Abstract
OBJECTIVE: To provide estimates of physical abuse and use of health services among depressed women in order to inform efforts to increase detection and treatment of physical abuse.
DESIGN: Retrospective assessment of abuse and health services use over 1 year in a cohort of depressed women.
SETTING: Statewide community sample from Arkansas.
PARTICIPANTS: We recruited 303 depressed women through random-digit-dial screening.
MEASUREMENTS AND MAIN RESULTS: Exposure to physical abuse based on the Conflict Tactics Scale, multi-informant estimate of health and mental health services. Over half of the depressed women (55.2%) reported experiencing physical abuse as adults, with 14.5% reporting abuse during the study year. Women abused as adults had significantly more severe depressive symptoms, more psychiatric comorbidity, and more physical illnesses than nonabused women. After controlling for sociodemographic and severity-of-illness factors, recently abused, depressed women were much less likely to receive outpatient care for mental health problems as compared to other depressed women (odds ratio [OR] 0.3; p=.013), though they were more likely to receive health care for physical problems (OR 5.7, p=.021).
CONCLUSIONS: Because nearly all depressed women experiencing abuse sought general medical rather than mental health care during the year of the study, primary care screening for physical abuse appears to be a critical link to professional help for abused, depressed women. Research is needed to inform primary care guidelines about methods for detecting abuse in depressed women.
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References
Council on Scientific Affairs American Medical Association. Violence against women: relevance for medical practitioners. JAMA. 1992;267:3184–9.
Plichta SB, Weisman CS. Spouse or partner abuse, use of health services, and unmet need for medical care in U.S. women. J Women’s Health. 1995;4:45–53.
Golding JM. Sexual assault history and medical care seeking: the roles of symptom prevalence and illness behavior. Psychol Health. 1996. In press.
Golding JM. The cost of domestic violence to the health care system: exploratory paper on mental health consequences. In: Rice DP, Max W, Golding JM, Pinderhughes H, eds. The Cost of Domestic Violence to the Health Care System: Final Report to the Office of the Assistant Planning and Evaluation. Washington, DC: U.S. Department of Health and Human Services; 1996.
Gin NE, Rucker L, Frayne S, Cygan R, Hubbell FA. Prevalence of domestic violence among patients in three ambulatory care internal medicine clinics. J Gen Intern Med. 1991;6:317–22.
Abbott J, Johnson R, Koziol-McLain J, Lowenstein SR. Domestic violence against women: incidence and prevalence in an emergency department population. JAMA. 1995;273:1763–7.
Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113:828–33.
Hamberger LK, Saunders DG, Hovey M. Prevalence of domestic violence in community practice and rate of physician inquiry. Fam Med. 1992;24:283–7.
Helton AS, McFarlene J, Anderson ET. Battered and pregnant: a prevalence study. Am J Public Health. 1987;77:1337–9.
Straus MA, Gelles RJ. Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys. J Marriage Fam. 1986;48:465–79.
Schulman MA. A Survey of Spousal Violence Against Women in Kentucky. Washington, DC: U.S. Department of Justice, Law Enforcement Assistance Administration; 1979.
Smith MD. The incidence and prevalence of women abuse in Toronto. Violence Victims. 1987;2:173–87.
McCauley J, 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;123:737–46.
Bergman B, Brismar B. Suicide attempts by battered wives. Acta Psychiatr Scand. 1991;83(5):380–4.
Ratner PA. The incidence of wife abuse and mental health status in abused wives in Edmonton. Alberta. Can J Public Health. 1993;84:246–9.
Wilson MI, Daly M. Male sexual proprietariness and violence against wives. Cur Directions Psychol Sci. 1996;5:2–7.
Smith PH, Earp JA, DeVellis R. Measuring battering: development of the Women’s Experience with Battering (WEB) scale. Women’s Health. 1995;1:273–88.
Burnam MA, Wells KB, Leake B, Landsverk J. Development of a brief screening instrument for detecting depressive disorders. Med Care. 1988;26:775–89.
Straus MA. Measuring intrafamily conflict and violence: the Conflict Tactics (CT) Scales. J Marriage Fam. 1979;February:75–88.
Straus MA. The Conflict Tactics Scales and its critics: an evaluation and new data on validity and reliability. In: Straus MA, Gelles RJ, eds. Physical Violence in American Families: Risk Factors and Adaptation to Violence in 8,145 Families. New Brunswick, NJ: Transaction; 1996:49–73.
U.S. Department of Commerce. Statistical Abstract of the U.S. Washington, DC: U.S. Department of Commerce; 1994.
Sherbourne CD, Stewart AL. The MOS Social Support Survey. Soc Sci Med. 1991;32:705–14.
Zimmerman M. A self-report scale to diagnose major depressive disorder. Arch Gen Psychiatry. 1986;43:1076–81.
Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381–9.
Pfohl B, Langdehn D. Iowa Personality Disorder Screen: Version 1.1. Ames, Iowa: University of Iowa, Department of Psychiatry; 1993.
Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA. 1989;262:914–9.
Elliott BA, Johnson MMP. Domestic violence in a primary care setting: patterns and prevalence. Arch Fam Med 1995;4:113–9.
Saunders DG, Kindy P Jr. Predictors of physicians’ responses to woman abuse: the role of gender, background, and brief training. J Gen Intern Med. 1993;8:606–9.
Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about victimization experiences: a survey of patient preferences and physician practices. Arch Intern Med. 1992;152:1186–90.
Currier GW, Barthauer LM, Begier E, Bruce ML. Training and experience of psychiatric residents in identifying domestic violence. Psychiatr Serv. 1996;47:529–30.
Randall T. ACOG renews domestic violence campaign, calls for changes in medical school curricula. JAMA. 1992;267:3131. News.
Novello AC, Rosenberg M, Saltzman L, Shosky J. From the Surgeon General, U.S. Public Health Service: a medical response to domestic violence. JAMA. 1992;267:3132.
Kellermann AL. Domestic violence and the internist’s response: advocacy or apathy. J Gen Intern Med. 1990;5:89–90.
Alpert EJ. Violence in intimate relationships and the practicing internist: new “disease” or new agenda? Ann Intern Med. 1995;123:774–81.
Ferris LE. Canadian family physicians’ and general practitioners’ perceptions of their effectiveness in identifying and treating wife abuse. Med Care. 1994;32:1163–72.
National Academy of Sciences. Violence in Families: Assessing Prevention and Treatment Programs. Washington, DC: National Academy Press; 1998.
Freund KM, Bak SM, Blackhall L. Identifying domestic violence in primary care practice. J Gen Intern Med. 1996;11:44–6.
Depression Guideline Panel. Depression in Primary Care: Volume 2. Treatment of Major Depression. Clinical Practice Guideline, Number 5. Rockville, Md: Public Health Service, Agency for Health Care Policy and Research; 1993.
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This research was supported by the National Institute of Mental Health funded grants MH48197 and MH54444 to the University of Arkansas and grant MH53817 to the University of Pittsburgh.
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Scholle, S.H., Rost, K.M. & Golding, J.M. Physical abuse among depressed women. J GEN INTERN MED 13, 607–613 (1998). https://doi.org/10.1046/j.1525-1497.1998.00183.x
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DOI: https://doi.org/10.1046/j.1525-1497.1998.00183.x