title: Loss and psychosocial factors as determinants of quality of life in a cohort of earthquake survivors.
abstract: BACKGROUND
  Despite the existing evidence of a long lasting effect of disaster related experiences on physical and psychological health, few studies have evaluated long-term quality of life (QOL) outcomes of disaster survivors and the factors associated with such outcomes.
  
  
  METHODS
  23 years after the 1988 Spitak earthquake in Armenia, the associations of demographic characteristics, trauma exposure and psychosocial variables on QOL were explored among a cohort of 725 exposed individuals. The EQ-5D-5 L instrument was applied to measure QOL of participants. Multivariate linear and ordinal logistic regressions were applied to evaluate the determinants of QOL and its underlying five domains (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression).
  
  
  RESULTS
  Older age, current depression, post-traumatic stress disorder and anxiety symptoms were negatively associated with QOL. Additionally, those with severe losses (who did not receive any financial/material aid) had significantly poorer QOL outcomes, with higher odds of mobility difficulties (OR = 1.86, p < 0.05), self-care difficulties (OR = 2.85, p < 0.05), and mood problems (OR = 2.69, p < 0.05). However, those with severe earthquake related losses who received financial/material aid reported less self-care difficulties (OR = 0.21, p < 0.05) usual activity difficulties (OR = 0.40, p < 0.05), and mood problems (OR = 0.44, p < 0.05). Finally, each unit increase in current social support score was found to be significantly associated with a better QOL outcome and better self-reported outcomes across all underlying domains of QOL.
  
  
  CONCLUSIONS
  These findings suggest that earthquake related loss and concurrent psychopathology symptoms can have adverse impact on the QOL of survivors. They also indicate that well-targeted post-disaster financial/material aid and social support should be considered as means for improving the long-term QOL outcomes of disaster survivors.
authors.affiliation: School of Public Health, American University of Armenia, Yerevan, Armenia. vkhachadourian@aua.am.
authors.forename: Vahe
authors.initials: V
authors.lastname: Khachadourian
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, CA, USA. harmenian@ucla.edu.
authors.forename: Haroutune K
authors.initials: HK
authors.lastname: Armenian
authors.affiliation: School of Public Health, American University of Armenia, Yerevan, Armenia. ademirch@aua.am.
authors.forename: Anahit
authors.initials: A
authors.lastname: Demirchyan
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, UCLA, Los Angeles, CA, USA. agoenjia@ucla.edu.
authors.forename: Armen
authors.initials: A
authors.lastname: Goenjian
mesh_terms: D000367:Age Factors; D000368:Aged; D001136:Armenia / Q000453:epidemiology; D015331:Cohort Studies; D004190:Disasters; D055866:Earthquakes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D017741:Survivors / Q000523:psychology*