Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care

Objective: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. Methods: A cross-sectional study was conducted among 234 American Indian women, age 18–45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. Results: Approximately three-quarters of respondents (76.5%; 95% CI=70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR]=3.9; 95% CI=1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR=2.3; 95% CI=1.6, 3.3); mood disorders (PR=2.1; 95% CI=1.4, 3.2); and with two or more disorders (PR=2.3; 95% CI=1.6, 3.4). Conclusion: CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women. Objectif: Examiner dans une population d’Amérindiennes qui reçoivent des soins de santé primaires (1) la prévalence, les types et la gravité des mauvais traitements et de la négligence vécus; et (2) la relation entre ces phénomènes et les désordres psychiatriques qu’elles vivent tout au long de leur vie. Méthode: On a mené une étude parmi 234 Amérindiennes âgées de 18 à 45 ans qui s’étaient présentées dans une clinique externe d’un hôpital communautaire indien à Albuquerque, au Nouveau Mexique. Les variables dépendantes qu’on a mesurées au moyen du Composite International Diagnostic Interview étaient l’état d’esprit, l’angoisse, l’abus de drogues et de l’alcool et le désordre du stress post traumatique. On a mesuré la maltraitance au moyen du