Distinct scars: unique effects of physical and sexual abuse on mental health outcomes in a gender-specific substance use disorder sample in Brazil from 1998 to 2024.

OBJECTIVES

(1) To compare sociodemographic characteristics, psychopathology, and substance use patterns among women diagnosed with substance use disorder (SUD) who experienced physical abuse (PA), sexual abuse (SA), or both (PSA); (2) to describe ages of onset; (3) to evaluate the impact of PA, SA, and their interaction on clinical outcomes.

METHODS

Observational retrospective study with patients from PROMUD (Drug Dependent Women Treatment Center) in Brazil. Questionnaires at admission assessed sociodemographics, history of SA and PA, substance use, and psychopathology. t-tests and chi-squared tests were used for descriptive statistics. Logistic and linear regressions estimated associations between clinical outcomes and history of SA or PA in crude and adjusted models. The PA–SA interaction was tested.

RESULTS

401 patients were included (1999–2024). Both SA and PA were associated with greater socioeconomic vulnerability and higher non-heterosexual orientation. SA often began in early childhood, PA more often in adolescence. PA was associated with higher odds of cocaine/crack as the main substance of dependence (OR = 2.7, p < 0.001) and lifetime physical aggression (OR = 1.9, p = 0.018). SA was linked to lifetime suicidal ideation (OR = 2.8, p < 0.01) and use of other substances (OR = 2.0, p = 0.041). No significant PA*SA interaction was found.

CONCLUSIONS

SA was associated with internalizing patterns, such as suicidal ideation and cannabis/sedative use, whereas PA was linked to externalizing patterns, including physical aggression and cocaine/crack use. These effects were independent, underscoring the need to assess both in women with SUD and to develop gender-sensitive, trauma-informed interventions, particularly where resources are limited.