Abused women and risk for pelvic inflammatory disease

Mexican and African American women with sexually transmitted diseases (STDs) underwent targeted physical exams and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and pelvic inflammatory disease (PID) risk behaviors to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms affecting diagnoses of STDs and risk for PID. Bivariate comparisons found abused women reported more PID risk behaviors including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found abused women were more likely to report pathologic genitourinary symptomatology than nonabused women. Clinicians made more presumptive diagnoses of PID for abused than for nonabused women upon physical examination. These findings indicate abused women are at high risk for PID. Its considerable impact on genitourinary symptomatology and risk for PID make assessment for abuse essential in clinical management of women with STDs and diagnosis of PID.     

Mediating factors in the development of psychopathology in victims of childhood sexual abuse

The effects of sexual abuse and victim-offender characteristics have been studied extensively in relation to short- and long-term psychological consequences. However, few studies have focused on mediating factors in the development of psychological sequelae associated with sexual abuse. Three hundred seventy-nine students at Washington State University were recruited from psychology courses and administered a battery of assessments. These assessments included a modified version of Groth's Sexual Victimization questionnaire, the Minnesota Multiphasic Personality Inventory (MMPI), and the Ways of Coping Questionnaire. Results revealed that 115 subjects (30%) reported at least one level of sexual abuse before the age of 18 years. Significant differences on the main effect of abuse were found between abused and nonabused subjects on selected validity, clinical, and research scales of the MMPI. When family dysfunction was covaried, no differences were found between abused and nonabused subjects on the main effect of abuse, suggesting that family dysfunction did not account for differences between groups. In addition, a main effect of psychopathology was found between victims who reported high and those who reported lower levels of psychopathology. Differences between subjects with a history of abuse and those with no history of abuse were found on the confrontive coping, escape-avoidance, self-controlling, and distancing scales. Finally, significant differences on the main effect of abuse were found between victims who had experienced more frequent abuse and who were more familiar to the offender and victims who were less frequently abused and less familiar to the offender. Differences were found on several clinical and research scales of the MMPI and on the self-control, accepting responsibility, and escape-avoidance scales of the Ways of Coping Questionnaire. The victims who were more frequently abused and familiar with the offender had elevated scores when compared to other victims. Mediating factors, such as coping, seemed to play some role in the long-term effects of sexual abuse. Recommendations for future research in the area of other possible mediating factors and longitudinal research are suggested.     

Health risk behaviors and medical sequelae of childhood sexual abuse.

The relationship between childhood sexual abuse and subsequent health risk behaviors and medical problems was examined in 511 women who had used a family practice clinic in a rural midwestern community during a 2-year period (1988 and 1989). These women completed a questionnaire that assessed various health risk behaviors--smoking, drinking, drug abuse, number of sexual partners, and age at first intercourse--and a medical symptom checklist that assessed 38 medical problems related to major systems of body function, the somatization scale from the SCL-90, a screen for sexual abuse, and a brief measure of social support. The results indicated that sexually abused women, who represented 22.1% of the sample, reported significantly more medical problems, greater levels of somatization, and more health risk behaviors than did the nonabused women. More severe abuse (for example, penetration or multiple abusers) correlated with more severe problems. Extent of social support correlated inversely with the number of gynecologic problems reported in the sexually abused group. Fewer than 2% of the sexually abused women had discussed the abuse with a physician. To identify and assist victims of sexual abuse, physicians should become experienced with nonthreatening methods of eliciting such information when the medical history is obtained.     

Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents

PURPOSE: Little is known about the relationship between minority adolescent's experiences of sexual or physical abuse and the pathology of gynecological symptoms that might have an impact on the diagnosis of sexually transmitted disease (STD) or risk for pelvic inflammatory disease (PID). The objective of this study was to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID among Mexican American and African American adolescent women with a current STD. METHODS: Mexican American and African American adolescent women (n = 373) with an STD underwent a targeted physical exam and questioning regarding sexual or physical abuse, current genitourinary symptomatology, and risk behaviors known to be associated with PID to determine the relationship of sexual or physical abuse to the pathology of genitourinary symptoms that impact diagnoses of STD and risk for PID. RESULTS: Bivariate comparisons found that abused adolescents (n = 232) reported more behaviors associated with increased risk for PID, including earlier coitus, more sex partners, higher STD recurrence, and delayed health-seeking behavior. Multivariate comparisons found that abused adolescents were more likely to report pathologic genitourinary symptomatology than those who were not abused. Clinicians reported more abnormal physical exams but did not make any more presumptive diagnoses of PID for abused than nonabused adolescents. CONCLUSIONS: Delayed treatment for PID dramatically worsens future fertility and chronic pelvic pain. These findings demonstrate that abused adolescent women are at high risk for PID. Because of its considerable impact on risk for PID, an assessment for abuse is essential in clinical management of adolescent women with STD and diagnosis of PID.     

