a1 Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
a2 Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
a3 Faculty of Philosophy, University of Zagreb, Croatia
a4 School of Medicine, University of Rijeka, Croatia
a5 Department of Psychiatry, University of Modena and Reggio Emilia, Italy
a6 School of Medicine, University of Sarajevo, Bosnia and Herzegovina
a7 Belgrade University School of Medicine, Belgrade, Serbia
a8 Department of Clinical Psychology, University of Amsterdam, The Netherlands
a9 Faculty of Philosophy, University of Skopje, FYR Macedonia
a10 Department of Psychiatry and Psychotherapy, University of Technology, Dresden, Germany
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.
(Received December 22 2011)
(Revised August 02 2012)
(Accepted October 25 2012)
(Online publication November 29 2012)