Skip to main content

“You Always End up Feeling Like You’re Some Hypochondriac”: Intimate Partner Violence Survivors’ Experiences Addressing Depression and Pain

Journal of General Internal Medicine volume 23, pages 1157–1163 (2008)Cite this article

Abstract

Objective

Little is known regarding how providers should use information about intimate partner violence (IPV) to care for depressed patients. Our objective was to explore what depressed IPV survivors believe about the relationship between abuse, mental health, and physical symptoms and to elicit their recommendations for addressing depression.

Design

Focus group study.

Patients/Participants

Adult, English-speaking, female, Internal Medicine clinic patients with depressive symptoms and a history of IPV.

Interventions

Thematic analysis using an inductive approach (consistent with grounded theory), at a semantic level, with an essentialist paradigm.

Measurements and Main Results

Twenty three women participated in 5 focus groups. Although selected because of their depression, participants often felt their greatest concerns were physical. They acknowledged that their abuse history, depression, and physical complaints compound each other. They appreciated the need for health care workers to know about their depression and IPV history to get a “full picture” of their health, but they were often hesitant to discuss such issues with providers because of their fear that such information would make providers think their symptoms were “all in their head” or would encourage providers to discount their pain. Participants discussed difficulties related to trust and control in relationships with providers and gave recommendations as to how providers can earn their trust.

Conclusions

Understanding a patient’s IPV history may allow providers to develop a better therapeutic relationship. To treat depression adequately, it is important for providers to reassure patients that they believe their physical symptoms; to communicate respect for patients’ intelligence, experience, and complexity; and to share control.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

39,95 €

Price includes VAT (Finland)

Figure 1

References

  1. Nelson HD, et al. Screening women and elderly adults for family and intimate partner violence: a review of the evidence for the U. S. Preventive Services Task Force.. Ann Intern Med. 2004;140(5):387–96.

    PubMed  Google Scholar 

  2. Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359(9314):1331–6.

    Article  PubMed  Google Scholar 

  3. Golding JM. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. J Fam Violence. 1999;14(2):99–132.

    Article  Google Scholar 

  4. Weinbaum Z, et al. Female victims of intimate partner physical domestic violence (IPP-DV), California 1998. Am J Prev Med. 2001;21(4):313–9.

    Article  PubMed  CAS  Google Scholar 

  5. Lown EA, Vega WA. Intimate partner violence and health: self-assessed health, chronic health, and somatic symptoms among Mexican American women. Psychosom Med. 2001;63(3):352–60.

    PubMed  CAS  Google Scholar 

  6. Campbell J, et al. Intimate partner violence and physical health consequences. Arch Intern Med. 2002;162(10):1157–63.

    Article  PubMed  Google Scholar 

  7. Tollestrup K, et al. Health indicators and intimate partner violence among women who are members of a managed care organization. Prev Med. 1999;29(5):431–40.

    Article  PubMed  CAS  Google Scholar 

  8. Coker AL, et al. Physical health consequences of physical and psychological intimate partner violence. Arch Fam Med. 2000;9(5):451–7.

    Article  PubMed  CAS  Google Scholar 

  9. McCauley J, et al. Relation of low-severity violence to women’s health. J Gen Intern Med. 1998;13(10):687–91.

    Article  PubMed  CAS  Google Scholar 

  10. Nicolaidis C, et al. Violence, mental health, and physical symptoms in an academic internal medicine practice. J Gen Intern Med. 2004;198(8):19–27.

    Article  PubMed  Google Scholar 

  11. Follingstad DR, et al. Factors moderating physical and psychological symptoms of battered women. J Fam Violence. 1991;6(1):81–95.

    Article  Google Scholar 

  12. Eby K, Campbell JC, Sullivan C, Davidson W. Health effects of experiences of sexual violence for women with abusive partners. Womens Health Int. 1995;16:563–76.

    Article  CAS  Google Scholar 

  13. McCauley J, et al. The “battering syndrome”: prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med. 1995;123(10):737–46.

    PubMed  CAS  Google Scholar 

  14. Wisner CL, et al. Intimate partner violence against women: do victims cost health plans more? J Fam Pract. 1999;48(6):439–43.

    PubMed  CAS  Google Scholar 

  15. Ulrich YC, et al. Medical care utilization patterns in women with diagnosed domestic violence. Am J Prev Med. 2003;24(1):9–15.

    Article  PubMed  Google Scholar 

  16. Sansone RA, Wiederman MW, Sansone LA. Health care utilization and history of trauma among women in a primary care setting. Violence Vict. 1997;12(2):165–72.

    PubMed  CAS  Google Scholar 

  17. Scholle SH, Rost KM, Golding JM. Physical abuse among depressed women. J Gen Intern Med. 1998;13(9):607–13.

    Article  PubMed  CAS  Google Scholar 

  18. Nicolaidis C, et al. Differences in physical and mental health symptoms and mental health utilization associated with intimate partner violence vs. child abuse. Psychosomatics. 2008 (in press).

