Psychosocial Effects of Physical and Verbal Abuse in Postmenopausal Women

Charles P. Mouton; Rebecca J. Rodabough; Susan L. D. Rovi; Robert G. Brzyski; David A. Katerndahl

doi:10.1370/afm.1095

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Table 1.

Characteristics of Baseline Sample by Baseline Psychosocial Scores

Variable	N (%)	Depressive Symptomatology^aMean (SD)	MCS Score^bMean (SD)	Social Support Construct^cMean (SD)	Social Strain Construct^dMean (SD)	Optimism Construct^eMean (SD)
GED = general equivalency diploma; MCS = mental component summary of the RAND 36-Item Health Survey 1.0.
^a Scores range from 0 to 18, with higher scores indicating greater depressive symptomatology.
^b Scores range from 0 to 100 with higher scores indicating better mental health.
^c Scores range from 9 to 45, with higher scores indicating greater social support.
^d Scores range from 4 to 20, with higher scores indicating greater social strain.
^e Scores range from 6 to 30, with higher scores indicating greater optimism about the future.
All	93,676 (100)	2.4 (2.6)	53.0 (8.5)	35.9 (7.9)	6.5 (2.5)	23.3 (3.5)
Abuse
No abuse	82,636 (88.2)	2.2 (2.4)	53.7 (8.0)	36.5 (7.6)	6.3 (2.4)	23.4 (3.4)
Physical abuse only	225 (0.2)	3.8 (3.4)	49.1 (11.0)	33.2 (8.6)	7.5 (3.0)	21.8 (3.8)
Verbal abuse only	9,239 (9.9)	3.8 (3.3)	48.3 (10.3)	31.9 (8.4)	8.2 (2.8)	22.2 (3.8)
Physical and verbal abuse	925 (1.0)	5.2 (4.0)	45.6 (11.5)	29.6 (9.4)	8.9 (3.4)	21.4 (3.9)
Age, y
≤58	26,284 (28.1)	2.6 (2.9)	51.5 (9.1)	36.2 (7.7)	7.0 (2.7)	23.3 (3.7)
59–64	23,771 (25.4)	2.3 (2.5)	53.2 (8.3)	36.3 (7.7)	6.6 (2.5)	23.3 (3.5)
65–69	20,847 (22.3)	2.2 (2.4)	53.8 (8.0)	35.9 (7.8)	6.3 (2.4)	23.3 (3.4)
70–74	15,655 (16.7)	2.3 (2.4)	54.0 (8.1)	35.3 (8.1)	6.1 (2.3)	23.2 (3.3)
>74	7,119 (7.6)	2.3 (2.3)	54.2 (8.2)	34.7 (8.4)	5.9 (2.3)	23.0 (3.3)
Ethnicity
American Indian/Alaskan Native	422 (0.5)	3.4 (3.5)	51.3 (9.9)	33.1 (9.4)	7.2 (3.1)	22.3 (3.6)
Asian/Pacific Islander	2,671 (2.9)	1.8 (2.2)	54.0 (7.6)	35.6 (7.7)	6.3 (2.6)	22.1 (3.1)
Black/African American	7,639 (8.2)	2.6 (2.9)	52.1 (9.3)	34.5 (8.4)	7.4 (3.1)	23.1 (3.5)
Hispanic/Latino	3,623 (3.9)	3.5 (3.4)	50.6 (10.0)	33.3 (9.3)	7.4 (3.1)	22.1 (3.6)
