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Melese M, Maru L, Esubalew D. Posttraumatic stress disorder and its associated factors among people living in Dabat district, northwest Ethiopia. Front Psychiatry 2024; 15:1359382. [PMID: 39140107 PMCID: PMC11320060 DOI: 10.3389/fpsyt.2024.1359382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/10/2024] [Indexed: 08/15/2024] Open
Abstract
Background The conflict between the Ethiopian government and the Tigray People's Liberation Front (TPLF) in the Dabat district of Ethiopia has led to significant civilian casualties, instances of rape, sexual abuse, and property theft. These traumatic events contribute to the development of post-traumatic stress disorder (PTSD) among local residents. However, there is currently no available data on the prevalence of PTSD and its associated factors in this region. This study seeks to fill this gap by assessing PTSD prevalence and identifying related factors among residents of the war-affected Dabat district in northwest Ethiopia. Method A community-based correctional study was conducted in the Woken and China kebeles of Dabat district, northwest Ethiopia, spanning from July 13 to September 19, 2023. A total of 410 participants were selected using systematic random sampling, making a 100% response rate. The study utilized an interviewer-administered questionnaire, which included the Post-Traumatic Stress Disorder Checklist (PCL-5) to assess PTSD. The research investigated the association between PTSD and various demographic and psychosocial characteristics using both bivariate and multivariable binary logistic regression analyses. Statistical significance was set at a P-value of 0.05. Results The majority of participants in the study were male (62%) with a mean age of 33 ( ± 1.67) years. The overall prevalence of PTSD was 30.7% (95% CI: 26.6-35.10). Multivariable logistic regression analysis identified several factors significantly associated with PTSD: symptoms of depression (AOR=3.5; 95% CI: 1.13-6.89), age between 45 and 67 years (AOR=1.68; 95% CI: 1.04-5.78), experiencing stressful life events (AOR=1.63; 95% CI: 1.05-7.86), experiencing sexual abuse or rape (AOR=1.53; 95% CI: 1.07-6.75), chewing khat (AOR=1.48; 95% CI: 1.08-4.56), being female (AOR=1.43; 95% CI: 1.13-3.67), and having an income of 34.6 USD (AOR=1.28; 95% CI: 1.07-4.67). Conclusion and recommendation This study reported that the prevalence of PTSD was high. As a result, the study suggested that governments and other stakeholders should be involved in implementing efficient interventions and quick measures to mitigate the effects of war on mental health following the conflict. The government and nongovernmental organizations were also advised by these studies to continue providing humanitarian assistance, which should include access to food, clean water, clothing, shelter, and education. This study also suggested that people living in conflict zones should be legally protected from rape, sexual abuse, arson, detention without cause, and kidnapping.
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Affiliation(s)
- Mihret Melese
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Lemlemu Maru
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dereje Esubalew
- Department of Human Physiology, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia Region, Ethiopia
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Rahnejat AM, Ebrahimi M, Salimi SH, Fathi Ashtiani A, Taghva A, Mohammadi T, Shahed Hagh Ghadam H, Shahmiri Barzoki H. Comparing the effect of prolonged exposure therapy (PET) and metacognitive therapy (MCT) on the quality of life among veterans with PTSD. MILITARY PSYCHOLOGY 2024; 36:422-430. [PMID: 38913765 PMCID: PMC11197894 DOI: 10.1080/08995605.2023.2195328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/17/2023] [Indexed: 06/26/2024]
Abstract
Veterans' quality of life (QoL) can be drastically affected by posttraumatic stress disorder (PTSD). We compared prolonged exposure therapy (PET) with metacognitive therapy (MCT) in their effects on quality of life (QoL) among veterans with post-traumatic stress disorder (PTSD). Overall, 57 veterans with PTSD were randomly assigned to three groups MCT (N = 17), PET (N = 17), and Control (N = 23). The 36-item short-form survey (SF-36) was used to evaluate QoL pretest, posttest, and after a 3-month follow-up. The MCT was based on the practice of detached mindfulness, controlling rumination/anxiety, and challenging negative beliefs about symptoms. The PET was based on in-vivo and imaginal exposure to trauma-related events, and discontinuation of avoidance-oriented coping strategies. Both MCT and PET groups significantly improved QoL at posttest and follow-up, compared with the control group (P < .001); however, the MCT and PET groups showed no significant difference at posttest (P = .644) or follow-up (P = .646). Our results support the efficacy of PET as the standard for PTSD treatment, while also signifying the effectiveness of MCT at increasing the QoL in war-related PTSD at a 3-month follow-up.
