Violence, mental health, and substance abuse in patients who are seen in primary care settings

Objective: To explore the associations among having feelings of anger, being the perpetrator or victim of violent acts, having symptoms of psychiatric distress, and being substance abusers in patients who were seen in primary care settings. Design and Setting: A brief self-administered questionnaire was completed by adults who were attending ambulatory clinics of a community hospital and of a neighborhood health center. Participants: Seventy-three percent of the participants were women; 45% were Hispanic or Portuguese, 10% were African American, 35% were white, and 10% were of other ethnic or racial backgrounds; and most were of a lower socioeconomic status. Results: Feelings of anger and acts of violence were most highly associated as follows: (1) among men, with being hit as a child, use of drugs, and symptoms of nervousness; (2) among all women, with a drinking problem and ''being down''; and among white women, with a drinking problem, being down, and being hit as a child or as an adult or both. Consequences of being hit as a child were feelings of anger and drug use among men, drinking problems among all women, and psychiatric symptoms among white women. Conclusions: An 18-item self-administered questionnaire can provide useful information on symptoms of psychiatric distress and substance abuse. These symptoms may be associated with feelings of anger and violence-both for the perpetrator and victim. This questionnaire may aid practitioners in the detection and management of physical and psychologic problems.