Domestic abuse survivors twice at risk of long-term illnesses

M

Milo

Senior Member (Voting Rights)
https://www.eurekalert.org/pub_releases/2019-12/uob-das120419.php


Female survivors of domestic abuse are at double the risk of developing long-term illnesses that cause widespread bodily pain and extreme tiredness, shows a study by the Universities of Birmingham and Warwick.

Published today (Dec 6th GMT) in the Journal of Interpersonal Violence, the research shows that women who have experienced domestic abuse are almost twice as likely to develop fibromyalgia and chronic fatigue syndrome (CFS) than those who have not.

Fibromyalgia causes pain all over the body, while CFS is an illness with a wide range of symptoms, most common of which is extreme tiredness. They are both long-term conditions.

The study, the first of its kind, examined the GP records dating between 1995 and 2017 of 18,547 women who had suffered domestic abuse, compared to 74,188 who had not. They found the risk of developing fibromyalgia and CFS in women who have experienced domestic abuse was twice the rate of those who had no recorded experience by their GP, after taking into account factors which may influence the association. The incidence rate ratio for developing fibromyalgia was 1.73 (1.36-2.22). The incidence rate ratio of developing CFS was 1.91 (1.11-3.33)
Click to expand...
 
From the article, only files for women were studied; records for men - too few available; this then doesn't accurately reflect the population demographics :

"In this study, the researchers were only able to review the GP patient records of female domestic abuse survivors because there were too few male abuse survivors' records available for sufficient analysis. It is not clear as to whether this is due to a lack of recording of male abuse by clinicians or fewer men reporting abuse. The researchers, who applaud the current work undertaken by GPs to identify domestic abuse, said more public health policies are needed to ensure men feel able to come forward and seek support and that investment in domestic abuse services in primary care such as IRIS, continue."
 
From the article:

"Fibromyalgia causes pain all over the body, while CFS is an illness with a wide range of symptoms, most common of which is extreme tiredness. They are both long-term conditions.

The study, the first of its kind, examined the GP records..."


Case definitions used in GP records to diagnose CFS and Fibromyalgia: were they appropriate? Was the Canadian Consensus Criteria for

ME/CFS:https://www.mefmaction.com/images/stories/Medical/ME-CFS-Consensus-Document.pdf,

as well as the Canadian Consensus Criteria for Fibromyalgia:https://www.mefmaction.com/images/stories/Medical/FMConsensusDocumentbk.pdf used?


The previously used over inclusive Oxford case definition for CFS has been noted by the National Institutes of Health:" Furthermore, the multiple case definitions for ME/CFS have hindered progress. Specifically, continuing to use the Oxford definition may impair progress and cause harm. Thus, for needed progress to occur we recommend (1) that the Oxford definition be retired..."

https://prevention.nih.gov/sites/de.../programs/mecfs/ODP-P2P-MECFS-FinalReport.pdf
 
I suppose I'd like to see the paper itself, which does not seem to be available, to assess the methodology. Although the thing with these sorts of studies is I'm not sure exactly what there is to be learned about the condition whether or not there is an association. And there could well be an association.
 
If someone has suffered domestic abuse and the abuse continues for years, the people being abused are very likely to have permanently high levels of cortisol and/or adrenaline. Studying the long-term effects of high stress hormones would be worth looking into for all sorts of chronic illnesses, in my opinion, but they hardly ever get a mention.

Unfortunately for sufferers of any kind of stress, long term or short term, society assumes being stressed is evidence of a mental health problem i.e. people just can't cope and this must be a mental flaw. The fact that high or low levels of cortisol can have lots of effects on body systems like the thyroid and ends up having a cascade effect on the body is almost never acknowledged.
 
Not all supposedly prospective research in ME/CFS is really for prospective. People can wait a long time to be diagnosed so people can be ill in time periods which are claimed to be before the illness started. This, for example, may be why depression may seem to be more common in the period before the illness supposedly starts. Similarly, why people might appear less active and may have more symptoms (I can't remember all the so-called prospective studies that I'm sceptical about).

