Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Academic Primary Healthcare Centre.
J Epidemiol Community Health. 2017 Jun;71(6):592-598. doi: 10.1136/jech-2016-208105. Epub 2017 Jan 11.
Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions.
Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated.
Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 0-17 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1).
Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.
先前基于自我报告的研究已经证明性虐待是疼痛和精神障碍的一个风险因素。然而，人们对这种情况在医疗体系中的反映知之甚少。本研究的目的是研究性虐待和伴随疾病的两年患病率。
使用来自 VAL 的数据，研究人群包括 2008 年 1 月 1 日至 2014 年 12 月 31 日期间斯德哥尔摩县瑞典的所有在世者（N=2549496）。2013-2014 年期间确定了性虐待的诊断，并记录了躯体疼痛、抑郁、焦虑、精神病、双相情感障碍、应激障碍以及酒精和药物滥用等伴随疾病的信息。所有诊断均为前瞻性登记。使用没有性虐待的个体作为参照，计算了有性虐待诊断的个体与没有性虐待诊断的个体相比，年龄和社区社会经济地位调整后的比值比（OR）及其 95%置信区间（CI）。
13-17 岁女孩的性虐待两年患病率最高（0.69%），其次是 5-12 岁女孩（0.11%）和 0-4 岁女孩（0.04%）。对于 45 岁及以上的女性，两年患病率则显著较低（0.008-0.004%）。男孩中，5-12 岁（0.03%）的性虐待两年患病率最高。本研究中人群中诊断为性虐待的两年总患病率为 0.04%。与没有性虐待的个体相比，患有性虐待的女孩（0-17 岁）的最高合并症比值比（OR）为：应激障碍 15.7（13.1-18.9）、药物滥用 10.0（7.7-13.0）和酒精滥用 9.7（7.8-12.0）。对于男孩（0-17 岁），最高的合并症 OR 为：应激障碍 12.4（6.0-25.7）、焦虑障碍 5.5（2.6-11.5）和酒精滥用 3.9（1.4-11.3）。患有性虐待的女性（18 岁以上）与没有性虐待的女性相比，最高的合并症 OR 为：酒精滥用 19.3（12.6-29.6）、药物滥用 16.7（10.7-26.1）和精神病 15.3（8.0-29.4）。对于男性（18 岁以上），最高的合并症 OR 为：酒精滥用 25.8（15.2-43.9）、焦虑障碍 14.3（8.5-24.2）、应激障碍 12.9（7.5-22.1）和药物滥用 12.9（6.9-24.1）。
与没有性虐待诊断的个体相比，有性虐待诊断的个体更常见药物和酒精滥用、精神病、双相情感障碍、应激焦虑障碍、抑郁和躯体疼痛的诊断。
