An Examination Of Women's Health Care Utilization Among Women Who Have Been Sexually Abused

An Examination of Health Care Utilization Among Sexually Abused Women Dana S. Munkirs, Michael S. McLaughlin, Susan M. Orsillo, Brian P. Marx Oklahoma State University

Introduction

The current investigation examines the perceptions concerning use of health care services and frequencies of the reported physical symptoms in a sample of women with a history of childhood sexual abuse (CSA) taken from a university population. Although in the previous literature there is overwhelming evidence indicating that women with a history of CSA over use medical services, in the current study women with a history of childhood sexual abuse self-reported that they would wait longer periods of time to see a physican if they were having gynecological problems. Specifically when compared to the control group, women with a history of CSA self-reported they would have no apprehension if they needed to see a physician when they were generally sick but when asked specifically how long they would wait if they expereinced partiucalr gynecological symptoms, they reported a longer waiting period before seeking a physican's help.

Methods

Participants were 178 female college students from the Oklahoma State University Department of Psychology research pool. Twenty-six women (14.6%) replied as having a history of childhood sexual abuse. As a part of a larger study, participants were asked to complete the following packets of questionnaires which included: the Posttraumatic Stress Diagnostic Scale (Foa et al., in press), the Emotional Numbing Scale (Fuemmeler & Orsillo, 1996), the Emotional Expressivity Scale (Kring, Smith, & Neale, 1994), and the Dissociative Experiences Scale (Bernstein & Putnam, 1986). In addition, a measure was constructed for the present study entitled the Inventory of Women’s Health and Care Utilization (IWHCU). In section one of the IWHCU, women are asked to indicate if they had experienced any of the 18 symptoms associated with gynecological disease (i.e., missing a period, severe abdominal pain, sores on genitalia or pain with intercourse) in the last three months. In section two, women are asked to indicate how many days they would wait to contact a doctor if they were to continuously experience each of these 18 symptoms. The IWHCU also contains items assessing discomfort associated with gynecological exams and general health care utilization.

Results

A two-tailed t-test conducted on the mean number of gynecological symptoms that each group reported experiencing over the previous three months. No significant differences emerged (CSA = 3.9 vs. no CSA = 3.5; t(167)=.97Also conducted were t-tests comparing the two groups on 4 questions assessing discomfort expereinced during gynecologial exams and frequency of helath care utilization. Women with a history of CSA reported that they would be more liekly to see a gynecoloigst if they were experiencing a problem. Results of the t-test were t(166) = 2.35, p<.02 No other significant differences were found. Finally, the mean number of days that women would wait to see a gynecologist if they were experiencing each of the 18 symptoms was compared for women with and without a history of CSA. A two- tailed t-test revealed taht as predicted, women with a history of CSA reported theat they would wait significatnly longer to contact a doctor (CSA = 3.3 vs. No CSA = 3.0, t(167) = 2.28, p < .05).

Discussion

This study may have implications for educating medical staff to become more sensitive to the needs of women with a CSA history. Assessment of a CSA history may allow for a better doctor-patient relationship and may eventually result in proper health care utilization (Holmes et al., 1996). Further if patient education results from this awareness, the patient herself would realize her behavior and alter it with the proper mental health treatments Our hypothesis that women with a history of childhood sexual abuse would be more avoidant of seeking gynecological services was not supported by the data. No differences were found between our two groups on the number of symptoms they experienced over the past three months, or on the number of symptoms for which individuals would not seek health services. These findings are also inconsistent with previous studies using samples derived from medical centers which have found CSA survivors to over-utilize health services. There are several potential explanations for our findings. One is that there are subgroups of CSA survivors. It may be that for a variety of reasons, some women with this history overtuilize health services. Comorbid mental health problems, such as depression or somatization, may be more prevalent among this subgroup. In contrast, our sample may represents a subtype of CSA survivors who do not have these comorbid conditions. An alternative explanation may have to do with our methodology. There may be important differences in actual and reported health care utilization that need to be further studied.
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