Exposure to Abuse Linked to Poorer Mental Health in Older, Functionally Independent Women

Laurie Barclay, MD

May 14, 2010

May 14, 2010 — Exposure to abuse in older, functionally independent women is associated with poorer mental health, according to the results of an observational cohort study reported in the May/June issue of the Annals of Family Medicine.

"Exposure to acts of abuse is a stressful event that has a negative effect on a woman's psychological well-being," write Charles P. Mouton, MD, MS, from Howard University College of Medicine in Washington, DC, and colleagues. "For older, functionally dependent adults, the prevalence of abuse ranges from approximately 1% for physical abuse to approximately 25% for psychological abuse. As with the younger population, abuse in older women is associated with poorer health outcomes."

The goal of the study was to evaluate the psychological impact of physical and verbal abuse in a cohort of women aged 50 to 79 years. At 40 clinical sites nationwide participating in the Women's Health Initiative, 93,676 women were assessed with the mental health subscales and the combined mental component summary (MCS) score of the RAND Medical Outcomes Study 36-item instrument.

Compared with women not reporting abuse at baseline, those reporting physical abuse only, verbal abuse only, or both physical and verbal abuse had more depressive symptoms (1.6, 1.6, and 3 more symptoms, respectively) and lower MCS scores (4.6, 5.4, and 8.1 lower scores, respectively).

Even after adjustment for sociodemographic factors, women had a greater increase in the number of depressive symptoms when they reported a 3-year incident exposure to physical abuse only (0.2; 95% confidence interval [CI], –0.21 to 0.60), verbal abuse only (0.18; 95% CI, 0.11 - 0.24), or both physical and verbal abuse (0.15; 95% CI, –0.05 to 0.36) vs women who had no exposure to abuse. Similarly, they had a decrease in MCS scores when they reported a 3-year incident exposure to physical abuse only (–1.12; 95% CI, –2.45 to 0.12), verbal abuse only (–0.55; 95% CI, –0.75 to –0.34), and both physical and verbal abuse (–0.44; 95% CI, –1.11 to –0.22).

"Exposure to abuse in older, functionally independent women is associated with poorer mental health," the study authors write. "The persistence of these findings suggests that clinicians need to consider abuse exposure in their older female patients who have depressive symptoms. Clinicians caring for older women should identify women at risk for physical and verbal abuse and intervene appropriately."

Limitations of this study include higher education and higher incomes in study participants vs the overall postmenopausal population; reliance on self-reports of victimization; and lack of follow-up data on optimism, social strain, and social support.

"Even in this cohort of well-functioning postmenopausal women, physical and verbal abuse exposure have greater adverse effects on psychological well-being than sociodemographic factors," the study authors conclude. "Furthermore, verbal abuse only had greater effects than physical abuse only. These results suggest that detecting and alleviating abusive situations may have important beneficial effects on the mental health and overall quality of life of older women."

The National Institutes of Health supported this study. The study authors have disclosed no relevant financial relationships.

Ann Fam Med. 2010;8:206-213. Abstract

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