Prevalence of sexual abuse history in a sample of women seeking treatment for premenstrual syndrome.

This study evaluated the prevalence and correlates of sexual abuse history among women seeking treatment for severe premenstrual syndrome (PMS). Of 77 women participating in a randomized clinical trial of non-pharmacological treatments for severe PMS, 42 were interviewed regarding their sexual abuse history. The interviewed women were a mean of 38 years old, and most were of European ancestry, heterosexual, married, employed and well-educated. At least one attempted or completed sexual abuse event was reported by 95% of the women, with 81% reporting completed penetration against their will and 85% of these sustaining physical threat or harm. Compared to prior studies of sexually abused women in general populations, these women were abused earlier in life, more frequently and by similar types of offenders. Most of the abused women (65%) were estimated to have post-traumatic stress disorder (PTSD). Most abused women (83%) had never disclosed the abuse to a health practitioner. The findings suggest that a history of sexual abuse, particularly in childhood or adolescence, may be extremely common among women seeking treatment for severe PMS, and that substantial undiagnosed PTSD may also be present in this population. Implications for patient screening and treatment are discussed.

The impact of DNA evidence in a child sexual assault trial.

Two experiments investigated the impact of DNA evidence in a child sexual assault (CSA) case involving a 6-year-old alleged victim. In Experiment 1, participants read criminal trial summaries of CSA cases in which only DNA evidence was presented, only the alleged child victim's testimony was presented, or both forms of evidence were presented. When DNA evidence was presented, there were more guilty verdicts and greater belief of the alleged victim than when only the alleged victim testified. In Experiment 2, DNA evidence was countered by an alibi witness testifying as to the defendant's whereabouts at the time of the alleged assault. The alibi witness reduced the influence of DNA evidence compared with when DNA evidence was presented without this witness. These results are discussed in terms of the comparative strengths of DNA evidence versus the testimony of the alleged victim.

Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995.

OBJECTIVE: Although poor prenatal care is detrimental to maternal and infant health, few studies have assessed the adequacy of prenatal care among women with psychiatric diagnoses. This investigation examined the association between chart-recorded psychiatric and substance use diagnoses at the time of delivery and adequacy of prenatal care among all women delivering babies in California hospitals during 1994 and 1995. METHODS: The authors undertook an archival analysis of data from the California Health Information for Policy Project (CHIPP), which consists of linked hospital discharge and birth certificate data for 1,094,178 deliveries in 1994 and 1995. The associations between International Classification of Diseases, 9th Revision, Clinical Modification psychiatric and substance abuse diagnoses and level of prenatal care were examined. Logistic regression analyses were conducted to assess the association between maternal diagnostic category and inadequate prenatal care while controlling for payment source, age, education, race, marital status, and parity (previous births). RESULTS: Women who received psychiatric and substance use diagnoses demonstrated significantly increased risk of inadequate prenatal care compared with women without those diagnoses. CONCLUSIONS: Psychiatric diagnoses were associated with an increased risk of inadequate prenatal care; the association between psychiatric and substance use diagnoses and poor prenatal care persisted even after the analysis controlled for known risk factors. Future investigations will need to elucidate the processes of prenatal care for women with psychiatric disorders so that preventive interventions can be developed.

Sexual assault history and headache: five general population studies.

Headache is a common and disabling symptom. Although it is known that sexual assault is associated with a wide range of physical symptoms, little research has addressed its association with headache. The present study evaluated this association in five independent samples of randomly selected household residents (pooled N = 7502). The weighted mean odds ratio (OR) linking sexual assault and headache, controlling age and education, was 1.70 (95% confidence interval [CI] = 1.40, 2.07). Odds ratios were homogeneous across studies, and were similar regardless of participants' gender or ethnicity. Persons sexually assaulted in childhood consistently had greater odds of headache than those first assaulted in adulthood (OR = 1.89, 95% CI = 1.19, 2.99). These results indicate that sexual assault, particularly in childhood, is associated with headache.

Brief research report: age factors affecting the believability of repressed memories of child sexual assault.

