Prevalence of Posttraumatic Stress Disorder
Among Gynecological Patients With a History of Sexual and Physical Abuse

Reviewed by
Priscilla Schulz, LCSW

from an article of the same title by:

Klaas Wijma, Johan Soderquist, Ingela Bjorklund, and Barbro Wijma, Linkoping University

Published:
Journal of Interpersonal Violence, V. 15 (9) September 2000, 944-958

Background

The prevalence of childhood sexual abuse has remained at 12% for females since the 1950's. Likewise, prevalence rates of sexual assault (against males and females), and physical abuse (females only, adult and children) are 13.2% and 14.6% respectively. Among psychiatric populations the prevalence of abuse is sometimes as high as 50%. The authors of the present study point out these statistics in light of other research findings about psychological and physical aftereffects of abuse. They point out that psychological problems commonly seen in abuse survivors fit the array of symptoms in Posttraumatic Stress Disorder (PTSD). The authors also cite studies that show an association between sexual and physical abuse, and chronic, and often medically unexplained, pelvic or abdominal pain. This last finding suggests that abuse survivors might seek help in medical, especially gynecological, clinics. The authors hypothesize that medical personnel may address physical complaints, but that this approach may be inadequate and frustrating if patients' abuse-related distress is not also addressed.

Purpose of the present study

The authors in this study looked at the prevalence of past experiences of abuse and the presence of PTSD among female and male patients of the Department of Obstetrics and Gynaecology of Linkoping University Hospital, Sweden. They examined whether PTSD and abuse histories affected frequency of clinic visits and patient satisfaction with care. They also examined the relationship between patients' perceptions of abuse severity and the impact of abuse and PTSD.

How was the study conducted?

Researchers recruited participants over a two-week period for the study at the Linkoping University Hospital OB/GYN Department. All patients (N=960), except for those visiting the clinic for childbirth and obstetric ultrasound examinations, were asked to participate. Of all who were asked to participate, 649 (68%) were included in the study. Male patients were part of a couple seeking help with fertility problems or sexuality issues at the clinic.

Participants provided socio-demographic data about themselves and their estimate of the number of clinic visits in the last year. They also completed questions on the following topics:

• Number of consultations with physicians in the last year.
• The quality of contact with their physician and medical staff during clinic visit.
• Ratings of satisfaction with help received during last clinic visit.
• Whether they had experienced sexual abuse during any of three time periods, 0 to 12 years old, 13 to 18 years old or after age 19.
• Whether they had experienced physical abuse during any of the same time periods.
• Whether any type of abuse occurred within the past year.
• Ratings on a zero to 10 Likert scale of the amount of horror they experienced during the abuse, and how much they suffered from the abuse.
  

Researchers categorized participants as abused or non-abused according to reported histories of abuse. PTSD was assessed only among abused participants using the Traumatic Event Scale (Wijma, et al, 1997).

Participants' responses were analyzed in light of researchers' hypotheses. Findings were considered significant only if statistical analyses demonstrated a less than 5% probability that the result was from chance (p<.05).

What did the study find?

Prevalence of abuse among Linkoping patients

Twenty-six percent (171) of the 649 participants reported experiencing sexual or physical abuse at some time in their lives.

1. 20.6% of all participants had experienced physical abuse
   
   • 16.9% childhood physical abuse
   • 7.9% adult physical abuse
     
2. 15.2% of all participants had experienced sexual abuse
   • 11.6% childhood sexual abuse
     
   • 6.5% adult sexual assault

Prevalence of PTSD among Linkoping patients who had histories of abuse

Only patients with abuse histories were evaluated for PTSD in this study. Of those with abuse histories, 17% met DSM-IV criteria for PTSD.

Relationship between PTSD and abuse histories

• Sexual and physical abuse in childhood, and experiences of abuse in both childhood and adulthood was related to PTSD among participants. Abuse in adulthood alone was not related to PTSD.
• Participants with higher amounts of abuse had significantly higher TES scores.
• Participants with PTSD reported significantly more sense of horror and more suffering related to abuse than those without PTSD reported.

PTSD and abuse histories' affect on patients' use and perceptions of medical care at the Linkoping OB/GYN clinic

• Patients with PTSD reported more physician visits than those without PTSD and than patients who did not have abuse histories.
• Patients diagnosed with PTSD were significantly less satisfied with their physician during their last clinic visit than patients without PTSD. However, PTSD made no difference in how satisfied they felt with their experiences with other medical staff.
• Patients with PTSD rated their last clinic visit as significantly less helpful than patients without PTSD, who in turn reported feeling less helped than non-abused patients reported.

What are the study's implications?

OB/GYN patients who also have PTSD resulting from abuse are complex cases to treat. To the extent that the present study is generalizable, it suggests that good practice for OB/GYN clinics would be to explore and consider patients' abuse histories when planning treatment, and to keep in mind that patients with abuse histories could also be suffering from PTSD.

Reviewed by Priscilla Schulz, LCSW Center for Trauma Recovery University of Missouri St. Louis
January 30, 2001