August 14, 1998
Shame, denial and fear of others' reactions keep many abused women from confiding in their physicians, a Johns Hopkins study among Baltimore women has found.
Although most of the women queried had sought medical attention for a variety of problems during the past year, only one in three discussed their abuse with doctors. While half of the women reported positive experiences with their physicians, some noted that the clinicians didn't listen or seemed uncaring, uncomfortable with the topic of abuse, too busy or only interested in money.
The study, published in the August issue of the Journal of General Internal Medicine, used questionnaires and focus groups to survey 21 Baltimore-area victims of domestic violence who already were participating in group therapy. Most of the women were single, separated or divorced, from a mix of income levels. The feelings of fear, shame and distrust crossed all class lines.
"Other studies indicate that as many as 44 percent of women who seek medical attention have been abused at some point in their lives, yet most physicians do not routinely screen their patients for abuse," says Jeanne McCauley, M.D., M.P.H., lead author of the study and a physician advisor for the Johns Hopkins Medical Services Corp. "Our study suggests that many of the barriers to discussing abuse could be overcome by a physician's understanding of the emotions surrounding abuse and the unique treatment concerns of abused women."
Eighteen of the women (88 percent) sought medical attention during the previous year. Their symptoms, which either began or worsened with abuse, included asthma, hypertension, headaches, eye pain, chest pain, stomach pains, back problems, vaginal bleeding, weight changes, insomnia, depression and anxiety. Although most women did not recognize an association between abuse and these symptoms, one in three noticed improvement when she left the relationship or discussed it with a health professional.
The study also found that:
* The doctor's gender was less of a barrier to discussing abuse than whether he or she appeared caring, easy to talk to and supportive.
* Domestic violence posters displayed in the medical office helped prompt some victims to speak up. Questionnaires, when administered in private, also helped.
* Although nearly all of the women who received prescription medications for depression, anxiety or sleep disturbances benefitted from them, many feared addiction or decreased alertness in the presence of an abusive partner.
The fact that all of the women were in group therapy, however, might have introduced bias in the study, McCauley says. "More studies need to be performed to confirm the findings of this study," she says.
The study's other authors were Robin A. Yurk, M.D., M.P.H.; Mollie W. Jenckes, M.H.S.; and Daniel E. Ford, M.D., M.P.H.