Predictors of Chronic Combat-Related Post-Traumatic Stress Disorder Group Psychotherapy Favorable Outcomes; A Prospective Cohort Study in Croatia.

BACKGROUND: Combat-related chronic post-traumatic stress disorder (PTSD) is a therapeutically resistant disorder of the fluctuating course. The success of a group psychotherapy is partial. The aim of this paper is to determine baseline characteristics of veterans for whom a group psychotherapy will be the effective psychotherapeutic treatment. SUBJECTS AND METHODS: We performed this prospective cohort study in two geographically distant institutions: Regional Psychotrauma Center at the Psychiatric Clinic Split, and the Daily Hospital of the Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia. We selected a consecutive sample of 86 veterans with combat-related chronic PTSD admitted to the group psychotherapy during 2009-2012. The primary outcome was ≥5% improvement in PTSD symptoms severity measured by Mississippi Scale for Combat-Related PTSD and adjusted for the baseline Mississippi scale score. Predictors were participants' 17 baseline sociodemographic and clinical characteristics and psychological features like personality traits, stress-coping mechanisms, and depression. RESULTS: We identified two patients' segments with significantly higher likelihood for the favorable treatment outcome. The first one were patients with the low score (≤8) on the phobia scale and high score (≥7) on the hysterical personality scale. In this segment 100% of patients experienced a favorable treatment outcome. The second one were the patiens with a higher score (>8) on the phobia scale, the low score (≤12) on the free-floating anxiety scale and the high score ≥8) on the obsession scale. In this segment, 64% experienced the favorable treatment outcome. CONCLUSION: The favorable outcome of the group psychotherapy of PTSD symptoms severity in patients with combat-related chronic PTSD can be predicted before the start of the treatment. The favorable outcome should be expected in patients with the low phobia and pronounced hysteria personality traits, or in patients with higher phobia, but with low free-floating anxiety and low obsession.

PTSD Symptoms and Coping with COVID-19 Pandemic among Treatment-Seeking Veterans: Prospective Cohort Study.

BACKGROUND: The aim of this study was to examine post-traumatic stress disorder (PTSD) symptom levels and coping strategies during the COVID-19 pandemic among treatment-seeking veterans with pre-existing PTSD. METHOD: A cohort of 176 male treatment-seeking veterans with pre-existing PTSD during the first COVID-19 pandemic lockdown (T1) and 132 participants from the same cohort one year after the onset of the pandemic (T2) participated in a longitudinal study. All participants responded to a COVID-19-related questionnaire and the following measures: the Life Events Checklist for DSM-5 (LEC-5), PTSD Checklist for DSM-5 (PCL-5) and the Brief COPE. RESULTS: The intensity of overall PTSD symptoms, avoidance symptoms and negative alterations in cognitions and mood was lower at T2. PTSD symptoms were not significantly correlated with SARS-CoV-2 potentially traumatic events (PTE) at T2. Veterans scored higher on emotion-focused and problem-focused coping than on dysfunctional coping. CONCLUSIONS: Veterans with pre-existing PTSD who were receiving long-term treatment coped with COVID-19 stressors without the effects of retraumatization and a consequent worsening of PTSD symptoms.

Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis.

BACKGROUND: Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. METHODS: We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. FINDINGS: Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. INTERPRETATION: Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. FUNDING: Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Posttraumatic stress disorder symptoms and coping with the lockdown among help-seeking veterans before and during the COVID-19 pandemic.

AIM: To compare the severity of posttraumatic stress disorder (PTSD) symptoms and of particular PTSD clusters among help-seeking veterans before and during the COVID-19 lockdown. The second aim was to identify the main coping strategies used. METHODS: Male war veterans (N=176) receiving outpatient treatment at the Referral Center for PTSD were assessed at baseline (12-18 months before the pandemic declaration in March 2020) and during the COVID-19 pandemic lockdown (March-June 2020). The Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, and The Brief COPE were used. RESULTS: Direct exposure to the virus in our sample was low, and the majority of participants followed the preventive measures. The severity of the overall PTSD symptoms and of clusters of symptoms significantly decreased compared with the first assessment. At the second assessment, all participants still fulfilled the PTSD diagnosis criteria. During the lockdown, the participants used emotion-focused and problem-focused coping rather than dysfunctional coping. CONCLUSION: The severity of PTSD symptoms decreased during the lockdown. Further research is needed to study the trajectories of long-term psychopathology.

