No CrossRef data available.
Article contents
Victims of physical abuse among patients with cancer referred to psychiatric clinic in a cancer center hospital: A pilot study
Published online by Cambridge University Press: 24 August 2005
Abstract
Objective: Physical abuse is one of the most important public health problems, but little is known about physical abuse of cancer patients. The objects of this study are (1) to identify whether cancer patients have sustained physical abuse; (2) to explore clinical characteristics of the abused patients.
Methods: We reviewed 584 cancer patients referred to our psychiatry clinic by a cancer center hospital and investigated whether there were victims of physical abuse among these patients. We also investigated psychiatric characteristics of the abused patients.
Results: Of these 584 patients, three patients were recognized as victims of physical abuse at the time of referral. The perpetrator of physical abuse was their husband (domestic violence) in all three cases. All three patients had sustained physical abuse from their husbands for years before being diagnosed with cancer. In addition to physical abuse, all three patients had sustained emotional abuse (e.g., threat or intimidation) from their husbands. Psychiatric diagnoses of all three patients fulfilled the DSM-IV criteria for post-traumatic stress disorder (PTSD) and the traumatic event was mainly physical abuse by their husbands.
Significance of results: Oncologists and psychiatrists should pay greater attention to the psychosocial and environmental problems of cancer patients and inquire about the presence of physical abuse in suspected cases. Medical staff should also know that early multidisciplinary interventions in addition to cancer treatments are needed for victims of physical abuse among cancer patients and that these interventions are necessary to improve compliance with treatment and proper decision making.
Information
- Type
- Research Article
- Information
- Copyright
- © 2005 Cambridge University Press
INTRODUCTION
Physical abuse is one of the most important public health problems (Marwick, 1994).
According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994), two problems are specified in relation to abuse of adults: (1) physical abuse of an adult, (2) sexual abuse of an adult. Regarding physical abuse of an adult, this category is used (1) when the focus of clinical attention is physical abuse of an adult (e.g., spousal beating, abuse of an elderly person) and (2) when the focus of clinical attention is on the victim.
As victims of physical abuse demonstrate a higher rate of suicide attempts, morbidity and mortality, and excessive ethanol use (Abbott et al., 1995; Acierno et al., 1997; Resnick et al., 1997; Thompson et al., 1999), early multidisciplinary interventions encompassing emotional, medical, and forensic care are necessary (Bessel & van den Kolk, 1995; Kilpatrick et al., 1997).
Psychological distress of cancer patients is recognized at various stages. These patients cope with this distress in varying degrees but most patients cope successfully. However, among patients with less successful coping skills, a relationship between stress and psychopathology was found (Finley-Jones, 1989). Adjustment disorder, major depression, and delirium are most commonly observed (Derogatis et al., 1983; Minagawa et al., 1996) and various kinds of disorders are recognized during the treatment (Derogatis et al., 1983; Minagawa et al., 1996; Onishi et al., 2000, 2003). It is known that psychosocial support such as social support and communication with confidants is an important factor in helping to cope with depression and anxiety disorder (Akechi et al., 1998a, 1998b; Watson et al., 1991). On the other hand, when cancer patients are abused, the psychological distress of the patients might be particularly high. However, physical abuse of cancer patients has not been reported. This issue might be overlooked or underestimated in oncological settings.
In this communication, we reviewed the records of cancer patients referred to the psychiatry clinic to identify whether any of these cancer patients had sustained physical abuse and investigated clinical characteristics of the abused patients.
PATIENTS AND METHODS
All psychiatric consultations referred to the Department of Psychiatry, Kanagawa Prefecture Cancer Center between November 2002 and July 2004 were reviewed by the authors.
We used our database, medical records, and nursing charts to identify the characteristics, reasons for psychiatric consultation, and psychiatric diagnosis of each referred cancer patient.
Psychiatric diagnoses including psychosocial and environmental problems were evaluated according to the DSM-IV (American Psychiatric Association, 1994).
DSM-IV is a multiaxial system that comprises five axes and evaluates the patients along this; Axes I and II comprise the entire classification of mental disorders, Axis III lists any physical disorder or general medical condition that is present in addition to mental disorder, Axis IV is used to code psychosocial and environmental problems that contribute significantly to the development or exacerbation of the current disorder, and Axis V is the global assessment of functioning scale. Victims of physical abuse are included on Axis IV and were extracted from the database. Psychiatric diagnosis of the patient was also extracted.
