Abstract
ObjectiveTo use data from electronic health records (EHRs) to describe the demographic, clinical and functional correlates of childhood sexual abuse (CSA) in patients with severe mental illness (SMI), and compare their clinical outcomes (admissions and receipt of antipsychotic medications) to those of patients with no recorded history of CSA.MethodsWe applied a string‐matching technique to clinical text records of 7000 patients with SMI (non‐organic psychotic disorders or bipolar disorder), identifying 619 (8.8%) patients with a recorded history of CSA. Data were extracted from both free‐text and structured fields of patients’ EHRs.ResultsComorbid diagnoses of major depressive disorder, post‐traumatic stress disorder and personality disorders were more prevalent in patients with CSA. Positive psychotic symptoms, depressed mood, self‐harm, substance use and aggression were also more prevalent in this group, as were problems with relationships and living conditions. The odds of inpatient admissions were higher in patients with CSA than in those without (adjusted OR = 1.95, 95% CI: 1.64–2.33), and they were more likely to have spent more than 10 days per year as inpatients (adjusted OR = 1.32, 95% CI: 1.07–1.62). Patients with CSA were more likely to be prescribed antipsychotic medications (adjusted OR = 2.48, 95% CI: 1.69–3.66) and be given over 75% of the maximum recommended daily dose (adjusted OR = 1.72, 95% CI: 1.44–2.04).ConclusionData‐driven approaches are a reliable, promising avenue for research on childhood trauma. Clinicians should be trained and skilled at identifying childhood adversity in patients with SMI, and addressing it as part of the care plan.
Highlights
There are many definitions of childhood sexual abuse (CSA), encompassing a range of sexually abusive acts towards children
We identified 7030 patients with severe mental illness (SMI) who were in contact with services at Camden & Islington NHS Foundation Trust (C&I) NHS FT in the years 2009–2 017 and had at least one recorded Health of the Nation Outcome Scales (HoNOS) assessment
The study demonstrated that exposure to CSA is associated with more severe symptomatology, impaired functioning, higher rates of comorbidities and negative clinical outcomes in adulthood
Summary
A string-matching technique was used to identify cases of CSA in clinical text notes. While the positive predictive value was high, this does not account for the possibility that some cases may have been missed. Patients with more or longer admissions might have had more opportunities to have CSA recorded in their EHRs, partially explaining some of the associations found in this study. Our search strategy did not allow us to extract information on the age or duration of sexual abuse, variables which have been shown to be associated with the clinical presentation of psychotic disorders
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