Abuse histories of psychiatric inpatients: to ask or not to ask?

The literature suggests that a high prevalence of a history of sexual and physical abuse among psychiatric inpatients is found when researchers inquire about abuse directly, but that relatively low rates are found in medical records. This study examined rates of reported abuse among patients who were and were not asked about abuse at admission.

The medical records of 100 consecutive admissions to an urban general hospital in New Zealand were examined after the introduction of a new admission form with a section inquiring about abuse. Use of the new admission form was recommended but not mandatory.

The abuse section of the new form was completed for only 17 of the 53 patients with whom the new form was used. Review of the medical records of all 100 consecutive admissions revealed a prevalence rate of 32 percent for one or more of the four types of abuse. However, 14 of the 17 patients (82 percent) who were asked directly about abuse reported having experienced abuse. Nonsignificant trends suggested that male gender and being more disturbed or disturbing may be negatively related to the probability of being asked about abuse. Men may be particularly unlikely to disclose childhood abuse if not asked directly.

The authors recommend including inquiry about abuse in standardized admission procedures and providing inpatient staff with training in how and when to ask patients about abuse and how to effectively follow up affirmative responses.