So some possible confounding issues:

(i) if somebody is ill with fibromyalgia or CFS this could cause relationship strain which could possibly lead to more intimate partner violence.

(ii) if one is ill with ME/CFS and probably fibromyalgia, one can be more sensitive to stress/less able to cope with situations so somebody with ME/CFS might dwell on and report some situations which healthy people might potentially not.
 
Last edited:
Intimate Partner Violence and the Risk of Developing Fibromyalgia and Chronic Fatigue Syndrome
Intimate partner violence (IPV) is a global public health issue with a variety of ill health consequences associated with exposure. Due to the stimulation of chronic stress and inflammatory pathways, childhood abuse has been associated with the subsequent development of functional syndromes such as fibromyalgia and chronic fatigue syndrome (CFS). Although IPV in women appears to elicit similar biochemical responses, this association has not been tested thoroughly in IPV survivors. These functional syndromes are complex in etiology and any indication of their risk factors would benefit health care professionals managing this population. Therefore, we aimed to investigate the association between exposure to IPV with functional syndromes: fibromyalgia and CFS.

We conducted a retrospective open cohort study using “The Heath Improvement Network” database between January 1, 1995 and December 1, 2017. A total of 18,547 women who were exposed to IPV were each matched by age to four controls who were not exposed (n = 74,188). The main outcome measures were the risk of developing fibromyalgia and CFS. These were presented as adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CIs). We found that 97 women in the exposed group developed fibromyalgia (incidence rate [IR] = 1.63 per 1,000 person-years) compared to 239 women in the unexposed group (IR = 0.83 per 1,000 person-years). Following adjustment, this translated to an IRR of 1.73 (95% CI = [1.36, 2.22]). Similarly, 19 women developed CFS in the exposed group (IR = 0.32 per 1,000 person-years), compared to 53 in the unexposed group (0.18 per 1,000 person-years), which translates to an aIRR of 1.92 (95% CI = [1.11, 3.33]).

Therefore, we have identified an association between a history of IPV in women and the development of these functional syndromes, which may provide more information to inform the biopsychosocial pathway precipitating the development of fibromyalgia and CFS.
Click to expand...
Paywall, https://journals.sagepub.com/doi/full/10.1177/0886260519888515
Scihub, https://sci-hub.se/10.1177/0886260519888515
 
In regard to diagnosis, my bolding.
The key limitation of this study relates to the limited recording of women with IPV in routinely collected primary care data, as the expected prevalence would be higher (UK Government, 2016; WHO, 2018). In addition, for outcomes (fibromyalgia/CFS), we have equally relied on the validity of coding by the GP taking care of these patients. This means that the validity of the diagnosis of fibromyalgia or CFS was decided by their GP prior to input. It is not possible to say whether the GP made the diagnosis using specific guidelines or were inputting data sent via secondary care reports of each patient.
Click to expand...
 
How many men compared to women suffer domestic abuse?

People with PTSD and trauma events appear to be more susceptible and more at risk of developing fibromyalgia. There are several studies to support this.
 
Compared to the increase in fibromyalgia diagnosis in the exposed group, the increase in ME/CFS was slight.
 
examined the GP records
Click to expand...
Hahaha, no. Both are difficult to diagnose and physicians have all sorts of weird beliefs about what they are at all, their clinical presentation and their basic definition. Many view "CFS" as the physical symptoms of depression, whatever that means, and so misdiagnoses are very common. Many physicians will simply label any unexplained pain as FM and tell the patient to GTFO.

One of the big problems with such diseases is how much misinformation and disinformation are out there. Those are reflected in medical records. I'm not convinced medical record-keeping on domestic abuse are that much better, frankly. And with women in general, to a shocking degree even, especially for anyone who believes in the "somatization" framing of those two diseases. Records can give you rough ideas through a whole population but trying to search for fine-grained correlations like this is not going to be accurate in the slightest.

