Exposure to non-domestic violence : short- and long-term psychological reactions and the impact on quality of life
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The purpose of this study was to describe characteristics of exposure to non-domestic violence, and to evaluate short- and long-term psychological consequences and the impact on quality of life. Demography, physical injuries, crime characteristics, and emotions during the assault were described, based on a cross-sectional design that combined data collected by questionnaires and semi-structured interviews. The association between these factors was also evaluated (Paper I). Our results showed that most of the victims were young men assaulted by unknown attackers in public places. Seventy-six per cent of the participants suffered injuries to the head, face or eyes. Anxiety was the most frequent emotion felt during the assault. About 60% experienced a combination of subjective factors, such as fear of serious injury or fear of being killed during the assault, and actual physical injury. Acute and subacute post-traumatic reactions were described through the examination of frequency and intensity of peritraumatic dissociation (PD), post-traumatic stress disorder (PTSD) symptoms, and anxiety and depressive symptoms, and the relationships between psychological reactions, level of physical injury, perceived threat, and sociodemographic variables were explored (Paper II). Thirty-three per cent of the victims scored as probable PTSD cases according to the PTSS-10; the corresponding IES-15 score identified prevalence of 34% respectively. Forty-four per cent scored as cases with probable anxiety and depression, according to the HSCL-25. Severity of perceived threat predicted higher scores on all measures of psychological reactions. Analyses of acute or subacute reactions showed no statistical significant differences between elapsed time since exposure to violence and PD, PTSD, anxiety and depression, or threat level. The prevalence of PTSD symptoms was measured in a one-year longitudinal perspective of physically injured victims. Furthermore, the predictors of PTSD symptoms were analysed in relation to PD, physical injury, perceived life threat, prior experience of violence, perceived social support, and perceived self-efficacy (Paper III). Results showed a high prevalence and severity of PTSD on all outcomes. Either injury severity or prior experience of being a victim of violence predicted PTSD in this study. Perceived life threat was a predictor of PD and early PTSD predicted subsequent PTSD in the present study. Low perceived self-efficacy was a predictor of PTSD and influenced perceived social support at T1. Furthermore, lack of perceived social support was a predictor of PTSD symptoms at T3. Quality of life (QoL) was also assessed in a one-year longitudinal perspective, and finally, possible predictive factors of QoL (prior experience of violence, level of physical injury, perceived life threat, cohabitation, and PTSD symptoms) were examined (Paper IV). Generally, WHOQOL-Bref values associated with probable PTSD were lower than values associated with no cases. Individuals who scored as probable PTSD or as risk level cases had significantly lower scores on the QoL domains such as physical health, psychological health, social relationships and environmental than those without PTSD symptoms. For each category of PTSD (probable cases, risk level cases and no cases), the mean levels of the WHOQOLBref subscales (the four domains and the two single items) were stable across time of assessment. PTSD symptoms predicted lower QoL at all three assessments. Similarly PTSD symptoms at T1 predicted lower QoL at T2 and PTSD symptoms at T2 predicted lower QoL at T3. Our findings support the understanding of PTSD as a complex phenomenon. Early identification of important risk factors, included in an optimal treatment strategy, would perhaps protect against the development of PTSD. Being aware of symptoms such as perceived life threat and PD during the event and PTSD symptoms in the acute phase, would help to identify some of those in need of special follow-ups.