Two experiments investigated how mock jurors react to testimony involving claims of a repressed memory in a case involving child sexual assault. Participants read a fictional civil trial summary presented in one of three conditions: (a) immediate condition--the alleged victim testified immediately after the incident; (b) repressed condition--the alleged victim reported the assault 1-39 years later, after remembering it for the first time; or (c) not-repressed condition--the alleged victim reported the assault 1-39 years later, but the memory of the assault had been present for those years. When there was any type of delayed reporting, either the age of the alleged victim at the time of the assault was constant and her age at reporting varied (Experiment 1) or the age of the alleged victim at the time of the assault varied and her age at reporting remained constant (Experiment 2). The results showed that (1) a delay in reporting an incident adversely affected believability of the alleged victim and led to fewer rulings in support of the plaintiff compared to reporting it immediately, (2) longer delays in reporting generally led to lower alleged victim believability and fewer decisions in support of the plaintiff than shorter delays, (3) the age of the alleged victim at the time of the incident was a critical variable in determining belief of the alleged victim, and (4) men generally rated believability of the alleged victim lower and ruled in favor of the plaintiff less often than women. The results are discussed in terms of the psychosocial factors affecting the perception of delayed reporting in a child sexual assault trial.

The effect of multiple childhood sexual assaults on mock-jurors' perceptions of repressed memories.

The effect of multiple childhood sexual assaults on the believability of a repressed memory of the assault was assessed using mock jurors. Participants read a fictional civil trial summary about a child sexual assault case presented in one of three reporting conditions: (a) immediate condition-the alleged victim testified immediately after the assault(s); (b) repressed condition-the alleged victim reported the assault(s) 20 years later, after remembering it/them for the first time; or (c) no-repressed condition-the alleged victim reported the assault(s) 20 years later, but the memory of the assault(s) had been present for those years. The number of assaults was either one or 30. The results showed that for all reporting conditions 30 alleged assaults led to relatively more decisions for the plaintiff than the defendant, and greater believability of the plaintiff. The increases in decisions rendered and believability were also generally true for the immediate condition compared to when there was a delay in reporting. The results are discussed in terms of mock jurors' perceptions of child sexual assault, both those reported immediately and those reported after many years.

Prevalence of sexual assault history among women with common gynecologic symptoms.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of a sexual assault history among women with and without 3 common gynecologic complaints: dysmenorrhea, menorrhagia, and sexual dysfunction. STUDY DESIGN: Data came from 3 surveys of women randomly selected from general populations: 2 United States regional samples (n = 1428 and n = 1703) and 1 national sample (n = 963). Prevalence rates and adjusted odds ratios were calculated and combined across the 3 samples with a meta-analysis. RESULTS: The prevalence of an assault history ranged from 6% to 26% among women with 1 symptom to 13% to 40% among women with 3 symptoms. Symptoms were associated with increased odds of an assault history for women 18 to 34 years old (odds ratio 1.90, 95% confidence interval 1.56 to 2.32), 35 to 44 years old (odds ratio 1.99, 95% confidence interval 1.57 to 2.53), and >54 years old (odds ratio 1.37, 95% confidence interval 1.04 to 1.80). Symptoms were unrelated to sexual assault history for women in the perimenopausal (45 to 54 years) age group (odds ratio 0.94, 95% confidence interval 0.71 to 1.24). Symptom level was unrelated to having disclosed assaults to a physician (odds ratio 1.17, 95% confidence interval 0.85 to 1.62). CONCLUSIONS: Women in the general population with common gynecologic complaints are at a substantially increased risk of having a history of sexual assault.

Physical abuse among depressed women.

OBJECTIVE: To provide estimates of physical abuse and use of health services among depressed women in order to inform efforts to increase detection and treatment of physical abuse. DESIGN: Retrospective assessment of abuse and health services use over 1 year in a cohort of depressed women. SETTING: Statewide community sample from Arkansas. PARTICIPANTS: We recruited 303 depressed women through random-digit-dial screening. MEASUREMENTS AND MAIN RESULTS: Exposure to physical abuse based on the Conflict Tactics Scale, multi-informant estimate of health and mental health services. Over half of the depressed women (55.2%) reported experiencing physical abuse as adults, with 14.5% reporting abuse during the study year. Women abused as adults had significantly more severe depressive symptoms, more psychiatric comorbidity, and more physical illnesses than nonabused women. After controlling for sociodemographic and severity-of-illness factors, recently abused, depressed women were much less likely to receive outpatient care for mental health problems as compared to other depressed women (odds ratio [OR] 0.3; p = .013), though they were more likely to receive health care for physical problems (OR 5.7, p = .021). CONCLUSIONS: Because nearly all depressed women experiencing abuse sought general medical rather than mental health care during the year of the study, primary care screening for physical abuse appears to be a critical link to professional help for abused, depressed women. Research is needed to inform primary care guidelines about methods for detecting abuse in depressed women.

