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Childhood Sexual Abuse, Psychological Distress, and Medical Use Among Women

From the Department of Psychiatry and Behavioral Sciences (B.A.A., S.H., C.S., C.B.T.), Stanford University School of Medicine, Stanford; Kaiser Permanente Medical Center (R.D.), Redwood City; and the California School of Professional Psychology (L.O.), Alameda, CA.

Address reprint requests to: Bruce A. Arnow, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, 40 Quarry Road, Stanford, CA 94305-5722. Email: baarnow{at}leland.stanford.edu

OBJECTIVE: This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting.

METHODS: Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions.

RESULTS: CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates.

CONCLUSIONS: Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns.

Key Words: sexual abuse • medical utilization • psychological distress • pain

Abbreviations: CSA = child sexual abuse; ER = emergency room; GSI =Global Severity Index; HMO = health maintenanceorganization; SCL-90-R = revised Symptom Checklist 90.

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