser-Meyer-Olkin coefficient (KMO) was equal to 0.897 and indicated the adequacy of the data and the selected sample number's desirability (df =253; p=0.0001). The Bartlett sphericity test result was 3339/311 and showed that the data correlation matrix in the community is not zero and the items can be reduced to some underlying factors, and factor analysis can be used to confirm the relevant factors (df=253; p=0.0001). With an eigenvalue greater than one, three factors were identified and explained 52.37% of the variance of the variables (Table 3). The scree diagrams also showed that scale items in 3 factors have a specific value greater than 1 (Figure 1). The results of factor analysis by Varimax rotation method for naming factors and extracting them as well as eliminating questions with factor loading less than 0.3 were reported in Table 4. The three main factors were obtained, and all 23 questions showed a good factor load with the three factors. The extracted factors were named according to the main scale for the first component, core (items 1-8), the second component, psychological vulnerability (items 9-16), and the third component, emotional attachment (items 17-23) (Table 4).Simultaneous implementation of the RAAS questionnaire was used to assess the simultaneous validity of SSS. SSS and its dimensions are significantly correlated with the RAAS questionnaire so that Stockholm syndrome has a significant negative correlation with the dimension of secure attachment, which indicates the divergent validity of the scale. Also, Stockholm syndrome has a positive and significant correlation with the dimensions of avoidant and ambivalent attachment, which indicates the convergent validity of this scale (Table 5). Cronbach's alpha coefficient with 0.88 and split-half coefficient with 0.70 indicate the favorable internal reliability and consistency of SSS (Table 6).

Simultaneous implementation of the RAAS questionnaire was used to assess the simultaneous validity of SSS. SSS and its dimensions are significantly correlated with the RAAS questionnaire so that Stockholm syndrome has a significant negative correlation with the dimension of secure attachment, which indicates the divergent validity of the scale. Also, Stockholm syndrome has a positive and significant correlation with the dimensions of avoidant and ambivalent attachment, which indicates the convergent validity of this scale (Table 5). Cronbach's alpha coefficient with 0.88 and split-half coefficient with 0.70 indicate the favorable internal reliability and consistency of SSS (Table 6).

Given that cultural contexts strongly influence the phenomenon of spousal abuse, it is suggested that researchers interested in this field use different statistical and ethnic samples to make the results of this type of study more comprehensive.

The self-reportability of the tools used in this study has limitations such as the questioners' desire for social desirability and the difficulty of obtaining honest answers.

The Stockholm Syndrome Scale has good reliability and validity in Iranian clinical specimens referred to the Legal Medicine Centers of Mashhad city. This questionnaire is a useful tool for screening and initial diagnosis; so that by this scale, women at risk of Stockholm syndrome in the field of marriage can be identified in the early stages, and the necessary measures can be taken for therapeutic intervention.

We thank all the subjects referred to the Forensic Medicine Center of Mashhad, who patiently helped us in this research.

There is no conflict of interest.

The ethical code of this research is IR.LMO.REC.1399.001.

This research is the approved project with the support of the Legal Medicine Organization of Iran.

TABLES and CHARTS

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