  19. Feder GS, et al. Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a meta-analysis of qualitative studies. Arch Intern Med. 2006;166(1):22–37.

    Article  PubMed  Google Scholar 

  20. Derogatis LR, et al. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19(1):1–15.

    Article  PubMed  CAS  Google Scholar 

  21. Lipman RS, Covi L, Shapiro AK. The Hopkins Symptom Checklist (HSCL)—factors derived from the HSCL-90. J Affect Disord. 1979;1(1):9–24.

    Article  PubMed  CAS  Google Scholar 

  22. Derogatis L. SCL-90-R Symptom Checklist -90-R Administration, Scoring, and Procedures Manual, 3rd edn. Minneapolis, MN: National Computer Systems; 1994:123.

    Google Scholar 

  23. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66.

    PubMed  Google Scholar 

  24. Kroenke K, et al. A symptom checklist to screen for somatoform disorders in primary care. Psychosomatics. 1998;39(3):263–72.

    PubMed  CAS  Google Scholar 

  25. Soeken S, et al. The abuse assessment screen. In: Campbell J, ed. Empowering Survivors of Abuse; Health Care for Battered Women and Children. Thousand Oaks, CA: SAGE Publications, Inc; 1998:195–203.

    Google Scholar 

  26. Krueger R. Moderating focus groups. In: Morgan D, Krueger R, eds. The focus group kit. Thousand Oaks, CA: Sage Publications; 1998:115.

    Google Scholar 

  27. Krueger R. Developing questions for focus groups. In: Morgan D, Krueger R, eds. The focus group kit. Thousand Oaks, CA: Sage Publications; 1998:107.

    Google Scholar 

  28. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

    Article  Google Scholar 

  29. Wathen CN, MacMillan HL. Interventions for violence against women: scientific review. JAMA. 2003;289(5):589–600.

    Article  PubMed  Google Scholar 

  30. Ramsay J, et al. Should health professionals screen women for domestic volence? Systematic review. BMJ. 2002;325:314–26.

    Article  PubMed  Google Scholar 

  31. U S Preventive Services Task Force. Screening for family and intimate partner violence: recommendation statement.[see comment]. Ann Intern Med. 2004;140(5):382–6.

    Google Scholar 

  32. Soler E, Campbell J. Screening for family and intimate partner violence.[comment]. Ann Intern Med. 2004;141(1):82. discussion 82.

    PubMed  Google Scholar 

  33. Nelson JC, Johnston C. Screening for family and intimate partner violence.[comment]. Ann Intern Med. 2004;141(1):81. discussion 82.

    PubMed  Google Scholar 

  34. Nicolaidis CA, American Medical Women’s, and M. Physicians Against Violence Interest Group of the Society of General Internal. Screening for family and intimate partner violence.[comment]. Ann Intern Med. 2004;141(1):81–2. discussion 82.

    PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by a grant from the Robert Wood Johnson Foundation Depression in Primary Care Program (#049268). Dr. Nicolaidis’ time is supported in part by a grant from the National Institute of Mental Health (K23 MH073008-03). We would like to thank Rebecca Ross, MHNP, Kaycee Mutschler, Jeannette Bardsley, and Vassiliki Touhiliotis for their efforts in recruiting and screening patients, cofacilitating focus groups, and transcribing data.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA

    Christina Nicolaidis MD, MPH, Jessica Gregg MD, PhD, Hilary Galian BA & Martha Gerrity MD, PhD

  2. Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA

    Christina Nicolaidis MD, MPH & Bentson McFarland MD, PhD

  3. Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA

    Bentson McFarland MD, PhD

  4. School of Nursing, Oregon Health & Science University, Portland, OR, USA

    MaryAnn Curry RN, DNSc

  5. Portland Veterans Administration Medical Center, Portland, OR, USA

    Martha Gerrity MD, PhD

Authors
  1. Christina Nicolaidis MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica Gregg MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hilary Galian BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bentson McFarland MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. MaryAnn Curry RN, DNSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martha Gerrity MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina Nicolaidis MD, MPH.

Electronic supplementary materials

Below is the link to the electronic supplemenatry materials.

ESM 1

(DOC 35.5 KB)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Nicolaidis, C., Gregg, J., Galian, H. et al. “You Always End up Feeling Like You’re Some Hypochondriac”: Intimate Partner Violence Survivors’ Experiences Addressing Depression and Pain. J GEN INTERN MED 23, 1157–1163 (2008). https://doi.org/10.1007/s11606-008-0606-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0606-0

KEY WORDS

  • intimate partner violence
  • depression
  • pain
  • physical symptoms
  • qualitative research
  • physician–patient relationship