Objective: Research with predominantly male combat veterans have found that persons with post-traumatic stress disorder (PTSD) are at risk for long-term health problems which include a higher lifetime prevalence of cardiovascular, respiratory, gastrointestinal, musculoskeletal, and infectious diseases (Beckman et al., 1998; Boscarino, 1997; Schnurr & Spiro, 1999). Recently, researchers have begun to examine the impact of psychological responses to trauma, specifically PTSD symptomatology, on health. A significant positive correlation has been reported between the severity of PTSD symptomatology and physical health problems in female victims of sexual assault and female war veterans (Kimerling et al., 2000; Zoellner et al., 2000). However, there is a paucity of research examining the relationship between PTSD symptoms and physical health in women who have left an intimate abusive relationship. The purpose of this paper presentation is to examine the relationships between violent and non-violent trauma, post-traumatic stress disorder and its symptom clusters of hypervigilance, instrusion, and avoidance, and self-reported physical health symptoms in post-abused women.
Design: A cross-sectional, predictive-correlational design was used in this study.
Sample, Setting, Years: A convenience sample of 50 post-abused women, who had been out of the intimate abusive relationship an average of almost seven years, was recruited from the community. The mean age was 37.28 (SD 11.13) years with 54% of the women identifying themselves as Caucasian, 36% African-American, and 10% American Indian or Alaskan Native and Hispanic. Data was collected during 1999 and 2000.
Concepts Studied Together: Types of violent trauma assessed included physical and sexual assault as an adult and child, mugging, and witness to mutilation or murder. Types of non-violent trauma included serious accident, serious surgery as a child, fire/explosion, natural disaster, loss of a child, homelessness, and news of traumatic injury/death. PTSD and its symptom clusters were measured by the SCL-PTSD. Physical health symptoms were assessed using a 40 item, self-report, physical health problems survey.
Methods: Descriptive, correlational, and multiple regression analyses were used to examine the relationships between violent and non-violent trauma, PTSD and its symptom clusters, and physical health symptoms in the post-abused women.
Findings: Results indicated that the number of different types of violent trauma experienced by post-abused women was strongly associated with increased physical health symptoms and moderately correlated with the PTSD avoidance symptom cluster. PTSD hypervigilance and avoidance symptom clusters were positively associated with physical health symptoms/problems. Violent and non-violent trauma accounted for 24% of the explained variance in physical health symptoms in post-abused women in this sample.
Conclusions: The results of this study demonstrates that violent trauma throughout life impacts the physical and mental health of post-abused women. The positive relationship between PTSD symptom clusters of hypervigilance and avoidance on the woman's physical health adds to the knowledge of the complicated interrelationships between chronic stress responses and health. The results of this research are somewhat consistent with a previous finding in which the hypervigilance cluster uniquely accounted for the variance associated with health complaints of female war veterans (Kimerling et al., 2000). The study results are inconsistent with previous reports that the PTSD intrusion cluster was associated with physical symptoms in female victims of sexual assault (Zoellner et al., 2000). The characteristics specific to the many types of trauma, for example, intentional human harm, stranger versus intimate partner, public acknowledgement or media coverage of war, and small sample sizes may partially account for the differences reported in both PTSD symptoms and health across women trauma survivor groups.
Implications: The prevalence of lifetime violent trauma in women and its short- and long-term sequelae on health and utilization of health care services is great. The results of this research highlights the need for health care practitioners in all settings to assess for a history of trauma in a woman's life, and if present, assess for PTSD symptomatology and begin providing intervention. Research is needed that concurrently examines physiololgic, immunulogic, and psychosocial responses to traumatic events. The long-term importance of such knowledge is its foundation for future research examining the effective components of nursing and psychosocial interventions with the goal of delaying the onset and progression of diseases in persons experiencing chronic stress as a result of violence or trauma.
Back to Violence: Symptoms and Consequences
Back to The Advancing Nursing Practice Excellence: State of the Science