Mental health status and risk factors during Covid-19 pandemic in the Croatia's adult population.

Background: The Covid-19 pandemic is associated with adverse mental health outcomes for people worldwide.Objective: The study aimed to assess mental health during the Covid-19 pandemic and the key risk factors from the human ecology perspective in Croatia's adult population.Method: An online panel survey with 1,201 adult participants (50.1% women) was done with a nationally representative sample in terms of gender, age, and country region four months after the nation lockdown began and two months after most of the restrictions were lifted. Indicators of mental health included symptoms of adjustment disorder (ADNM-8); depression, anxiety, and stress (DASS-21); symptoms of post-traumatic stress disorder (PC-PTSD-5); and well-being (WHO-5).Results: In the entire sample, 9.8% (95% confidence interval [CI]: 7.9%, 14.0%) of the participants were at risk of adjustment disorder, 7.7% (95% CI: 6.7%, 11.9%) were at risk of depression disorder, and 7.8% (95% CI: 5.3%, 10.3%) were at risk of anxiety disorder. In addition, 7.2% (95% CI: 5.3%, 10.2%) were experiencing high levels of stress. The average well-being score was 56.5 (SD = 21.91) on a scale from 0 to 100. Among the participants who have lifetime traumatic experience (n = 429), 14% (95% CI: 10.6%, 17.2%) were at risk for PTSD. Key risk factors for specific mental health outcomes differed, but the common ones included: current health status, previous mental health diagnosis, and psychological resilience. Being younger, having a below-average income, and excessively following news about Covid-19 were predictive for some of the mental health problems.Conclusions: Together, the key risk factors identified in this study indicate the need for public health interventions addressing the general population's mental health, but also for specific risk groups. Lower rates of mental health symptoms assessed soon after lifting quarantine measures that have been found in other studies may indicate human resilience capacity.

Key risk factors for mental health disorders during the Covid-19 pandemic in Croatia were: current health status, previous mental health diagnosis, psychological resilience, younger age, below-average income, and excessively following news about the pandemic.

Complex PTSD among treatment-seeking veterans with PTSD.

Background: In the ICD-11 hierarchical classification structure, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are separate and distinct but also 'sibling' disorders, meaning that the diagnoses follow from the parent category of traumatic stress disorders. Objective: The aim of this study was to examine the prevalence of CPTSD in treatment-seeking war veterans with PTSD more than 20 years after the exposure to cumulative war-related trauma(s). The second aim was to examine if there was an association between demographic and psychosocial variables and CPTSD or PTSD. Method: A sample of 160 male war veterans with PTSD referred to the outpatient service of the PTSD Referral Centre at the Clinical Hospital Centre (CHC) Rijeka participated in a cross-sectional study. Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview (MINI) and participants completed validated self-report measures: The Life Events Checklist for DSM-5 (LEC-5), International Trauma Questionnaire (ITQ). Results: In total, 80.63% of the sample met criteria for a probable diagnosis of CPTSD. The study revealed that there was no significant difference in the length of deployment, in the intensity of the PTSD symptoms, types of trauma exposure and pharmacotherapeutic treatment between PTSD and CPTSD group. It was found that veterans with PTSD were more likely to be divorced and to participate in PTSD clubs. On the other hand, veterans with CPTSD were significantly more likely to have higher levels of functional impairment and comorbidity with general anxiety disorder (GAD) compared to the PTSD group. Conclusions: This study supports the proposition that a prolonged trauma of severe interpersonal intensity such as war is related to high rates of CPTSD among treatment-seeking veterans, years after the war. The distinction between PTSD and complex PTSD may help the selection of person-centred treatment interventions that would target specific mental health and functional problems in patients.

