EARLY-CHILDHOOD ABUSE IN CHRONIC SPINAL-DISORDER PATIENTS - A MAJOR BARRIER TO TREATMENT SUCCESS

Study Design. Prevalence rates of childhood abuse, socioeconomic outco me data, and levels of psychopathology were evaluated for graduates of a functional restoration program for chronically disabled spinal diso rder patients in a workers' compensation environment. Objectives. To d escribe psychological profiles and evaluate treatment outcomes for chr onic spinal disorder patients with a history of childhood abuse. Summa ry of Background Data, There is increasing evidence to indicate that t raumatic childhood events may leave adult survivors psychologically di stressed. It is possible that because of this level of psychological d istress, chronic spinal disorder patients may be unable to return to a productive life-style after completing a rehabilitation program. Meth ods. Two hundred ninety-nine male and 174 female patients from a cohor t (N = 473) of consecutive graduates of a functional restoration progr am were assessed for the presence of childhood abuse by structured int erview. Prevalence rates were compared with a comparison group of subj ects without a history of chronic spinal disorder disability. In addit ion, the 79 chronic spinal disorder patients with a history of childho od abuse were compared on several socioeconomic outcomes with a matche d group of workers with chronic spinal disorders without a history of childhood abuse. Psychopathology in the two groups of chronic spinal d isorder patients was evaluated using Diagnostic and Statistical Manual of Mental Disorders criteria, the Minnesota Multiphasic Personality I nventory, and Symptom Checklist-90-Revised. Results. A history of chil dhood abuse was found to be related to a higher level of psychological distress in chronic spinal disorder patients. In addition, poorer soc ioeconomic outcomes, such as lower work retention rates and higher pos trehabilitation operations to the same area of injury, were found in t he chronic spinal disorder patients with a history of childhood abuse compared with workers without a history of childhood abuse in whom chr onic spinal disorders developed. Conclusions. These results demonstrat e that although a history of childhood abuse is associated with greate r psychosocial disturbances in chronically disabled spinal disorder pa tients, such disturbances do not interfere with an initial positive re sponse to an effective tertiary rehabilitation program such as functio nal restoration. However, a history of childhood abuse may be related to poorer socioeconomic outcomes after discharge from rehabilitation p rograms. Additional treatment options may be needed for these patients .