The human response to interpersonal violence, is one of the most important public health problems in the world [1
]. Exposure to a terrifying event such as violence may confront an individual with such horror and threat to a degree that usual psychological defenses are incapable of coping with the impact. The consequences may be temporarily or permanently altered capacity to cope, changed concept of self and reduced quality of Life (QoL). Research shows that the anxiety disorder, post-traumatic stress disorder (PTSD) is a common problem following violence, and that other emotional problems may be secondary to PTSD [2
Three clusters of symptoms, namely re-experiencing, avoidance and hyperarousal define PTSD. In almost all persons, intrusive and repetitious symptoms develop after exposure to extreme stress. However, only a certain proportion develop avoidance and hyperarousal symptoms [4
]. The risk of posttraumatic emotional problems has been found to be highest in persons who report that during the assault they feared they would be killed or seriously injured, or actually were injured [2
]. Prior experiences of victimization have also been found to elevate the risk of emotional problems following new victimization [6
]. In other studies, experiences of earlier violence, perceived threat and injury severity have been found to be important predictors of PTSD [2
]. Individuals who develop symptoms of PTSD usually recover within one year after the event. Those who do not rarely recover completely [7
Knowledge about people's experience of reactions following exposure to violence, including the impact on their QoL, is needed to improve the understanding of these complex psychological processes [8
]. Publications on the subject of QoL in psychiatric research are of later date than those in somatic medicine [9
]. Quality of Life (QoL) has been defined in a number of ways such as symptom status, functional health, general health perceptions, general life satisfaction, well-being and overall QoL. Terms such as health-related QoL, functional status, subjective health status and overall QoL are used interchangeably to express different aspects of the term QoL in the field. Numerous questionnaires have been developed for assessing the construct. Most authors agree that QoL should be approached as a complex and multidimensional construct [10
]. The World Health Organization defines QoL as: "the individual's perception of his/her position in life in the context of the culture and value system in which he/she lives and in relation to his/her goals, expectations, standards and concerns" [12
]. This definition reflects the multidimensional nature of QoL as the subjective evaluation is embedded in the individual's physical health, psychological state, level of independence, social relationships, personal beliefs and relationships to salient features of the environment [12
The relationship between physical symptoms, health status, psychological status and satisfaction with life is complex [13
]. Wilson and Cleary (1995) constructed a conceptual model of health-related quality of life (HRQoL) that integrates both biological and psychological aspects of health outcomes linked with both individual and environmental characteristics [15
]. This model linked physiological variables, symptom status, functional health, general health perceptions and overall QoL. Health perception, subjective measures of life satisfaction and well-being are not found directly as a one-to-one relationship to severity of symptoms, disability and functional limitations in their review of research on interrelationships of patients' outcome [15
]. The model integrates a continuum of increasing levels of complexity for understanding the impact on QoL. The causal pathway of the model begins with biological aspects where overall QoL is the final outcome. The model has been widely applied to examine populations with a spectre of different diseases according to QoL [16
The European Study of Epidemiology of Mental Disorders (ESEMeD) reported that mental disorders were associated with substantial levels of disability and loss of QoL [17
]. Some QoL assessments reflect a new evaluation of functional and social outcomes associated with recovery from mental illness. The assessments of QoL in the psychiatric field are emerging as important, both in consideration of different diagnoses and in consideration of the impact of treatment intervention, and also in evaluation of medical disability.
Several studies of Vietnam veterans examining the impact of PTSD on QoL by a wide range of QoL measures, show that PTSD have negative influence on QoL in both females and males [18
]. The influence on QoL is not found only among the veterans with the diagnosis of PTSD, but also among family members [21
]. Still there is an obvious lack of research on the implications of PTSD for QoL [10
]. Also QoL studies based on civilian populations have been shown to predict QoL impairment in patients diagnosed as suffering from PTSD [10
How PTSD- symptoms after exposure to non-domestic violence influence QoL is less known, as well the impact of PTSD on QoL over time. As far as we know, no longitudinal studies of civilians have evaluated the relationship between QoL and PTSD after exposure to non-domestic violence. The aims of the present study are as follows.
1) To investigate QoL in victims of non-domestic violence by assessing the appearance of PTSD symptoms over a one-year period following the trauma.
2) To investigate the predictive value of prior experience of violence, level of physical injury, perceived life threat and the presence of PTSD symptoms on QoL in victims of non-domestic violence over a one-year period following the trauma.