Antecedentes: En la estructura de clasificación jerárquica de la CIE-11, el trastorno por estrés postraumático (TEPT) y el TEPT complejo (TEPT-C) son trastornos separados y distintos, pero también "hermanos", lo que significa que los diagnósticos se derivan de la categoría principal de los trastornos por estrés traumático.Objetivo: El objetivo de este estudio fue examinar la prevalencia del TEPT-C en veteranos de guerra en busca de tratamiento con TEPT más de 20 años después de la exposición a trauma(s) acumulado(s) relacionado(s) con la guerra. El segundo objetivo fue examinar si había una asociación entre las variables demográficas y psicosociales y el TEPT-C o el TEPT.Método: Una muestra de 160 veteranos de guerra, varones con TEPT derivados al servicio ambulatorio del Centro de Referencia del TEPT en el Centro Clínico Hospitalario (CCH) Rijeka, participó en un estudio transversal. La comorbilidad psiquiátrica se evaluó utilizando la Mini-International Neuropsychiatric Interview (MINI) y los participantes completaron las medidas validadas de autoinforme: La Lista de Verificación de Eventos Vitales para el DSM-5 (LEC-5 en su sigla en inglés), Cuestionario Internacional de Trauma (ITQ en su sigla en inglés).Resultados: En total, el 80.63% de la muestra cumplió con los criterios para un diagnóstico probable de TEPT-C. El estudio reveló que no hubo diferencias significativas en la duración del despliegue, en la intensidad de los síntomas del TEPT, los tipos de exposición al trauma y el tratamiento farmacoterapéutico entre el grupo de TEPT y TEPT-C. Se descubrió que los veteranos con TEPT tenían más probabilidades de divorciarse y participar en clubes de TEPT. Por otro lado, los veteranos con TEPT-C tenían significativamente más probabilidades de tener mayores niveles de deterioro funcional y comorbilidad con Trastorno de Ansiedad General (TAG) en comparación con el grupo de TEPT.Conclusiones: Este estudio apoya la propuesta de que un trauma prolongado de intensidad interpersonal severa, como la guerra, está relacionado con altas tasas de TEPT-C entre los veteranos que buscan tratamiento, años después de la guerra. La distinción entre el TEPT y el TEPT complejo podría ayudar a la selección de intervenciones de tratamiento centradas en la persona, que apunten a problemas funcionales y de salud mental específicos en los pacientes.

Effects of Psychosocial Day Care Programme on Quality of Life in Patients Affected with Schizophrenia - a Prospective Study.

BACKGROUND: The basic aim of this prospective research was to establish the effect of psychosocial day care programme on the therapy outcomes in patients with schizophrenia. SUBJECTS AND METHODS: While 115 patients with schizophrenia were invited to participate, 100 of them completed the study and were subdivided into two groups. In addition to pharmacotherapy, the experimental group only (N=50) was integrated into a day-hospital-based psychosocial day care programme. The instruments were applied in three phases: the first measurement for experimental group subjects took place on the first day of psychosocial day-care programme, while for the control group subjects the same was performed on the last day of inpatient care. The second measurement for the experimental group was performed in the end of psychosocial day-care programme, while for the control group patients it occurred four months after inpatient treatment. The third measurement was carried out six months after the second one. The following instruments were applied: General Demographic Questionnaire at the first measurement, Manchester Short Assessment of Quality of Life-MANSA both at the first and third measurement, and Positive and Negative Symptoms Scale-PANSS at all three measurements. RESULTS: Experimental group patients showed a statistically significant increase in quality of life outcomes as well as statistically significant decrease in positive symptoms and general psychopathology at all three measurements and with regard to the control group. As to the negative symptoms, only the third measurement revealed a statistically significant difference. CONCLUSION: The results obtained indicate that the adjuvant treatment of psychosocial day care programme has a positive effect on treatment outcomes: on the increase of the patients' quality of life, and, to some extent, on the decrease of symptom intensity in positive symptoms in schizophrenia spectrum. However, the effect of psychosocial day-care programme on the negative symptoms was proved to be considerably smaller.

Relationship of early-life trauma, war-related trauma, personality traits, and PTSD symptom severity: a retrospective study on female civilian victims of war.

BACKGROUND: Consequences of war-related traumatisation have mostly been investigated in military and predominant male populations, while research on female civilian victims of war has been neglected. Furthermore, research of post-war posttraumatic stress disorder (PTSD) in women has rarely included early-life trauma in their prediction models, so the contribution of trauma in childhood and early youth is still unexplored. OBJECTIVE: To examine the relationship of early-life trauma, war-related trauma, personality traits, and symptoms of posttraumatic stress among female civilian victims of the recent war in Croatia. METHOD: The cross-sectional study included 394 participants, 293 war-traumatised adult women civilians, and 101 women without war-related trauma. Participants were recruited using the snowball sampling method. The applied instruments included the Clinician-Administrated PTSD Scale (CAPS), the NEO Personality Inventory-Revised (NEO-PI-R), the War Stressors Assessment Questionnaire (WSAQ), and the Early Trauma Inventory Self Report-Short Form (ETISR-SF). A hierarchical multiple regression analysis was performed to assess the prediction model of PTSD symptom severity measured by CAPS score for current PTSD. RESULTS: The prevalence of current PTSD (CAPS cut-off score=65) in this cohort was 20.7%. The regression model that included age, early-life trauma, war-related trauma, neuroticism, and extraversion as statistically significant predictors explained 45.8% of variance in PTSD symptoms. CONCLUSIONS: Older age, exposure to early-life trauma, exposure to war-related traumatic events, high neuroticism, and low extraversion are independent factors associated with higher level of PTSD symptoms among women civilian victims of war.

