title: Childhood sexual abuse, psychological distress, and medical use among women.
abstract: OBJECTIVE
  This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting.
  
  
  METHODS
  Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions.
  
  
  RESULTS
  CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates.
  
  
  CONCLUSIONS
  Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5722, USA. baarnow@leland.stanford.edu
authors.forename: B A
authors.initials: BA
authors.lastname: Arnow
authors.forename: S
authors.initials: S
authors.lastname: Hart
authors.forename: C
authors.initials: C
authors.lastname: Scott
authors.forename: R
authors.initials: R
authors.lastname: Dea
authors.forename: L
authors.initials: L
authors.lastname: O'Connell
authors.forename: C B
authors.initials: CB
authors.lastname: Taylor
mesh_terms: D000328:Adult; D002140:California; D016022:Case-Control Studies; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010146:Pain / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires