Severity of child maltreatment, pain complaints and medical utilization among women

High medical utilization in adults has been linked to both reported history of childhood abuse and mental health problems. However, few studies have e xplored relationships between abuse severity and psychological distress to identify subgroups with unique utilization patterns and medical complaints. This study compared two groups of psychologically distressed, high utilize rs. One group (DS) was comprised of those with psychological distress, who reported a history of child sexual abuse (CSA); the other group (DSP) consi sted of those with psychological distress, who reported CSA plus a history of childhood physical abuse. The groups were compared on severity of sexual and nonsexual child maltreatment. medical complaints and medical utilizati on. From a convenience sample of 206 females age 20-63, recruited while wai ting for a physician appointment in a primary care clinic, we compared 25 D SPs to 33 DSs. Compared with DSs, DSPs reported significantly more severe: (1) sexual abuse including completed intercourse; (7) emotional abuse; (3) emotional neglect; and (4) psychological distress. DSPs also showed a nonsi gnificant trend towards more severe physical neglect. In addition to bring significantly higher on emergency room visits, DSPs were marginally higher than DSs on nonpsychiatric outpatient visits. DSPs had significantly more f requent chronic and acute pain complaints at emergency room (ER) visits. He adaches were the most frequently coded diagnosis at ER visits in this sampl e. DSPs accounted for 89% of these ER visits attributable to headaches. The interaction of psychological distress and reported severity of child maltr eatment reveals subgroups with unique utilization patterns and medical comp laints. Physicians should screen patients for child maltreatment severity a nd psychological distress and should be involved in mental health referral where necessary, (C) 2001 Elsevier Science Ltd. All rights reserved.