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 Sun ey (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.
