By David Finkelhor and Lucy Berliner, JAMA Internal Medicine, May 3, 2021
The heartfelt essay by Dr Austin captures well the experience of many survivors of childhood sexual abuse and other traumatic and adverse experiences. Faced with medical history questionnaires, they may feel ambivalent about disclosing and disappointed with the follow-up when they do.
As she points out, screening for the variety of adverse experiences has been rapidly increasing, in wake of the recognition of their prevalence and their contribution to poor health. But while screening is proliferating, it is not clear how beneficial it has been for patients and their health. Little is known about outcomes or whether those who disclose get an appropriate response.
Trauma and adverse experiences are very common in both children and adults. For example, childhood sexual abuse/assault histories are prevalent in 6% of adult men and 16% of adult women in the US population.3 Such histories are an established risk marker for higher rates of physical and behavioral health problems, with particularly high odds ratios for survivors of sexual abuse/assault, such as recent PTSD (4.1), suicide attempt (8.0), and mood disorder (3.4).