Association between self-reported health and physical and/or sexual abuse experienced before age 18

Abstract

Objective

The present study evaluated the association between women's health and physical and sexual abuse suffered before age 18.

Methods

A total of 3,568 randomly sampled insured women ages 18–64 completed a telephone interview to assess history of physical only, sexual only, or both physical and sexual abuse before age 18 (Behavioral Risk Factor Surveillance System); and current health (Short Form-36, Center for Epidemiologic Studies-Depression, Presence of Symptoms surveys). Adjusted analyses compared the health of women with physical abuse only, sexual abuse only, or physical and sexual abuse to the health of women without these abuse histories.

Results

Poorest health status was observed in women with a history of both physical and sexual child abuse compared to women without these abuse histories. In models that adjusted for age and income, women with both abuse types had increased prevalence of depression (prevalence ratio, 2.16), severe depression (PR, 2.84), physical symptoms (PR range, 1.33 for joint pain to 2.78 for nausea/vomiting), fair/poor health (PR, 1.84), and lower SF-36 scores (3.15–5.40 points lower). Women with physical abuse only or sexual abuse only also had higher prevalence of symptoms and lower SF-36 scores but the associations were not as strong.

Conclusions

This study adds to the literature showing a graded association between multiple adverse events in childhood and adult health.

Introduction

Women with a history of physical and/or sexual child abuse experience adverse health into adulthood, including cardiovascular symptoms, impaired physical function, pain, gastrointestinal symptoms, gynecological disorders, depressive disorders, and psychosomatic symptoms of anxiety, panic, or post-traumatic stress disorder (Arnow, 2004; Batten, Aslan, Maciejewski, & Mazure, 2004; Bensley, Van Eenwyk, & Wynkoop Simmons, 2003; Carlson, McNutt, & Choi, 2003; McCauley et al., 1997; Moeller, Bachmann, & Moeller, 1993; Newman et al., 2000; Nicolaidis, Curry, McFarland, & Gerrity, 2004; Walker et al., 1999). However, in all but one of these studies, it was not possible to determine health effects attributable to physical versus sexual childhood abuse.

Bensley et al. (2003) isolated the health effects of physical versus sexual child abuse. Their study found that women who experienced physical abuse only were twice as likely to report poor physical health and 3.4 times more likely to report frequent mental distress than women without the abuse histories examined in their study (physical, sexual, witnessing violence between parents). Women with childhood sexual abuse only were 2.1 times as likely to report frequent mental distress than women without an abuse history. Other studies that examined health associated with physical only or sexual only child abuse history concentrated on combined samples of women and men (Teicher, Samson, Polcari, & McGreenery, 2006).

Despite the important contribution of the Bensley study, it did not evaluate the specific health effects for women who experienced both physical and sexual child abuse. Studies suggest a graded relationship between adverse childhood exposures (including child abuse) and poor health in adulthood—the more traumatic exposures in childhood, the more adverse adult health behaviors and consequences, such as smoking, heart disease, cancer, emphysema, skeletal fractures and poor self-rated health (Anda et al., 1999, Bensley et al., 2003; Edwards, Holden, Felitti, & Anda, 2003; Felitti et al., 1998, Teicher et al., 2006). These findings suggest that the health effects of multiple types of abuse experiences accumulate and worsen over time, leading to poorer adult health than if only one type of abuse was experienced (Irving & Ferraro, 2006).

Additionally, while prior studies reported useful information regarding the relationship between women's health and history of physical and sexual child abuse, many used clinic-based samples (Hulme, 2000, McCauley et al., 1997, Moeller et al., 1993, Nicolaidis et al., 2004), reported a narrow range of health outcomes (Batten et al., 2004, Carlson et al., 2003), and did not account for intimate partner violence (IPV) exposure in adulthood (Batten et al., 2004, Hulme, 2000, Moeller et al., 1993, Newman et al., 2000, Nicolaidis et al., 2004, Walker et al., 1999). Studies have shown a strong association between physical and sexual childhood abuse and IPV exposure in adulthood (Bensley et al., 2003, Coid et al., 2001, Thompson et al., 2006; Whitfield, Anda, Dube, & Felitti, 2003), and also adverse health associated with IPV (Bonomi et al., 2006, Campbell et al., 2002, Carlson et al., 2003; Centers for Disease Control and Prevention, 1998; Coker, Smith, Bethea, King, & McKeown, 2000; Kramer, Lorenzon, & Mueller, 2004; McCauley et al., 1995, Nicolaidis et al., 2004). Thus, in studies that did not account for IPV, it is unknown whether the relationship between health status and child abuse history persists after accounting for the effects of IPV.

The present investigation adds to the literature by describing the relationship between women's health and history of physical only, sexual only, or both physical and sexual childhood abuse (in models that account for and do not account for IPV in adulthood). We use a population-based random sample drawn from the membership files of a large health plan, and examine a wide range of physical, mental and social health indicators including data from the widely used SF-36 survey (Ware, Kosinski, & Dewey, 2000).