Screening for Childhood Trauma in Adult Primary Care Patients

Linda Weinreb · Judith A. Savageau · Lucy M. Candib · George W Reed · Kenneth E. Fletcher · J. Lee Hargraves

89 citations0/0 files storedThe Primary Care Companion to The Journal of Clinical Psychiatry

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Child Abuse and Trauma Intimate Partner and Family Violence Child Abuse and Related Trauma

Abstract

Article Abstract Objective: Compared to screening for partner violence, screening for childhood physical and sexual abuse among adult patients has received little attention, despite associated adverse health consequences. The objective of this exploratory study was to describe the practices, skills, attitudes, and perceived barriers of a large sample of family physicians in screening adult patients for childhood sexual or physical abuse. Method: Surveys were mailed to the 833 members of the Massachusetts Academy of Family Physicians in 2007 eliciting information about screening practices. Factors associated with routine or targeted screening among adult primary care patients were evaluated. Results: Less than one-third of providers reported usually or always screening for childhood trauma and correctly estimated childhood abuse prevalence rates; 25% of providers reported that they rarely or never screen patients. Confidence in screening, perceived role, and knowledge of trauma prevalence were associated with routine and targeted screening. Women and physicians reporting fewer barriers were more likely to routinely screen adult patients. Conclusions: Despite the 20%-50% prevalence of child abuse exposure among adult primary care patients, screening for childhood abuse is not routine practice for most physicians surveyed; a large subgroup of physicians never screen patients. Study findings draw attention to a largely unexplored experience associated with considerable health care costs and morbidity. Results highlight the need to develop training programs about when to suspect trauma histories and how to approach adult patients. Prim Care Companion J Clin Psychiatry 2010;12(6):e1-e10 Submitted: January 11, 2010; accepted March 5, 2010. Published online: November 4, 2010 (doi:10.4088/PCC.10m00950blu). Corresponding author: Linda Weinreb, MD, University of Massachusetts Medical School, Family Medicine and Community Health, 55 Lake Ave N, Worcester, MA 01655 (Linda.Weinreb@umassmemorial.org).

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References

1998Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults 1990Child abuse: Adolescent records vs. adult recall 2003Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women 2007Long-term physical and mental health consequences of childhood physical abuse: Results from a large population-based sample of men and women 1999Adult health status of women with histories of childhood abuse and neglect 2003Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice 1999Screening and Intervention for Intimate Partner Abuse 2008Accumulated childhood trauma and symptom complexity

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