Severity of child maltreatment, pain complaints and medical utilization among women.

High medical utilization in adults has been linked to both reported history of childhood abuse and mental health problems. However, few studies have explored relationships between abuse severity and psychological distress to identify subgroups with unique utilization patterns and medical complaints. This study compared two groups of psychologically distressed, high utilizers. One group (DS) was comprised of those with psychological distress, who reported a history of child sexual abuse (CSA); the other group (DSP) consisted of those with psychological distress, who reported CSA plus a history of childhood physical abuse. The groups were compared on severity of sexual and nonsexual child maltreatment, medical complaints and medical utilization. From a convenience sample of 206 females age 20-63, recruited while waiting for a physician appointment in a primary care clinic, we compared 25 DSPs to 33 DSs. Compared with DSs, DSPs reported significantly more severe: (1) sexual abuse including completed intercourse; (2) emotional abuse; (3) emotional neglect; and (4) psychological distress. DSPs also showed a nonsignificant trend towards more severe physical neglect. In addition to being significantly higher on emergency room visits, DSPs were marginally higher than DSs on nonpsychiatric outpatient visits. DSPs had significantly more frequent chronic and acute pain complaints at emergency room (ER) visits. Headaches were the most frequently coded diagnosis at ER visits in this sample. DSPs accounted for 89% of these ER visits attributable to headaches. The interaction of psychological distress and reported severity of child maltreatment reveals subgroups with unique utilization patterns and medical complaints. Physicians should screen patients for child maltreatment severity and psychological distress and should be involved in mental health referral where necessary.