Introduction 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 15 16 17 18 19 20 21 22 23 Our aims were to investigate the occurrence of a history of sexual, physical or emotional abuse experienced in childhood or later in life among women and men with FGID in the general population and the possible association with consultation rate, as compared with subjects free from FGID, controlling for age, sex, education and psychological distress. Methods Setting and sampling n 24 n n n 25 n n 26 1 Fig. 1 Formation and sampling procedure for the study groups from the population of Östhammar  Questionnaires 27 29 30 2 31 23 32 33 34 36 All participants per definition completed the ASQ, 231 (97.1%) the Abuse Questionnaire, 237 (99.6%) the PGWB questionnaire and 217 (91.1%) the Hospital Anxiety and Depression Questionnaire. Educational background was registered at five levels and dichotomized, with low including elementary, comprehensive, secondary level and high upper secondary, university level. Data of previous consultations for GI symptoms and educational background were taken from questions added to the 1995 ASQ. This study was approved by the Ethics Committee of the Medical Faculty, Uppsala University, on 5 June  1996. Statistical analyses 37 P  38 Results Demography and sexual, physical and emotional abuse 1 P Table 1 Distribution of age, sex, education, previous GI consultation and abuse for women and men with functional gastrointestinal disorder (FGID) and strictly GI symptom free (SSF) and previous consulters/non-consulters for FGID  n  n n  n P n  n n  n P b 45.7 (14.3) 52.4 (15.4) 0.0007 46.7 (13.4) 41.4 (14.2) 0.041 a 93 (66.0) 51 (52.6) 0.038  66 (66.7) 26 (66.7)  a 66 (47.1) 28 (29.5) 0.007 43 (43.4) 23 (60.0) 0.100 a 99 (71.7) 8 (8.3) <0.001 Not relevant Not relevant  b 96.8 114.6 <0.0001 96.8 96.6 0.963 a 13 (10.0) 0 (0.0) 0.002 5 (7.5) 8 (13.1) 0.507 a 5 (4.8) 1 (1.7) 0.319 3 (5.4) 2 (4.3) 0.942 Childhood abuse a 19 (13.9) 3 (3.1) 0.006 16 (16.5) 3 (7.9) 0.196 a 15 (11.0) 3 (3.2) 0.029 14 (14.4) 1 (2.6) 0.050 a 37 (27.4) 15 (16.1) 0.046 32 (33.7) 5 (13.2) 0.017 a 43 (31.4) 18 (18.8) 0.031 37 (38.1) 6 (15.8) 0.012 Adulthood abuse a 17 (12.4) 2 (2.1) 0.005 14 (14.4) 3 (7.9) 0.303 a 3 (2.2) 1 (1.1) 0.513 3 (3.1) 0 (0.0) 0.273 a 32 (23.7) 5 (5.4) <0.001 24 (25.3) 8 (21.1) 0.608 a 40 (29.2) 8 (8.3) <0.001 30 (30.9) 10 (26.3) 0.598 a 16 (14.6) 11 (12.4) 0.654 15 (20.0) 1 (3.0) 0.022 a 13 (11.8) 1 (1.1) 0.003 8 (10.7) 5 (15.2) 0.509 Any abuse  child or adult a 30 (21.9) 4 (4.2) <0.001 25 (25.8) 5 (13.2) 0.113 a 17 (12.4) 3 (3.2) 0.014 16 (16.5) 1 (2.6) 0.029 a 48 (35.6) 15 (16.1) 0.001 39 (41.1) 9 (23.7) 0.060 a 56 (40.9) 19 (19.8) 0.001 45 (46.4) 11 (29.0) 0.064 a 2 b t Women P 2 Table 2 The number of people and the proportion of individuals (%) with a history of sexual, physical and emotional abuse in women and men with a functional gastrointestinal disorder (FGID) and strictly GI symptom free (SSF). The total number of FGID/SSF for both childhood and adulthood abuse in women was 93/51 and 48/46 in men  n P n P Sexual Physical Emotional Any Sexual Physical Emotional Any Women 18(19)/3(6) 0.027 11(12)/1(2) 0.048 26(28)/5(10) 0.021 32(34)/7(14) 0.006 14(15)/2(4) 0.044 2(2)/0(0) 0.403 24(26)/2(4) 0.001 31(33)/4(8) <0.001 Men 1(1)/0(0) 1.00 4(8)/2(4) 0.876 11(23)/10(22) 0.937 11(23)/11(24) 1.00 3(6)/0(0) 0.331 1(2)/1(2) 1.00 8(17)/3(7) 0.343 9(19)/4(9) 0.382 P n n P P P Men P 2 Anxiety and depression P P P P Quality of life Subjects with FGID had a significant reduction in HRQL, as measured by the PGWB, with a mean value of 97 (95% CI: 94–99), as compared with SSF controls, who scored 115 (95% CI: 112–116). There was no significant difference in HRQL between women and men either for the FGID subjects (women 96; 95% CI: 92–99; men 99; 95% CI: 95–102) or for the SSF group (women 114; 95% CI: 110–117; men 115; 95% CI: 112–119). Women with a history of some kind of abuse and FGID had significantly reduced HRQL, with a mean value of 91 (95% CI: 85–97) as compared with a mean value of 100 (95% CI: 96–104) for women without abuse history. Similarly, men with a history of some kind of abuse and FGID had significantly