Experience of abuse in primary care patients. Racial and rural differences
P. J. Wagner, P. Mongan, D. Hamrick and L. K. Hendrick
Department of Family Medicine, Medical College of Georgia, Augusta, USA.
OBJECTIVE: To examine the experience of abuse in rural, urban, black, and
white women on the following dimensions: prevalence, symptom experience,
health status, medical services utilization, and coping mechanisms. DESIGN:
Retrospective study using patient interviews. SETTING: Half the subjects
were recruited from a large medical university family medicine center and
half from a rural family medicine center, both in the Southeast. PATIENTS:
Four hundred seven women were interviewed. Groups were distributed as
follows: urban white, 24.9% (n = 99); urban black, 25.6% (n = 102); rural
white, 11.1% (n = 44); and rural black, 38.4% (n = 153). MAIN OUTCOME
MEASURES: Self-report of abuse (sexual, physical, and emotional) was
related to symptom history, current health status, medical services
utilization, and coping styles. RESULTS: Sixty-six percent of the total
sample reported some kind of abuse. Black, rural women reported the least
(52.3%). Presence of greater numbers of symptoms, greater medical services
utilization, and lower health status were found in the abused population.
Abused women used all types of coping mechanisms to a greater extent than
non-abused women. Black women were more likely to use confrontation (F =
8.82 [P = .003]), problem solving (F = 8.24 [P = .004]), and reappraisal (F
= 4.13 [P = .04]) than white women. Rural women were more likely to use
psychological distancing (F = 5.25 [P = .02]) and escape (F = 5.67 [P =
.02]) than urban women, although abused women in general use those coping
methods more than nonabused women. CONCLUSIONS: The experience of abuse
remains similar across black, white, rural, and urban women; however,
coping mechanisms appear to be influenced by group membership.
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