Typical GIGO cherry-picking, trying to find an outcome by selectively filtering data to fit the view.
 
Given that this is a retrospective study and the authors have already published a paper on other associations, it is possible that they've been fishing for significance. I don't see evidence of them prospectively publishing their hypotheses.

Dolphin said:
So some possible confounding issues:

(i) if somebody is ill with fibromyalgia or CFS this could cause relationship strain which could possibly lead to more intimate partner violence.

(ii) if one is ill with ME/CFS and probably fibromyalgia, one can be more sensitive to stress/less able to cope with situations so somebody with ME/CFS might dwell on and report some situations which healthy people might potentially not.
Click to expand...

Yes, diagnosis biases. Given the known delays and difficulties when it comes to getting a CFS or FM diagnosis. There are related biases, such as that those who are unable to support themselves are more likely to get diagnoses for social and economic reasons.

At baseline, 251 (1.4%) women had fibromyalgia and 121 (0.7%) women had CFS in the exposed group as compared to 525 (0.7%) and 480 (0.7%) in the unexposed group, respectively. These women were excluded from the analysis.
Click to expand...
There were significantly greater levels of deprivation, smoking, obesity, and excessive drinking in the exposed group compared to the unexposed.
Click to expand...

The sensitivity analysis which adjusted for anxiety/depression as covariates did not find an effect for CFS.
fibromyalgia (IRR = 1.39; 95% CI = [1.08, 1.78], p = .010) and CFS (1.46; 95% CI = [0.83, 2.55], p = .189)
Click to expand...

A Spanish single-center case-control study (Ruiz-Pérez et al., 2009), where women with fibromyalgia (n = 287) were compared to controls (n = 287), disputed a relationship between fibromyalgia and IPV (odds ratio [OR] = 1.14; 95% CI = [0.77, 1.69])
Click to expand...

I think diagnoses of this kind in Spain are less common in general...

The association found in this study is interesting, but it is only "suggestive" quality evidence and need to be confirmed in a genuine prospective study that would eliminate the diagnosis biases (on both timing, frequency).
 
Last edited:
I would wonder if it simply comes down to history of abuse being commonly noted during and as a consequence of the odyssey that getting a ME or CFS diagnosis often is - before the ME/CFS diagnosis is made.

Unfortunately they do not give an idea of the timescale distribution.

This would be a relevant for some autoimmune conditions, as well, as it seems that people have been pushing this association.
 
Yes, @rvallee, I couldn't agree more. What a confusion to review files for ME ("cfs") diagnoses and Fibro, and take them as completely correct. Could have been a mixed bag too of case definitions, not to mention misdiagnoses, of which we know there is a significant level.
 
I believe that having a long term illness is a major risk factor for being abused or being subject to violence.

This abuse could easily start well before it is apparent that a chronic illness is present. That could on some analyses make it look like chronic illness follows abuse, when it might be the other way around.
 
shak8 said:
Compared to the increase in fibromyalgia diagnosis in the exposed group, the increase in ME/CFS was slight.
Click to expand...

It really wasn't.
The raw incidence rate ratio (% more women with IPV that develop CFS) was 70% more, compared to 95% more for FM.
That's not what I'd call 'slight'.
However, due to the lower numbers, the 95% confidence bound of CFS increase was almost zero. (1%), whereas for FM it's 54%.

So MANY confounders.
Is IPV flagging an indication of a caring physician who actually listens to patients and helps them get a correct diagnosis?
Meaning that IPV flag is only a 'GP quality' metric and has nothing to do with it.
Is CFS more common in deprived areas where abuse might be more commonly flagged.
Is 'subdiagnosed' CFS more likely to progress or be diagnosed in the presence of IPV.
...
 
You must log in or register to reply here.
Back
Top Bottom