reduced quality of life, with a mean value of 90 (95% CI: 82–99) as compared with a mean value of 102 (95% CI: 98–105) for men without abuse history. P r P r P Multivariate risk modeling Persons with FGID had higher odds ratio 2.2 (95% CI: 1.1–4.4) of a history of some kind of abuse (in childhood or adulthood, sexual, physical or emotional) as compared with the SSF controls adjusted for age, sex and HRQL (main model, adding the variable anxiety or education did not improve the model). Some kind of abuse in adulthood had odds ratio 2.8 (95% CI: 1.1–7.1) with the same strategy. Emotional abuse in adulthood had the highest (and only significant) odds ratio 3.1 (95% CI: 1.0–9.4), while sexual abuse did not reach significance. In childhood, physical abuse seems to have the highest odds ratio 2.9 (95% CI: 0.7–12) for future FGID, although significance was not reached in this study (data not shown). 3 3 Table 3 Odds ratio and 95% confidence interval (CI) for having a functional gastrointestinal disorder (FGID) (logistic regression) in different groups of abuse, women and men, in crude model and main model adjusted for age and HRQL Variable Crude model Main model (adjusted for age and HRQL) Women Men Women Men Childhood abuse No childhood sexual abuse 1  1  Childhood sexual abuse 3.95 (1.10–14.1) * 2.44 (0.60–10.0) * No childhood physical abuse 1 1 1 1 Childhood physical abuse  6.88 (0.86–54.9) 1.95 (0.34–11.2) 4.93 (0.53–46.3) 1.61 (0.21–12.3) No childhood emotional abuse 1 1 1 1 Childhood emotional abuse  3.71 (1.32–10.4) 1.00 (0.38–2.68) 2.71 (0.87–8.4) 1.14 (0.37–3.55) No childhood abuse 1 1 1 1 Any childhood abuse 3.41 (1.38–8.43) 0.94 (0.36–2.47) 2.50 (0.91–6.85) 1.10 (0.36–3.38) Adulthood abuse No adult sexual abuse 1  1 1 Adult sexual abuse 4.45 (0.97–20.5) * 3.20 (0.60–16.9) 1.51 (0.53–4.29) No adult physical abuse  1  1 Adult physical abuse  * 0.93 (0.06–15.4) * 0.84 (0.03–25.3) No adult emotional abuse 1 1 1 1 Adult emotional abuse  8.86 (2.00–39.3) 2.74 (0.67–11.1) 3.42 (0.70–16.9) 2.78 (0.55–14.0) No adulthood abuse 1 1 1 1 Any adulthood abuse 6.07 (2.00–18.4) 2.43 (0.69–8.57) 3.10 (0.92–10.3) 2.41 (0.55–10.5) Any abuse  child or adult No sexual abuse 1  1 1 Sexual abuse 3.57 (1.34–9.5) * 3.03 (0.89–10.3) 1.49 (0.52–4.24) No physical abuse 1 1 1 1 Physical abuse 7.59 (0.96–60.2) 2.5 (0.46–13.6) 5.07 (0.55–47.1) 1.84 (0.26–13.0) No emotional abuse 1 1 1 1 Emotional abuse 5.83 (2.11–16.1) 1.26 (0.48–3.28) 3.66 (1.22–11.0) 1.31 (0.43–3.95) No abuse 1 1 1 1 Any abuse 4.61 (1.95–10.9) 1.31 (0.52–3.32) 3.13 (1.21–8.10) 1.32 (0.45–3.90) 1 = Reference, * too few observations 3 Consulters and non-consulters with FGID P 1 P P P P Discussion Women, but not men, with longstanding FGID often have a history of abuse. Women with FGID reported past sexual, physical or emotional abuse in 45% of the cases, as compared with 16% for women without FGID, 29% in men with FGID and 25% in men without FGID. In this study emotional and sexual abuse are the most common type of threats to women’s health related to FGID. This study also shows that childhood emotional abuse is a predictor for consulting for GI problems. Moreover, longstanding FGID is associated with a significantly reduced HRQL, and a history of abuse further reduces the HRQL in women and men. The findings reveal that a history of abuse is an important psycho-social factor linked to FGID in women. In contrast, the association in men is less clear, although men with a history of some kind of abuse and FGID had significantly reduced HRQL as compared with men with FGID without any history of abuse. Our study does not support the idea that consulters with FGID generally have a poorer HRQL than non-consulters, but a history of abuse had a negative effect on HRQL for consulters with FGID. 24 26 23 39 25 39 23 40 41 42 43 44 45 46 47 48 42 22 49 50 51 51 49 52 53 5 54 Conclusions We conclude that women with longstanding FGID in many cases have a history of physical, emotional or sexual abuse in childhood or adulthood, which is associated with a poor HRQL and increased health care seeking. This is important for physicians to consider when diagnosing and treating FGID in women.