Course of post-traumatic stress disorder following war in the Balkans: 1-year follow-up study.

BACKGROUND: Prevalence rates of post-traumatic stress disorder (PTSD) following the experience of war have been shown to be high. However, little is known about the course of the disorder in people who remained in the area of conflict and in refugees. Method We studied a representative sample of 522 adults with war-related PTSD in five Balkan countries and 215 compatriot refugees in three Western European countries. They were assessed on average 8 years after the war and reinterviewed 1 year later. We established change in PTSD symptoms, measured on the Impact of Events Scale - Revised (IES-R), and factors associated with more or less favourable outcomes. RESULTS: During the 1-year period, symptoms decreased substantially in both Balkan residents and in refugees. The differences were significant for IES-R total scores and for the three subscales of intrusions, avoidance and hyperarousal. In multivariable regressions adjusting for the level of baseline symptoms, co-morbidity with depression predicted less favourable symptom change in Balkan residents. More pre-war traumatic events and the use of mental health services within the follow-up period were associated with less improvement in refugees. CONCLUSIONS: Several years after the war, people with PTSD reported significant symptom improvement that might indicate a fluctuating course over time. Co-morbid depression may have to be targeted in the treatment of people who remained in the post-conflict regions whereas the use of mental health services seems to be linked to the persistence of symptoms among refugees.

Depression and torture.

Torture represents an exceptionally traumatic experience in which horror, helplessness, and hopelessness are extreme. Therefore, it can be expected that depression, along with other trauma-related disorders is present in torture victims at higher rates than in other psychotraumatized individuals. To demonstrate this, we examined two groups of refugees, all suffering the post-traumatic stress disorder. The first group (N = 50) had combat experience but were imprisoned and tortured as well. Members of the second group (N = 29) had combat experience. A third group (N = 30) consisted of local people with no traumatic experience. Using the Hamilton scale, the Beck Depression Inventory and structured dedicated interviews, we tried to determine whether those groups differed in level of depression based on their different levels of traumatic experience. The results of our study indicate that torture victims showed a significantly higher level of depression that is clinically relevant.

The impact of traumatic experience on attitude towards future in refugee adolescents.

Traumatic experience has overall far reaching consequences on personality. In particular, it has significant impact on teenagers that are just approaching the phase of solving their identity problems. This research examines the relation of traumatic experience and attitude towards the future in two groups of adolescents. The first group consists of 20 adolescents-refugees from the East Slavonia that were settled in Rijeka area with their parents during the last six years. The second group consists of 20 adolescent's local inhabitants that were influenced by the war only indirectly. Results show significant difference between refugees and non-refugees in expressed interpersonal trust, frustration tolerance, and formation of close contacts, adaptability, precaution, bitterness, and social desirability. Both groups show increased depression, pessimism and poor self-control. This might be considered as general characteristic of society in war.

Trauma and suicidality in war affected communities.

PURPOSE: The aim was to assess whether experiences of war trauma remain directly associated with suicidality in war affected communities when other risk factors are considered. MATERIALS AND METHODS: In the main sample 3313 participants from former Yugoslavia who experienced war trauma were recruited using a random sampling in five Balkan countries. In the second sample 854 refugees from former Yugoslavia recruited through registers and networking in three Western European countries. Sociodemographic and data on trauma exposure, psychiatric diagnoses and level of suicidality were assessed. RESULTS: In the main sample 113 participants (3.4%) had high suicidality, which was associated with number of potentially traumatic war experiences (odds ratio 1.1) and war related imprisonment (odds ratio 3) once all measured risk factors were considered. These associations were confirmed in the refugee sample with a higher suicidality rate (10.2%). DISCUSSION AND CONCLUSIONS: Number of potentially traumatic war experiences, in particular imprisonment, may be considered as a relevant risk factor for suicidality in people affected by war.

Psychiatric comorbidity and PTSD-related health problems in war veterans: Cross-sectional study

Background and objectives: PTSD rarely occurs on its own and opinions on the correlation between PTSD and its comorbidities are still divided. Methods: To identify the comorbidity profile of psychiatric diagnoses in PTSD - affected war veterans and to determine the correlation with mental and health problems. Participants and methods: The experimental group consisted of 154 war veterans with combat-related PTSD. The control group was made of 77 veterans without PTSD. The study applied a general demographic questionnaire, the Harvard Trauma Questionnaire - Bosnia and Herzegovina version and the MINI. Results: A 97.4% of PTSD-diagnosed veterans satisfied criteria for other mental disorders and that 44.8% suffered chronic somatic problems. More frequently they suffered from current depressive episode (41.6%), past depressive episode (36.4%), depressive episode with melancholic features (36.4%), dysthymia (13.6%), panic disorder with agoraphobia (11.0%), generalized anxiety disorder (82.5%) alcohol abuse (34.4%) and suicidal ideation (26.0%). Conclusion: The study showed that chronic PTSD in war veterans was almost always accompanied by multiple psychiatric and often somatic comorbidities

No disponible