By LESLIE H. LANG UNC-CH School of Medicine
CHAPEL HILL, NC - Women with a history of sexual and physical abuse are more likely to have poor health during pregnancy and after childbirth, according to a study at the University of North Carolina at Chapel Hill.
The study - presented March 18 at the Psychosomatic Society of America Annual Meeting in Vancouver, Canada - is among the first to examine how a history of abuse may affect postpartum depression and other indicators of health status after pregnancy, says Dr. Jane Leserman, research associate professor of psychiatry at the UNC-CH School of Medicine.
"The association of poor health with sexual and physical abuse history has been established among patient populations with chronic pain and in primary care, including women with gastrointestinal disorders," Leserman says. "I was interested in seeing whether abuse history would be an important predictor of health during a vulnerable time in women's lives."
The medical sociologist notes anecdotal reports suggesting that the experience of pregnancy and giving birth might "bring back" memories and feelings associated with physical and sexual abuse suffered earlier.
The new study involved 68 pregnant patients at a university obstetrics clinic. Leserman and her colleagues established sexual abuse histories through responses to key interview questions, such as, "Had anyone ever succeeded in touching the sex parts of your body or made you touch the sex parts of their body by using force or threatening to harm you?" Physical abuse was tapped by asking, "Had anyone, including family or friend, ever attacked you with or without a weapon but with the intent to kill you or seriously injure you?" Also included were questions pertaining to physical harm from being kicked, beaten or hurt in other ways.
Of 47 women for whom complete data were available, 16 (34 percent) said they had been physically or sexually abused in their lifetime. "The large majority had both sexual and physical abuse," the Leserman says. On average, more than five years had passed since the abuse, with many having been abused 10 or 15 years earlier. Only one woman said she was currently being abused.
"We found that the abused women had on average four more medical symptoms, such as headaches and pain, than those without histories of abuse," says Leserman. "And that was true during their pregnancy and during the postpartum period."
In terms of depression, the study shows that levels of depressive symptoms among abused women remain high during pregnancy and throughout the postpartum period, whereas depressive symptoms decreased for the non-abused. Abused women had more calls to the doctor and more self-reports of poor health, particularly pain. For example, 84 percent of the non-abused women reported little or no postpartum pain vs. 44 percent of abused women. In addition, 38 percent of abused women met criteria for major depression vs. 10 percent of women without histories of abuse, based on a self-report scale.
Thus, according to Leserman, "the women with abuse histories looked worse on our measures during pregnancy and they stay in poorer health after giving birth." She points out that although both the abused and non-abused women studied showed decreased medical symptoms after childbirth, "the differences between the groups remained constant because the abused women start out with more symptoms."
"Our understanding of why this happens is in its infancy. It may be that women with abuse histories become hypersensitive or hypervifgilant to pain and medical symptoms. That is, they become hyper-reactive to symptoms, or possibly more sensitive to pain," she says. She notes this may be similar to findings in post-traumatic stress disorder suggesting that trauma, such as combat, can have a long-lasting effect on a person's physiology and health.
The study also found that the abused women reported feeling less happy about being pregnant and were less positive toward their pregnancy. "And that may be partially because of the traumas they have had," Leserman says.
According to Leserman, the new findings have implications for health professionals. "In a general medical population, at 20-30 percent of women are going to have physical and/or sexual abuse histories. It is a lot more common than most people think. And since such a history is associated with poor health, it's important for physicians to find out about it and then refer these patients to appropriate caregivers."
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