Resumen de Construcción y validación del instrumento de codependencia (ICOD) para las mujeres mexicanas
Gloria Noriega Gayol, Luciana Ramos Lira
- español
El Instrumento de Codependencia (ICOD) es una prueba de tamizaje para detectar los casos de codependencia dentro de la relación de pareja. El objetivo de este trabajo es mostrar su construcción, así como los resultados sobre la validez del constructo y la validez por criterio externo en las mujeres mexicanas. El ICOD se construyó con base en la bibliografía más importante sobre el tema, la experiencia clínica de la primera autora y un estudio piloto. El instrumento se compone de 30 reactivos con respuestas de 0 (no) a 3 (mucho).
Se llevaron a cabo dos estudios para su validación: el primero tenía como fin analizar la estructura factorial y la consistencia interna del instrumento y se llevó a cabo en una muestra de 230 mujeres de 18 a 65 años, que habían vivido con una pareja heterosexual por lo menos durante un año, y que habían acudido a consulta a un centro de salud. Este estudio consistió en una encuesta en la que el ICOD se administró en forma auto-aplicada previo consentimiento informado.
El segundo estudio pretendía determinar la capacidad del instrumento para discriminar entre casos y no casos de codependencia, y definir un punto de corte para diferenciarlos. Se llevó a cabo en un grupo de 41 mujeres: 20 que habían acudido a psicoterapia por primera vez y 21 que las acompañaban. Las mujeres tenían entre 18 y 65 años, y un año como mínimo de cohabitar con una pareja heterosexual. Todas las mujeres respondieron en forma autoaplicada la versión definitiva del ICOD, y 2 terapeutas las evaluaron independientemente como caso o no caso de codependencia.
En el primer estudio se aplicó un análisis factorial con rotación varimax que arrojó cuatro factores con valores Eigen superiores o iguales a 1.00, los cuales explicaron 50.8% de la varianza total. El instrumento quedó constituido por los 30 reactivos originales, que se agruparon en cuatro dimensiones conceptualmente congruentes: mecanismo de negación, desarrollo incompleto de la identidad, represión emocional y orientación rescatadora. El instrumento total obtuvo un Alpha de Cronbach de .9201.
En el segundo estudio se llevó a cabo una valoración del acuerdo entre los terapeutas expertos. El estadístico Kappa mostró un valor de acuerdo significativo de .8409. En cuanto a las pruebas de validez de criterio externo, se identificó una sensibilidad de 76.00% y una especificidad de 69.05%. Se estableció un punto de corte de 32 o más para definir los probables casos de codependencia. Adicionalmente se tomó una muestra de 230 mujeres para determinar la capacidad del instrumento para diferenciar probables casos de codependencia versus no casos, según el punto de corte establecido, considerando el que su pareja pareja tomara o no tomara alcohol en exceso, y el que su pareja la maltratara o no la maltratara físicamente. Esto se hizo por medio de una prueba de X 2 comparando los casos y los no casos de codependencia en los que su pareja bebiera o no bebiera en exceso, con los casos y no casos de codependencia en los que su pareja las maltratara o no las maltratara físicamente. Se encontró un porcentaje significativamente mayor de codependencia en las mujeres cuya pareja abusaba del alcohol y las maltrataba, en comparación con las mujeres cuya pareja no tenía estos problemas.
Los resultados del estudio permiten afirmar que el ICOD es un instrumento de tamizaje válido y confiable para detectar los probables casos de codependencia de la pareja en las mujeres mexicanas. Es particularmente útil como una prueba que filtra la codependencia en los estudios epidemiológicos o para hacer evaluaciones clínicas, lo que permitiría proporcionarle a las mujeres un tratamiento apropiado y evitar que se presenten problemas más severos de salud mental.
- English
Codependency is a concept that has been considered of great interest for the general population but has been widely questioned in the scientific literature. Criticism has been focused in two aspects: a) variability in the definitions and lack of clinical consensus, and b) the possible influence of culture in the establishment of couple relationships, particularly in terms of power, which seems to put women in a disadvantageous situation in comparison with men.
