Sandra K. Burge

Prevalence and 3-Year Incidence of Abuse Among Postmenopausal Women

OBJECTIVES We examined prevalence, 3-year incidence, and predictors of physical and verbal abuse among postmenopausal women. METHODS We used a cohort of 91,749 women aged 50 to 79 years from the Womens Health Initiative. Outcomes included self-reported physical abuse and verbal abuse. RESULTS At baseline, 11.1% reported abuse sometime during the prior year, with 2.1% reporting physical abuse only, 89.1% reporting verbal abuse only, and 8.8% reporting both physical and verbal abuse. Baseline prevalence was associated with service occupations, having lower incomes, and living alone. At 3-year follow-up, 5.0% of women reported new abuse, with 2.8% reporting physical abuse only, 92.6% reporting verbal abuse only, and 4.7% reporting both physical and verbal abuse. CONCLUSIONS Postmenopausal women are exposed to abuse at similar rates to younger women; this abuse poses a serious threat to their health.

Predictors of development of adult psychopathology in female victims of childhood sexual abuse

The purpose of this study is to identify predictors of resilience and adult mental disorders in women with a history of childhood sexual abuse. This cross-sectional study was conducted in a family practice center using adult female (age 18–40) patients. Outcome measures assessed the prevalence of major depressive episode, panic disorder, agoraphobia, substance abuse, posttraumatic stress disorder, borderline personality disorder, bulimia, and suicidality. Seventy-six percent of the 90 women with sufficient data met criteria for at least one adult disorder. Mental health was related to high SES, lack of family alcohol abuse, lower frequency of first perpetrator abuse, and few perpetrators. Specifics of the abuse were associated with development of borderline personality disorder, substance abuse, major depressive episode, suicidality, bulimia, agoraphobia, and panic disorder. Maternal violence against the father, substance abuse within the household of origin, and maternal care and overprotection were also important. The specifics about the abuse and the family environment during childhood are important predictors of adult psychopathology.

The Family Contribution to Health Status: A Population-Level Estimate

PURPOSE Clinical studies have shown strong family influences on individual health, but the aggregate importance of family effects for population health is unknown. Our objective was to estimate, at a population level, the variance in individual health status attributable to the family. METHODS Secondary data were used from the Community Tracking Study, a stratified random sample of the US population. Hierarchical linear modeling was used to estimate the individual and family components of health status. The setting was 60 US communities, which account for approximately one half of the population. Participants were US residents aged 18 years and older who shared a household with family members in the study (N = 35,055). Main outcome measures were the Short Form-12 (SF-12) self-reported physical and mental subscales. RESULTS Depending on the family configuration, 4.5% to 26.1% of the variance in individual health status was derived from the family. The proportion was highest for older married persons. The family effect on health status was generally similar for physical and mental health. Including age, family income, and health insurance status in the regression equations moderately reduced the family variance component. CONCLUSIONS At a population level, the family contribution to individual health status is measurable and substantial. The shared characteristics of income and health insurance account for only a modest portion of the effect. Health policy and interventions should place more emphasis on the family’s role in health.

Use of complementary and alternative medicine among family practice patients in South Texas

Americans spend

Change in opioid dose and change in depression in a longitudinal primary care patient cohort

27 billion out of pocket every year on complementary and alternative medicine (CAM).1 Nearly all CAM users see physicians for health care,2–4 but few mention their use of CAM to their doctors.5–7 The “typical” CAM user is a young woman of European descent with higher than average income and education.5,7–9 However, Keegan reported that many low-income Latinos use folk practitioners such as the curandero (healer), the yerbero (herbalist), the sobador (masseur), or practices such as spiritual healing rather than treatments offered by health clubs or health food stores.6 These patterns of CAM use are different than those of the majority population and deserve closer scrutiny.

Post‐traumatic stress disorder in victims of rape

Abstract Depression is associated with receipt of higher doses of prescription opioids. It is not known whether the reverse association exists in that an increased opioid dose is associated with increased depression. Questionnaires were administered to 355 patients with chronic low back pain at baseline and 1-year and 2-year follow-up. Depression, pain, anxiety, health-related quality of life, and social support or stress were obtained by survey. Opioid type and dose and comorbid conditions were derived from chart abstraction. Random intercept, generalized linear mixed models were computed to estimate the association between change in opioid morphine equivalent dose (MED) thresholds (0, 1-50, >50 mg) and probability of depression over time. Second, we computed the association between change in depression and odds of an increasing MED over time. After adjusting for covariates, an increase to >50 mg MED from nonuse increased a participants probability of depression over time (odds ratio [OR] = 2.65; 95% confidence interval [CI], 1.17-5.98). An increase to 1 to 50 mg MED did not increase an individuals probability of depression over time (OR = 1.08; 95% CI, 0.65-1.79). In unadjusted analysis, developing depression was associated with a 2.13 (95% CI, 1.36-3.36) increased odds of a higher MED. This association decreased after adjusting for all covariates (OR = 1.65; 95% CI, 0.97-2.81). Post hoc analysis revealed that depression was significantly associated with a 10.1-mg MED increase in fully adjusted models. Change to a higher MED leads to an increased risk of depression, and developing depression increases the likelihood of a higher MED. We speculate that treating depression or lowering MED may mitigate a bidirectional association and ultimately improve pain management.

