title: The association of interpersonal trauma with somatic symptom severity in a primary care population with chronic pain: exploring the role of gender and the mental health sequelae of trauma.
abstract: OBJECTIVE
  Female trauma survivors develop somatic symptoms more frequently than males. We propose a model for somatic symptom development among trauma survivors, focusing on gender.
  
  
  METHODS
  Among 597 urban primary care patients with chronic pain, we examined the association between somatic symptom severity and three interpersonal trauma types: 1) sexual trauma (ST), 2) intimate partner violence (IPV), and 3) childhood trauma history (≥3 adverse childhood experiences (3+ACE)). We developed a structural equation model in which PTSD, depression, and substance abuse were evaluated as potential mediators of the path between trauma exposure and somatic symptom severity, and explored the role of gender in this model.
  
  
  RESULTS
  350 (59%) respondents were female; the mean age was 47. Women reported significantly more somatic symptoms than men, although somatic symptoms were increased among all interpersonal trauma survivors. In models in which the potential intervening variables are considered in aggregate, we did not find a signficant interaction between gender and trauma on somatic symptom severity, with the exception of 3+ACEs. A structural equation model showed depression and substance abuse, for men, and depression, for women, were associated with somatic symptom severity. PTSD was not associated with somatic symptom severity. Paths from trauma exposures to mental health sequelae were stronger for men.
  
  
  CONCLUSIONS
  Women have more severe somatic symptoms. With the exception of 3+ACEs, the association between trauma and somatic symptoms is amplified in both genders. Structural equation models showed the pathways differed by gender in function and strength of association.
authors.affiliation: Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States. Electronic address: jmccallhosenfeld@hmc.psu.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McCall-Hosenfeld
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA, United States. Electronic address: mwinter@bu.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Winter
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States. Electronic address: tch@bu.edu.
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.affiliation: MPH Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States. Electronic address: jane.liebschutz@bmc.org.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Liebschutz
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011602:Psychophysiologic Disorders / Q000453:epidemiology / Q000209:etiology*; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology*; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology*
keywords: Adult; Depression; Pain; Post-traumatic; Psychosomatic medicine; Stress disorders; Substance-related disorders