Drug utilization trends in patients with posttraumatic stress disorder in a postconflict setting: consistency with clinical practice guidelines.

OBJECTIVE: The objective of this study was to compare observed patterns of drug utilization among patients with posttraumatic stress disorder (PTSD) in a postconflict setting with current guidelines and to present baseline period prevalence and change in period prevalence from 2 time periods, 2002 and 2012. METHOD: The study provides details of the annual number of patients with PTSD with at least 1 redeemed prescription containing the diagnostic code F43.1 according to International Classification of Diseases (ICD-10) for fiscal years 2002 through 2012 in Croatia. Using longitudinal data analysis, overall change in medication use frequency was calculated for each medication and therapeutic subgroup classified by the Anatomic Therapeutic Chemical classification system according to absolute frequency. RESULTS: Over the 11-year study period, the number of patients receiving pharmacotherapy associated with PTSD increased 7-fold. The annual frequency of drug use was highest for anxiolytics, with use of anxiolytics increasing from 73.32% in 2002 to 75.83% in 2012; antidepressants, from 44.56% to 61.36%; hypnotics, from 18.67% to 35.68%; and antipsychotics, from 21.81% to 30.21%. Overall change in drug utilization frequency was most prominent for hypnotics (17.01%), antidepressants (16.80%), and antipsychotics (8.40%) during the period 2002-2012. CONCLUSIONS: Drug utilization trends in our postconflict setting were predominantly inconsistent with current guidelines for treatment of PTSD due to excessive anxiolytic use, implying that psychopharmacotherapy was used mainly for tranquilizing properties to address non-diagnosis-specific symptoms. Promising rising trends in utilization of antidepressants were not followed with compensatory reductions in anxiolytic use. These data revealed areas of inconsistent use of drugs, generating suggestions for interventions to improve drug use and also hypotheses for additional research.

Depression and auto-aggressiveness in adolescents in Zagreb.

BACKGROUND: The aim of the study was to explore the frequency of depression among the general population of adolescents who were high school students in the city of Zagreb. As depression is associated with increased suicidal risk we wanted to check to what extent depression, as an emotional problem among youth, is associated with auto-aggression in the general population of adolescents. SUBJECTS AND METHODS: The study was conducted on a sample of high school students in Zagreb and it included 701 students of both genders aged from 14-19 years of age. To test the depression a Beck Depression Inventory (BDI) was administered for youth between 11-18 years of age (Youth Self Report for ages 11-18). To test auto-aggression a Scale of Auto-destructiveness (SAD) was used. RESULTS: Results obtained by this study show that about 20.7% of high school students have mild and borderline depressive disorders while moderate or severe depression shows about 5% of them, whereby depression is statistically significant among girls who, on average, report more symptoms of depression. It has also been proven a significant impact of depression levels (F (2,423)=35.860, p<0.001) on auto-aggression in subjects of both genders. In both genders, moderately depressed show more auto destructiveness than those without depression symptoms (p<0.01). In the group of heavily depressed (n=30), significantly higher self-destructiveness is shown by girls (p<0.01). CONCLUSIONS: The data suggest the importance of early recognition, understanding and treatment of depressive symptoms in adolescents in order to reduce the risk of subsequent chronic psychosocial damage.

Outcome of treatment with antidepressants in patients with hypertension and undetected depression.