Alcohol consumption and mortality. I. Characteristics of drinking groups.

AIMS: This is the first of a set of three papers evaluating drinking status and mortality risk. Analyses of multiple studies describe associations of drinking patterns with characteristics hypothesized to confound the relationships between drinking status and mortality. Characteristics which both significantly differentiate drinking groups and are consistent across studies would suggest that mortality studies not controlling for them may be compromised. DESIGN AND PARTICIPANTS: Associations are evaluated from the raw data of 10 general population studies which contained mortality data. Long-term abstainers are compared to former drinkers, long-term abstainers and former drinkers are compared to light drinkers (by quantity, frequency and volume in separate analyses) and moderate to heavy drinkers are compared to light drinkers. Tetrachoric correlation coefficients assess statistical significance; meta-analysis determines if associations are homogeneous across studies. MEASUREMENTS: Measures of alcohol consumption are quantity, frequency and volume; long-term abstainers are differentiated from former drinkers. Multiple measures of health, social position, social integration and mental health characteristics are evaluated. FINDINGS: Across studies, adult male former drinkers are consistently more likely to be heavier smokers, depressed, unemployed, lower SES and to have used marijuana than long-term abstainers. Adult female former drinkers are consistently more likely to be heavier smokers, in poorer health, not religious, and unmarried than long-term abstainers. Both types of abstainers tend to be of lower SES than light drinkers and report poorer health (not consistent). Female abstainers are more likely to be of normal or overweight than light drinkers. CONCLUSIONS: Characteristics of two groups of abstainers, other than their non-use of alcohol, may confound the associations found between drinking and mortality risk.

Alcohol consumption and mortality. II. Studies of male populations.

AIMS: This is the second of a set of three papers evaluating drinking status and mortality risk. Analysis of eight general population surveys of men evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of youth and five studies of adults were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (as well as abstinence in the youth models and long-term abstainers and former drinkers in adult models), age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: No evidence was found for the hypothesis that abstinence is associated with greater mortality risk than light drinking. In the youth samples, abstainers had a lower risk of dying than those drinking less than 15 times per month. One study of the adult samples showed a significant age by former drinker interaction; this did not alter the lack of association of former drinking with mortality risk or the homogeneity of results across studies for this finding. The most consistent finding was the association of heavy drinking with mortality among youth. Among adults, drinking 43 or more drinks per month and drinking 21 or more times per month were associated with increased mortality risk. Quantity per occasion was not significantly associated with mortality risk among adults. CONCLUSIONS: That frequent drinking was related to mortality risk, whereas heavier quantity was unrelated, is inconsistent with the belief that daily consumption of a few glasses of wine has salutary effects. Empirically, however, this pattern tends to be unusual. Findings were homogeneous across studies lending generalizability to results.

Alcohol consumption and mortality. III. Studies of female populations.

AIMS: This is the third of a set of three papers evaluating drinking status and mortality risk. Analysis of three general population surveys of women evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of adult women were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (including long-term abstainers and former drinkers) as well as age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: In models in which age was controlled, odds of death for long-term abstainers and former drinkers (defined by volume or quantity) were greater than those for light drinkers; odds of death for moderate and heavy drinkers (defined by quantity) were greater than those for light drinkers. When other psychosocial attributes were controlled, odds of death were similar for abstainers and light drinkers. When other psychosocial attributes were controlled, odds of death for heavy drinkers (defined by volume and quantity) were greater than those for light drinkers. When interactions of age and the two forms of abstinence were introduced, one study showed a significant effect of age and former drinking. CONCLUSIONS: Results were consistent with the hypothesis that characteristics of abstainers other than their non-use of alcohol may account for their higher mortality risk. With the exception of former drinkers compared to light drinkers, when interactions were introduced into models (for measures of quantity and frequency) findings were homogeneous across studies, lending generalizability to results.

Unmet mental health needs of women in public-sector gynecologic clinics.

