Quality of life after exposure to a single traumatic event: The relationship between post traumatic symptoms and quality of life, the mediation of depression of this relationship, and the connection between treatment type and timing of treatment to change

Almost 90% of the population is exposed to at least one traumatic event during their lifetime, with almost 8% developing posttraumatic stress disorder (PTSD). This syndrome includes symptoms of intrusion, avoidance and hyper arousal which influence the quality of life of people who suffer from it(Kessler, 2000). Quality of life (QOL), which is a well known measure in social science research, refers to the physical, mental and social welfare of the person, and today it is customary to assess it subjectively, as perceived by the person herself (Andrew & Witney, 1976).  

Over the years there have been many studies about the relationship between PTSD symptoms and quality of life. These studies have shown that higher levels of PTSD are related to lowered QOL. There have been also studies about the relationship between change in symptoms, as result of treatment, and change in QOL. Those studies referred to a variety of treatments such as cognitive therapy and pharmacological treatment. These studies found that as PTSD reduced, QOL increased. Most of those studies referred to people with chronic PTSD, that is, symptoms that have lasted for more than three months, rather than those who had suffered from the symptoms for a shorter time. In addition, no study has yet examined the relationship between change in symptoms and in QOL close to the traumatic event. The contribution of different types of treatments, and timing of treatment time on QOL following treatment have not been examined.

The purpose of the current study was to examine the relationship between PTSD symptoms and subjective QOL, a month after a traumatic event, through a number of variables.

First, the study wanted to examine the relationship between PTSD and QOL as soon as possible after the traumatic event, in order to examine the immediate impact of symptoms on quality of life. It also sought to examine the contribution of depression, which many people with PTSD suffer from (Rapaport, Clary, Fayyad, & Endicott, 2005), to this relationship. In addition, this study examined the contribution of treatment, on symptoms and QOL following treatment. The study did that by examining the relationship between change in symptoms, as a result of providing treatment close to the traumatic event, and change in quality of life after treatment. The study also examined the relationship between type of treatment and the timing of treatment to the quality of life after treatment.

The present study is a quantitative study which was based on an existing database of a study that examined the prevention of PTSD by early treatment. This study followed up adults who came to emergency room following a traumatic event. The current study is based on 185 subjects from this database, who suffered from post-traumatic symptoms and participated in one of the following treatments: early and late prolonged exposure therapy, cognitive therapy, medication and placebo treatment.

The current study used a clinical interview for diagnosing PTSD(CAPS; Blake, Weathers, Nagy, Kaloupek, Klauminzer, Chamey, & Keane, 1990), a questionnaire to test the level of symptoms of depression (BDI; Beck, Ward, & Mendelson, 1961), a questionnaire for assessing subjective quality of life (WHOQOL-BREF; World Health Organization, 1996) and a demographic questionnaire. Data analysis was done using Pearson test, one-way ANOVA test, a multi-way repeated measures test and regression tests. 

The hypotheses of this study were based on previous research, and also on the theory of Shattered Assumptions.

This theory explains the cognitive changes that occur after a traumatic event, that contribute to the way the individual will evaluate the quality of their life. The main hypothesis in this study was that a negative correlation between PTSD symptoms and QOL would be found, as well as between change in PTSD symptoms and QOL. In addition it was hypothesized that depression would be a mediating variable in this relationship. In addition, it was hypothesized that there will be a connection between the time treatment started to the level of QOL following treatment. It was hypothesized that QOL will be higher among study participants who received treatment sooner. In addition, it was also hypothesized that there will be an association between type of treatment and QOL after treatment, and that the quality of life will be higher in participants who received cognitive therapy than in participants who received prolonged exposure therapy. In addition, it was hypothesized that quality of life, after treatment, of those who were treated with prolonged exposure and cognitive therapy would be higher than quality of life of those who received medication and placebo.

The findings confirmed the hypothesized that there would be a negative correlation between symptoms and quality of life and between change in symptoms and change in quality of life. The findings also confirmed the assumption that depression would be a mediating variable in the relationship between symptoms and quality of life. Depression was found to be a full mediator in the relationship between PTSD symptoms and psychological, social and environmental quality of life and a partial mediator in the relationship between PTSD symptoms and health quality of life. The hypothesis that there will be a relationship between timing of treatment and quality of life after treatment was confirmed in part.The psychological quality of life of the group who received early treatment was significantly higher than of the group who received late treatment.

However, no differences were found between the two treatment groups in regard to health, social and environmental quality of life. The hypothesis that there will be a relationship between type of treatment and quality of life after treatment was confirmed in part as well. There was a significant difference in social quality of life between drug therapy and cognitive therapy but no other differences were found. The discussion chapter offers explanations regarding why not all the assumptions were fully confirmed.                                                                                                              

The limitations of this study are its small sample and that it applies only to victims of one time traumatic event, so there is difficulty in generalizing the findings to all trauma victims. The study also focuses on time period of up to nine months after the event, making it difficult to examine the long-term contribution of different kinds of therapy on quality of life. It recommended for further research to take a larger sample, which would also address chronic PTSD, and to examine the population for a longer period of time.

Despite these limitations, there are significant theoretical and practical implications of this research. This study is the first to examine the relationship between post-traumatic symptoms and quality of life, starting from a close time period after the traumatic event, and reiterates the current knowledge on this relationship. The current findings are also in line with the theory of shattered assumptions, and there by strengthen this theory. It contribution to the therapeutic field is the finding that treatment for reducing symptoms improves quality of life, thereby there is no need for further treatment to improve the quality of life . However, the study shows that depression is a variable which leads to lower quality of life and not PTSD symptoms themselves, so the most effective way to improve quality of life is to reduce the symptoms of depression. Therefore, treatments that directly focus on reducing depression symptoms would be the most effective in improving quality of life.

From a different point of view, the study shows that SSRI medication, which in previous studies was found as less effective in reducing post traumatic symptoms than cognitive therapy and prolonged exposure therapy, are equally effective as the above treatments in improving quality of life. This is probably due to the fact that those medications are known to be effective in reducing depression. Therefore, when it is not possible in the immediate phase to given on-drug treatments for PTSD, there is a value in giving medications. In addition, the study indicates the importance of early treatment in improving quality of life.

In conclusion, the findings of this study can help in building the most appropriate treatment program for people who are suffering from post-traumatic symptoms after a one time traumatic event. A program which sees the importance not only of reducing PTSD symptoms but also of improving the quality of life of those suffering from them.