1
|
Hayes S, Linardon J, Kim C, Mitchison D. Understanding the relationship between sexual harassment and eating disorder psychopathology: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:673-689. [PMID: 33751633 DOI: 10.1002/eat.23499] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The experience of sexual harassment (SH) may exacerbate the drive toward an ideal and often unattainable physical appearance, creating the foundation of unhealthy eating, and greater shape and weight concerns. This systematic review aimed to synthesize evidence on the relationship between SH and eating disorder psychopathology, as well as mediating and moderating factors that contribute to this relationship. METHOD Six key databases were searched from inception to August 2020; including CINAHL, PsycInfo, PubMed, Medline, Scopus, and Web of Science. RESULTS Overall, 15 studies meeting inclusion criteria were found, with 14 reporting a statistically significant relationship between SH and eating disorder psychopathology. A meta-analysis with 12 cross-sectional studies confirmed a small but significant effect for this concurrent association. Moderators of this relationship included gender, posttraumatic stress, and anxiety. No studies in this review conducted true mediation. DISCUSSION Conclusions about causal and mediating relationship between SH and eating disorder psychopathology are constrained by the preponderance of cross-sectional design (14 of the 15 studies). Therefore, it is recommended that future studies focus on the use of longitudinal design, and also on adolescent populations, where first experiences of SH are usually reported, and which is also the peak age of onset for eating disorders.
Collapse
Affiliation(s)
- Samantha Hayes
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Christina Kim
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
López-Martínez AE, Serrano-Ibáñez ER, Ruiz-Párraga GT, Gómez-Pérez L, Ramírez-Maestre C, Esteve R. Physical Health Consequences of Interpersonal Trauma: A Systematic Review of the Role of Psychological Variables. TRAUMA, VIOLENCE & ABUSE 2016; 19:305-322. [PMID: 27456113 DOI: 10.1177/1524838016659488] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Interpersonal forms of trauma are among the most commonly reported traumas. These types of traumas are more damaging to well-being than noninterpersonal forms. They have also been strongly associated with somatic symptoms and more general physical health problems. Nevertheless, the results of trauma studies are mixed and suggest that pathways may vary according to the stressors, mediators, and health outcomes investigated. This article presents a systematic qualitative review of published studies that have investigated interpersonal trauma, its association with physical health, and the potential role of intervening psychological variables. A systematic search was made of four psychology and health electronic databases. Of the 863 studies reviewed, 50 were preselected, 11 of which met the inclusion and methodological quality criteria. All but one study had a cross-sectional design. The findings showed that childhood trauma exposure was the most common category of interpersonal trauma addressed in the reviewed studies and that the physical health variables investigated were diverse. The psychological variables most frequently investigated in the studies were posttraumatic stress disorder, depression, dissociation, and substance abuse. Overall, the results suggest that interpersonal trauma exposure is associated with poorer physical health; however, the role of intervening psychological variables remains unclear. The limitations of the reviewed literature are discussed, and methodological recommendations are made for future research.
Collapse
Affiliation(s)
- Alicia E López-Martínez
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | - Elena R Serrano-Ibáñez
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | - Gema T Ruiz-Párraga
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | | | - Carmen Ramírez-Maestre
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| | - Rosa Esteve
- 1 University of Málaga, Faculty of Psychology, Instituto de Investigaciones Biomédicas, Málaga, Spain
| |
Collapse
|
3
|
Mansur RB, Zugman A, Asevedo EDM, da Cunha GR, Bressan RA, Brietzke E. Cytokines in schizophrenia: possible role of anti-inflammatory medications in clinical and preclinical stages. Psychiatry Clin Neurosci 2012; 66:247-60. [PMID: 22624729 DOI: 10.1111/j.1440-1819.2012.02354.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS In this paper, we review the literature on the efficacy of anti-inflammatory agents as neuroprotectors in clinical and preclinical stages of schizophrenia. METHOD A synthetic and integrative approach was applied to review studies stemming from epidemiology, phenomenology, cognition, genetics and neuroimaging data. We provide conclusions and future directions of research on early-onset schizophrenia. RESULTS Abnormal inflammatory activation has been demonstrated in schizophrenia. Increases or imbalances in cytokines before birth or during childhood may impact neurodevelopment and produce vulnerability to schizophrenia. The specificity of inflammatory abnormalities in psychiatric disorders is controversial. Similar increases in pro-inflammatory cytokines have been described in other disorders, especially mood and anxiety disorders. One of the most important challenges at this point is the understanding of neurobiological correlates of prodromal stages of schizophrenia. CONCLUSION Although future research should investigate the exact role of different cytokines in pathophysiology of schizophrenia, these mediators emerge as promising molecular targets to its prevention and treatment.
