The Role of Health Risk Behaviours in the Link between Posttraumatic Stress Symptoms and Physical Health among Women with Histories of Interpersonal Trauma




Eadie, Erin MacKenzie

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Women with histories of interpersonal trauma (physical, sexual, or psychological abuse experienced during childhood, adolescence, and adulthood) are more likely to experience posttraumatic stress symptoms (PTSS) and to develop physical health problems than women without trauma histories. In fact, PTSS and posttraumatic stress disorder (PTSD) have been established in the literature as mediators of the relation between interpersonal trauma and physical health outcomes (e.g., Resnick et al., 1997; Schnurr & Green, 2004). What remains to be determined is a clear understanding of the various mechanisms explaining why individuals with trauma histories, and subsequently PTS symptoms, go on to develop physical health problems. The purpose of this study was to examine the role of health risk behaviours, specifically sexual risk taking and substance use, as possible mechanisms through which interpersonal trauma and PTSS might influence physical health. These relations were examined, through structural equation modelling, in a sample of 475 women currently attending university. Models were tested separately for sexual traumas (childhood sexual abuse and sexual assault experienced during adolescence and adulthood) and nonsexual interpersonal traumas (physical and psychological maltreatment by parents in childhood, witnessing violence between parents, and intimate partner violence in their own relationships). Results indicated that PTSS severity partially mediated pathways from both types of interpersonal trauma, sexual and nonsexual, to adverse health outcomes, contributing to the existing theory that one’s psychological response to a trauma may be more important in determining physical health outcomes than the trauma itself. Furthermore, a significant indirect pathway was found to link nonsexual trauma to risky sexual behaviours through PTSS severity. In addition, PTSS severity fully mediated the relation between nonsexual trauma and substance use behaviours. These latter findings suggest that the likelihood of engaging in substance use and/or risky sexual behaviours may be greater in trauma survivors who are suffering from posttraumatic stress symptoms. Contrary to hypotheses, no significant pathways were found from risky sexual behaviours or substance use to physical health outcomes in the context of trauma variables and PTSS severity. Consequently, these health risk behaviours were not found to operate as mechanisms explaining the link from PTSS severity to physical health outcomes. Limitations and alternative hypotheses are presented. Implications for clinical interventions and recommendations for future research are discussed.



abuse, posttraumatic stress disorder, women's health, health risk behaviours, substance use, physical health, posttraumatic stress symptom severity, interpersonal trauma, structural equation modelling