Talbot Nancy L, Chapman Ben, Conwell Yeates, McCollumn Kelly, Franus Nathan, Cotescu Stefan, Duberstein Paul R
Department of Psychiatry, Rochester Center for Mind-Body Research, University of Rochester, School of Medicine and Dentistry, 300 Crittenden Blvd., Box PSYCH, Rochester, New York 14642, USA.
Psychosom Med. 2009 May;71(4):417-22. doi: 10.1097/PSY.0b013e318199d31b. Epub 2009 Feb 27.
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 >or=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.
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.
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.
Strong relationships exist between CSA and medical illness burden, function, and pain among psychiatric patients >or=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.
在年龄≥50岁的男性和女性精神科患者样本中，研究童年期性虐待（CSA）与累积疾病负担、身体功能及身体疼痛（BP）之间的关联。先前关于性虐待对健康影响的研究主要集中在非精神科的年轻成年样本，尤其是女性。尚未探讨虐待对老年精神科患者混合性别样本的健康影响。
参与者为163例原发性情绪障碍患者。通过患者自我报告收集性虐待史及身体疼痛情况。疾病负担的测量基于病历审查。临床访谈者使用日常生活活动（ADL）和工具性日常生活活动（IADL）量表对身体功能进行评分。线性回归和逻辑回归分析了CSA与健康结局之间的关联。
如假设所示，严重的童年期性虐待与更高的累积疾病负担、更差的身体功能及更严重的身体疼痛相关。回归系数比较显示，严重CSA对疾病负担的影响大致相当于年龄增加8岁的影响。对于ADL受损和身体疼痛，其影响相当于年龄增加20岁的影响。
在年龄≥50岁的精神科患者中，CSA与疾病负担、功能及疼痛之间存在密切关系。这些关系不能归因于共同的方法变异。早期发现患者的虐待史可为有针对性的干预提供依据，以预防或减缓这一高危群体发病的进程。