Context of sexual risk behaviour among abused ethnic minority adolescent women

CHAMPION J.D. (2011) Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58 , 61–67 Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14–18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self‐report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self‐reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported ‘getting high’ and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.     

Gender differences in college student sexual abuse victims and their offenders

A sample of 796 students in psychology classes completed an anonymous sex survey that included questions to identify sexual abuse victims (as children, teenagers, or adults) and their offenders. Most child sexual abuse was incestuous, with women students more likely to have been abused by a nuclear or non-nuclear family member, and men students were more likely to have been abused by a non-nuclear family member or family friend. Heterosexual abuse predominated in both genders, but more so in women (86%) than in men (64%). Homosexual child abuse predominated in males offended by a family friend and was common in women only when the offender was a babysitter. Though most child sexual abuse in college students was incestuous (59% of female and 38% of male child victims), the incidence of incestuous abuse was less than that found in a clinical sample (71% and 60%, respectively). On the other hand, college student male child victims were not abused at a younger age than female child victims, as has been reported in clinical samples. The latter finding may be spurious, a function of the inclusion of teenage victims in clinical samples, where females are over-represented. Cognitive predictors of teenage or adult sexual abuse were: uncertainty that forcible rape in a date rape vignette really was rape; a lesser tendency to blame the male perpetrator; and more accurate sexual knowledge. Child sexual abuse also was a predictor of teenage or adult sexual abuse, especially in women.     

Childhood Physical and Sexual Abuse: Their Relationship with Depressive Symptoms in Adulthood

The purposes of this study were to determine the prevalence of childhood physical and sexual abuse among 206 low-income single mothers and to examine the relationship of childhood abuse to current maternal depressive symptoms. Severe physical abuse was reported by 36 percent of the women. The prevalence of sexual abuse was 22 percent; more than one-half of these women were violently abused. High depressive symptoms were reported by 51 percent of the mothers. Both severe physical abuse and sexual abuse in childhood were associated with high depressive symptoms. Women who experienced violent sexual abuse were almost four and one-half times more likely to report high depressive symptoms, compared to the women who were not sexually abused. These findings provide further evidence that childhood abuse may have long-term consequences for women's mental health .     

A Prevalence Study of Sexual Abuse of Adults with Intellectual Disabilities Referred for Sex Education

This paper reports on a prevalence study of sexual abuse of 65 women and 120 men with intellectual disabilities who were referred for sex education. The prevalence rate of abuse was found to be significantly higher for women (61%) than men (25%). Almost all perpetrators were men, with the majority being men with intellectual disabilities or fathers. Women are shown to experience the sexual contact more negatively than the men, although it was usual for both the women and men to feel quite ambivalent about the perpetrator and what he had done to them. Typically the abuse was revealed by the victims themselves, but they were unaware of its social meaning. Generally responses to the abuse were very weak, however there is evidence that the abuse of men is taken more seriously. The poorest service responses were recorded for women who had been abused by men with intellectual disabilities.     

Referring abused women: does police assistance decrease abuse?

To evaluate if abused women's use of the police reduced further violence experienced, 90 abused women were interviewed at a large urban police department and followed for 6 months. Frequency and severity of violence as well as danger of homicide were measured before and at 3 and 6 months after women sought police help. Women seeking police help had significantly reduced threats of abuse (F = 124.62, df = 2,81; p < .0005), actual abuse (F = 90.11, df = 2,81; p < .0005), and danger of being killed (F = 188.69, df = 2,81; p < .0005) by her intimate partner. Bonferroni post hoc tests showed that significantly fewer threats of abuse, physical abusive acts, and risk indicators for homicide had occurred from prefiling to 3 months (p <.0005) and prefiling to 6 months (p <.0005). The data indicate that referring abused women to the police is an appropriate intervention.     