Physical abuse was defined as an assault (hitting, punching, slapping, or other trauma) by family members or strangers (Abbott et al., 1995).
RESULTS
During the period, 687 cancer patients were referred for psychiatric consultation. Of the 687 patients, 103 patients were diagnosed with delirium and appropriate information could not be obtained from these patients; therefore, we reviewed 584 referred cancer patients.
Of the 584 referred patients, three patients were recognized as victims of physical abuse at the time of referral.
The clinical characteristics, psychiatric diagnosis, and problems of the patients are summarized in Table 1.
Victims of physical abuse among patients with cancer referred to psychiatry clinic
Two patients were referred for psychiatric consultation because of physical abuse by the husband and each asked for psychiatric intervention, whereas the remaining one patient was referred for depressed mood, and psychiatric interview revealed physical abuse by her husband.
The perpetrator of physical abuse was the husband (domestic violence) in all three patients. All three patients had sustained physical abuse by their husbands for years before being diagnosed with cancer. In addition to physical abuse, all three patients had sustained emotional abuse (e.g., threat or intimidation) from their husbands. Psychiatric diagnoses of all three patients fulfilled the DSM-IV criteria for posttraumatic stress disorder (PTSD) and the traumatic event was mainly physical abuse by their husband. One patient (case 1) was receiving social support and admitted to the hospital from a shelter to avoid physical abuse by her husband. The other two patients were not receiving any psychosocial support.
DISCUSSION
In this study, we recognized three cancer patients who had sustained physical abuse among cancer patients referred by a cancer center hospital. Our study is the first report describing victims of domestic violence among cancer patients during treatment and shows the clinical characteristics of these patients.
Regarding the reason for referral, two patients had asked for help because of spousal abuse, and one patient was referred because of depressed mood. It is reported that nontrauma complaints predominate among the reasons for medical consultation by battered women (Stark & Flitcraft, 1988; Abbott et al., 1995).
All three patients had sustained physical abuse by their husbands for years and two patients were not receiving any psychosocial support. It is reported that when the perpetrator is a spouse, boyfriend, or acquaintance, many victims are reluctant to report physical assault, as many victims feel emotionally dependent on their assailant and fear the stigma attached to being socially recognized as a victim of domestic violence (Bessel & van den Kolk, 1995.
All three patients fulfilled the DSM-IV criteria for PTSD by psychiatric interview and the traumatic event was physical abuse by their husbands. All three reported intrusive thoughts regarding physical abuse by their husbands. It is reported that after physical assaults approximately 25% of victims develop PTSD, and more than half of various shelter populations currently have PTSD (Bessel & van den Kolk, 1995). PTSD is also associated with increased suicide risk and noncompliance with treatment including decision making (Kingston & Rosser, 1974). Avoidant responses associated with PTSD often prevent or delay these cancer patients from seeking professional assistance.
It is necessary for oncologists to inquire whether there are psychosocial and/or environmental problems such as domestic violence in the family, as drug and alcohol abuse are routinely assessed in clinical settings. If psychosocial and environmental problems are found, early multidisciplinary interventions are necessary to prevent further physical abuse and provide patient care.
In abused cancer patients diagnosed with PTSD, physicians should pay attention to the negative aspects of PTSD to identify any noncompliance with treatment or inappropriate decision making derived from symptoms of PTSD.
The limitations of this study are as follows. As this study was retrospective and did not directly investigate physical abuse, patients who have sustained physical abuse might be reluctant to report physical assault and there may be undetected cases included in this series. It has been reported that the low rate of documentation is a problem in domestic violence (Goldberg & Tomlanovich, 1984). Structured psychiatric interview regarding domestic violence might be necessary and the referred patient sample may have been influenced by physician bias. Furthermore, as this study was performed at only one cancer center, institutional bias may be problematic.
In conclusion, we identified victims of physical abuse among patients receiving cancer treatments. Oncologists and psychiatrists should pay greater attention to psychosocial and environmental problems of cancer patients and inquire into the presence of physical abuse in suspected cases. Medical staff should also know that early multidisciplinary interventions in addition to cancer treatments are needed for these patients and that these interventions improve compliance with treatment as well as proper decision making. Further study will more clearly demonstrate the prevalence and appropriate interventions for the victims of physical abuse among patients with cancer.
References
REFERENCES
Abbott, J.,
Johnson, R.,
Koziol-McLain, J.,
et al.
(1995).
