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Childhood Sexual Abuse is Associated With Physical Illness Burden and Functioning in Psychiatric Patients 50 Years of Age and Older

From the Department of Psychiatry and the Rochester Center for Mind-Body Research (N.L.T., B.C., N.F., S.C., P.R.D.), University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Psychiatry and the Center for the Study and Prevention of Suicide (Y.C., P.R.D.), University of Rochester School of Medicine and Dentistry, Rochester, New York; and Child Study Center (K.M.), Yale University, New Haven, Connecticut.

Address correspondence and reprint requests to Nancy Talbot, Department of Psychiatry, University of Rochester, School of Medicine and Dentistry, 300 Crittenden Blvd., Box PSYCH, Rochester, New York 14642. E-mail: Nancy_Talbot{at}urmc.rochester.edu

Objective: To examine the association of childhood sexual abuse (CSA) with cumulative illness burden, physical function, and bodily pain (BP) in a sample of male and female psychiatric patients 50 years of age. Previous research on the health consequences of sexual abuse has focused on nonpsychiatric samples of younger-age adults, especially women. The health implications of abuse for mixed-gender samples of older psychiatric patients have not been explored.

Methods: Participants were 163 patients with primary mood disorders. Sexual abuse histories were collected via patient self-report, as was BP. The measure of medical illness burden was based on chart review. Clinical interviewers rated physical function, using the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) scales. Linear and logistic regressions examined the association between CSA and health outcomes.

Results: As hypothesized, severe childhood sexual abuse was associated with higher cumulative medical illness burden, worse physical function, and greater BP. Comparisons of regression coefficients revealed that severe CSA's influence on illness burden is roughly comparable to the effects of adding 8 years of age. For ADL impairment and BP, the effects are comparable to adding 20 years of age.

Conclusions: Strong relationships exist between CSA and medical illness burden, function, and pain among psychiatric patients 50 years of age. These relationships cannot be ascribed to shared method variance. Early detection of patients' abuse histories could inform targeted interventions to prevent or decelerate the progression of morbidity in this high-risk group.

Key Words: older adults • medical illnesses • childhood sexual abuse

Abbreviations: ADLs = activities of daily living; IADLs = instrumental activities of daily living; CSA = childhood sexual abuse; CTQ = Childhood Trauma Questionnaire; CIRS = Cumulative Illness Rating Scale; PSMS = Physical Self Maintenance Scale; BP = bodily pain; SF-36 = Medical Outcome Study 36-Item Short Form; PTSD = posttraumatic stress disorder.

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