Differences in Social Network Structure and Support Among Women in Violent Relationships

Rape is a stressor that legitimately can be included in experiences that cause post-traumatic stress. A review of the professional literature on rape shows evidence for each of the criteria for PTSD. A sample of convenience of 29 rape victims showed a range of PTSD patterns, but 25 (86%) were either moderately or severely stressed. Victims consistently scored higher on standard stress measures than normal or out-patient samples. Implications of the study are discussed in terms of reframing the rape victims experience as a response to traumatic stress.

Differences in Childhood Sexual Abuse Experience between Adult Hispanic and Anglo Women in a Primary Care Setting.

Social support is critical for women in abusive relationships. While social support may decrease the risk of getting into a violent relationship, it can also allow battered women to remain in violent relationships by reducing the negative impact of intimate partner violence (IPV). In addition to the social isolation that women in abusive relationships may experience, her social contacts appear to be important. The purpose of this study was to compare the size, structure, and composition of the social networks of women in abusive relationships with those of a matched cohort of nonabused women. The authors enrolled women from primary care clinics who reported abuse within the prior month, and a demographically matched comparison group of women in nonabusive relationships. Participants completed a social network analysis, and investigators compared social networks of abused with nonabused women. The networks of women in abusive relationships were smaller in size, but more efficient in their ability to reach their members, than those of nonabused women. Proportionally, networks of abused women had more women but fewer in-laws than those of comparison women. The women in these abusive relationships had higher measures of centrality, suggesting that they were more critical in holding their networks together. Yet, they had fewer social contacts, and provided more support than they received with fewer reciprocated ties. Thus, social networks of women in violent relationships are small and offer less support than those of comparison women. However, previous work on networks with weak ties and structural holes suggests that access to resources may be available through these networks.

Communication Technology Access, Use, and Preferences among Primary Care Patients: From the Residency Research Network of Texas (RRNeT)

ABSTRACT The literature on racial and ethnic factors in childhood sexual abuse is limited. The purpose of this exploratory study was to document Hispanic-Anglo differences in childhood sexual abuse experiences and assess whether these differences may be explained by socio-demographic and family environmental differences. Adult Hispanic (n = 69) and Anglo (n = 19) women from a family medicine clinic waiting room reporting a history of childhood sexual abuse completed an in-depth survey concerning the sexual abuse experience and their childhood environment. In this study, Hispanics were more likely to report a family member as the perpetrator and to experience more self-blame as a result of the abuse. Hispanics were also more likely to take action in response to the abuse, especially those who were more acculturated to U.S. culture. However, most of the observed differences in this study could be explained by socio-demographic or family environment variables, not by ethnic background. Qualitative research on the family environments of Hispanic victims of child sexual abuse may further explicate the dynamics and risk factors for abuse by family members.

Complex Dynamics in Intimate Partner Violence: A Time Series Study of 16 Women

Objective: The digital revolution is changing the manner in which patients communicate with their health care providers, yet many patients still lack access to communication technology. We conducted this study to evaluate access to, use of, and preferences for using communication technology among a predominantly low-income patient population. We determined whether access, use, and preferences were associated with type of health insurance, sex, age, and ethnicity. Methods: In 2011, medical student researchers administered questionnaires to patients of randomly selected physicians within 9 primary care clinics in the Residency Research Network of Texas. Surveys addressed access to and use of cell phones and home computers and preferences for communicating with health care providers. Results: In this sample of 533 patients (77% response rate), 448 (84%) owned a cell phone and 325 (62%) owned computers. Only 48% reported conducting Internet searches, sending and receiving E-mails, and looking up health information on the Internet. Older individuals, those in government sponsored insurance programs, and individuals from racial/ethnic minority groups had the lowest levels of technology adoption. In addition, more than 60% of patients preferred not to send and receive health information over the Internet, by instant messaging, or by text messaging. Conclusions: Many patients in this sample did not seek health information electronically nor did they want to communicate electronically with their physicians. This finding raises concerns about the vision of the patient-centered medical home to enhance the doctor-patient relationship through communication technology. Our patients represent some of the more vulnerable populations in the United States and, as such, deserve attention from health care policymakers who are promoting widespread use of communication technology.