Dickinson L M, deGruy F V, Dickinson W P, Candib L M
Department of Family Practice and Community Medicine, College of Medicine, University of South Alabama, Mobile, USA.
Arch Fam Med. 1999 Jan-Feb;8(1):35-43. doi: 10.1001/archfami.8.1.35.
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.
Structured interview and self-report questionnaire.
Three family practice outpatient clinics.
A total of 252 women selected by somatization status using a screen for unexplained physical symptoms.
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.
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.
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.
确定在基层医疗环境中的女性患者样本中，性虐待严重程度与精神或医学问题之间的关联，并在控制当前精神或医学诊断的影响前后，评估性虐待严重程度与健康相关生活质量之间的关系。
结构化访谈和自我报告问卷。
三家家庭医疗门诊诊所。
通过筛查无法解释的身体症状，根据躯体化状态共选取252名女性。
在实施医学结局研究36项简短健康调查问卷和自我报告医学问题问卷后进行患者评估；安德鲁斯和威西编制的生活质量量表；《精神障碍诊断与统计手册》第三版修订本、诊断访谈表中的诊断和症状计数；分离体验量表；以及改良的分离性障碍访谈表。
性虐待史与健康相关生活质量的显著受损以及更多的躯体化症状（P < 0.001）、医学问题（P < 0.01）、精神症状和诊断（P < 0.001）相关。在回归分析中，性虐待严重程度是医学结局研究简短健康调查问卷8个分量表中6个的高分显著预测因素（P < 0.05），以及安德鲁斯和威西编制的所有生活质量分量表的高分显著预测因素（P < 0.01），中度受虐女性平均下降高达0.41标准差，重度受虐女性平均下降0.56标准差。此外，即使在调整了几种常见精神诊断的存在后，性虐待严重程度仍然是心理健康（P < 0.05）、社会功能（P < 0.05）和生活质量（P < 0.05）分量表高分的显著预测因素。
有性虐待史的女性基层医疗患者比没有既往虐待史的患者有更多的身体和精神症状，且健康相关生活质量更低。此外，在控制当前精神诊断的影响前后，性虐待严重程度与健康相关生活质量受损之间均存在线性关系。