Collapse
Affiliation(s)
- Rodrigo Barbachan Mansur
- Program for Recognition and Intervention in Individuals in at Risk Mental States, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
4
|
Konings M, Stefanis N, Kuepper R, de Graaf R, ten Have M, van Os J, Bakoula C, Henquet C. Replication in two independent population-based samples that childhood maltreatment and cannabis use synergistically impact on psychosis risk. Psychol Med 2012; 42:149-159. [PMID: 21676285 DOI: 10.1017/s0033291711000973] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There may be biological plausibility to the notion that cannabis use and childhood trauma or maltreatment synergistically increase the risk for later development of psychotic symptoms. To replicate and further investigate this issue, prospective data from two independent population-based studies, the Greek National Perinatal Study (n=1636) and The Netherlands Mental Health Survey and Incidence Study (NEMESIS) (n=4842), were analyzed. METHOD Two different data sets on cannabis use and childhood maltreatment were used. In a large Greek population-based cohort study, data on cannabis use at age 19 years and childhood maltreatment at 7 years were assessed. In addition, psychotic symptoms were assessed using the Community Assessment of Psychic Experiences (CAPE). In NEMESIS, the Composite International Diagnostic Interview (CIDI) was used to assess psychotic symptoms at three different time points along with childhood maltreatment and lifetime cannabis use. RESULTS A significant adjusted interaction between childhood maltreatment and later cannabis use was evident in both samples, indicating that the psychosis-inducing effects of cannabis were stronger in individuals exposed to earlier sexual or physical mistreatment [Greek National Perinatal Study: test for interaction F(2, 1627)=4.18, p=0.02; NEMESIS: test for interaction χ2(3)=8.08, p=0.04]. CONCLUSIONS Cross-sensitivity between childhood maltreatment and cannabis use may exist in pathways that shape the risk for expression of positive psychotic symptoms.
Collapse
Affiliation(s)
- M Konings
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Ferrier AG, Martens MP, Cimini MD. The Relationship Between Physical, Sexual, and Emotional Abuse and Unhealthy Weight Loss Behaviors. JOURNAL OF COLLEGE COUNSELING 2011. [DOI: 10.1002/j.2161-1882.2005.tb00078.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
6
|
Rowe EL, Gradus JL, Pineles SL, Batten SV, Davison EH. Military Sexual Trauma in Treatment-Seeking Women Veterans. MILITARY PSYCHOLOGY 2009. [DOI: 10.1080/08995600902914768] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Erin L. Rowe
- a Institute on Urban Health Research, Northeastern University , Boston , Massachusetts
| | - Jaimie L. Gradus
- b National Center for PTSD, Women's Health Sciences Division , VA Boston Healthcare System , Boston , Massachusetts
| | - Suzanne L. Pineles
- c Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts
| | - Sonja V. Batten
- d VA Maryland Healthcare System, University of Maryland School of Medicine , Baltimore , Maryland
| | - Eve H. Davison
- b National Center for PTSD, Women's Health Sciences Division , VA Boston Healthcare System , Boston , Massachusetts
- c Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts
| |
Collapse
|
7
|
Shevlin M, Houston JE, Dorahy MJ, Adamson G. Cumulative traumas and psychosis: an analysis of the national comorbidity survey and the British Psychiatric Morbidity Survey. Schizophr Bull 2008; 34:193-9. [PMID: 17586579 PMCID: PMC2632373 DOI: 10.1093/schbul/sbm069] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Previous research has shown that traumatic life events are associated with a diagnosis of psychosis. Rather than focus on particular events, this study aimed to estimate the effect of cumulative traumatic experiences on psychosis. The study was based on 2 large community samples (The National Comorbidity Survey [NCS], The British Psychiatric Morbidity Survey [BPMS]). All analyses were conducted using hierarchical binary logistic regression, with psychosis diagnosis as the dependent variable. Background demographic variables were included in the first block, in addition to alcohol/drug dependence and depression. A variable indicating the number of traumas experienced was entered in the second block. Experiencing 2 or more trauma types significantly predicted psychosis, and there appeared to be a dose-response type relationship. Particular traumatic experiences have been implicated in the etiology of psychosis. Consistent with previous research, molestation and physical abuse were significant predictors of psychosis using the NCS, whereas for the BPMS, serious injury or assault and violence in the home were statistically significant. This study indicated the added risk of multiple traumatic experiences.
