Bassuk E L, Dawson R, Perloff J, Weinreb L
Better Homes Fund, 181 Wells Ave, Newton, MA 02459, USA.
J Am Med Womens Assoc (1972). 2001 Spring;56(2):79-85.
To identify childhood antecedents for lifetime post-traumatic stress disorder (PTSD) and to determine how this diagnosis relates to health and service use among extremely poor women.
We conducted a secondary data analysis of 425 women in the Worcester Family Research Project, a case-control longitudinal study of 220 sheltered homeless and 216 extremely poor housed (never homeless) women in Worcester, Massachusetts.
We found that extremely poor women with lifetime PTSD were more likely to have grown up in family environments of violence, threat, and anger than those without PTSD. The strongest risk factor for PTSD was childhood sexual abuse with threat. Low-income women with lifetime PTSD had more bodily pain, even when controlling for other health and demographic factors. Women with PTSD experienced more chronic health conditions and had more problematic relationships with their health care providers and perceived more barriers to care.
Many low-income women have difficulty using medical care appropriately because of childhood histories of physical and sexual abuse, the subsequent development of post-trauma responses, and structural barriers to care. Given these factors, it is critical that health care clinicians routinely screen for histories of violence and PTSD and develop treatment plans that ensure safety, link current symptoms with prior experiences, and provide support as necessary. A team approach coordinated by a case manager may be the best strategy. Without routine screening for PTSD and sensitive treatment, many extremely poor women will receive compromised health care and may even be retraumatized.
确定终生创伤后应激障碍（PTSD）的童年先兆，并确定该诊断与极端贫困女性的健康及医疗服务利用情况之间的关系。
我们对伍斯特家庭研究项目中的425名女性进行了二次数据分析，该项目是一项病例对照纵向研究，研究对象为马萨诸塞州伍斯特市220名受庇护的无家可归女性和216名极端贫困的有住房（从未无家可归）女性。
我们发现，患有终生PTSD的极端贫困女性比未患PTSD的女性更有可能在暴力、威胁和愤怒的家庭环境中长大。PTSD最强的风险因素是伴有威胁的童年性虐待。患有终生PTSD的低收入女性身体疼痛更多，即便在控制了其他健康和人口因素之后也是如此。患有PTSD的女性经历了更多的慢性健康问题，与医疗服务提供者的关系更成问题，并且认为就医存在更多障碍。
由于童年时期的身体和性虐待经历、创伤后反应的后续发展以及就医的结构性障碍，许多低收入女性难以恰当地利用医疗服务。鉴于这些因素，医疗保健临床医生定期筛查暴力和PTSD病史，并制定确保安全、将当前症状与既往经历联系起来并在必要时提供支持的治疗计划至关重要。由个案管理员协调的团队方法可能是最佳策略。如果不常规筛查PTSD并进行敏感治疗，许多极端贫困女性将获得质量受损的医疗保健，甚至可能再次受到创伤。
