Screening Adult Primary Care Patients for a History of Child Abuse: A Survey of Massachusetts Family Physicians

Background: Childhood abuse can have long-lasting adverse repercussions in a person's life, placing adults at risk for adverse psychological and physical health sequelae. Estimates of the proportion of adult primary care patients with histories of child physical or sexual abuse range from 18% to 50%. While extensive attention has been focused on screening for partner violence, considerably less is known about physician practices regarding inquiry about childhood physical or sexual abuse.

Methods: A self-administered survey was mailed (Fall, 2007) to all members of the Massachusetts Academy of Family Physicians (n=833). With a response rate of 45.3%, 310 completed surveys were available for analysis. The survey asked about respondents' socio-demographic and practice characteristics; screening practices for physical and/or sexual childhood abuse; provider role and confidence in screening; barriers to screening; treatment practices; and personal exposure to violence. Univariate and bivariate statistics were initially conducted looking at frequency and percent distributions of key variables, and their relationship to physician gender, practice type and location, and years of practice. Screening practices were compared to the perceived role of providers, barriers, and confidence about screening.

Results: While 27.0% of physicians report that they usually or always screen female patients for childhood abuse, fewer (12.2%) routinely screen male patients. Almost one-third of physicians (32.9%) rarely or never screen female patients, whereas 60.7% do not screen male patients. Although three-quarters of respondents believed that it was their role to screen adult patients for a history of childhood abuse and that it is useful to patients, more than half did not report at least moderate confidence in their ability to screen and did not feel confident in their ability to use screening results. The most commonly reported screening barriers were time to evaluate and counsel patients (70.4%), time to ask about child abuse histories (58.6%), and competing primary care recommendations (39.0%). One-third (33.6%) of surveyed physicians reported some form of personal exposure to childhood violence.

Conclusion: Primary care is a setting where health care providers might identify and treat the physical and emotional sequelae of early abuse. Despite the fact that most physicians surveyed report screening for childhood violence is part of their role and that patients with abuse histories favor screening about childhood abuse, many family physicians do not screen their patients, nor do they feel confident about their ability to screen patients or use screening information. Implications of these findings will be discussed.