Abuse, Outpatient Charges and Utilization, and Psychiatric Symptoms among Urban Women on Medicaid

The Journal of the American Board of Family Medicine

John H. Porcerelli³  Mary Anne Porcerelli¹  William Murdoch³  Tsveti Markova³  Rosemary Cogan² 

[1] Bloomfield Hills, MI (MAP);Department of Psychology, Texas Tech University, Lubbock (RC);Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Rochester, MI (JHP, TM, WM)

关键词: Sexual Abuse;    Physical Abuse;    Adult;    Child;    Utilization;    Symptoms;    Psychiatry;   

DOI  :  10.3122/jabfm.2010.03.090121

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Adult and childhood sexual and physical abuse are common and intertwined. Our objectives were to assess (1) the relationship between different forms of abuse; (2) outpatient charges and hospital and emergency department use among women with and without childhood and adult abuse; (3) psychiatric symptoms of women with and without childhood and adult abuse; and (4) the relationship between psychiatric symptoms and outpatient charges and hospital and emergency department use among a group of Medicaid-insured women seeking outpatient services in a primary care setting.

Methods: We recruited female primary care patients for this cross-sectional study. Women reported childhood and adult sexual and physical abuse and anxiety, depression, and posttraumatic stress symptoms. We assessed outpatient charges through reviews of clinic records. Patients reported hospital and emergency department use.

Results: Childhood and adult sexual and physical abuse were highly interrelated. Adult sexual abuse showed a trend toward significantly greater outpatient charges. Women who had experienced physical abuse during childhood had more emergency department visits and women who experienced physical abuse as an adult had more days of hospitalization. Childhood and adult sexual abuse were both related to higher levels of anxiety, depression, and posttraumatic stress symptoms. Anxiety, depression, and posttraumatic stress symptoms were related to higher outpatient charges. Depression and posttraumatic stress symptoms were related to greater emergency department use.

Conclusions: Women who experience abuse often have psychiatric symptoms. In our sample it was the severity of psychiatric symptoms rather than reported abuse alone that was related to outpatient charges and emergency department visits.

• Sexual Abuse
• Physical Abuse
• Adult
• Child
• Utilization
• Symptoms
• Psychiatry

Sexual and physical abuse among children and adults are common. During childhood, between 4%¹ and 26.9%² of girls experience sexual abuse and between 17%² and 40%³ experience physical abuse. Between 1.7%⁴ and 25.6%⁵ of women have been sexually abused by their partners and between 1.1%⁶ and 30.6%³ have been physically abused during the past year. Women also experience abuse by nonpartners. Between 2.3%⁷ and 20.9%⁸ of women have been physically abused by a nonpartner during the past year. Extremely high rates of childhood and adult abuse were reported in a sample of women seen at a Veteran's Affairs women's clinic, of whom 90% were veterans.⁹ Of these women, 59% experienced sexual abuse during childhood, 39% experienced sexual abuse as an adult, and 74% experienced physical abuse by partners. Although the prevalence estimates differ for many reasons, one contributing factor is differences in the economic circumstances of the women in the samples; abuse rates are higher among low-income women¹⁰ and women receiving public assistance than among other women.¹¹

Sexual abuse during childhood and sexual abuse as an adult are often interrelated, as is the experience of physical abuse during childhood and as an adult.^3,4,12–14 Women with a history of both sexual and physical abuse as children are several times more likely than other women to experience sexual and physical abuse as adults.³ Abuse seems to lead to increased health care costs and mental health problems. Among more than 2000 women in a health care delivery system, women who experienced both sexual and physical abuse during childhood had higher use of mental health resources, emergency departments, hospitals, outpatient services, pharmacies, and specialty care than did women who experienced only sexual or only physical abuse.¹⁴ In several other large samples, outpatient costs were higher among women who were physically abused by their partners as compared with those who were not physically abused by a partner.^5,15 In a comparison of women who experienced and women who did not experience physical abuse by partners, women who were physically abused by a partner had $1,775 more in health costs during a sample year, with more hospitalizations and more use of outpatient clinics.¹⁶ Abuse during childhood is associated with depression among women as adults¹⁷ and lifetime abuse is associated with more anxiety and depression.² Studies of abuse and health care costs have generally failed to take into account the impact of abuse on mental health.

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