Promotion of Adaptation in Battered Women: A Self-Efficacy Approach

The purpose of this article is to describe the use of the Self-Efficacy Scale for Battered Women (SESFBW) in the development of a treatment plan for the abused woman. The authors describe how the SESFBW was developed to assess the self-efficacy needs of women (N= 43) who came to the emergency department with injuries and self-reported current abuse. Four needs related to self-efficacy were identified: a decreased ability to (a) talk to the nurse or doctor about the abusive situation, (b) call a shelter for abused women, (c) shrug off self doubts, and (d) express thoughts and feelings without fear. How data from a self-efficacy assessment were used in developing a teaching plan and intervention is included. Pre- and posttest scores on the SESFBW of six battered women showed a significant increase in self-efficacy scores at the completion of a group educational program. They conclude that the SESFBW is an easy and effective tool to assess self-efficacy and can form the basis for developing an individualized teaching plan to increase self-efficacy.     

Group therapy for survivors of childhood sexual abuse who have chronic mental illness

Medication and supportive services are usually the approaches used to treat women with chronic mental illness (CMI). The goal of this study was to evaluate the outcomes of group therapy for women with CMI in comparison with those for women without CMI, all of whom experienced childhood sexual abuse. The sample ( N=121) consisted of women, all of whom were sexually abused as children. The results indicated that abused women with CMI had improved self-esteem and decreased symptom scores at the same rate as abused women without CMI. It was suggested that nurses can play an essential role in their practice with this population.     

Do physical and sexual abuse differentially affect chronic pain states in women?

To evaluate the role of physical and/or sexual abuse on chronic pain symptoms and health care utilization in women, 104 consecutive female patients presenting to a multidisciplinary pain center for management of chronic pain were surveyed. Outcomes included a measure of sexual or physical abuse history (Drossman Sexual-Physical Abuse Survey), and measures of anxiety, health care utilization, substance abuse, and somatic symptoms. Forty-eight percent of the sample reported a history of physical abuse (PA) or sexual abuse (SA). Forty percent of the abused patients reported both PA and SA and the remainder reported SA (37%) or PA (23%) alone. The women who reported abuse had increased pain, physical symptoms, anxiety symptoms, and mental health care utilization compared to nonabused women. The women who reported abuse were also more likely to smoke and abuse street drugs. Women who reported both PA and SA were more likely to report head pain when compared to those who reported only PA or SA. Given the impact of abuse, particularly SA, on the presentation of chronic pain, queries regarding abuse should become a routine component of the patient interview. Abused patients should be referred to mental health care practitioners as a component of successful pain management if unresolved issues persist.     

Characteristics of sex offenders who were sexually victimized as children

From a data bank of 479 sex offenders, a comparison was undertaken of those reporting any childhood sexual abuse versus those reporting none. A total of 201 men (42.0%) reported abuse, 261 (54.5%) did not and for 17 (3.5%), information was unavailable. The Abused and Nonabused Groups were compared on demographic information, the MMPI, Clarke Sex History Questionnaire and the Clarke Parent Child Relations Questionnaire. The Abused and Nonabused groups were similar in age, marital status, income, and criminal history, but the Abused Group had significantly less education. The Abused Group showed sexualization of their childhood, not only in the number of contacts with adults but also with age peers and siblings of both sexes. They tended to have wider ranging and more frequent sexual experiences as adults both with men and women. They more often raped. The Abused Group tended to show more emotional instability than the Nonabused Group in more frequent suicidal ideation and suicide attempts, as well as in elevated Mania Scale Scores on the MMPI. The family background of the Abused Group was more disturbed than the Nonabused Group's; especially father-son relations. They reported more alcohol use and abuse in their parents and more parent-child aggression than nonabused offenders did. Although it is unlikely that child sexual abuse causes sexual anomalies, the results of the present study suggest that childhood sexual victimization in the lives of adult sex offenders merits further investigation and has implications for treatment.     

Intimate partner violence screening and intervention: data from eleven Pennsylvania and California community hospital emergency departments.

OBJECTIVE: To provide clinical practice recommendations for screening and interventions for intimate partner violence (IPV) in ED settings. SETTING: Eleven mid-sized community-level hospital emergency departments (20,000 to 40,000 admissions annually) in Pennsylvania and California. PARTICIPANTS: All women (4641) aged 18 years or older who came to the emergency department during 309 selected shifts. METHODS: An anonymous survey inquiring about physical, sexual, and emotional IPV was conducted from 1995 through 1997. In addition, medical records were abstracted for every woman (18 years and older) seen in the 11 participating emergency departments during the study period. RESULTS: The vast majority of both abused and nonabused women supported routine screening for IPV; however, fewer than 25% of women said they were asked about IPV by ED staff. ED screening rates for IPV were higher among women who came to the emergency department because of acute trauma from abuse (39%) than for women who reported that they had been abused within the past year (13%). The prevalence of past year and lifetime IPV was significantly higher when the questionnaire was self-administered than when it was administered by a nurse. More than a third of women who had recently been abused and 76% of women who acknowledged experiencing physical or sexual IPV within the past year reported that they did not come to the emergency department for treatment of an injury. Although the majority of women (76% to 90%) agreed with the concept of health care providers reporting IPV to the police, women abused recently were significantly less likely to support this practice. CONCLUSION: The study provides evidence supporting standard protocols for routine screening for IPV among women who come to emergency departments and chart prompts for both screening and interventions. These actions are acceptable to the majority of both abused and nonabused women seen in the emergency department and should be considered in systematic repeated training of health care professionals in emergency departments. This information is important for health care providers who are seeking to improve their identification of and care for abused women.     

Sexually transmitted diseases in abused children and adolescents

The prevalence of abnormal physical signs (e.g., bleeding, scars, or bruises) and genital infections, notably Chlamydia Trachomatis, Neisseria Gonorrhea, and Herpes Simplex Genitalis was studied in 219 female children with validated sexual abuse. They were compared to 113 nonabused female children. The average abused child was 8.3 years old, with 69% having been abused on multiple occasions. Most offenders were family members (65%) or a close family friend (22%). Stranger-perpetrated sexual assault, in the sample, was low (9.1%). Few children had severe vaginal tears, though 56% showed signs of subtle anatomical injury to their genitalia. No similar anatomical abnormalities were present in nonabused children. Among the sexually abused children and adolescents, 35% were colonized with a pathogen or a potential pathogen, compared to a prevalence rate of 18.5% in non-abused children. The proportion of abused children colonized with Ureaplasma Urealyticum and Mycoplasma Hominis was not significantly different from that found in nonabused children. At present, Neisseria gonorrhea and Chlamydia Trachomatis remain the only conclusive markers for sexual abuse. It is recommended that routine cultures of the pharyngeal, rectal, and vaginal areas be taken in all cases of suspected child sexual abuse, regardless of clinical findings.     

Parental stress response to sexual abuse and ritualistic abuse of children in day-care centers

The purpose of this study was to examine the stress responses of parents to the sexual and ritualistic abuse of their children in day-care centers. Sixty-five mothers and 46 fathers of children sexually abused in day-care centers completed the Symptom Checklist-90-Revised (SCL-90-R), a measure of psychological distress. These scores were compared with a carefully matched comparison group of parents of 67 nonabused children. Parents of abused children also completed the Impact of Event Scale (IES), a measure which indexes symptoms that characterize posttraumatic stress disorder. Parents of sexually abused children reported significantly more psychological distress than parents of nonabused children, with parents of ritually abused children displaying the most severe psychological distress. Parents of abused children reported symptom profiles on the SCL-90-R and IES consistent with posttraumatic stress disorder.     

探究与大学生抑郁症自杀未遂行为相关的社会心理因素

目的:探究与大学生抑郁障碍患者自杀未遂行为相关的童年创伤、家庭功能及社会支持。方法:招募大学生抑郁障碍患者156例,根据既往是否存在自杀行为分为自杀未遂组(n=78)和非自杀未遂组(n=78)。采用儿童创伤问卷中文版(CTQ)、家庭功能量表(FAD)、社会支持量表(SSRS)对2组进行评估。结果:与非自杀未遂组相比,自杀未遂组的情感虐待(P0.001)、情感忽视(P=0.001)、性虐待(P=0.002)、躯体虐待(P0.001)、躯体忽视(P=0.001)因子评分及总分(P0.001)更高;角色(P=0.039)、情感介入(P=0.023)、家庭总功能(P=0.010)及总分(P=0.018)更高;主观支持(P=0.007)、支持利用率(P=0.005)因子评分及总分(P=0.011)更高。情感虐待、性虐待、支持利用率是导致自杀行为发生的独立危险和保护因素。结论:伴自杀未遂行为的大学生抑郁障碍患者存在更严重的童年创伤、更差的家庭功能以及更少的社会支持。