OBJECTIVE: We examined the mental health needs of poor young women seen in public-sector gynecologic settings. STUDY DESIGN: Participants were 205 ethnically diverse women, mean age 29 years, seen by gynecologists at San Francisco General Hospital, all either uninsured or receiving public medical assistance. An interview with an instrument designed to diagnose mood, anxiety, alcohol, and eating disorders in medical patients, the Prime-MD, was used to assess current mental disorders. Any history of sexual or other physical assault was recorded. Receipt of primary care was scored for comprehensiveness. RESULTS: The rates of current psychiatric disorders were extremely high; 21.5% had current major depression. The prevalence of anxiety disorders was also elevated among these women. Many had a history of sexual trauma, and 28% had been the victims of unwanted intercourse. Finally, many reported behaviors that pose serious health risks. For example, 32% smoked and 2% used illicit drugs. Fewer than half had access to comprehensive primary medical care. CONCLUSIONS: Young, poor women who seek care in public-sector gynecologic clinics would benefit from comprehensive medical care addressing their psychosocial needs.

Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.

OBJECTIVE: Although posttraumatic stress disorder (PTSD) is a highly prevalent and often chronic condition, the relationship between PTSD and functioning and quality of life remains incompletely understood. METHOD: The authors undertook an archival analysis of data from the National Vietnam Veterans Readjustment Study. The study subjects consisted of the nationally representative sample of male Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. The authors estimated PTSD at the time of the interview with the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. They examined the following outcomes: diminished well-being, physical limitations, bed day in the past 2 weeks, compromised physical health status, currently not working, and perpetration of violence. Logistic models were used to determine the association between PTSD and outcome; adjustment was made for demographic characteristics and comorbid psychiatric and other medical conditions. RESULTS: The risks of poorer outcome were significantly higher in subjects with PTSD than in subjects without PTSD in five of the six domains. For the outcome domains of physical limitations, not working, compromised physical health, and diminished well-being, these significantly higher risks persisted even in the most conservative logistic models that removed the shared effects of comorbid psychiatric and other medical disorders. CONCLUSIONS: The suffering associated with combat related-PTSD extends beyond the signs and symptoms of the disorder to broader areas of functional and social morbidity. The significantly higher risk of impaired functioning and diminished quality of life uniquely attributable to PTSD suggests that PTSD may well be the core problem in this group of difficult to treat and multiply afflicted patients.

Post-traumatic stress disorder and functioning and quality of life outcomes in female Vietnam veterans.

OBJECTIVE: This investigation assessed whether current post-traumatic stress disorder (PTSD) was associated with impaired functioning in a nationally representative sample of female Vietnam veterans. METHODS: Logistic models were used to determine the association between PTSD and outcome while adjusting for demographic characteristics and medical and psychiatric co-morbidities. RESULTS: PTSD was associated with significantly elevated odds of poorer functioning in five of the six outcome domains; only the association between perpetration of violence in the past year and PTSD did not achieve statistical significance. After adjusting for demographics and medical and psychiatric co-morbidities, PTSD remained associated with significantly elevated odds of bed days, poorer physical health, and currently not working. CONCLUSIONS: Among female Vietnam veterans PTSD is associated with a broad profile of functional impairment. The significantly increased odds of impaired functioning and diminished quality of life suggest that PTSD may be the core problem of the set of problems afflicting female Vietnam veterans.

Sexual assault history and health perceptions: seven general population studies.

This article uses data from 7 population surveys to evaluate the association of sexual assault history with health perceptions. It estimates the extent of generalizability across gender, ethnic groups, and studies; the extent to which depression accounts for or mediates the association; and whether some circumstances of assault are more strongly related to poor subjective health. Data from each of 18 subsamples of the surveys were analyzed (pooled N = 10,001; 7,550 women and 2,451 men), and results were combined by using meta-analysis. Assault was associated with poor subjective health (odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.36, 1.95) and this result was consistent regardless of gender, ethnicity, or sample. Controlling depression did not markedly change this result (OR = 1.46, 95% CI = 1.21, 1.77), indicating that depression did not account for or mediate the assault-health perceptions association. Multiple assaults and assaults by strangers or spouse were most strongly associated with poor subjective health.

Vulnerability of Jews to affective disorders.

