Use of medical and mental health care by World War II survivors in The Netherlands

Vrije Universiteit Amsterdam, The Netherlands.
Journal of Traumatic Stress (Impact Factor: 2.72). 05/1999; 12(2):243-61. DOI: 10.1023/A:1024720324688
Source: PubMed


This study examined the mental and medical health care utilization of World War II (WW II) survivors and the characteristics of survivors seeking professional health care. Forty seven years after the end of WW II, a random sample of 4,057 Dutch WW II survivors answered a four-page questionnaire; 1,461 persons subsequently answered an extensive follow-up questionnaire. Twenty-two percent had sought some form of health care for war-related complaints at some time since WW II. Most consultations were made in the 1940s. More consultations were made to general practitioners or to medical specialists as opposed to mental health specialists. Although the level of posttraumatic stress disorder (PTSD) symptoms was most important for discriminating between help-seeking and non-help-seeking respondents, 59% of the highly-exposed respondents with PTSD had not sought professional help in the years 1990-1992. The results show the importance of primary health care in recognizing PTSD symptoms and referring survivors to the appropriate professional helper.

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    • "Nevertheless, previous studies in combat and peacekeeping veterans [1] [2] [3] [4] [5]; in victims of rape, physical, or sexual abuse [6]; in survivors of natural disasters [7] and in primary care attendees [8] [9] [10] documented the association with increased health care utilization. Some of these studies exclusively investigate the association of traumatic exposure with increased health care utilization (e.g., [1] [6]), and other studies focus on the association of PTSD with increased health care utilization (e.g., [2] [3] [10]). Generally, studies about the association of traumatic exposure or PTSD with health care utilization found positive associations. "
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    ABSTRACT: Traumatic experiences (TE) and posttraumatic stress disorder (PTSD) are related to impaired mental and physical health and to increased health care utilization (HCU). However, general population studies simultaneously investigating the association of TE and PTSD with HCU in the elderly are lacking to date. A representative sample of 1456 people aged 60-85 years from the German general population was examined using self-rating instruments for TE, PTSD, HCU and physical health (PH). In regression analyses including age and gender, TE are significantly associated with increased probability of visits to specialists and to mental health professionals, and of hospitalization, but not with the frequency of HCU. Current PTSD is significantly associated with increased probability of visits to mental health professionals and of hospitalization, and with increased frequency of general practitioner visits, of specialist visits, and of visits to mental health professionals. In two mediation models, the relationships between TE and PTSD, respectively, with HCU were weakened but remained significant after including PTSD and physical morbidity, respectively. These results indicate that both trauma and PTSD are positively associated to some indicators of HCU. Posttraumatic stress disorder has a weak mediating role in the association of TE and HCU. Physical health has a weak mediating role in the association of PTSD and HCU.
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    ABSTRACT: Most studies of the long-term after-effects of war have focused on survivors seeking treatment or financial compensation. The present study examined the current psychological adjustment of a community sample of ageing World War II (WW II) survivors, including survivors of bombardments, persecution, resistance, combat and other violence. A community sample of 4057 Dutch WW II survivors answered a 4-page postal questionnaire. Of these, 1461 survivors answered a second follow-up questionnaire. Even 50 years after World War II, a statistically significant but modest relationship was found to exist between exposure to shocking war events and current psychological adjustment in terms of symptoms of post-traumatic stress disorder (PTSD), anxiety and anger. A total of 66 respondents (4.6%) met the criteria for PTSD. The highest level of current PTSD (13%) was found among survivors of persecution. The lowest level of PTSD (4%) was found among civilian war victims and resistance participants, while military veterans had an intermediate score (7%). With regard to absolute numbers, civilian war victims represented the largest proportion of PTSD sufferers. In a study of a community sample of WW II survivors, we found that most of these survivors had no severe symptoms of PTSD. Nevertheless, probably tens of thousands of Dutch individuals are still suffering from long-term after-effects from World War II. For these vulnerable survivors, the ageing process will complicate the coping process.
    Acta Psychiatrica Scandinavica 12/1999; 100(5):350-8. · 5.61 Impact Factor

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