Nevertheless, codependency seems to be a useful and necessary construct because it gives a name to a group of difficulties in terms of interpersonal relations and selfperceptions. It also represents an existing problem which can seriously affect the physical and mental health particularly of women. That is why it is important to seriously review this issue, and construct a valid instrument for measuring it within our context, for exploring the magnitude and severity of this problem.
The Codependency Instrument(ICOD) is a screening test for detecting cases of codependency within couple relationships. The objective of this study is to explain its construction as well as the results obtained in terms of the validity of the construct and its validity for external criteria in Mexican women.
ICOD was constructed based on the most relevant bibliography, the clinical experience of the first author and a pilot study. It consists of 30 items with responses ranging from 0 (no) to 3 (a lot).
Two studies were carried out for its validation: the first aimed to analyze the factorial structure and the internal consistency of the instrument, and was carried out in a sample of 230 women ranging from 18 to 65 years of age, who had lived with an heterosexual partner for at least one year and were attending a health center. A survey was carried out in which the ICOD was administered in a self-applied manner after signing an informed prior consent.
The second study aimed to determine the capacity of the instrument to discriminate between cases and non-cases of codependency and to define a cut off point to differentiate probable cases from no-cases. It was carried out in a group of 41 women, 20 of whom had come to psychotherapy for the first time, and 21 who had accompanied them. Women were between 18 and 65 years and had cohabited for a minimum of one year with an heterosexual partner. All women answered the final version of the ICOD on their own and were then evaluated by two therapists according to the same guideline, and were classified as either cases or non-cases of codependency.
In the first study, a factor analysis with varimax rotation was applied which produced four factors with Eigen values greater than or equal to 1.00. These values explained 50.8% of the total variance. The instrument remained with the 30 original items grouped according to these four conceptually congruent dimensions: denial mechanism, incomplete development of identity, emotional repression and rescuer orientation. The tests on the internal consistency of the instrument showed a Cronbach Total Alpha of .9201.
The second study consisted of the evaluation according to the agreement of experts, that is to say, according to the judgment of the two psychotherapists. The Kappa statistic of .8409 demonstrated a significant level of agreement between the two psychotherapists. As for the tests on the validity of the external criteria, the following values were identified: a sensitivity of 76% and a specificity of 69.05%. In order to determine the score that would identify probable from non-probable cases of codependency, the cut off point of a 32 score or more was established.
Additionally, the survey of 230 women was retaken to determine the capacity of the instrument to differentiate probable cases of codependency versus non-cases, according to the established cut-off point in women involved in relationship situations that, according to the literature, are often associated with codependency. For this study, X2 tests were carried out comparing cases and non-cases of codependency with the presence or absence of an alcohol abusing partner;
and codependency cases and non-cases with the presence or absence of a physically abusive partner.
Significantly higher percentages of codependency were found within the group of women with an alcoholic partner according to the cut off point of the ICOD, in comparison with women without this problem. A similar situation occurred in the group of women with physically abusive partners. The instrument demonstrated its capacity to significantly distinguish probable cases from non-cases.
The results of the study show that the ICOD is a valid and reliable screening instrument for detecting probable cases of women codependency in couple relationships in Mexican women. ICOD is a test that can be used for screening in epidemiological studies or clinical evaluations. Nevertheless, it requires confirmatory questions to confirm codependency.
Conceptually, the construct showed that codependency refers to a highly abusive style of partner relationship, associated with perceptions and behaviors that reflect excessive awareness of the partner’s demands, and a lack of self-recognition as an independent being. Operationally, results show that ICOD can measure and differentiate cases versus non cases of codependency in relationships theoretically related with the presence of alcohol abuse and domestic violence.
Mental health professionals interested in this topic could use this instrument in future studies. ICOD can be very useful in health institutions for early detection of women in codependent partner relationships. In this way, women could receive appropriate treatment and serious mental health problems could be prevented.
Considering the complexities of this construct a deeper approach it is necessary for studying the codependency of Latin American women, and aim to detect a possibly denied problem of the society in general and of women in particular.