OBJECTIVE: Psychiatric literature over the past 100 years suggests that Jews are at higher risk for affective disorders than numbers of other religious groups. To examine these claims, the authors analyzed data from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study. In addition, the relationships among gender, alcoholism, and major depression were investigated. METHOD: The period prevalence and lifetime rates of DSM-III major depression among Jews, Catholics, Protestants, individuals in other religious groups, and individuals with no religious affiliation were examined in the Los Angeles and New Haven, Conn., ECA data. Logistic regression with covariates for site, gender, marital status, and socioeconomic status was used to estimate odds ratios and 95% confidence intervals. The calculated rates, based on the combined data from ECA study waves 1 and 2 for the white population, were weighted according to the 1980 U.S. population census. Female-to-male rate ratios and rates of alcohol abuse/dependence were also obtained. RESULTS: While no differences were found among females, Jewish males had significantly higher rates of major depression than Catholics, Protestants, and all non-Jews combined. Jews had a 1:1 female-to-male ratio for major depression, in contrast to the other religious groups, which approached the universal 2:1 ratio. Rates of alcohol abuse/dependence were inversely related to rates of major depression. CONCLUSIONS: The results support only in part the earlier reports that Jews have higher rates of depression. The equal gender distribution of major depression among Jews may be associated with the lower rate of alcoholism among Jewish males.

The believability of hearsay testimony in a child sexual assault trial.

Two experiments investigated how mock jurors react to hearsay testimony in a case involving child sexual assault. Participants read fictional criminal trial summary involving the sexual assault of a 4-(Experiment 2 only), 6-, or 14-year old female. The summaries were presented in one of four conditions: (a) child condition--the alleged victim testified; (b) hearsay condition--the alleged victim did not testify, but an adult hearsay witness did testify; (c) multiple condition (Experiment 1 only)--both the alleged victim and the adult hearsay witness testified; and (d) no-witness condition--neither the alleged victim nor the hearsay witness testified. The hearsay testimony was believed to a considerable degree, and this testimony led to an increase in the perceived guilt of the defendant. Moreover, these results were comparable to those of conditions in which the alleged victim testified. The results are discussed in terms of the psychosocial factors affecting the perception of hearsay testimony in a child sexual assault trial.

Aggregate-level predictors of the prevalence of selected drinking patterns in multiple studies: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project.

This paper examines the prevalence of two "at-risk" alcohol drinking patterns (infrequent heavy drinking and frequent heavy drinking) within age/gender groups in multiple general population studies. When heterogeneity in findings across studies is found, we test the hypotheses that suicide, divorce, unemployment rates, and the per capita consumption of alcohol in each country are associated with the prevalence of these drinking patterns. These analyses should inform the literature on the relationships between societal factors and the prevalence of persons in different societies and periods in history that drink at these levels.

To forget or not to forget: the effect of probability of test on directed forgetting.

Two experiments investigated how individuals use explicit memory cues that designate different probabilities of test. As in typical directed forgetting studies, subjects received words explicitly cued as having either a 0% or a 100% chance of being on a subsequent memory test (i.e. forget and remember cues, respectively). In addition, some words were explicitly cued as having the potential to be either forgotten or remembered (i.e. a 50% cue). Recall of 50% words was between that of 0% and 100% words. In addition, the presence of 50% words lowered recall of the 100% words compared to that of a control group that did not receive 50% words, but received the same number of 100% words. A think-aloud task indicated that these results were due to 50% words being treated like either 100% of 0% words at encoding. The results are discussed in terms of the effect of different probabilities of test on the strategic processing and representation of information.

Sexual assault history and eating disorder symptoms among White, Hispanic, and African-American women and men.

Data from two Epidemiologic Catchment Area Program sites (Los Angeles and North carolina) were analyzed to examine relations of sexual assault history to eating disorder symptoms. In regression analyses controlling for age, gender, ethnicity, income, socioeconomic status, and study site, persons with sexualy assault history (n = 514) were more likely than those not assaulted (n = 5511) to report thinking they were too fat (odds ratio [OR] = 1.6); losing > or = 15 lb (OR = 1.86); weight loss to 85% of normal (OR = 2.08); one or more anorexia symptoms (OR = 1.81); and sudden weight change (OR = 2.32). Ethnicity and income modified the relations. The data support an association of sexual assault history with eating disorder symptoms.