Jacqueline M. Golding

Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis

This article reviews literature on the prevalence of mental health problems among women with a history of intimate partner violence. The weighted mean prevalence of mental health problems among battered women was 47.6% in 18 studies of depression, 17.9% in 13 studies of suicidality, 63.8% in 11 studies of posttraumatic stress disorder (PTSD), 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. These were typically inconsistent across studies. Weighted mean odds ratios representing associations of these problems with violence ranged from 3.55 to 5.62, and were typically consistent across studies. Variability was accounted for by differences in sampling frames. Dose-response relationships of violence to depression and PTSD were observed. Although research has not addressed many criteria for causal inferences, the existing research is consistent with the hypothesis that intimate partner violence increases risk for mental health problems. The appropriate way to conceptualize these problems deserves careful attention.

Unmet mental health needs of women in public-sector gynecologic clinics

OBJECTIVE We examined the mental health needs of poor young women seen in public-sector gynecologic settings. STUDY DESIGN Participants were 205 ethnically diverse women, mean age 29 years, seen by gynecologists at San Francisco General Hospital, all either uninsured or receiving public medical assistance. An interview with an instrument designed to diagnose mood, anxiety, alcohol, and eating disorders in medical patients, the Prime-MD, was used to assess current mental disorders. Any history of sexual or other physical assault was recorded. Receipt of primary care was scored for comprehensiveness. RESULTS The rates of current psychiatric disorders were extremely high; 21.5% had current major depression. The prevalence of anxiety disorders was also elevated among these women. Many had a history of sexual trauma, and 28% had been the victims of unwanted intercourse. Finally, many reported behaviors that pose serious health risks. For example, 32% smoked and 2% used illicit drugs. Fewer than half had access to comprehensive primary medical care. CONCLUSIONS Young, poor women who seek care in public-sector gynecologic clinics would benefit from comprehensive medical care addressing their psychosocial needs.

Prevalence of sexual assault history among women with common gynecologic symptoms.

OBJECTIVE The purpose of this study was to evaluate the prevalence of a sexual assault history among women with and without 3 common gynecologic complaints: dysmenorrhea, menorrhagia, and sexual dysfunction. STUDY DESIGN Data came from 3 surveys of women randomly selected from general populations: 2 United States regional samples (n = 1428 and n = 1703) and 1 national sample (n = 963). Prevalence rates and adjusted odds ratios were calculated and combined across the 3 samples with a meta-analysis. RESULTS The prevalence of an assault history ranged from 6% to 26% among women with 1 symptom to 13% to 40% among women with 3 symptoms. Symptoms were associated with increased odds of an assault history for women 18 to 34 years old (odds ratio 1.90, 95% confidence interval 1.56 to 2.32), 35 to 44 years old (odds ratio 1.99, 95% confidence interval 1.57 to 2.53), and >54 years old (odds ratio 1.37, 95% confidence interval 1.04 to 1.80). Symptoms were unrelated to sexual assault history for women in the perimenopausal (45 to 54 years) age group (odds ratio 0.94, 95% confidence interval 0.71 to 1.24). Symptom level was unrelated to having disclosed assaults to a physician (odds ratio 1.17, 95% confidence interval 0.85 to 1.62). CONCLUSIONS Women in the general population with common gynecologic complaints are at a substantially increased risk of having a history of sexual assault.

Sexual-Assault History and Long-Term Physical Health Problems Evidence From Clinical and Population Epidemiology

Having a history of sexual assault is associated with both poor general health and limitations in physical functioning, as well as with specific health problems such as chronic pelvic pain, premenstrual disturbance, other gynecologic symptoms, fibromyalgia, headache, other pain syndromes, and gastrointestinal disorders. In studies evaluating the possible role of depression in these associations, depression among sexually assaulted persons did not account for their poorer health. Although there are unanswered questions in the literature on the associations between sexual assault and health, existing findings are consistent with standard criteria for inferring causal relationships from observational data. For example, many assault-health associations are supported by multiple, independent studies, and many demonstrate dose-response relationships (i.e., more incidents of sexual assault, or more severe assaults, are associated with more adverse health outcomes).

Sexual assault history and limitations in physical functioning in two general population samples

The purpose of this study was to evaluate the functional impact of sexual assault history in two general population surveys (pooled N = 6,024). Sexual assault was associated with functional impairment regardless of gender, ethnicity, and study site. Repeated assaults, spousal assaults, physically threatening assaults, and those resulting in intercourse or sexual disturbances were most strongly related to impairment. The greater numbers of severe physical symptoms experienced by sexually assaulted persons accounted for their poorer functioning. Depression did not account for this association despite its mediating role. Physical symptoms and depression had similar relationships to functioning for assaulted and nonassaulted persons.