Collapse
Affiliation(s)
- Mark Shevlin
- School of Psychology, University of Ulster, Londondderry, Northern Ireland.
| | | | | | | |
Collapse
|
8
|
Goldzweig CL, Balekian TM, Rolón C, Yano EM, Shekelle PG. The state of women veterans' health research. Results of a systematic literature review. J Gen Intern Med 2006; 21 Suppl 3:S82-92. [PMID: 16637952 PMCID: PMC1513165 DOI: 10.1111/j.1525-1497.2006.00380.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Assess the state of women veterans' health research. DESIGN Systematic review of studies that pertained specifically to or included explicit information about women veterans. A narrative synthesis of studies in 4 domains/topics was conducted: Stress of military life; Health and performance of military/VA women; Health services research/quality of care; and Psychiatric conditions. MEASUREMENTS AND MAIN RESULTS We identified 182 studies. Of these, 2 were randomized-controlled trials (RCTs) and the remainder used observational designs. Forty-five percent of studies were VA funded. We identified 77 studies pertaining to the stress of military life, of which 21 reported on sexual harassment or assault. Rates of harassment ranged from 55% to 79% and rates of sexual assault from 4.2% to 7.3% in active duty military women and 11% to 48% among women veterans. Forty-two studies concerned the health and performance of military/VA women, with 21 studies evaluating sexual assault and posttraumatic stress disorder (PTSD) and their effect on health. Fifty-nine studies assessed various aspects of health services research. Eight studies assessed quality of care and 5, patient satisfaction. Twenty-five studies assessed utilization and health care organization, and findings include that women veterans use the VA less than men, that gender-specific reasons for seeking care were common among female military and veteran personnel, that provision of gender-specific care increased women veterans' use of VA, and that virtually all VAs have available on-site basic women's health services. Fifty studies were classified as psychiatric; 31 of these were about the risk, prevalence, and treatment of PTSD. CONCLUSIONS Most research on VA women's health is descriptive in nature and has concerned PTSD, sexual harassment and assault, the utilization and organization of care, and various psychiatric conditions. Experimental studies and studies of the quality of care are rare.
Collapse
Affiliation(s)
- Caroline L Goldzweig
- Southern California Evidence-Based Practice Center, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.
| | | | | | | | | |
Collapse
|
9
|
Whitfield CL, Dube SR, Felitti VJ, Anda RF. Adverse childhood experiences and hallucinations. CHILD ABUSE & NEGLECT 2005; 29:797-810. [PMID: 16051353 DOI: 10.1016/j.chiabu.2005.01.004] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2003] [Revised: 01/18/2005] [Accepted: 01/22/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Little information is available about the contribution of multiple adverse childhood experiences (ACEs) to the likelihood of reporting hallucinations. We used data from the ACE study to assess this relationship. METHODS We conducted a survey about childhood abuse and household dysfunction while growing up, with questions about health behaviors and outcomes in adulthood, which was completed by 17,337 adult HMO members in order to assess the independent relationship of 8 adverse childhood experiences and the total number of ACEs (ACE score) to experiencing hallucinations. We used logistic regression to assess the relationship of the ACE score to self-reported hallucinations. RESULTS We found a statistically significant and graded relationship between histories of childhood trauma and histories of hallucinations that was independent of a history of substance abuse. Compared to persons with 0 ACEs, those with 7 or more ACEs had a five-fold increase in the risk of reporting hallucinations. CONCLUSION These findings suggest that a history of childhood trauma should be looked for among persons with a history of hallucinations.
