Conclusion:
Previous childhood abuse was associated with adult health problems.

STUDY

1. Cross-sectional, self administered, anonymous survey entered over 19 000 women in 4 community-based primary care practices.
2. Questions asked about past and present and past physical and sexual abuse, current physical and psychological symptoms, current alcohol abuse, and street drug use.

RESULTS

1. 22% reported childhood or adolescent physical or sexual abuse.1
2. Compared with women who reported never having experienced abuse, women who reported abuse as children (but not as adults) had more physical symptoms, lower self esteem, and higher scores for depression, anxiety, and somatization. They were more likely to abuse drugs and alcohol, were more likely to have attempted suicide, and were more likely to have had a psychiatric admission.
3. Women abused only as children did not differ from women who reported current, but not childhood abuse, in numbers of physical symptoms, emotional distress, substance abuse, and suicide attempts.
4. Women who reported both childhood and adult abuse had higher levels of psychological problems and physical symptoms than those who reported childhood or adult abuse alone.

DISCUSSION

1. Women who reported having been abused as children were less likely to be married. This could indicate a difficulty initiating or maintaining permanent emotional relationships.
2. Childhood abuse is associated with adult abuse—50% of those who reported having been abused as children also reported being abused as adults.
3. In this study, it made little difference whether the abuse was sexual or physical.
4. "Overall, our study suggests that patients who have experienced childhood abuse, but not adult abuse, have levels of physical symptoms and psychological problems that are as severe as those of patients experiencing current abuse."
5. The wounds of childhood abuse may go unhealed.

CONCLUSION
Childhood abuse is associated with health problems including physical symptoms, psychological problems, and substance abuse. For many variables the association is as strong as for patients experiencing current abuse.
JAMA May 7, 1997; 1362-68 Original investigation, first author from Johns Hopkins Univ. School of Medicine, Baltimore, MD

Comment:

1. Certainly, we should screen for any condition with a prevalence of 1 in 4.