White	78,013 (83.3)	2.3 (2.5)	53.2 (8.3)	36.2 (7.7)	6.4 (2.4)	23.4 (3.5)
Unknown	1,308 (1.4)	2.6 (2.8)	52.4 (9.0)	34.3 (8.6)	6.9 (2.7)	22.5 (3.6)
Education
0–8 y	1,560 (1.7)	3.7 (3.4)	49.3 (10.0)	32.3 (9.7)	7.6 (3.3)	20.9 (3.4)
Some high school, high school diploma/GED	18,409 (19.8)	2.7 (2.8)	52.3 (9.0)	35.7 (8.2)	6.6 (2.7)	22.3 (3.4)
School after high school	33,933 (36.5)	2.5 (2.6)	53.0 (8.7)	35.6 (8.0)	6.6 (2.6)	23.2 (3.4)
College graduate or higher	39,002 (42.0)	2.1 (2.4)	53.6 (7.9)	36.4 (7.4)	6.3 (2.4)	23.9 (3.4)
Family income
<$20,000	14,016 (16.2)	3.1 (3.1)	51.2 (9.9)	32.4 (9.0)	7.0 (2.9)	22.1 (3.6)
$20,000–$34,999	20,226 (23.3)	2.5 (2.6)	52.9 (8.7)	34.9 (8.0)	6.5 (2.6)	22.9 (3.5)
$35,000–$49,999	17,429 (20.1)	2.3 (2.5)	53.3 (8.3)	36.1 (7.5)	6.4 (2.4)	23.4 (3.4)
$50,000–$74,999	17,486 (20.2)	2.1 (2.4)	53.5 (8.0)	37.2 (7.1)	6.4 (2.4)	23.7 (3.4)
≥$75,000	17,608 (20.3)	2.0 (2.2)	53.9 (7.5)	38.4 (6.5)	6.3 (2.3)	24.2 (3.3)
Marital status
Never married	4,390 (4.7)	2.4 (2.6)	52.8 (8.7)	32.9 (8.2)	6.6 (2.6)	22.9 (3.6)
Divorced/separated	14,727 (15.8)	2.8 (2.9)	51.6 (9.6)	32.4 (8.4)	6.8 (2.7)	23.1 (3.8)
Widowed	16,290 (17.5)	2.6 (2.7)	52.9 (8.7)	33.0 (8.3)	6.3 (2.5)	22.9 (3.5)
Presently married	57,805 (62.0)	2.2 (2.4)	53.5 (8.1)	37.9 (6.9)	6.5 (2.5)	23.4 (3.4)
Smoking
Never smoked	47,023 (50.9)	2.3 (2.5)	53.3 (8.3)	36.2 (7.8)	6.4 (2.5)	23.3 (3.5)
Past smoker	39,514 (42.8)	2.4 (2.5)	53.1 (8.4)	35.9 (7.8)	6.5 (2.5)	23.3 (3.5)
Current smoker	5,791 (6.3)	2.9 (3.0)	50.7 (9.9)	34.1 (8.6)	7.1 (2.9)	22.6 (3.7)
Alcohol intake
Nondrinker	10,477 (11.3)	2.4 (2.7)	53.3 (8.6)	35.6 (8.4)	6.5 (2.7)	22.8 (3.5)
Past drinker	17,555 (18.9)	2.7 (2.8)	52.2 (9.2)	34.8 (8.4)	6.9 (2.8)	22.8 (3.6)
<1 Drink per week	29,461 (31.7)	2.4 (2.6)	52.9 (8.5)	35.7 (7.8)	6.5 (2.5)	23.2 (3.4)
≤7 Drinks per week	23,842 (25.6)	2.2 (2.4)	53.4 (8.1)	36.7 (7.3)	6.3 (2.4)	23.6 (3.4)
>7 Drinks per week	11,709 (12.6)	2.2 (2.3)	53.8 (7.8)	37.0 (7.3)	6.2 (2.3)	23.8 (3.4)
Living alone
No	68,307 (73.5)	2.3 (2.5)	53.2 (8.3)	37.2 (7.3)	6.5 (2.5)	23.3 (3.4)
Yes	24,603 (26.5)	2.6 (2.8)	52.5 (9.0)	32.3 (8.3)	6.4 (2.5)	23.1 (3.6)

