Domestic abuse survivors twice at risk of long-term illnesses

https://www.eurekalert.org/pub_releases/2019-12/uob-das120419.php

 

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.

 

Intimate Partner Violence and the Risk of Developing Fibromyalgia and Chronic Fatigue Syndrome

Paywall, https://journals.sagepub.com/doi/full/10.1177/0886260519888515
Scihub, https://sci-hub.se/10.1177/0886260519888515

 

In regard to diagnosis, my bolding.

 

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.

 

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.

 

According to the longitudinal Dunedin study...

"Women are as likely as men to commit intimate partner violence."

https://www.sciencemag.org/news/201...ders-decades-here-s-what-they-found-about-how

 

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.

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.

The sensitivity analysis which adjusted for anxiety/depression as covariates did not find an effect for CFS.

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).

 

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.

 

My thoughts too.

 

Disability in general is subject to increased risk of violence, a greater effect than shown in the above study.

 

Beeing a victim of domestic violence is damaging your body. How dangerous concussions can be for longterm health is only known recently in rugby and other sports and was long overlooked in women living in abusive partnerships.

https://www.health.harvard.edu/blog...nvisible-public-health-epidemic-2018121315529

 

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.
...