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

Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
Psychological Medicine (Impact Factor: 5.94). 09/2013; 43:1837-1847. DOI: 10.1017/S0033291712002681
Source: PubMed


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.

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.

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.

69 Reads
  • Source
    • "remitted) PTSD symptomatology for up to 4-year follow-up. This general finding has been obtained from prospective studies among war-affected communities/refugees (Cohen et al., 2011; Priebe et al., 2013), disaster survivors or rescue workers (Cukor et al., 2011; Fullerton, Ursano, & Wang, 2004; Lai, La Greca, Auslander, & Short, 2013; Tural et al., 2012), sexual assault survivors (Darves et al., 1998), and medical settings (Zatzick et al., 2006). "
    Nordic psychology 09/2015; · 0.18 Impact Factor
  • Source
    • "The total score was used as a measure of traumatization (a 00.96). The translated scale has been shown to retain the original metric properties (Morina et al., 2010) and has been widely used on different war-affected samples in the former Yugoslavia (e.g., Priebe et al., 2013). The Changed Worldview Scale (CWS; Corkalo & Ajdukovic, 2002) measures changes attributed to warrelated experiences in a set of basic beliefs about the world as a just, safe and trustful place. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Traumatic experience can affect the individual's basic beliefs about the world as a predictable and safe place. One of the cornerstones in recovery from trauma is reestablishment of safety, connectedness, and the shattered schema of a worldview. Objective This study explored the role of negatively changed worldview in the relationship between war-related traumatization and readiness for social reconstruction of intergroup relations in a post-conflict community measured by three processes: intergroup rapprochement, rebuilding trust, and need for apology. It was hypothesized that more traumatized people are less supportive of social reconstruction and that this relationship is mediated by the changed worldview. Method The study included a community random sample of 333 adults in the city of Vukovar, Croatia, that was most devastated during the 1991–1995 war. Six instruments were administered: Stressful Events Scale, Impact of Event Scale-Revised, Changed Worldview Scale, and three scales measuring the post-conflict social reconstruction processes: Intergroup Rapprochement, Intergroup Trust and Need for Apology. Results Mediation analyses showed that the worldview change fully mediated between traumatization and all three aspects of social reconstruction. Conclusions In a population exposed to war traumatization the worldview change mediates post-conflict social recovery of community relations.
    European Journal of Psychotraumatology 09/2014; 5. DOI:10.3402/ejpt.v5.24098 · 2.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Evidence suggests that post-traumatic stress disorder (PTSD) is associated with substantially reduced subjective quality of life (SQOL). This study aimed to explore whether and how changes in the levels of PTSD symptom clusters of intrusion, avoidance and hyperarousal are associated with changes in SQOL. Two samples with PTSD following the war in former Yugoslavia were studied, i.e. a representative sample of 530 people in five Balkan countries and a non-representative sample of 215 refugees in three Western European countries. They were assessed on average eight years after the war and re-interviewed one year later. PTSD symptoms were assessed on the Impact of Event Scale - Revised and SQOL on the Manchester Short Assessment of Quality of Life. Linear regression and a two-wave cross lagged panel analysis were used to explore the association between PTSD symptom clusters and SQOL. The findings in the two samples were consistent. Symptom reduction over time was associated with improved SQOL. In multivariable analyses adjusted for the influence of all three clusters, gender and time since war exposure, only changes in hyperarousal symptoms were significantly associated with changes in SQOL. The two-wave cross-lagged panel analysis suggested that the link between hyperarousal symptoms and SQOL is bidirectional. Low SQOL of patients with war-related PTSD is particularly associated with hyperarousal symptoms. The findings suggest a bidirectional influence: a reduction in hyperarousal symptoms may result in improved SQOL, and improvements in SQOL may lead to reduced hyperarousal symptoms.
    PLoS ONE 04/2013; 8(4):e60991. DOI:10.1371/journal.pone.0060991 · 3.23 Impact Factor