Walker E A, Torkelson N, Katon W J, Koss M P
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195-2519.
J Am Board Fam Pract. 1993 Sep-Oct;6(5):465-71.
Despite the high prevalence rate of sexual victimization in the general population, little is known about the characteristics of abuse victims in primary care. We studied the prevalence rate of childhood and adult sexual trauma in a primary care clinic, associated psychological distress, and patients' attitudes about physician inquiry into past sexual victimization.
Self-report questionnaires were given to 162 women in a primary care clinic inquiring about past episodes of childhood sexual abuse, adult sexual assault, and patients' desire that their physicians be aware of their sexually traumatic experiences. The women also completed the Trauma Symptom Checklist-40 (TSC-40), a measure of psychological distress.
The rates of childhood sexual abuse (37 percent) and adult sexual assault (29 percent) in this primary care clinic were comparable with, but somewhat above, the rates reported for the general population. Although most of the women (61 percent) believed it was appropriate for their physician to ask about previous victimization, only 4 percent had been asked. Women who had experienced sexual trauma were more distressed when compared with nonvictimized women, as measured by the TSC-40. Childhood sexual abuse was associated with greater distress than was adult sexual assault, and combinations of childhood and adult trauma were associated with the highest distress levels.
A history of sexual abuse or assault can be a relatively common finding in primary care clinics. Patients might benefit from routine physician inquiry into histories of childhood and adult sexual victimization, and physicians should be mindful of the long-term medical and psychological sequelae that frequently result from this trauma.
尽管普通人群中性侵犯的发生率很高，但对于初级保健中虐待受害者的特征却知之甚少。我们研究了一家初级保健诊所中儿童期和成年期性创伤的发生率、相关的心理困扰以及患者对医生询问过去性侵犯经历的态度。
向一家初级保健诊所的162名女性发放了自我报告问卷，询问她们过去儿童期性虐待、成年期性侵犯的经历以及她们希望医生了解其性创伤经历的意愿。这些女性还完成了创伤症状清单-40（TSC-40），这是一种心理困扰的测量工具。
这家初级保健诊所中儿童期性虐待的发生率（37%）和成年期性侵犯的发生率（29%）与普通人群报告的发生率相当，但略高于后者。尽管大多数女性（61%）认为医生询问她们以前的受侵害情况是合适的，但只有4%的女性曾被询问过。根据TSC-40的测量，经历过性创伤的女性与未受侵害的女性相比，心理困扰更严重。儿童期性虐待比成年期性侵犯导致的困扰更大，儿童期和成年期创伤的组合导致的困扰程度最高。
性虐待或性侵犯史在初级保健诊所可能是一个相对常见的发现。患者可能会从医生对儿童期和成年期性侵害史的常规询问中受益，医生应该注意到这种创伤经常导致的长期医学和心理后遗症。