OBJECTIVE: The objective of the research was to determine whether the administration of antidepressants, concurrently with antihypertensive therapy, leads to the better regulation of blood pressure in patients with hypertension and increased depressiveness. METHODS: Research was conducted in two outpatient family clinics in Rijeka, Croatia, on 452 patients with arterial hypertension who had not been diagnosed with depression prior to the study. The diagnosis of hypertension was made in accordance with the European Society of Hypertension and the European Society of Cardiology Guidelines for the Management of Arterial Hypertension. Using the Beck Depression Inventory and the ICD-10 criteria for depression, a group of depressed hypertensive patients (N = 134) was selected. Out of a total of 134 selected patients, 73 patients (N = 73) were receiving antidepressants together with antihypertensives for 24 weeks. They formed the experimental group. The rest of the patients (N = 61) continued to receive only antihypertensives and they formed the control group. RESULTS: After the end of the 24-week therapy, the experimental group of patients had significantly lower levels of both systolic and diastolic blood pressure (Z = 7.42; P < 0.001; and Z = 7.36; P < 0.001). The control group saw no significant difference between the level of blood pressure (both systolic and diastolic) prior to and after this period. CONCLUSION: The application of antidepressant therapy in patients with hypertension who are also depressed may be associated with the better control of blood pressure, which reduces the risk of cardiovascular disease in addition to alleviating depressive symptoms.

Recovery from posttraumatic stress symptoms: a qualitative study of attributions in survivors of war.

OBJECTIVE: The study explored factors to which people traumatized by war attribute their recovery from posttraumatic symptoms and from war experiences. METHODS: In-depth interviews were conducted with two groups of participants with mental sequelae of the war in the former Yugoslavia: 26 people who had recovered from posttraumatic stress disorder (PTSD) and 17 people with ongoing symptoms of PTSD. Participants could attribute their recovery to any event, person or process in their life. The material was subjected to thematic analysis. RESULTS: Eight themes covered all factors to which participants attributed their recovery. Six themes described healing factors relevant for both groups of participants: social attachment and support, various strategies of coping with symptoms, personality hardiness, mental health treatment, received material support, and normalization of everyday life. In addition to the common factors, recovered participants reported community involvement as healing, and recovered refugees identified also feeling safe after resolving their civil status as helpful. Unique to the recovered group was that they maintained reciprocal relations in social attachment and support, employed future-oriented coping and emphasised their resilient personality style. CONCLUSIONS: The reported factors of recovery are largely consistent with models of mental health protection, models of resilience and recommended interventions in the aftermath of massive trauma. Yet, they add the importance of a strong orientation towards the future, a reciprocity in receiving and giving social support and involvement in meaningful activities that ensure social recognition as a productive and valued individual. The findings can inform psychosocial interventions to facilitate recovery from posttraumatic symptoms of people affected by war and upheaval.

Subjective quality of life in war-affected populations.

BACKGROUND: Exposure to traumatic war events may lead to a reduction in quality of life for many years. Research suggests that these impairments may be associated with posttraumatic stress symptoms; however, wars also have a profound impact on social conditions. Systematic studies utilising subjective quality of life (SQOL) measures are particularly rare and research in post-conflict settings is scarce. Whether social factors independently affect SQOL after war in addition to symptoms has not been explored in large scale studies. METHOD: War-affected community samples were recruited through a random-walk technique in five Balkan countries and through registers and networking in three Western European countries. The interviews were carried out on average 8 years after the war in the Balkans. SQOL was assessed on Manchester Short Assessment of Quality of Life--MANSA. We explored the impact of war events, posttraumatic stress symptoms and post-war environment on SQOL. RESULTS: We interviewed 3313 Balkan residents and 854 refugees in Western Europe. The MANSA mean score was 4.8 (SD = 0.9) for the Balkan sample and 4.7 (SD = 0.9) for refugees. In both samples participants were explicitly dissatisfied with their employment and financial situation. Posttraumatic stress symptoms had a strong negative impact on SQOL. Traumatic war events were directly linked with lower SQOL in Balkan residents. The post-war environment influenced SQOL in both groups: unemployment was associated with lower SQOL and recent contacts with friends with higher SQOL. Experiencing more migration-related stressors was linked to poorer SQOL in refugees. CONCLUSION: Both posttraumatic stress symptoms and aspects of the post-war environment independently influence SQOL in war-affected populations. Aid programmes to improve wellbeing following the traumatic war events should include both treatment of posttraumatic symptoms and social interventions.

Secondary traumatisation and systemic traumatic stress.

