Leserman J, Li Z, Drossman D A, Toomey T C, Nachman G, Glogau L
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27599-7160, USA.
Psychosom Med. 1997 Mar-Apr;59(2):152-60. doi: 10.1097/00006842-199703000-00007.
Despite the abundant literature showing a relationship of sexual and/or physical abuse history with poor health status, few studies provide evidence about which dimensions of abuse may have a worse impact on health. In female patients with gastrointestinal (GI) disorders, the present study aims to identify which dimensions of abuse history (eg, number of perpetrators, injury) might predict poor current health status, in order to develop an empirically based severity of abuse measure.
Of a sample of 239 female patients from a referral gastroenterology clinic, this paper primarily focuses on 121 women with a past history of contact sexual abuse (N = 99), and/or life threatening physical abuse (N = 68).
Among those with a sexual abuse history, 24% of current health status was explained by serious injury during abuse (p = .0006), victimization by multiple perpetrators (p = .03), and being raped (p = .09). Among the physically abused, rape (in addition to life threat) (p = .0001), and multiple life-threatening incidents (p = .002) explained 39% of the variance in overall health. Among the women with a sexual and/or physical abuse history, the experience of rape, serious injury during sexual abuse, and multiple life-threatening incidents explained one fourth of the variance in current health status. Based on these three dimensions of abuse, we created an abuse severity measure which explained about one fourth of the variance in health status among the subgroup with abuse history, and among the entire clinic sample.
Given the high prevalence of abuse in referral practice, and the potential health impact of previous abuse, it is important that history taking include details concerning the abuse experience. The severity of abuse measure developed in this paper should prove useful for both research and clinical practice.
尽管有大量文献表明性虐待和/或身体虐待史与健康状况不佳有关，但很少有研究能提供证据证明哪种虐待维度可能对健康产生更严重的影响。在患有胃肠道（GI）疾病的女性患者中，本研究旨在确定虐待史的哪些维度（例如，施虐者数量、伤害情况）可能预示当前健康状况不佳，以便制定基于实证的虐待严重程度衡量标准。
在一家转诊胃肠病诊所的239名女性患者样本中，本文主要关注121名有过接触性性虐待史（N = 99）和/或危及生命的身体虐待史（N = 68）的女性。
在有性虐待史的人群中，虐待期间的重伤（p = .0006）、多名施虐者的侵害（p = .03）以及被强奸（p = .09）可解释当前健康状况的24%。在遭受身体虐待的人群中，强奸（除危及生命外）（p = .0001）和多次危及生命的事件（p = .002）可解释整体健康状况差异的39%。在有性虐待和/或身体虐待史的女性中，强奸经历、性虐待期间的重伤以及多次危及生命的事件可解释当前健康状况差异的四分之一。基于这三个虐待维度，我们创建了一个虐待严重程度衡量标准，该标准可解释有虐待史亚组以及整个诊所样本中健康状况差异的约四分之一。
鉴于转诊实践中虐待的高发生率以及既往虐待对健康的潜在影响，询问病史时纳入有关虐待经历的细节非常重要。本文制定的虐待严重程度衡量标准应在研究和临床实践中都很有用。
