VALIDATING THE CONCEPT OF ABUSE - WOMENS PERCEPTIONS OF DEFINING BEHAVIORS AND THE EFFECTS OF EMOTIONAL ABUSE ON HEALTH INDICATORS

Objectives: To validate the construct of abuse in 2 ways: first, to ex amine female patients' perceptions of abusive behaviors that are typic ally used in standardized abuse scales; and second, to determine healt h status symptom and medical utilization differences between women who report emotional abuse and women who are not abused. Design: Cross-se ctional. interviews and medical record reviews. Main Outcome Measures: Modified directions to the Conflict Tactics Scale were used to identi fy women's perceptions of abusive behaviors. Personal history of abuse was determined by self-report. Health status was measured using the M edical Outcomes Study Short-Form Health Survey-36 and medical services utilization was determined from medical records. The Wahler Physical Symptom Inventory was used to measure symptom experience. Setting: Pat ients were interviewed in either a rural primary care practice or an u rban medical university practice. Patients: Four hundred seven women o lder than 18 years were interviewed. Half were from an urban and half from a rural setting. Sixty-four percent of the sample was black. Resu lts: Women saw more behaviors as abusive than are typically identified by the Conflict Tactics Scale and abused women identified more abusiv e behaviors than nonabused women. Significant health status difference s were found between women who reported emotional abuse with no concur rent physical or sexual abuse and nonabused women on 7 of the 8 dimens ions of the Short-Form Health Survey health status scales and on 25% o f measured symptoms. Conclusions: These findings reflect the idea that women consider many behaviors to be abusive and that abused women per ceive more behaviors as abusive than do nonabused women. Given that si gnificant health status differences are shown between emotionally abus ed and nonabused women, emotional abuse can be viewed as a critical va riable in patient-health behavior.