Clinical Studies
Adult health status of women with histories of childhood abuse and neglect

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Abstract

Purpose: Several recent studies have found associations between childhood maltreatment and adverse adult health outcomes. However, methodologic problems with accurate case determination, appropriate sample selection, and predominant focus on sexual abuse have limited the generalizability of these findings.

Subjects and Methods: We administered a survey to 1,225 women who were randomly selected from the membership of a large, staff model health maintenance organization in Seattle, Washington. We compared women with and without histories of childhood maltreatment experiences with respect to differences in physical health status, functional disability, numbers and types of self-reported health risk behaviors, common physical symptoms, and physician-coded ICD-9 diagnoses.

Results: A history of childhood maltreatment was significantly associated with several adverse physical health outcomes. Maltreatment status was associated with perceived poorer overall health (ES = 0.31), greater physical (ES = 0.23) and emotional (ES = 0.37) functional disability, increased numbers of distressing physical symptoms (ES = 0.52), and a greater number of health risk behaviors (ES = 0.34). Women with multiple types of maltreatment showed the greatest health decrements for both self-reported symptoms (r = 0.31) and physician coded diagnoses (r = 0.12).

Conclusions: Women with childhood maltreatment have a wide range of adverse physical health outcomes.

Section snippets

Sample selection

We drew a random sample of 1,963 English-speaking women, aged 18 to 65 years, from the enrolled membership of Group Health Cooperative of Puget Sound, a large staff model HMO in Washington State. Using the total design method of Dillman (44), we mailed an introductory letter to each of the women announcing the study, followed by a 22-page questionnaire and consent form. The questionnaire had been reviewed and approved by the Human Subjects Committees of both Group Health and the University of

Results

Of the 1912 surveys initially mailed to eligible participants, 1,225 (62%) were completed. There were no significant differences between women who did and did not complete the survey with respect to age, mean number of primary care or specialty clinic visits, emergency room visits, outpatient mental health days, pharmacy visits, filled prescriptions, or physician-coded diagnoses. Participants had a mean age of 42 ± 12 years. Fifty-one percent were married and 57% had completed college. The

Discussion

Compared with women who did not meet the threshold criteria for childhood maltreatment, those with childhood abuse or neglect had significantly greater levels of functional disability, more physical symptoms, more health risk behaviors, and a greater number of physician-coded diagnoses. The number of maltreatment categories was significantly correlated with the number of physical symptoms and physician-coded diagnoses as well as increased functional disability and health risks.

This study has

References (52)

  • E.A Walker et al.

    Medical and psychiatric symptoms in female gastroenterology clinic patients with histories of sexual victimization

    Gen Hosp Psychiatry

    (1995)
  • D.A Drossman et al.

    Health status by gastrointestinal diagnosis and abuse history

    Gastroenterology

    (1996)
  • N.J Talley et al.

    Gastrointestinal tract symptoms and self-reported abusea population-based study

    Gastroenterology

    (1994)
  • Child Abuse and Neglect Case-Level Data 1993Working Paper I

    (1996)
  • E Walker et al.

    Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse

    Am J Psychiatry

    (1988)
  • S.K Wurtele et al.

    Childhood sexual abuse among chronic pain patients

    Clin J Pain

    (1990)
  • M.P Koss et al.

    Relation of criminal victimization to health perceptions among women medical patients

    J Cons Clin Psychology

    (1990)
  • C.M Earls

    Early family and sexual experiences of male and female prostitutes

    Can Mental Health

    (1990)
  • J.R Butler et al.

    Rethinking teenage childbearingis sexual abuse a missing link

    Fam Relations

    (1990)
  • R.P Arnold et al.

    Medical problems of adults who were sexually abused in childhood

    BMJ

    (1990)
  • A.J Rapkin et al.

    History of physical and sexual abuse in women with chronic pelvic pain

    Obstet Gynecol

    (1990)
  • R.C Reiter et al.

    Demographic and historic variables in women with idiopathic chronic pelvic pain

    Obstet Gynecol

    (1990)
  • M.P Koss et al.

    Deleterious effects of criminal victimization on women’s health and medical utilization

    Arch Intern Med

    (1991)
  • V.J Felitti

    Long-term medical consequences of incest, rape and molestation

    So Med J

    (1991)
  • E.A Walker et al.

    Medical and psychiatric symptoms in women with childhood sexual abuse

    Psychosom Med

    (1992)
  • J Schofferman et al.

    Childhood psychological trauma and chronic refractory low back pain

    Clin J Pain

    (1993)
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    Supported by a grant from the National Institutes of Mental Health K-20 MH-01106.

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