Physical abuse among depressed women

AbstractOBJECTIVE: To provide estimates of physical abuse and use of health services among depressed women in order to inform efforts to increase detection and treatment of physical abuse. DESIGN: Retrospective assessment of abuse and health services use over 1 year in a cohort of depressed women. SETTING: Statewide community sample from Arkansas. PARTICIPANTS: We recruited 303 depressed women through random-digit-dial screening. MEASUREMENTS AND MAIN RESULTS: Exposure to physical abuse based on the Conflict Tactics Scale, multi-informant estimate of health and mental health services. Over half of the depressed women (55.2%) reported experiencing physical abuse as adults, with 14.5% reporting abuse during the study year. Women abused as adults had significantly more severe depressive symptoms, more psychiatric comorbidity, and more physical illnesses than nonabused women. After controlling for sociodemographic and severity-of-illness factors, recently abused, depressed women were much less likely to receive outpatient care for mental health problems as compared to other depressed women (odds ratio [OR] 0.3; p=.013), though they were more likely to receive health care for physical problems (OR 5.7, p=.021). CONCLUSIONS: Because nearly all depressed women experiencing abuse sought general medical rather than mental health care during the year of the study, primary care screening for physical abuse appears to be a critical link to professional help for abused, depressed women. Research is needed to inform primary care guidelines about methods for detecting abuse in depressed women.

Sexual assault history and social support: Six general population studies†

We evaluated the association of sexual assault history with later social support, operationalized as network size, marital status, presence of a partner, frequency of network contacts, and emotional support from friends and family, from spouse, and from partner. Data came from six independent general population surveys (pooled N = 9,865) whose results were summarized using meta-analysis. People who had been sexually assaulted were less likely than others to be married (OR = 0.75, 95% CI = 0.65, 0.87) or to report at least weekly contact with friends and relatives (OR = 0.48, 95% CI = 0.31, 0.75), and reported less emotional support from friends and family (OR = 0.72, 95% CI = 0.58, 0.89) and spouse (OR = 0.67, 95% CI = 0.54, 0.82). Results were consistent across studies, genders, and ethnic groups. Circumstances of sexual assault were sometimes related to social support.

MENTAL PRACTICE AMONG OLYMPIC ATHLETES

Recent research has focused on the relation of mental rehearsal, specifically visualization, to enhanced performance. Some have suggested that mental practice enhances performance on cognitive tasks more than on motoric ones. The present study describes two waves of survey data from elite track and field athletes before the 1988 US Olympic trials (n = 633) and those same athletes after the Olympic Games in Seoul (n = 450). The focus was on several measures of mental practice and visualization, including internal and external perspectives and association with sociodemographic data, prior collegiate experience, coaching influences, and Olympic team selection. Analyses suggest that mental practice may be associated with more successful track and field performance for selected groups of athletes.

Domestic violence and abuse, health status, and social functioning

ABSTRACT Background: Current and past history of domestic violence (DV), including physical, sexual, and emotional abuse is common among women patients seen in health care settings and is associated with a higher frequency of many health problems. However, the association of DV with self-assessed social functioning is less well known. Methods: We administered a telephone survey to a random sample of 391 women HMO members seen for a routine annual check-up. The survey included questions about current and past physical, sexual, and emotional violence and self-assessed social functioning and health status from the SF-36. We included questions about attitudes toward routine DV screening, likelihood of disclosure, and the health care setting as a resource. Results: Seven percent of the women reported recent DV and 34% reported lifetime abuse. Abuse was related to limitations in social functioning (adjusted OR = 2.26). Among women with no recent history of abuse, those with a history of past physical (adjusted OR = 1.90), sexual (adjusted OR = 2.04), or emotional (adjusted OR = 2.20) abuse reported significantly poorer social functioning. Emotional abuse, even in the absence of a history of physical or sexual abuse, was strongly associated with limitations in social functioning (adjusted OR = 4.95). Most women believed it appropriate for clinicians to inquire routinely about DV (87%) and 83% believed that the health care setting was a source of help. Conclusions: Current and past DV, including emotional abuse, adversely affect social functioning. Therefore, clinicians in the health care setting have a unique and important opportunity to assist women victims of DV and abuse.

Comparing sex buyers with men who do not buy sex: new data on prostitution and trafficking

We investigated attitudes and behaviors associated with prostitution and sexual aggression among 101 men who buy sex and 101 age-, education-, and ethnicity-matched men who did not buy sex. Both groups tended to accept rape myths, be aware of harms of prostitution and trafficking, express ambivalence about the nature of prostitution, and believe that jail time and public exposure are the most effective deterrents to buying sex. Sex buyers were more likely than men who did not buy sex to report sexual aggression and likelihood to rape. Men who bought sex scored higher on measures of impersonal sex and hostile masculinity and had less empathy for prostituted women, viewing them as intrinsically different from other women. When compared with non-sex-buyers, these findings indicate that men who buy sex share certain key characteristics with men at risk of committing sexual aggression as documented by research based on the leading scientific model of the characteristics of non-criminal sexually aggressive men, the Confluence Model of sexual aggression.