Study Examines Effect of Childhood Physical and Sexual Abuse on Female Veterans' Health and Healthcare Use
BACKGROUND:
Female Veterans use outpatient care for primary care and mental health services more heavily than do their male counterparts, but little is known about the reasons for ill health among female Veterans. Numerous studies among women in the general population reveal a strong association between childhood maltreatment and more physical and psychological symptoms, greater disability, and increased healthcare use; however, less is known about how childhood abuse experiences contribute to female Veterans' current health and healthcare use. This study sought to investigate whether childhood physical abuse and childhood sexual abuse predict health symptoms and healthcare use by asking female Veterans, whether they had ever been "Hit or kicked hard enough to injure - as a child" or "Forced or made to have sexual contact - as a child." In order to rigorously evaluate the impact of childhood abuse on health and healthcare use, investigators also accounted for the impact of military sexual trauma (MST). Using VA data, investigators identified a random sample of female Veterans receiving care within the VA New England Healthcare System, 369 of whom responded and completed a written survey between 2/12 and 4/12. In addition to questions related to childhood abuse and MST, the survey included questions regarding demographics, military branch and service, as well as self-report measures for current overall physical and mental health, depression, and PTSD, as well as past-year healthcare use.
FINDINGS:
- Childhood physical abuse was an important contributor to both physical and mental health for female Veterans. After adjusting for age, race, military branch, childhood sexual abuse, and MST, childhood physical abuse was predictive of poorer physical health, greater depressive and PTSD symptoms, and more frequent use of medical healthcare.
- No significant association was found between childhood sexual abuse and poor physical or mental health, and it was not a predictor for healthcare use.
- Of the 369 female Veterans in this study, 109 (29%) reported experiencing childhood abuse, with 22 (6%) experiencing physical abuse only, 41 (11%) experiencing sexual abuse only, and 46 (12%) experiencing physical and sexual abuse during childhood. Half of the respondents also reported experiencing MST.
LIMITATIONS:
- The survey used for this study relied on a retrospective design and self-report measures.
- Study data lacked contextual information with respect to childhood physical and sexual abuse (i.e., age of onset, frequency and severity), and combat exposure.
IMPLICATIONS:
- Screening for adverse childhood experiences may facilitate access to appropriate physical and mental health treatment, as well as inform mental health assessment and treatment planning, among female Veterans.
Mercado R, Wiltsey-Stirman S, and Iverson K. Impact of Childhood Abuse on Physical and Mental Health Status and Healthcare Utilization among Female Veterans. Military Medicine. October 2015;180(10):1065-74.
