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Health-Related Quality of Life and Symptom Profiles of Female Survivors of Sexual Abuse
L. Miriam Dickinson, PhD;
Frank Verloin deGruy III, MD;
W. Perry Dickinson, MD;
Lucy M. Candib, MD
Arch Fam Med. 1999;8:35-43.
Objectives To determine the association between severity of sexual abuse and psychiatric or medical problems in a sample of female patients from primary care medical settings and to assess the relationship between sexual abuse severity and health-related quality of life before and after controlling for the effects of a current psychiatric or medical diagnosis.
Design Structured interview and self-report questionnaire.
Setting Three family practice outpatient clinics.
Subjects A total of 252 women selected by somatization status using a screen for unexplained physical symptoms.
Main Outcome Measures Patient assessment after administering the Medical Outcomes Study 36-item Short-Form Health Survey and self-report medical problems questionnaire; the quality-of-life scale developed by Andrews and Withey; Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses and symptom counts from the Diagnostic Interview Schedule; the Dissociative Experiences Scale; and the modified Dissociative Disorders Interview Schedule.
Results A history of sexual abuse is associated with substantial impairment in health-related quality of life and a greater number of somatized symptoms (P<.001), medical problems (P<.01), and psychiatric symptoms and diagnoses (P<.001). In regression analyses, sexual abuse severity was a significant predictor of high scores on 6 of the 8 subscales of the Medical Outcomes Study Short-Form Health Survey (P<.05) and all of the quality-of-life subscales developed by Andrews and Withey (P<.01), with average decrements of up to 0.41 SDs for moderately abused women and 0.56 SDs for severely abused women. Furthermore, sexual abuse severity remained a significant predictor of high scores on the subscales mental health (P<.05), social functioning (P<.05), and quality of life (P<.05), even after adjusting for the presence of several common psychiatric diagnoses.
Conclusions Female primary care patients with a history of sexual abuse have more physical and psychiatric symptoms and lower health-related quality of life than those without previous abuse. In addition, a linear relationship exists between the severity of sexual abuse and impairment in health-related quality of life, both before and after controlling for the effects of a current psychiatric diagnosis.
From the Department of Family Practice and Community Medicine, College of Medicine, University of South Alabama, Mobile (Drs L. Dickinson, deGruy, and W. Dickinson); and the Department of Family Practice, University of Massachusetts School of Medicine, Worcester (Dr Candib).
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