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Table 2.

Associations of Changes in Mental Health with New Reports of Physical and Verbal Abuse at Year 3

	Depressive Symptomatology^a		MCS Score^a
Abuse	Mean (SD)	P Value^b	Mean (SD)	P Value^b
MCS = mental component summary, from the RAND 36-Item Health Survey 1.0.
Note: The cohort for this analysis is women who reported no abuse exposure at baseline.
^a The values for depressive symptomatology and the MCS score represent a change in score from baseline. Negative values represent a decline in score.
^b P values from simple linear regression models with 3 indicators for categories of abuse; reference level is no abuse.
No abuse (n = 75,376)	0.09 (2.6)	–	0.51 (8.35)	–
Physical abuse only (n = 136)	0.43 (3.3)	.14	−1.34 (11.2)	.016
Verbal abuse only (n = 6,133)	0.65 (3.3)	<.001	−1.26 (10.4)	<.001
Physical and verbal abuse (n = 483)	0.77 (3.9)	<.001	−1.82 (11.7)	<.001

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Table 3.

Multivariate Analysis of Variance Showing the Association of Change in Mental Health at Year 3 and Incident Abuse, Controlling for Baseline Psychosocial Characteristics

	Change in No. of Depressive Symptoms at 3-Year Follow-up	Change in MCS Score at 3-Year Follow-up
Characteristic	Parameter Estimate (95% CI)	Parameter Estimate (95% CI)	OverallP Value
CI=confidence interval; MCS = mental component summary, from the RAND 36-Item Health Survey 1.0.
Abuse
Incident abuse (vs no abuse)
Physical abuse only (n = 136)	0.20 (−0.21 to 0.60)	−1.12 (−2.45 to 0.21)	.006
Verbal abuse only (n = 6,133)	0.18 (0.11 to 0.24)	−0.55 (−0.75 to −0.34)	<.001
Physical and verbal abuse (n = 483)	0.15 (−0.05 to 0.36)	−0.44 (−1.11 to −0.22)	<.001
Baseline psychosocial characteristics
Depressive symptoms		−0.20 (−0.23 to −0.16)	<.001
MCS score	0.06 (0.05 to 0.06)		<.001
Social support	−0.01 (−0.01 to −0.01)	0.05 (0.04 to 0.06)	<.001
Social strain	0.07 (0.06 to 0.08)	−0.24 (−0.27 to −0.22)	<.001
Optimism	−0.04 (−0.05 to −0.04)	0.16 (0.14 to 0.18)	<.001
Demographic characteristics
Age, years (vs 50–58 years)
59–64	−0.08 (−0.13 to −0.03)	0.59 (0.44 to 0.74)	<.001
65–69	−0.07 (−0.12 to −0.02)	0.61 (0.45 to 0.77)	<.001
70–79	0.01 (−0.05 to 0.06)	0.41 (0.23 to 0.60)	<.001
Race (vs non-Hispanic Whites)
American Indian	−0.05 (−0.13 to 0.03)	0.10 (−0.16 to 0.36)	<.001
Asian/Pacific Islander	0.22 (0.11 to 0.33)	−0.24 (−0.61 to 0.13)	<.001
African American	0.19 (−0.11 to 0.49)	−0.29 (−1.29 to 0.71)	.005
Hispanic American	−0.36 (−0.46 to −0.25)	−0.08 (−0.42 to 0.27)	<.001
Unknown	0.24 (0.08 to 0.40)	−0.44 (−0.96 to 0.09)	<.001
Education (vs college graduate)
High school diploma or less	0.06 (0.01 to 0.12)	0.27 (0.08 to 0.46)	<.001
Some college/technical school	0.08 (0.04 to 0.13)	0.07 (−0.08 to 0.22)	<.001
Income (vs $75,000+)
<$20,000	0.22 (0.14 to 0.29)	−0.67 (−0.92 to −0.42)	<.001
$20,000–$34,999	0.13 (0.07 to 0.19)	−0.52 (−0.72 to −0.32)	<.001
$35,000–$49,999	0.07 (0.01 to 0.13)	−0.16 (−0.35 to 0.03)	<.001
$50,000–$74,999	0.03 (−0.02 to 0.09)	−0.12 (−0.30 to 0.06)	<.001
Marital status (vs presently married)
Never married	−0.11 (−0.20 to −0.01)	0.32 (0.00 to 0.64)	<.001
Divorced	−0.06 (−0.13 to 0.01)	0.13 (−0.10 to 0.37)	<.001
Widowed	−0.22 (−0.29 to −0.15)	0.99 (0.75 to 1.22)	<.001
Smoking status (vs never smoked)
Past smoker	0.06 (0.02 to 0.10)	−0.05 (−0.17 to 0.08)	<.001
Current smoker	0.22 (0.14 to 0.30)	−1.06 (−1.32 to −0.80)	<.001
Alcohol use (vs past or never drank)
<1 Drink per week	−0.04 (−0.90 to 0.01)	0.07 (−0.08 to 0.23)	<.001
≥1 Drink per week	−0.04 (−0.09 to 0.00)	0.04 (−0.12 to 0.19)	<.001
How much does your religion comfort you (vs little/none)
A great deal	−0.03 (−0.07 to 0.01)	0.12 (−0.01 to 0.25)	<.001
Living alone (vs no)
Yes	−0.06 (−0.12 to 0.00)	0.25 (0.04 to 0.46)	.005

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The Article in Brief

Psychosocial Effects of Physical and Verbal Abuse in Postmenopausal Women

Charles P. Mouton , and colleagues

Background Although researchers have examined the physical effects of abuse on older women, there has been little research into the psychological effects of abuse. This study examines the psychological effects of physical and verbal abuse on older women.

What This Study Found Older women who have been exposed to abuse have worse mental health than nonabused women. In this study, abused women had more symptoms of depression, greater social strain, and lower optimism. Exposure to verbal abuse only, without physical abuse, had greater psychological effects than physical abuse alone.

Implications

Detecting and alleviating abusive situations may have significant beneficial effects on the mental health and quality of life of older women.
Clinicians should consider possible exposure to abuse in older female patients with depression.