Abstract
OBJECTIVE: To determine if women who experience low-severity violence differ in numbers of physical symptoms, psychological distress, or substance abuse from women who have never been abused and from women who experience high-severity violence.
DESIGN: Cross-sectional, self-administered, anonymous survey.
SETTING: Four community-based, primary care, internal medicine practices.
PATIENTS: Survey respondents were 1,931 women aged 18 years or older.
SURVEY DESIGN: Survey included questions on violence; a checklist of 22 physical symptoms; the Symptom Checklist-22 (SCL-22) to measure depression, anxiety, somatization, and self-esteem; CAGE questions for alcohol use; and questions about past medical history. Low-severity violence patients had been “pushed or grabbed” or had someone “threaten to hurt them or someone they love” in the year prior to presentation. High-severity violence patients had been hit, slapped, kicked, burned, choked, or threatened or hurt with a weapon.
MAIN RESULTS: Of the 1,931 women, 47 met criteria for current low-severity violence without prior abuse, and 79 met criteria for current high-severity violence without prior abuse, and 1,257 had never experienced violence. The remaining patients reported either childhood violence or past adult abuse. When adjusted for socioeconomic characteristics, the number of physical symptoms increased with increasing severity of violence (4.3 for no violence, 5.3 for low-severity violence, 6.4 for high-severity violence, p<.0001). Psychological distress also increased with increasing severity of violence (mean total SCL-22 scores 32.6 for no violence, 35.7 for low-severity violence, 39.5 for high-severity violence, p<.0001). Women with any current violence were more likely to have a history of substance abuse (prevalence ratio [PR] 1.8 for low-severity, 1.9 for high-severity violence) and to have a substance-abusing partner (PR 2.4 for both violence groups).
CONCLUSIONS: In this study, even low-severity violence was associated with physical and psychological health problems in women. The data suggest a dose-response relation between the severity of violence and the degree of physical and psychological distress.
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References
McCauley J, Kern DE, Kolodner K, et al. Clinical characteristics of women with a history of childhood violence: unhealed wounds. JAMA. 1997;227:1362–8.
McCauley JM, Kern DE, Kolodner K, 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.
Bullock L, McFarlane J, Bateman LH, Miller V. The prevalence and characteristics of battered women in a primary care setting. Nurse Pract. 1989;14:47–55.
Hamberger LK, Saunders DG, Hovey M. Prevalence of domestic violence in community practice and rate of physician inquiry. Fam Med. 1992;24:283–7.
Rath GD, Jarratt LG, Leonardson G. Rates of domestic violence against women by male partners. J Am Board Fam Pract. 1989;2:227–33.
Elliot BA, Johnson MM. Domestic violence in a primary care setting. Arch Fam Med. 1995;4:113–9.
Gin NE, Ruker L, Frayne J, Cygan R, Hubbel FA. Prevalence of domestic violence among patients in three ambulatory care internal medicine practice. J Gen Intern Med. 1991;6:317–20.
Plichta S. The effects of women violence on health care utilization and health status: a literature review. Women’s Health Issues. 1992;2:154–63.
Drossman DA, Leserman J, Nachman G, et al. Sexual and physical violence in women with functional or organic gastrointestinal disorder. Ann Intern Med. 1990;113:828–33.
Walker EA, Katon WJ, Hanson J, et al. Medical and psychiatric symptoms in women with childhood sexual violence. Psychosom Med. 1992;54:658–64.
Jaffe P, Wolfe DA, Wilson S, Zak L. Emotional and physical health problems of battered women. Can J Psychiatry. 1986;625–9.
Mullen PE, Romans-Clarkson SE, Walton VA, Herbison GP. Impact of sexual and physical violence on women’s mental health. Lancet. 1988;12:51–9.
Schei B, Bakketeig. Gynaecological impact and sexual and physical violence by spouse: a study of intrafamily conflict and violence: the conflict tactics (CT) scale. J Marriage Fam. 1979;41:75–88.
Koss MP, Koss PG, Woodruff WJ. Deleterious effects of criminal victimization on women’s health and medical utilization. Arch Intern Med. 1991;151:342–7.
McFarlane J, Parker R, Soeken K, Bullock I. Assessing for violence during pregnancy. Severity and frequency of injuries and associated entry into prenatal care. JAMA. 1992;152:1186–90.
Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist. Behav Sci. 1974;19:1–15.
Derogatis LR. Administration Scoring and Procedures Manual for the SCL-90 R. Minneapolis, Minn: National Computer Systems; 1994.
Buchsbaum DG, Buchanan RG, Centor RM, Schnoll SH, Lawton MJ. Screening for alcohol violence using CAGE scores and likelihood ratios. Ann Intern Med. 1991;115:774–7.
Checkoway H, Pearce N, Crawford-Brown DJ. Research Methods in Occupational Epidemiology. New York, NY: Oxford University Press; 1989.
Lilienfeld DE, Stolley PD. Foundations in Epidemiology. New York, NY: Oxford University Press; 1994.
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Dr. Derogatis was affiliated with Hahnemann University, Philadelphia, Pa., during this study.
This study was supported in part by two grants from the Chesapeake Educational Research Trust (03600 and 100-95) of Johns Hopkins Bayview Physicians, and by the Division of General Internal Medicine, Johns Hopkins Bayview Medical Center.
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McCauley, J., Kern, D.E., Kolodner, K. et al. Relation of low-severity violence to women’s health. J GEN INTERN MED 13, 687–691 (1998). https://doi.org/10.1046/j.1525-1497.1998.00205.x
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DOI: https://doi.org/10.1046/j.1525-1497.1998.00205.x