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A Systematic Review and Meta-analysis

Molly L. Paras, BS; Mohammad Hassan Murad, MD; Laura P. Chen, BS; Erin N. Goranson, BS; Amelia L. Sattler, BS; Kristina M. Colbenson, BS; Mohamed B. Elamin, MBBS; Richard J. Seime, PhD; Larry J. Prokop, MLS; Ali Zirakzadeh, MD

JAMA. 2009;302(5):550-561.

Context  Many patients presenting for general medical care have a history of sexual abuse. The literature suggests an association between a history of sexual abuse and somatic sequelae.

Objective  To systematically assess the association between sexual abuse and a lifetime diagnosis of somatic disorders.

Data Sources and Extraction  A systematic literature search of electronic databases from January 1980 to December 2008. Pairs of reviewers extracted descriptive, quality, and outcome data from included studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I² statistic was used to assess heterogeneity.

Study Selection  Eligible studies were longitudinal (case-control and cohort) and reported somatic outcomes in persons with and without history of sexual abuse.

Results  The search identified 23 eligible studies describing 4640 subjects. There was a significant association between a history of sexual abuse and lifetime diagnosis of functional gastrointestinal disorders (OR, 2.43; 95% CI, 1.36-4.31; I² = 82%; 5 studies), nonspecific chronic pain (OR, 2.20; 95% CI, 1.54-3.15; 1 study), psychogenic seizures (OR, 2.96; 95% CI, 1.12-4.69, I² = 0%; 3 studies), and chronic pelvic pain (OR, 2.73; 95% CI, 1.73-4.30, I² = 40%; 10 studies). There was no statistically significant association between sexual abuse and a lifetime diagnosis of fibromyalgia (OR, 1.61; 95% CI, 0.85-3.07, I² = 0%; 4 studies), obesity (OR, 1.47; 95% CI, 0.88-2.46; I² = 71%; 2 studies), or headache (OR, 1.49; 95% CI, 0.96-2.31; 1 study). We found no studies that assessed syncope. When analysis was restricted to studies in which sexual abuse was defined as rape, significant associations were observed between rape and a lifetime diagnosis of fibromyalgia (OR, 3.35; 95% CI, 1.51-7.46), chronic pelvic pain (OR, 3.27; 95% CI, 1.02-10.53), and functional gastrointestinal disorders (OR, 4.01; 95% CI, 1.88-8.57).

Conclusion  Evidence suggests a history of sexual abuse is associated with lifetime diagnosis of multiple somatic disorders.

Author Affiliations: Mayo Clinic College of Medicine (Mss Paras, Chen, Goranson, Sattler, and Colbenson); Division of Preventive Medicine (Dr Murad) and Knowledge and Encounter Research Unit (Drs Murad and Elamin); Department of Psychiatry and Psychology (Dr Seime); Mayo Clinic Libraries (Mr Prokop); and Department of General Internal Medicine (Dr Zirakzadeh), Mayo Clinic, Rochester, Minnesota.

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