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Self-reported Childhood Abuse in an Adult Population in a Primary Care SettingPrevalence, Correlates, and Associated Suicide Attempts
Debra Ann Gould, MD, MPH;
Nancy G. Stevens, MD, MPH;
Nicholas G. Ward, MD;
Albert S. Carlin, PhD;
Heather E. Sowell;
Belinda Gustafson
Arch Fam Med. 1994;3(3):252-256.
Abstract
Objective
To describe the prevalence of childhood physical, sexual, and emotional abuse and suicide attempts in a sample of adult patients from a primary care setting and to examine the relationship between suicide attempts and a self-reported history of childhood abuse.
Design
Cross-sectional sampling via a selfadministered survey that included an abuse questionnaire, the Inventory to Diagnose Depression, and questions regarding suicide.
Setting
University medical center family medicine practice.
Patients
A convenience sample of patients aged 18 years and older presenting for care. Of the 778 patients approached, 448 patients (58%) consented and returned their surveys. We report only on the 292 surveys (38%) returned with complete information. Subjects were predominantly middle class and white, with a mean age of 37 years.
Measurements and Main Results
Forty-four percent of the patients reported experience of childhood abuse, and 22% reported multiple forms of abuse. Eighteen percent of abused vs 3% of nonabused patients (P=.00001) reported a history of suicide attempts. Being female, younger, and less educated were associated with any abuse. Females reported more sexual abuse; less educated patients, more physical abuse; and younger patients, more physical and sexual abuse and suicide attempts. Odds ratios for suicide attempts, when adjusted by abuse status, were 6.4 for any abuse (95% confidence intervals [CI], 2.4 to 17.6), 4.1 for sexual abuse (95% CI, 1.7 to 9.9), 3.7 for emotional abuse (95% CI, 1.4 to 10.0), and 1.2 for physical abuse (95% CI, 0.5 to 3.1).
Conclusion
A history of childhood abuse was a common experience in this sample. Patients with a history of abuse, particularly sexual and emotional abuse, are at increased risk of suicidal behavior. To facilitate more appropriate care and treatment, primary care practitioners should question patients regarding a history of abuse.
Author Affiliations
From the Departments of Family Medicine (Drs Gould and Stevens) and Psychiatry and Behavioral Sciences (Drs Ward and Carlin and Mss Sowell and Gustafson), University of Washington School of Medicine, Seattle. Dr Gould is now with the Department of Family Medicine, University of Rochester School of Medicine—Highland Hospital, Rochester, NY, and Ms Sowell is now with the Department of Family Medicine, Mercy Medical Center, Denver, Colo.
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