Adult Health and Relationship Outcomes among Women with Abuse Experiences during Childhood
Cannon, Elizabeth A., Bonomi, Amy E., Anderson, Melissa L., Rivara, Frederick P., Thompson, Robert S., Violence and Victims
Associations between child abuse and/or witnessing intimate partner violence (IPV) during childhood and women's health, adult IPV exposure, and health care use were examined. Randomly sampled insured women ages 18-64 (N = 3,568) completed a phone interview assessing childhood exposure to abuse and witnessing IPV, current health, and adult IPV exposure. Women's health care use was collected from automated health plan databases. Poor health status, higher prevalence of depression and IPV, and greater use of health care and mental health services were observed in women who had exposure to child abuse and witnessing IPV during childhood or child abuse alone, compared with women with no exposures. Women who had witnessed IPV without child abuse also had worse health and greater use of health services. Findings reveal adverse long-term and incremental effects of differing child abuse experiences on women's health and relationships.
Keywords : adult health ; health care utilization ; intimate partner violence ; child abuse ; witnessing intimate partner violence
Child abuse history is prevalent among women ( Arnow, 2004 ; Chartier, Walker, & Naimark, 2007 ; Newman et al., 2000 ; Tang et al., 2006 ; Thompson et al., 2006 ) and is associated with poor health across the lifespan ( Batten, Aslan, Maciejewski, & Mazure, 2004 ; Bensley, Van Eenwyk, & Wynkoop Simmons, 2003; Carlson, McNutt, & Choi, 2003 ; McCauley et al., 1997 ; Moeller, Bachmann, & Moeller, 1993 ; Nicolaidis, Curry, McFarland, & Gerrity, 2004 ; Thurston et al., 2008 ; Walker et al., 1999 ). As well, witnessing intimate partner violence (IPV) in childhood-a stressful, adverse experience ( Felitti et al., 1998 )-is associated with poor health well into adulthood ( Dube Anda, Felitti, Edwards, & Williamson, 2002 ). Studies suggest a dose-response relationship between adverse childhood exposures (such as child abuse and witnessing IPV) and poor self-rated health in adulthood ( Bensley et al., 2003 ; Dube, Felitti, Dong, Giles, & Anda, 2003 ; Edwards, Holden, Felitti, & Anda, 2003 ; Felitti et al., 1998 ). Anda, Felitti, Edwards, & Williamson, 2002 ). Studies suggest a dose-response relationship
Studies have also shown an association between childhood abuse and adverse relationship outcomes in adulthood, including IPV victimization ( Bensley et al., 2003 ; Coid et al., 2001 ; Nicolaidis et al., 2004 ; Thompson et al., 2006 ; Whitfield, Anda, Dube, & Felitti, 2003 ). This relationship has also been shown for witnessing IPV during childhood and IPV exposure in adulthood ( Bensley et al., 2003 ; Thompson et al., 2006 ; Whitfield et al., 2003 ). Moreover, a graded relationship has been found between the number of child abuse exposures and IPV ( Bensley et al., 2003 ; Whitfield et al., 2003 ). In addition, the extant literature points to higher health care use for women with exposure to childhood physical and sexual abuse ( Anda, Brown, Felitti, Dube, & Giles, 2008 ; Arnow, 2004 ; Arnow et al., 2000 ; Bonomi, Anderson, et al., 2008 ; Chartier et al., 2007 ; Finestone et al., 2000 ; Newman et al., 2000 ; Tang et al., 2006 ). For example, one recent study found that adverse childhood experiences (such as physical abuse, sexual abuse, and witnessing IPV) were associated with increased prescription drug use ( Anda et al., 2008 ).
In addition, the same study found a graded relationship between number of adverse childhood experiences and risk for number of classes of drugs used.
Although some studies have examined the individual and combined effects of child abuse and witnessing IPV on adult health status, IPV exposure (i.e., Bensley et al., 2003 ) and adult health care utilization, they have examined only a couple of outcomes, such as IPV victimization and self-reported overall health, and none to our knowledge have examined more than one objective indicator of health care use by these exposures. In addition, prior studies did not conceptualize IPV as including physical, sexual, and nonphysical types of abuse ( Bensley et al. …