Objectives: To validate the construct of abuse in 2 ways: first, to examine female patients' perceptions of abusive behaviors that are typically used in standardized abuse scales; and second, to determine health status symptom and medical utilization differences between women who report emotional abuse and women who are not abused.
Design: Cross-sectional interviews and medical record reviews.
Main outcome measures: Modified directions to the Conflict Tactics Scale were used to identify women's perceptions of abusive behaviors. Personal history of abuse was determined by self-report. Health status was measured using the Medical Outcomes Study Short-Form Health Survey-36 and medical services utilization was determined from medical records. The Wahler Physical Symptom Inventory was used to measure symptom experience.
Setting: Patients were interviewed in either a rural primary care practice or an urban medical university practice.
Patients: Four hundred seven women older than 18 years were interviewed. Half were from an urban and half from a rural setting. Sixty-four percent of the sample was black.
Results: Women saw more behaviors as abusive than are typically identified by the Conflict Tactics Scale and abused women identified more abusive behaviors than nonabused women. Significant health status differences were found between women who reported emotional abuse with no concurrent physical or sexual abuse and nonabused women on 7 of the 8 dimensions of the Short-Form Health Survey health status scales and on 25% of measured symptoms.
Conclusions: These findings reflect the idea that women consider many behaviors to be abusive and that abused women perceive more behaviors as abusive than do nonabused women. Given that significant health status differences are shown between emotionally abused and nonabused women, emotional abuse can be viewed as a critical variable in patient health behavior.