Collapse
Affiliation(s)
- Charles L Whitfield
- Private Practice in Addiction and Trauma Medicine, Atlanta, GA 30341-3717, USA
| | | | | | | |
Collapse
|
10
|
Lang AJ, Rodgers CS, Laffaye C, Satz LE, Dresselhaus TR, Stein MB. Sexual trauma, posttraumatic stress disorder, and health behavior. Behav Med 2004; 28:150-8. [PMID: 14663922 DOI: 10.1080/08964280309596053] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors tested whether sexual traumatization is associated with poorer health behavior and also evaluated the role of posttraumatic stress disorder (PTSD) in this relationship. They mailed questionnaires to 419 women who had visited a San Diego Veterans Administration primary care clinic in 1998 and received 221 responses, a 56% return rate. They found that a history of sexual assault was associated with increased substance use, risky sexual behaviors, less vigorous exercise, and increased preventive healthcare. They then used regression-based techniques to test whether PTSD mediates the relationship between a history of sexual assault and health behaviors and discovered support for this hypothesis in relation to substance use. PTSD symptoms were also associated with less likelihood of conducting regular breast self-examinations. Findings from the study highlight the value of programs designed to (1) identify trauma victims, (2) screen for problematic behaviors, and (3) intervene to improve long-term health outcomes.
Collapse
Affiliation(s)
- Ariel J Lang
- Behavioral Medicine Service, Veterans Administration San Diego Healthcare System (VASDHS), USA.
| | | | | | | | | | | |
Collapse
|
11
|
Rodgers CS, Lang AJ, Twamley EW, Stein MB. Sexual Trauma and Pregnancy: A Conceptual Framework. J Womens Health (Larchmt) 2003; 12:961-70. [PMID: 14709184 DOI: 10.1089/154099903322643884] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this paper, we propose that a history of sexual traumatization is associated with pregnancy complications and poor pregnancy-related outcomes. We further hypothesize that this relationship is mediated by the sequelae of trauma (psychopathology, health problems, and increased negative health behaviors). We review the literature linking sexual trauma with psychopathology, health, and health behavior and then outline the impact of these variables on pregnancy. Based on this review, we draw conclusions about the potential impact of sexual trauma on pregnancy outcomes. We suggest future directions for this area of research and discuss the clinical implications of this association, including the development of prenatal intervention and prevention programs.
Collapse
Affiliation(s)
- Carie S Rodgers
- VA San Diego Healthcare System, San Diego, California 92108, USA.
| | | | | | | |
Collapse
|
12
|
|
13
|
Flannery RB. The employee victim of violence: recognizing the impact of untreated psychological trauma. Am J Alzheimers Dis Other Demen 2001; 16:230-3. [PMID: 11501345 PMCID: PMC10833782 DOI: 10.1177/153331750101600406] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of psychological trauma in the workplace often goes unaddressed. The untreated aftermath of these critical incidents may manifest itself in various states of anxiety, depression, substance use disorders, and even subsequent violence by the victims. This paper reviews common presentations of untreated traumatic events and provides suggestions for outreach to untreated employee victims as well as basic prevention strategies to reduce the risk of additional episodes of violence and enhance safety in health care facilities, including long-term care (LTC) and special-care units (SCU) for dementia patients.
