Asking about abuse during mental health assessments: clients' views and experiences

This study reports the perceptions of 74 members of mental health consumer groups in New Zealand regarding their first assessment. Two-thirds of the participants reported sexual, physical or emotional abuse at some point in their lives, but only 20% had been asked about abuse on assessment. However the likelihood of being asked about abuse was higher the more recently the assessment had occurred. The majority (69%) of those who reported abuse believed there was a connection between having been abused and their mental health problems, but few (17%) thought the clinician saw such a connection. Those reporting abuse were more likely than other participants to believe that their diagnosis was not an accurate description of their difficulties and to be dissatisfied with their treatment. Recommendations for staff training and routine abuse inquiry are offered. ********** Causal relationships between child abuse and adult psychological disorders have now been established, including: depression, anxiety disorders, post traumatic stress disorder, substance abuse, personality disorders, sexual dysfunction, eating disorders and dissociative disorders (Beitchman et al., 1992; Briere, Berliner, Bulkley, Jenny, & Reid, 1996). A New Zealand study found that even after controlling for mediating variables measuring other childhood disadvantages, the relationships between child sexual abuse [CSA] anda range of disorders at age 18 remain significant (Fergusson, Horwood, & Lynskey, 1996). Sexual and physical assaults in adulthood are also related to psychiatric disorders (Ritscher, Coursey, & Farrell, 1997). A review of 15 studies, of a total of 817 female inpatients, calculated that 44% reported child physical abuse [CPA], 50% CSA and 64% either CSA or CPA (Read 1997). Male inpatients also report significantly higher rates of child abuse than men in the general population (Rose, Peabody, & Stratigeas, 1991). A community survey of New Zealand women found that the relationship between CSA and becoming an inpatient remains after controlling for other measures of disadvantage that might account for the relationship (Mullen, Martin, Anderson, Romans, & Herbison, 1993). Child abuse seems to be particularly related to psychotic symptoms and diagnoses of schizophrenia (Bryer, Nelson, Miller, & Krol, 1987; Read, 1997; Read, Agar, Argyle & Aderhold, in press; Read, Perry, Moskowitz & Connolly, 2001; Ross, Anderson, & Clark, 1994). A New Zealand study found that 77% of adult psychiatric inpatients that reported either CSA or CPA experienced hallucinations, delusions or thought disorder, and that the content of about half of these symptoms appeared to be related to the abuse (Read & Argyle, 1999). Another New Zealand study, of 200 adult outpatients, found that child abuse is a significant predictor of hallucinations, and that a combination of childhood and adulthood abuse significantly predicts delusions and thought disorder (Read, Agar, Argyle, & Aderhold, in press). A study of American of women attending a psychiatric emergency service found that after controlling for "the potential effects of demographic variables, most of which also predict victimization and/or psychiatric outcome", CSA was related to "nonmanic psychotic disorders (e.g., schizophrenia, psychosis not otherwise specified)" (Briere, Woo, McRae, Foltz, & Sitzman, 1997). A history of abuse is also related to severity of disturbance, including: suicidality, age at first admission, frequency and length of admissions, time spent in seclusion, likelihood and dosage of psychiatric medication, and global symptom severity (Beitchman et al., 1992; Briere et al., 1997; Bryer et al., 1987; Pettigrew & Burcham, 1997). Read (1998) found that of those New Zealand inpatients who reported either CSA or CPA, 64% were acutely suicidal on admission, compared to 22% of those who had not been abused. …