Multi-type maltreatment in childhood and psychological adjustment in adolescence: questionnaire study among adolescents in Western Herzegovina Canton.

AIM: To determine the prevalence and intercorrelation of different forms of childhood maltreatment and psychological problems in adolescents in Western Herzegovina Canton. METHOD: A questionnaire study was conducted in March 2003 on a convenient sample of 458 third-grade high-school students (39% boys) aged between 15 and 20 (median age, 17). Data were collected using a sociodemographic questionnaire, Family Adaptability and Cohesion Evaluation Scales III, Child Maltreatment Questionnaire, Youth Self-Report, and Rosenberg Self-Esteem Scale. Sociodemographic and family characteristics and exposure to maltreatment were analyzed as possible predictors of exposure to a particular type of abuse and subsequent psychological adjustment problems. RESULTS: Out of 458 students, 77% were emotionally abused, 52% physically abused, 30% neglected, 20% witnessed family violence, and 13% of girls and 21% of boys were sexually abused before the age of 14. Significant association between the maltreatment by a mother, father, and other adults were found for emotional and physical abuse and for neglect and witnessing family violence (r=0.413-0.541, P<0.001 for all). Significant correlation was found between all forms of abuse (r=0.163-0.594, P<0.05), except between sexual abuse and witnessing family violence (r=0.048, P=0.351). Almost two-thirds of students were exposed to multi-type maltreatment in childhood. Family characteristics and maltreatment scores significantly predicted anxiety/depression (R=0.456, R(2)=0.076), withdrawal (R=0.389, R(2)=0.049), somatic complaints (R=0.437, R(2)=0.059), social problems (R=0.417, R(2)=0.063), attention deficit and hyperactivity disorder (R=0.368, R(2)=0.045), rule-breaking behavior (R=0.393, R(2)=0.045), aggression (R=0.437, R(2)=0.078) (P<0.001 for all), as well as self-esteem (R=0.371, R(2)=0.035, P=0.003). CONCLUSION: Most third-grade high-school students in Western Herzegovina Canton were exposed to multi-type maltreatment in childhood, regardless of the war experience. Emotional and physical abuse were most frequently combined forms of maltreatment. Sociodemographic and family characteristics and exposure to some forms of abuse were significant predictors of exposure to other forms of abuse. Exposure to maltreatment in childhood predicted difficulties in psychological adjustment in adolescence.

Long-term follow-up of blood pressure in family members of soldiers killed during the war in Bosnia and Herzegovina.

AIM: To asses prevalence of essential arterial hypertension in family members of soldiers killed in 1992-1995 war in Bosnia and Herzegovina. METHODS: The study enrolled 1144 subjects who lost a family member in the war and 582 of their close neighbors who experienced no such loss. Data on their medical history and habits were collected, and their blood pressure was recorded in 1996 and 2003. Arterial hypertension was defined as systolic blood pressure > or =140 mm Hg (> or =130 mm Hg in patients with diabetes mellitus), or diastolic blood pressure > or =90 mm Hg (> or =80 mm Hg in patients with diabetes mellitus), or taking antihypertensive therapy. Additional laboratory and clinical tests were performed in subjects with hypertension. RESULTS: The prevalence of hypertension at both time points was higher in the group with a killed family member than in the group without the loss (55.1% vs 42.1%, P<0.001 in 1996, and 50.7% vs 39.0%, P<0.001 in 2003, respectively). However, there was also a significant decrease in the prevalence of hypertension in the group with the loss in 2003 (P<0.001), but not in group without the loss. Posttraumatic stress disorder (PTSD), smoking, and alcohol consumption were more prevalent in the group with a killed family member, but not cholesterol and triglyceride blood concentrations. In both groups, hypertension was more prevalent in subjects with PTSD and smoking or drinking habit. Proportion of subjects with hypertension who smoked and used alcohol was similar in both groups. Proportion of subjects with hypertension who did not smoke or drink was higher in the group with the loss (51.1% vs 36.7%, P<0.001; 46.2% vs 35.0%, P=0.006; respectively). CONCLUSION: This study showed higher prevalence of hypertension in family members of killed soldiers, regardless of the presence of other cardiovascular risk factors. Only the stress of mourning was associated with higher prevalence of hypertension. Over time, proportion of hypertensive subjects with the loss decreased in the group with a killed family member, further suggesting that at least a part of their hypertension might have been of psychological origin.