Health Care Utilization and History of Trauma among Women in a Primary Care Setting

By Sansone, Randy A.; Wiederman, Michael W. et al. | Violence and Victims, January 1, 1997 | Go to article overview

Health Care Utilization and History of Trauma among Women in a Primary Care Setting


Sansone, Randy A., Wiederman, Michael W., Sansone, Lori A., Violence and Victims


Participants were 150 women seen consecutively by a female family physician in an HMO setting for nonemergent medical care. Each participant completed a questionnaire that explored three areas of trauma. Twelve months after the administration of the questionnaire, medical records of each participant were reviewed for several measures of health care utilization (i.e., number of telephone contacts, physician visits, ongoing prescriptions, acute prescriptions, specialist referrals). Age, education, and current marital status were unrelated to medical utilization. Participants' acknowledged history of physical and emotional abuse significantly correlated with most measures of health care utilization, whereas sexual abuse generally did not. The implications of these findings are discussed.

Trauma appears to be a nonspecific but contributory factor to many types of emotional disturbances (Browne & Finkelhor, 1986; Hart & Brassard, 1987; Malinosky-Rummell & Hansen, 1993; Weaver & Clum, 1995). These include posttraumatic stress disorder (Kiser, Heston, Millsap, & Pruitt, 1991), major depression as well as dysthymia (Kaufman, 1991; Kiser et al., 1991; Margo & McLees, 1991), substance use disorders (Dembo et al., 1989; Hart, Mader, & Griffith, 1989; Margo et al., 1991; Swett, Cohen, Surrey, Compaine, & Chavez, 1991), eating disorders (Welch & Fairburn, 1994) including obesity (Sansone, Sansone, & Fine, 1995), hypochondriasis (Barsky, Wool, Barnett, & Cleary, 1994), multiple personality disorder (Braun, 1984), and borderline personality disorder (Brown & Anderson, 1991; Ludolph et al., 1990; Shearer, Peters, Quaytman, & Ogden, 1990; Silk, Lee, Hill, & Lohr, 1995). Although some of these disorders, particularly depression (Berkanovic & Hurwicz, 1992; Howland, 1993a, 1993b; Karisson, Lehtinen, & Joukamaa, 1995) and borderline personality disorder (Hueston, Mainous, & Schilling, 1996; Sansone, Sansone, & Wiederman, in press), have been shown to result in greater health care utilization, the direct relationship between various types of trauma (as opposed to specific psychiatric diagnoses) and health care utilization has not been well studied.

In one study that examined the relationship between abuse and subjects' health care utilization, Moeller, Bachman, and Moeller (1993) administered anonymous surveys to women attending a gynecologic clinic. The investigators determined that a prior experience of sexual, physical, or emotional abuse was related to a greater incidence of medical hospitalization, as was the total number of different trauma types experienced. However, the results of this study are compromised by a relatively low participation rate, the self-report format for medical utilization, and use of only one health care utilization variable for study (hospitalizations).

Golding (1996) found an association between a history of sexual assault and the presence of reproductive and sexual symptoms in women. Likewise, Kimerling and Calhoun (1994) found that, compared with controls, female rape victims reported more somatic complaints, poorer perceptions of physical health, and greater use of medical services.

In a study of domestic violence in a primary care setting, women who were currently being abused were more likely than nonabused women to have more physical symptoms and higher scores on measures of somatization (McCauley et al., 1995), suggesting the possibility of greater health care utilization. Among women being evaluated in an emergency department, those who were exposed to domestic physical abuse were more likely to have a greater number of hospital admissions, not only for treatment of traumatic injuries but also for medical, gynecological and psychiatric services (Bergman & Brismar, 1991; Bergman, Brismar, & Nordin, 1992).

Finally, based on a literature review of research articles and observational data, Drossman, Talley, Leserman, Olden, and Barreiro (1995) concluded that an association exists between a history of sexual and/or physical abuse, and gastrointestinal illness. …

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