Deleterious effects of criminal victimization on women's health and medical utilization.

The long-term consequences of criminal victimization on physical health were examined among 390 adult women (74 nonvictims and 316 victims of crime). Data included health status self-ratings and objective service utilization. Findings indicated that severely victimized women, compared with nonvictims, reported more distress and less well-being, made physician visits twice as frequently in the index year, and had outpatient costs that were 2.5 times greater. Criminal victimization severity was the most powerful predictor of physician visits and outpatient costs. Utilization data across 5 years preceding and following crime were obtained from 15 rape victims, 26 physical assault victims, and 27 noncontact crime victims and were compared with five continuous years of utilization among 26 nonvictims. Victims' physician visits increased 15% to 24% during the year of the crime compared with less than 2% change among nonvictims. We conclude that these long-term deleterious effects suggest that criminally victimized women's needs for medical treatment transcend the traditional focus on emergency care and forensic evaluation.

Criminal victimization among primary care medical patients: prevalence, incidence, and physician usage.

The study addressed the extent to which primary care physicians encounter crime victims in their practices. Crime prevalence and incidence rates were calculated from responses to a mailed survey of 2,291 women medical patients (45% response rate). The prevalence of crime victimization was 57%. The 12 month incidence of violent crime was 118 per 1,000 patients. Most notable was the finding that rape incidence was approximately 15 times higher than National Crime Survey estimates for women, even after adjustment for telescoping. Post-crime physician usage was documented by medical chart review. Although few crime victims required hospitalization for injuries, virtually all made out-patient physician visits in each of two post-crime years. The findings suggest that physicians are an important potential source of assistance for traumatized crime victims.

Relation of criminal victimization to health perceptions among women medical patients.

The relation of criminal victimization to health perceptions (self-rated current health) was determined among women health maintenance organization patients. Data were survey responses from 2,291 women (45% response rate), 57% of whom had experienced crime. Reliability was evaluated by assessing 241 respondents both by survey and by interview. Data were analyzed by hierarchical multiple regression, which indicated that criminal victimization was an important predictor of health perceptions even after accounting for the contributions of demographics and other stressful life events with known links to illness. Validity was supported because medical care was actually sought by 92% of crime victims during the 1st year following the crime and by 100% during the 2nd year. Conclusions included the following: (a) Crime victimization history is relevant to health status assessment, and (b) primary care medical populations are an important locus from which crime victims could be identified and their treatment options considered.

Effects of daily activities and social behavior on blood-pressure elevation.

This study examined the effects of daily activities and social behavior on the blood-pressure elevation in 21 normotensives, 20 borderline hypertensives, and 20 sustained essential hypertensives. Blood pressures were recorded over a 24-hr period using an ambulatory monitor while subjects recorded their daily activities and social involvement at each cuff inflation. Results indicated that only a moderate proportion of the blood pressure readings of the two clinical groups exceeded 140/90 mm Hg. Results also suggested that the blood pressures of normotensives were more responsive to changes in physical activity, while the blood pressures of sustained hypertensives were more responsive to social involvement. When group differences emerged on mean blood-pressure elevation, analyses indicated that the two hypertensive groups frequently differed from the normotensive group but rarely from each other. The results suggest that differences in blood-pressure elevation cannot be fully understood without considering behavior and support its continued inclusion in the study of blood pressure.

Behavioral predictors of blood pressure variation in hypertensives and normotensives.

This study examined the relative impact of five behavioral factors--activity, posture, location, social involvement, and tension--on the 24-hr blood pressure (BP) variability of 21 normotensives, 18 borderline hypertensives, and 18 sustained essential hypertensives. Multiple-regression analyses indicated that within each diagnostic group, activity accounted for more variance in BP variability than any other behavioral dimension. For each behavioral dimension examined, the magnitude of the relationship with BP was generally greater for the normotensives than for both hypertensive groups. In contrast, variation due to individuals was a better predictor of BP variability for the two hypertensive groups than for the normotensive group. Number of months hypertensive and use of antihypertensive medication were related to BP variability for the sustained hypertensive group. Findings have implications for the use of ambulatory BP monitors and interpretation of resulting data.