History of childhood maltreatment and symptoms of anxiety and depression in women with chronic pelvic pain

Abstract

Objective: To determine the prevalence of physical, sexual and emotional abuse and physical and emotional neglect suffered by women with chronic pelvic pain (CPP) during childhood and whether these occurrences are associated with symptoms of pain, anxiety and depression.

Methods: A case–control study was conducted on 154 women older than 18 years, 77 of them healthy and 77 with CPP. A history of sexual, physical, and emotional abuse and physical and emotional neglect was determined using the Childhood Trauma Questionnaire (CTQ). Anxiety and depression symptoms were determined using the Hospital Anxiety and Depression (HAD) scale. Pain intensity was determined using a visual analog scale (VAS). The quantitative variables were compared by the Wilcoxon test, and the qualitative variables were compared by the Chi-square test or exact Fisher test when appropriate. Correlation between the CTQ, HAD and VAS scores was estimated by the Spearman’s p coefficient. Independent association of the variables with the presence of CPP was determined by logistic multiple regression analysis.

Results: The prevalence of childhood maltreatment was 77.9% and 64.9%, respectively, for women with CPP and healthy women (p = 0.07). Emotional neglect was more frequent among women with CPP than among healthy women (58.4% versus 41.5%, p = 0.04). There was a moderate correlation between anxiety and depression symptoms and CTQ scores for women with CPP. Unemployment (OR = 4.15, 95% CI 1.73–9.94; OR_adj =  3.30, 95% CI 1.26–8.55) was independently associated with the presence of CPP.

Conclusions: Women with CPP reported emotional neglect abuse more frequently than healthy women. There was a direct correlation between maltreatment scores and anxiety and depression scores. On the other hand, CPP was independently associated only with unemployment.

Keywords:

• Anxiety
• chronic pelvic pain
• childhood maltreatment
• depression
• neglect

Acknowledgements

We wish to thank the statistician Suleimy Cristina Mazin for her assistance.

Disclosure statement

The authors declare that there was no conflict of interest.

Current knowledge on the subject

• Physical and sexual abuse during childhood is associated with the presence of symptoms of depression during adulthood

• These types of abuse have been considered to be risk factors for the development of chronic pelvic pain in women

• There is no information in the literature about a history of neglect and emotional abuse in this group of women

What this study adds

• We observed that a report of maltreatment (especially emotional neglect) was more frequent among women with chronic pelvic pain

• There was a direct correlation between maltreatment scores and scores for anxiety and depression symptoms

• In contrast to unemployment, a report of childhood maltreatment is not an independent factor associated with the presence of chronic pelvic pain

• We suggest that maltreatment, of itself, is not a determinant of CPP, but may participate in a complex set that predisposes to the development of this condition

Additional information

Funding

Conselho Nacional de Desenvolvimento Científico e Tecnológico [10.13039/501100003593], Banco Santander [10.13039/100010784].