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.

    • "People with comorbid major depression and PTSD at admission may be of special concern to develop persistent major depression during imprisonment. Especially for this comorbidity, unfavorable courses of symptoms over long-term follow up periods have been observed among traumatized people in the community (Priebe et al., 2013). PTSD receives increasing clinical recognition in prison populations (Wolff et al., 2015). "
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    ABSTRACT: Background: First longitudinal studies in prisoners point to improvements of depressive symptoms during imprisonment. The aim of the present study was to assess the course of major depressive disorder during imprisonment and to identify factors influencing remission. Methods: Prisoners with major depressive disorder in a sample of consecutive admissions to the penal justice system in Santiago de Chile were reassessed after one year of imprisonment. Psychiatric diagnoses were established using the Mini-International Neuropsychiatric Interview; psychological symptoms were assessed with the Symptom-Check-List 90 Revised (SCL-90-R). Mean symptom scores were compared at baseline and follow-up using Student's t-test. Odds ratios (OR) of comorbid disorders and socio-demographic factors at baseline to predict depression at follow-up were calculated. Results: N=79 out of 80 inmates (99%) with major depression at baseline were included. Thirty-five prisoners (44%) had major depression at follow-up. The mean global severity score and all mean subscale scores of the SCL-90-R improved. High suicide risk was present in 37 prisoners (47%) at admission and in 11 (14%) at follow-up. The comorbid diagnosis of PTSD (OR 6.3; p<0.001) at admission and having been previously imprisoned (OR 2.5; p=0.05) predicted major depressive disorder at follow-up. Limitations: The study could not account for temporary improvements between the assessments. Conclusion: In spite of important symptom improvements, only about half of the prisoners with major depression at admission remit after one year of imprisonment. New interventions should target people with major depression and comorbid PTSD at admission.
    Journal of Affective Disorders 09/2015; 189. DOI:10.1016/j.jad.2015.09.003 · 3.38 Impact Factor
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    • "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
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    • "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. "
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    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
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