Posttraumatic stress disorder symptoms and coping with the lockdown among help-seeking veterans before and during the COVID-19 pandemic.

AIM: To compare the severity of posttraumatic stress disorder (PTSD) symptoms and of particular PTSD clusters among help-seeking veterans before and during the COVID-19 lockdown. The second aim was to identify the main coping strategies used. METHODS: Male war veterans (N=176) receiving outpatient treatment at the Referral Center for PTSD were assessed at baseline (12-18 months before the pandemic declaration in March 2020) and during the COVID-19 pandemic lockdown (March-June 2020). The Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, and The Brief COPE were used. RESULTS: Direct exposure to the virus in our sample was low, and the majority of participants followed the preventive measures. The severity of the overall PTSD symptoms and of clusters of symptoms significantly decreased compared with the first assessment. At the second assessment, all participants still fulfilled the PTSD diagnosis criteria. During the lockdown, the participants used emotion-focused and problem-focused coping rather than dysfunctional coping. CONCLUSION: The severity of PTSD symptoms decreased during the lockdown. Further research is needed to study the trajectories of long-term psychopathology.

Social support and posttraumatic stress disorder in combat veterans in Croatia.

Recent studies have shown that greater social support after combat stress is associated with better psychological posttraumatic outcomes. By comparison of a group of veterans (n = 71) who sought psychiatric help and were diagnosed with PTSD (clinical group) and a group of veterans (n = 43) without PTSD (control group) we examined various components of structural and functional social support in war veterans in Croatia. The measures of social support were assessed for two time periods: a) immediately after the war, and b) at the present time. Results of two-way analysis of variance indicate that veterans without PTSD tend to report significantly higher number of persons who provide them different forms of social support than veterans with PTSD. Perceived family and friends support is higher in veterans without PTSD than in veterans with PTSD. Support received from friends and fellow soldiers decreases over time in both groups, whereas for the clinical group support of friends decreases significantly more.

Social support and PTSD symptoms in war-traumatized women in Bosnia and Herzegovina.

OBJECTIVE: To determine the correlation between social support and PTSD symptoms in women traumatized by the war and postwar social insecurity in Herzegovina. SUBJECTS AND METHODS: The experimental group consisted of 187 randomly selected women living in Mostar, who were exposed to a wide spectrum of traumatic events during the war. The control group included 180 women living in the area surrounding Mostar who were not directly exposed to war destruction. Demographic data were obtained and a battery of psychological tests was used to measure the level of war traumatization and PTSD symptoms, along with the perception of social support. RESULTS: Women in the experimental group had significantly lower levels of perceived social support from friends (t=2.91; p<0.05) and coworkers (t=2.30; p<0.05). However, its protective significance for all levels of posttraumatic symptoms was strong, even stronger than social support from the family. Of all the sources of emotional social support, low level of perceived support from friends is the only significant predictor of PTSD. CONCLUSION: The sources of social support which the traumatized women drew from family, friends and coworkers change their significance depending on their availability. These sources are a strong predictive factor of PTSD development.

Psychological consequences of war trauma and postwar social stressors in women in Bosnia and Herzegovina.

AIM: To assess the consequences of psychotrauma in civilian women in Herzegovina who were exposed to prolonged and repetitive traumatic war events and postwar social stressors. METHODS: The study included a cluster sample of 367 adult women, divided into two groups. One group (n=187) comprised women from West Mostar who were exposed to serious war and posttraumatic war events. The other group (n=180) comprised women from urban areas in Western Herzegovina who were not directly exposed to war destruction and material losses, but experienced war indirectly, through military drafting of their family members and friends. Demographic data on the women were collected by a questionnaire created for the purpose of this study. Data on trauma exposure and posttraumatic stress disorder (PTSD) symptoms were collected by Harvard Trauma Questionnaire (HTQ)--Bosnia-Herzegovina version. General psychological symptoms were determined with Symptom Check List-90-revised (SCL-90-R). Data on postwar stressors were collected by a separate questionnaire. RESULTS: In comparison with the control group, women from Western Mostar experienced significantly more traumatic events (mean+/-standard deviation [SD], 3.3+/-3.2 vs 10.1+/-4.9, respectively, t=15.91; P<0.001) and had more posttraumatic symptoms (12.3+/-10.3 vs 21.2+/-10.9, respectively, t=8.42; P<0.001). They also had significantly higher prevalence of PTSD (4.4% vs 28.3%, respectively; chi(2)=52.56; P<0.001). The number of traumatic events experienced during the war was positively associated with postwar stressful events both in the West Mostar group (r=0.223; P=0.002) and control group (r=0.276; P<0.001). Postwar stressful events contributed both to the number and intensity of PTSD symptoms and all general psychological symptoms measured with SCL-90 questionnaire, independently from the number of experienced traumatic war events. CONCLUSION: Long-term exposure to war and postwar stressors caused serious psychological consequences in civilian women, with PTSD being only one of the disorders in the wide spectrum of posttraumatic reactions. Postwar stressors did not influence the prevalence of PTSD but they did contribute to the intensity and number of posttraumatic symptoms.

Secondary traumatization of wives of war veterans with posttraumatic stress disorder.

AIM: To determine the symptoms of secondary traumatic stress and possible influences of demographic and socioeconomic factors on the occurrence of secondary traumatic stress in wives of war veterans with posttraumatic stress disorder (PTSD). METHOD: The study included 56 wives of war veterans diagnosed with PTSD and treated at the Center for Psychotrauma in Rijeka, Croatia. A short structured interview was conducted with each woman to collect demographic and socioeconomic data. The women independently completed an adapted 16-item version of Indirect Traumatization Questionnaire to determine the presence of secondary traumatic stress symptoms, which corresponded with PTSD symptoms as defined by the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders. RESULTS: Out of 56 veterans' wives included in the study, 32 had six or more symptoms of secondary traumatic stress, whereas only 3 had none of the symptoms. Twenty-two women met the diagnostic criteria for secondary traumatic stress. Women with secondary traumatic stress were married longer than those without it (mean+/-standard deviation, 19.1+/-9.1 vs 13.2+/-7.8 years, respectively; P=0.016). Eleven of 22 women with secondary traumatic stress and 8 of 34 women without secondary traumatic stress were unemployed (P=0.05). CONCLUSION: As more than a third of war veterans wives met the criteria for secondary traumatic stress, any treatment offered to veterans with PTSD must address the traumatization of their family.

Psychotic symptoms in combat-related post-traumatic stress disorder.

The presence of psychotic symptoms in post-traumatic stress disorder (PTSD) has already been recognized. Using the Structured Clinical Interview Diagnostic and Statistical Manual, we searched for and assessed psychotic symptoms in 91 males suffering from combat-related PTSD. Hallucinations and delusions were present in 20% of patients. We divided all patients into three groups: the group with hallucinations and delusions, the group without these symptoms, and the group with "subthreshold" psychotic symptoms. Using the Harvard Trauma Questionnaire, Clinician-Administered PTSD Scale, and Structured Clinical Interview Diagnostic and Statistical Manual, we investigated differences between groups in the intensity of traumatization, severity of PTSD symptoms, and the frequency of depression. There were no significant differences between groups; however, there was one exception: severity of hyperarousal symptoms was positively correlated with occurrence of psychotic symptoms.