Ann Petruckevitch

Relation between childhood sexual and physical abuse and risk of revictimisation in women: a cross-sectional survey

BACKGROUND Women who are physically and sexually abused in childhood are at increased risk of victimisation in adulthood. Research has concentrated on sexual revictimisation, and has not included investigation of other abusive experiences, nor examination of prevalence and effects of abuse on adult revictimisation. We aimed to examine the relation between childhood trauma and adult revictimisation, and identify confounding factors. METHODS We did a cross-sectional survey of 2592 women who were attending primary care practices in east London, UK, with self-administered anonymous questionnaires. We included questions on physical and sexual abuse in childhood; on domestic violence, rape, indecent assault, and other traumatic experiences in adulthood; and on alcohol and other drug abuse. We analysed associations between childhood and adulthood abuse with multiple logistic regression. FINDINGS 1207 (55%) of 2192 eligible women were recruited and completed the questionnaire. Abusive experiences co-occurred in both childhood and adulthood. Repetition and severity of childhood abuse were independently associated with specific types of adult revictimisation. Unwanted sexual intercourse (<16 years) was associated with domestic violence in adulthood (odds ratio 3.54; 95% CI 1.52-8.25) and with rape (2.84; 1.09-7.35); and severe beatings by parents or carers with domestic violence (3.58; 2.06-6.20), rape (2.70; 1.27-5.74), and other trauma (3.85; 2.23-6.63). INTERPRETATION Childhood abuse substantially increases risk of revictimisation in adulthood. Women who have experienced multiple childhood abuse are at most risk of adult revictimisation. Identification of women who have undergone childhood abuse is a prerequisite for prevention of further abuse.

Identifying domestic violence: cross sectional study in primary care

Abstract Objectives: To measure the prevalence of domestic violence among women attending general practice; test the association between experience of domestic violence and demographic factors; evaluate the extent of recording of domestic violence in records held by general practices; and assess acceptability to women of screening for domestic violence by general practitioners or practice nurses. Design: Self administered questionnaire survey. Review of medical records. Setting: General practices in Hackney, London. Participants: 1207 women (>15 years) attending selected practices. Main outcome measures: Prevalence of domestic violence against women. Association between demographic factors and domestic violence reported in questionnaire. Comparison of recording of domestic violence in medical records with that reported in questionnaire. Attitudes of women towards being questioned about domestic violence by general practitioners or practice nurses. Results: 425/1035 women (41%, 95% confidence interval 38% to 44%) had ever experienced physical violence from a partner or former partner and 160/949 (17%, 14% to 19%) had experienced it within the past year. Pregnancy in the past year was associated with an increased risk of current violence (adjusted odds ratio 2.11, 1.39 to 3.19). Physical violence was recorded in the medical records of 15/90 (17%) women who reported it on the questionnaire. At least 202/1010 (20%) women objected to screening for domestic violence. Conclusions: With the high prevalence of domestic violence, health professionals should maintain a high level of awareness of the possibility of domestic violence, especially affecting pregnant women, but the case for screening is not yet convincing. What is already known on this topic Domestic violence is associated with a wide range of health and social problems for women and their children Women experiencing violence are often not identified by health professionals in hospital settings Professional organisations and politicians are promoting a policy of screening for domestic violence What this study adds Over a third of women attending general practices had experienced physical violence from a male partner or former partner Most women who had experienced physical violence were not identified by general practitioners, according to data extracted from their medical records Women pregnant in the previous year were at high risk for current physical violence A substantial minority of women object to routine questioning about domestic violence

Psychiatric morbidity in prisoners and solitary cellular confinement, I: disciplinary segregation

Surveys of prisoners have demonstrated a high prevalence of psychiatric morbidity. There is increasing concern that behavioural disorder secondary to psychiatric morbidity may be perceived and dealt with by prison staff as a disciplinary problem instead of as illness-related behaviour. A survey among prisoners in England and Wales identified the characteristics of those who had been placed in disciplinary segregation. There was no evidence that prisoners with severe mental illness were more likely to report disciplinary segregation following adjudication under the prison rules. Segregated prisoners were more likely to be younger, with histories of violent offending, career criminality, early environmental disadvantage, anti-social personality disorder, drug misuse - specifically crack cocaine - and higher scores of psychopathy. Disciplinary segregation may be an indicator of increased risk of future offending.