Alhalal Eman, Ford-Gilboe Marilyn, Wong Carol, AlBuhairan Fadia
Nursing College, King Saud University, Riyadh, Saudi Arabia.
Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
BMC Womens Health. 2018 Oct 3;18(1):160. doi: 10.1186/s12905-018-0642-9.
Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women's well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain.
We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2).
Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms.
These results underscore the significance of considering lifetime abuse, women's mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment.
大多数关于亲密伴侣暴力（IPV）和虐待儿童对健康影响的研究是在西方国家进行的，可能不适用于生活在不同环境中的女性，比如沙特阿拉伯的女性。慢性疼痛是一种与女性遭受儿童虐待和亲密伴侣暴力经历相关的致残性健康问题，会对女性的幸福感、生活质量和功能水平产生负面影响。然而，对于解释虐待与慢性疼痛之间关系的心理社会机制，我们了解甚少。我们开发并测试了一个理论模型，以解释亲密伴侣暴力和儿童虐待如何与慢性疼痛相关。
2015年6月至8月期间，我们从沙特阿拉伯的九个初级卫生保健中心招募了299名沙特女性作为便利样本，这些女性在过去12个月内遭受过亲密伴侣暴力。女性们完成了一项结构化访谈，其中包括对亲密伴侣暴力、儿童虐待、创伤后应激障碍（PTSD）、抑郁症状、慢性疼痛和社会支持的自我报告测量。使用结构方程模型（SEM），我们以不同的心理健康指标作为中介变量，对提出的模型进行了两次分析：创伤后应激障碍症状（模型1）和抑郁症状（模型2）。
两个模型均被发现与数据拟合良好，分别解释了慢性疼痛严重程度变异的31.6%（模型1）和32.4%（模型2）。在两个模型中，心理健康问题（创伤后应激障碍和抑郁症状）完全中介了亲密伴侣暴力和儿童虐待严重程度与慢性疼痛严重程度之间的关系。感知到的家庭支持部分中介了虐待严重程度与抑郁症状之间的关系。
这些结果强调了在慢性疼痛管理和治疗中考虑终身虐待、女性心理健康（抑郁和创伤后应激障碍症状）及其社会资源的重要性。
