title: Impact of sexual and physical abuse dimensions on health status: development of an abuse severity measure.
abstract: OBJECTIVE
  Despite the abundant literature showing a relationship of sexual and/or physical abuse history with poor health status, few studies provide evidence about which dimensions of abuse may have a worse impact on health. In female patients with gastrointestinal (GI) disorders, the present study aims to identify which dimensions of abuse history (eg, number of perpetrators, injury) might predict poor current health status, in order to develop an empirically based severity of abuse measure.
  
  
  METHODS
  Of a sample of 239 female patients from a referral gastroenterology clinic, this paper primarily focuses on 121 women with a past history of contact sexual abuse (N = 99), and/or life threatening physical abuse (N = 68).
  
  
  RESULTS
  Among those with a sexual abuse history, 24% of current health status was explained by serious injury during abuse (p = .0006), victimization by multiple perpetrators (p = .03), and being raped (p = .09). Among the physically abused, rape (in addition to life threat) (p = .0001), and multiple life-threatening incidents (p = .002) explained 39% of the variance in overall health. Among the women with a sexual and/or physical abuse history, the experience of rape, serious injury during sexual abuse, and multiple life-threatening incidents explained one fourth of the variance in current health status. Based on these three dimensions of abuse, we created an abuse severity measure which explained about one fourth of the variance in health status among the subgroup with abuse history, and among the entire clinic sample.
  
  
  CONCLUSIONS
  Given the high prevalence of abuse in referral practice, and the potential health impact of previous abuse, it is important that history taking include details concerning the abuse experience. The severity of abuse measure developed in this paper should prove useful for both research and clinical practice.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27599-7160, USA.
authors.forename: J
authors.initials: J
authors.lastname: Leserman
authors.forename: Z
authors.initials: Z
authors.lastname: Li
authors.forename: D A
authors.initials: DA
authors.lastname: Drossman
authors.forename: T C
authors.initials: TC
authors.lastname: Toomey
authors.forename: G
authors.initials: G
authors.lastname: Nachman
authors.forename: L
authors.initials: L
authors.lastname: Glogau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002650:Child Abuse, Sexual / Q000523:psychology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000523:psychology; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D010553:Personality Development; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology*; D011902:Rape / Q000523:psychology