Traditionally, research has been focused on the development of symptoms in direct trauma survivors. However, during the last two decades researchers and clinicians have started exploring the way individual traumatic stress exposure affects trauma victims' spouses, children and professional caregivers. Studying trauma within the family is a part of what is called systemic traumatology, a study of groups, institutions and other human systems that show stress reactions directly caused by a traumatic event or series of events. The effect of an individual's traumatic stress on family members and on persons in direct contact is conceptualized as secondary traumatisation. In its narrow sense, secondary traumatisation involves a transfer of nightmares, intrusive thoughts, flashbacks and other Posttraumatic Stress Disorder symptoms, which are typically experienced by individuals suffering from PTSD, onto their immediate surroundings. In its broader sense, the term refers to any kind of distress transfer from a trauma victim to their immediate surroundings, and includes a broad spectrum of distress manifestation along with that resembling Posttraumatic Stress Disorder. Beyond that, a family member's PTSD is potentially transferable to subsequent generations, interfering with the psychological development of children.

The utilization and perceived usefulness of health care and other support services by people exposed to traumatic events related to the war in the Balkans.

OBJECTIVE: To explore which health care and other support services people exposed to traumatic events related to the war use, how helpful they perceive them in the course of their post-war adaptation and whether utilization and perceived usefulness depend on the mental health status of participants. METHODS: A community sample of 3304 adults exposed to at least one war-related traumatic event was randomly selected in different regions in the former Yugoslavia. A specifically designed instrument, the Matrix for the Assessment of Community and Healthcare Services, was used to record service utilization and their perceived usefulness. The mental health status of participants was assessed using the Mini International Neuropsychiatric Interview. RESULTS: Primary health care was the most frequently used type of service (80.5%). Services providing help with leisure activities, social support and social contacts were perceived as most helpful. Participants with current post-traumatic stress disorder used all types of health care services and employment support services significantly more often than participants without mental disorders and participants with other mental disorders. They were more satisfied with primary health care services than participants without mental disorders and less satisfied with financial and material support services as compared to participants with other mental disorders. CONCLUSIONS: The frequency of utilization of different types of services varies greatly in war affected communities. Medical services are widely used and therefore have a central role in the care provision following a war. Services providing help with leisure activities and social support are most appreciated and may be more widely established.

Co-occurrence of major depressive episode and posttraumatic stress disorder among survivors of war: how is it different from either condition alone?

OBJECTIVE: Major depressive episode (MDE) and posttraumatic stress disorder (PTSD) have been shown to be the most common mental disorders following traumatic war experiences and have been found to frequently co-occur. This study, designed as a randomized cross-sectional interview survey, aimed to identify whether the co-occurence of MDE and PTSD following exposure to war-related experiences is associated with different demographics, exposure to previous traumatic events, and clinical characteristics than either condition alone. METHOD: After a random-walk technique was used to randomly select participants, face-to-face interviews were conducted among war-affected community samples in 5 Balkan countries (N = 3,313) in the years 2006 and 2007. The mean age of participants was 42.3 years, and all participants had experienced potentially traumatic events during war in the countries of the former Yugoslavia. Current prevalence rates of MDE and PTSD and suicide risk were assessed using the Mini-International Neuropsychiatric Interview. Levels of general psychological distress, posttraumatic stress, and quality of life were assessed with self-reports. RESULTS: 30.5% of the sample met DSM-IV diagnostic criteria for either MDE or PTSD, and 9.1% had both disorders. Participants with concomitant MDE and PTSD reported significantly higher numbers of prewar and postwar traumatic events than participants with PTSD only and higher numbers of war-related events than those with MDE only (all P values < .001). Participants with both MDE and PTSD had significantly higher levels of general psychological and posttraumatic stress symptoms, a higher suicide risk, and lower levels of quality of life than participants with either condition alone (all P values < .001). CONCLUSIONS: Concomitant MDE and PTSD are associated with the experience of different traumatic events and are characterized by more general psychological distress than either condition alone. The assessment of concomitant MDE and PTSD can facilitate better identification of individuals with severe psychopathology and poor quality of life. People with co-occurrence of MDE and PTSD may require specific health care programs following war.

Psychological symptoms as long-term consequences of war experiences.

