Health-related quality of life and symptom profiles of female survivors of sexual abuse

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 \u3c .001), medical problems (P \u3c .01), and psychiatric symptoms and diagnoses (P \u3c .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 \u3c .05) and all of the quality-of-life subscales developed by Andrews and Withey (P \u3c .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 \u3c .05), social functioning (P \u3c .05), and quality of life (P \u3c .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