title: Abuse, outpatient charges and utilization, and psychiatric symptoms among urban women on medicaid.
abstract: BACKGROUND
  Adult and childhood sexual and physical abuse are common and intertwined. Our objectives were to assess (1) the relationship between different forms of abuse; (2) outpatient charges and hospital and emergency department use among women with and without childhood and adult abuse; (3) psychiatric symptoms of women with and without childhood and adult abuse; and (4) the relationship between psychiatric symptoms and outpatient charges and hospital and emergency department use among a group of Medicaid-insured women seeking outpatient services in a primary care setting.
  
  
  METHODS
  We recruited female primary care patients for this cross-sectional study. Women reported childhood and adult sexual and physical abuse and anxiety, depression, and posttraumatic stress symptoms. We assessed outpatient charges through reviews of clinic records. Patients reported hospital and emergency department use.
  
  
  RESULTS
  Childhood and adult sexual and physical abuse were highly interrelated. Adult sexual abuse showed a trend toward significantly greater outpatient charges. Women who had experienced physical abuse during childhood had more emergency department visits and women who experienced physical abuse as an adult had more days of hospitalization. Childhood and adult sexual abuse were both related to higher levels of anxiety, depression, and posttraumatic stress symptoms. Anxiety, depression, and posttraumatic stress symptoms were related to higher outpatient charges. Depression and posttraumatic stress symptoms were related to greater emergency department use.
  
  
  CONCLUSIONS
  Women who experience abuse often have psychiatric symptoms. In our sample it was the severity of psychiatric symptoms rather than reported abuse alone that was related to outpatient charges and emergency department visits.
authors.affiliation: Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Rochester, MI 48308-1831, USA. jporcer@med.wayne.edu
authors.forename: John H
authors.initials: JH
authors.lastname: Porcerelli
authors.forename: Rosemary
authors.initials: R
authors.lastname: Cogan
authors.forename: Tsveti
authors.initials: T
authors.lastname: Markova
authors.forename: William
authors.initials: W
authors.lastname: Murdoch
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Porcerelli
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D010045:Outpatients / Q000706:statistics & numerical data; D011594:Psychometrics; D012720:Severity of Illness Index; D012742:Sex Offenses / Q000191:economics* / Q000706:statistics & numerical data; D013179:Spouse Abuse / Q000191:economics* / Q000706:statistics & numerical data; D013223:Statistics as Topic; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*