BACKGROUND/AIMS: War experiences can affect mental health, but large-scale studies on the long-term impact are rare. We aimed to assess long-term mental health consequences of war in both people who stayed in the conflict area and refugees. METHOD: On average 8 years after the war in former Yugoslavia, participants were recruited by probabilistic sampling in 5 Balkan countries and by registers and networking in 3 Western European countries. General psychological symptoms were assessed on the Brief Symptom Inventory and posttraumatic stress symptoms on the Impact of Event Scale-Revised. RESULTS: We assessed 3,313 interviewees in the Balkans and 854 refugees. Paranoid ideation and anxiety were the severest psychological symptoms in both samples. In multivariable regressions, older age, various specific war experiences and more traumatic experiences after the war were all associated with higher levels of both general psychological and posttraumatic stress symptoms in both samples. Additionally, a greater number of migration stressors and having only temporary legal status in the host country were associated with greater severity of symptoms in refugees. CONCLUSIONS: Psychological symptoms remain high in war-affected populations many years after the war, and this is particularly evident for refugees. Traumatic war experiences still predict higher symptom levels even when the findings have been adjusted for the influence of other factors.

Family factors associated with auto-aggressiveness in adolescents in Croatia.

The aim of this research is to look into the roles of families' social situation and cohesion in adolescent auto-aggressiveness in Croatia. The research was conducted on a sample of Zagreb high school students which encompassed 701 pupils of both genders aged 14-19. The basic demographic data were obtained using the Structured Demographic and Family Data Questionnaire. Auto-aggressiveness was tested using a section of the Report on Youth Aged 11-18 and the Scale of Auto-destructiveness--SAD, whereas the family cohesion was tested with the Family Adaptability and Cohesion Evaluation Scales FACES III. The obtained results show differences according to the gender: girls are more prone to auto-aggressiveness than boys (t = -3.385, df = 565, p = 0.001) and girls more often show symptoms of destructiveness (t = -3.809, df = 637, p < 0.001) and anxiety (t = -6.562, df = 640, p < 0.001), while boys show pronounced aggressiveness (t = 2.655, df = 653, p = 0.008). Significant family factors associated with auto-aggressiveness are parents' marital status (chi2 = 18.039, df = 4, p = 0.001), their financial situation (F(2.548) = 4.604, p = 0.010), alcoholic father (chi2 = 9.270, df = 2, p = 0.010), mentally ill mother (t = 5.264, df = 541, p < 0.001), as well as mentally ill father (t = 4.744, df = 529, p < 0.001), and corporal punishment by mother (F(2.542) = 8.132, p < 0.001) or father (F(2.530) = 5.341, p = 0.005). Adolescents from split families show more auto-aggressiveness. Family cohesion appears to be considerably associated with auto-aggressiveness and the adolescents that see their families as less cohesive have more mental problems (chi2 = 29.98, df = 2, p < 0.001). There is a connection between auto-destructive behavior in adolescents and family factors. Knowledge of family's social situation and cohesion may help understand, prevent and treat auto-aggressiveness in adolescents.

Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder.

BACKGROUND: Along with primary traumatization, wives of PTSD-diagnosed war veterans often become victims of the altered and dysfunctional state of their partners, which adds to the severity of symptoms of primary traumatization and furthers the development of other mental disorders. The aim of this study was to compare the effects of primary and secondary traumatization in wives of PTSD-diagnosed war veterans and wives of war veterans without PTSD. SUBJECTS AND METHODS: The experimental group consisted of 154 wives whose veteran husbands had been treated in Mostar Clinical Hospital for psychotrauma-induced PTSD. The control group was formed of 77 wives of war veterans who do not suffer from PTSD. The research used a general demographic questionnaire, the Harvard Trauma Questionnaire (HTQ) and the MINI International Neuropsychiatric Interview. RESULTS: Wives of veterans with chronic PTSD experienced a significantly greater number of traumatic events (t=2.66; p=0.008) and had higher scores of PTSD symptoms (t=8.93; p<0.001). A significantly larger number of these women reported chronic somatic diseases (χ²=4.553; p=0.033). Furthermore, wives of PTSD-affected veterans significantly more frequently met criteria for current depression episode (χ²=20.65; p<0.001), past depression episode (χ²=24.40; p<0.001), depression with melancholic features (χ²=19.20; p<0.001), dysthymia (χ²=7.15; p=0.007), panic disorder with agoraphobia (χ²=5.28; p=0.022), PTSD (χ²=18.39; ss=1; p<0.001) and generalized anxiety disorder (χ²=19.58; p<0.001). This group also showed a higher level of suicidality (χ²=8.95; p=0.003). CONCLUSION: The findings of this research show how mental difficulties experienced by wives of PTSD-diagnosed war veterans affect the interrelationship of their primary and secondary traumatization.