Self-reported childhood abuse in an adult population in a primary care setting. Prevalence, correlates, and associated suicide attempts
D. A. Gould, N. G. Stevens, N. G. Ward, A. S. Carlin, H. E. Sowell and B. Gustafson
Department of Family Medicine, University of Washington School of Medicine, Seattle.
OBJECTIVE: To describe the prevalence of childhood physical, sexual, and
emotional abuse and suicide attempts in a sample of adult patients from a
primary care setting and to examine the relationship between suicide
attempts and a self-reported history of childhood abuse. DESIGN:
Cross-sectional sampling via a self-administered survey that included an
abuse questionnaire, the Inventory to Diagnose Depression, and questions
regarding suicide. SETTING: University medical center family medicine
practice. PATIENTS: A convenience sample of patients aged 18 years and
older presenting for care. Of the 778 patients approached, 448 patients
(58%) consented and returned their surveys. We report only on the 292
surveys (38%) returned with complete information. Subjects were
predominantly middle class and white, with a mean age of 37 years.
MEASUREMENT AND MAIN RESULTS: Forty-four percent of the patients reported
experience of childhood abuse, and 22% reported multiple forms of abuse.
Eighteen percent of abused vs 3% of nonabused patients (P = .00001)
reported a history of suicide attempts. Being female, younger, and less
educated were associated with any abuse. Females reported more sexual
abuse; less educated patients, more physical abuse; and younger patients,
more physical and sexual abuse and suicide attempts. Odds ratios for
suicide attempts, when adjusted by abuse status, were 6.4 for any abuse
(95% confidence intervals [CI], 2.4 to 17.6), 4.1 for sexual abuse (95% CI,
1.7 to 9.9), 3.7 for emotional abuse (95% CI, 1.4 to 10.0), and 1.2 for
physical abuse (95% CI, 0.5 to 3.1). CONCLUSION: A history of childhood
abuse was a common experience in this sample. Patients with a history of
abuse, particularly sexual and emotional abuse, are at increased risk of
suicidal behavior. To facilitate more appropriate care and treatment,
primary care practitioners should question patients regarding a history of
abuse.
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