Domestic violence against women. Incidence and prevalence in an
emergency department population.
Journal of the American Medical Association,
273,
1763–1767.Google Scholar
Acierno, R.,
Resnick, H.S., &
Kilpatrick, D.G.
(1997).
Health impact of interpersonal violence. 1: Prevalence rates, case
identification, and risk factors for sexual assault, physical assault, and
domestic violence in men and women.
Behavioral Medicine,
23,
53–64.Google Scholar
Akechi, T.,
Kugaya, A.,
Okamura, H.,
et al.
(1998a).
Predictive factors for psychological distress in ambulatory lung
cancer patients.
Supportive Care in Cancer,
6,
281–286.Google Scholar
Akechi, T.,
Okamura, H.,
Yamawaki, S.,
et al.
(1998b).
Predictors of patients' mental adjustment to cancer: Patient
characteristics and social support.
British Journal of Cancer,
77,
2381–2385.Google Scholar
American Psychiatric Association
(1994).
Diagnostic and Statistical Manual of Mental Disorders,
4th ed.
Washington, DC:
American Psychiatric Press.
Bessel, A.
(1995).
Physical and sexual abuse of adults. In
Textbook of Psychiatry,
6th edition, Kaplan H.I. &
Sadock, B.J. (eds.), pp.
2002–2008.
Baltimore, MD:
Williams & Wilkins.
Derogatis, L.R.,
Morrow, G.R.,
Fetting, J.,
et al.
(1983).
The prevalence of psychiatric disorders among cancer
patients.
Journal of the American Medical Association,
249,
751–757.Google Scholar
Finley-Jones, R.A.
(1989).
Life Events and Illness,
Brown, G.W. &
Harris, T.O. (eds.). pp.
95–112.
London:
Fuilford Press.
Goldberg, W.G. &
Tomlanovich, M.C.
(1984).
Domestic violence victims in the emergency department. New
findings.
Journal of the American Medical Association,
251,
3259–3264.Google Scholar
Kilpatrick, D.G.,
Resnick, H.S., &
Acierno, R.
(1997).
Health impact of interpersonal violence. 3: Implications for
clinical practice and public policy.
Behavioral Medicine,
23,
79–85.Google Scholar
Kinston, W. &
Rosser, R.
(1974).
Disaster: Effects on mental and physical state.
Journal of Psychosomatic Research,
18,
437–456.Google Scholar
Marwick, C.
(1994).
Health and justice professionals set goals to lessen domestic
violence.
Journal of the American Medical Association,
271,
1147–1148.Google Scholar
Minagawa, H.,
Uchitomi, Y.,
Yamawaki, S.,
et al.
(1996).
Psychiatric morbidity in terminally ill cancer patients.
Cancer,
76,
1131–1137.Google Scholar
Onishi, H.,
Miyashita, A., &
Kosaka, K.
(2000).
Manic episode associated with bereavement in a patient with lung
cancer.
Supportive Care in Cancer,
8,
339–340.Google Scholar
Onishi, H.,
Onose, M.,
Yamada, T.,
et al.
(2003).
Brief psychotic disorder associated with bereavement in a patient
with terminal stage uterine cervical cancer: A case report and review of
the literature.
Supportive Care in Cancer,
11,
491–493.Google Scholar
Resnick, H.S.,
Acierno, R., &
Kilpatrick, D.G.
(1997).
Health impact of interpersonal violence. 2: Medical and mental
health outcomes.
Behavioral Medicine,
23,
65–78.Google Scholar
Stark, E. &
Flitcraft, A.
(1988).
Violence among intimates: An epidemiologic review. In
Handbook of Family Violence,
Van Hasselt, V.B.,
Morrison, R.L.,
Bellack, A.S. &
Hersen, M. (eds.). pp.
293–314.
New York:
Plenum Press.
Thompson, M.P.,
Kaslow, N.J.,
Kingree, J.B.,
et al.
(1999).
Partner abuse and posttraumatic stress disorder as risk factors for
suicide attempts in a sample of low-income, inner-city women.
Journal of Trauma and Stress,
12,
59–72.Google Scholar
Watson, M.,
Greer, S.,
Rowden, L.,
et al.
(1991).
Relationships between emotional control, adjustment to cancer and
depression and anxiety in breast cancer patients.
Psychological Medicine,
21,
51–57.Google Scholar
Victims of physical abuse among patients with cancer referred to psychiatry clinic
You have
Access
- 4
- Cited by