Collapse
Affiliation(s)
- R B Flannery
- Massachusetts Department of Mental Health, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Abstract
OBJECTIVE Prior reports have pointed to an adverse effect of sexual assault on subsequent health, particularly depression and obesity, in women. The objective of this study was to determine whether there is an association between self-reported sexual assault history and objective parameters of physical health in a sample of older men and women. METHODS We conducted a cross-sectional study of white, middle to upper middle class, older (median age 75 years) men (N = 533) and women (N = 826) within a defined community setting. Sex-specific, age-adjusted risks were calculated for 11 common chronic medical conditions (10 for each sex: coronary heart disease, hypertension, diabetes, osteoporosis, obesity, asthma, migraine, thyroid disease, and arthritis in all subjects; breast cancer in women; and prostate cancer in men) and confirmed by physical or laboratory examination or review of medical records. RESULTS Sexual assault was reported by 5.4% of men and 12.7% of women; repeated exposure was reported by 10.3 and 21.9% of sexually assaulted men and women, respectively. In women, a history of sexual assault was associated with an increased risk of 2 of 10 conditions: arthritis (OR = 1.76, 95% CI = 1.13-2.76) and breast cancer (OR = 2.21, 95% CI = 1.12-4.33). A "dose-response" effect was observed: Multiple episodes of sexual assault carried a two- to three-fold increased risk of these diseases compared with a single episode. In men, the only statistically significant association was between sexual assault and thyroid disease (OR = 4.68, 95% CI = 1.08-20.3). CONCLUSIONS These data partially replicate findings from other studies of adverse effects of sexual trauma on health, although the specific diseases are different. Causal mechanisms cannot be inferred from these data. Studies in other cohorts are warranted.
Collapse
Affiliation(s)
- M B Stein
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla 92093-0985, USA.
| | | |
Collapse
|
15
|
Abstract
Six stress-related variables, gender, age, and ethnicity were investigated as concurrent and prospective predictors of three types of drug use (cigarettes, alcohol, and illicit drug use) among 875 "high risk" adolescents. The stress-related variables were socioeconomic status, "missing" one's parent(s), family conflict, victimization, perceived stress, and stress-drug beliefs. In general, concurrent regression models indicated that those who were lower in socioeconomic status, held stress-drug beliefs favorable toward drug use, and who had been victimized in the last year were more likely to be cigarette, alcohol, or illicit drug users. Prospective regression models indicated that those who had used drugs at baseline and had been victimized in the last year were relatively likely to use drugs the next year. Significant predictors in the multivariable models accounted for between 56 and 85% of those subjects who were above the median on later drug use. Victimization is apparently a relatively important source of stress in the prediction of future drug use. Drug-use intervention implications of these results include the need to provide supportive services to those who have been victims of violent attacks on their person or property.
Collapse
Affiliation(s)
- S Sussman
- Institute for Health Promotion and Disease Prevention Research and Department of Preventive Medicine, University of Southern California, Los Angeles 90089, USA.
| | | |
Collapse
|
16
|
Frayne SM, Skinner KM, Sullivan LM, Tripp TJ, Hankin CS, Kressin NR, Miller DR. Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 1999; 8:835-45. [PMID: 10495264 DOI: 10.1089/152460999319156] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To profile differences in current physical symptoms and medical conditions among women users of Veterans Administration (VA) health services with and without a self-reported history of sexual assault sustained during military service, we conducted a cross-sectional analysis of a nationally representative, random sample of women veterans using VA outpatient services (n = 3632). A self-administered, mailed survey asked whether women had sustained sexual assault while in the military and requested information about a spectrum of physical symptoms and medical conditions. A history of sexual assault while in the military was reported by 23% of women VA users and was associated with current physical symptoms and medical conditions in every domain assessed. For example, women who reported sexual assault were more likely to indicate that they had a "heart attack" within the past year, even after adjusting for age, hypertension, diabetes, and smoking history (OR 2.3, 95% CI 1.3-4.0). Among women reporting a history of sexual assault while in the military, 26% endorsed > or = 12 of 24 symptoms/conditions, compared with 11% of women with no reported sexual assault while in the military (p < 0.001). Clinicians need to be attuned to the high frequency of sexual assault occurring while in the military reported by women VA users and its associated array of current physical symptoms and medical conditions. Clinicians should consider screening both younger and older patients for a sexual violence history, especially patients with multiple physical symptoms.
Collapse
Affiliation(s)
- S M Frayne
- Boston VA Medical Center, Massachusetts, USA
| | | | | | | | | | | | | |
Collapse
|