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Affiliation(s)
- Amir Mohsen Rahnejat
- Behavioral and Cognitive Science Research Center, Department of Clinical Psychology, Aja University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ebrahimi
- Behavioral and Cognitive Science Research Center, Department of Psychiatry, Aja University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Salimi
- Research Center for Exercise Physiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Fathi Ashtiani
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Arsia Taghva
- Behavioral and Cognitive Science Research Center, Department of Psychiatry, Aja University of Medical Sciences, Tehran, Iran
| | - Tina Mohammadi
- Faculty of Psychology and Educational Sciences, Allameh Tabataba’i University, Tehran, Iran
| | | | - Hassan Shahmiri Barzoki
- Behavioral and Cognitive Science Research Center, Department of Psychiatry, Aja University of Medical Sciences, Tehran, Iran
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Yennu A, Tian F, Smith-Osborne A, J Gatchel R, Woon FL, Liu H. Prefrontal responses to Stroop tasks in subjects with post-traumatic stress disorder assessed by functional near infrared spectroscopy. Sci Rep 2016; 6:30157. [PMID: 27452397 PMCID: PMC4995363 DOI: 10.1038/srep30157] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 06/29/2016] [Indexed: 11/10/2022] Open
Abstract
Studies on posttraumatic stress disorder (PTSD) showing attentional deficits have implicated abnormal activities in the frontal lobe. In this study, we utilized multichannel functional near-infrared spectroscopy (fNIRS) to investigate selective attention-related hemodynamic activity in the prefrontal cortex among 15 combat-exposed war-zone veterans with PTSD and 13 age- and gender-matched healthy controls. While performing the incongruent Stroop task, healthy controls showed significant activations in the left lateral prefrontal cortex (LPFC) compared to baseline readings. This observation is consistent with previously reported results. In comparison, subjects with PTSD failed to activate left LPFC during the same Stroop task. Our observations may implicate that subjects with PTSD experienced difficulty in overcoming Stroop interference. We also observed significant negative correlation between task reaction times and hemodynamic responses from left LPFC during the incongruent Stroop task in the PTSD group. Regarding the methodology used in this study, we have learned that an appropriate design of Stroop paradigms is important for meeting an optimal cognitive load which can lead to better brain image contrasts in response to Stroop interference between healthy versus PTSD subjects. Overall, the feasibility of fNIRS for studying and mapping neural correlates of selective attention and interference in subjects with PTSD is reported.
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Affiliation(s)
- Amarnath Yennu
- The University of Texas at Arlington, Department of Bioengineering, Arlington, TX 76019, USA
| | - Fenghua Tian
- The University of Texas at Arlington, Department of Bioengineering, Arlington, TX 76019, USA
| | - Alexa Smith-Osborne
- The University of Texas at Arlington, School of Social Work, Arlington, TX 76019, USA
| | - Robert J Gatchel
- The University of Texas at Arlington, Department of Psychology, Arlington, TX 76019, USA
| | - Fu Lye Woon
- The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Hanli Liu
- The University of Texas at Arlington, Department of Bioengineering, Arlington, TX 76019, USA
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Debell F, Fear NT, Head M, Batt-Rawden S, Greenberg N, Wessely S, Goodwin L. A systematic review of the comorbidity between PTSD and alcohol misuse. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1401-25. [PMID: 24643298 DOI: 10.1007/s00127-014-0855-7] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 02/27/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic review aimed to assess (1) the level of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse reported in research studies since 2007 and (2) any associations found between specific PTSD symptom clusters and alcohol misuse. METHODS A literature search was carried out to capture any papers published from 2007 to the end of July 2012. Six hundred and twenty abstracts were identified and reviewed, and 42 papers were included in the final review after applying inclusion and exclusion criteria. RESULTS The prevalence of comorbid alcohol misuse in those with PTSD ranged from 9.8 to 61.3 %. The prevalence of comorbid PTSD in those with alcohol misuse ranged from 2.0 to 63.0 %, and the majority of prevalence rates were over 10.0 %. Almost all of the odds ratios representing the strength of association between the conditions across a variety of populations were significant, and those ranged from 1.1 to 4.87. Of the different PTSD symptom clusters, this review found most evidence for associations between alcohol misuse and both avoidance/numbing symptoms and hyperarousal symptoms. CONCLUSIONS Given that comorbidity appears to be common, the evidence from this systematic review supports the use of routine screening for comorbidity in populations who are known to have PTSD or alcohol misuse.
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Affiliation(s)
- Frances Debell
- King's College London School of Medicine, Hodgkin Building, Guy's Campus, London, SE1 1UL, UK
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Tian F, Yennu A, Smith-Osborne A, Gonzalez-Lima F, North CS, Liu H. Prefrontal responses to digit span memory phases in patients with post-traumatic stress disorder (PTSD): a functional near infrared spectroscopy study. Neuroimage Clin 2014; 4:808-19. [PMID: 24936431 PMCID: PMC4055895 DOI: 10.1016/j.nicl.2014.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/08/2014] [Accepted: 05/11/2014] [Indexed: 11/16/2022]
Abstract
Neuroimaging studies of post-traumatic stress disorder (PTSD)-related memory impairments have consistently implicated abnormal activities in the frontal and parietal lobes. However, most studies have used block designs and could not dissociate the multiple phases of working memory. In this study, the involvement of the prefrontal cortex in working memory phases was assessed among veterans with PTSD and age-/gender-matched healthy controls. Multichannel functional near infrared spectroscopy (fNIRS) was utilized to measure prefrontal cortex hemodynamic activations during memory of neutral (i.e., not trauma-related) forward and backward digit span tasks. An event-related experimental design was utilized to dissociate the different phases (i.e., encoding, maintenance and retrieval) of working memory. The healthy controls showed robust hemodynamic activations during the encoding and retrieval processes. In contrast, the veterans with PTSD were found to have activations during the encoding process, but followed by distinct deactivations during the retrieval process. The PTSD participants, but not the controls, appeared to suppress prefrontal activity during memory retrieval. This deactivation was more pronounced in the right dorsolateral prefrontal cortex during the retrieval phase. These deactivations in PTSD patients might implicate an active inhibition of dorsolateral prefrontal neural activity during retrieval of working memory.
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Affiliation(s)
- Fenghua Tian
- Department of Bioengineering, The University of Texas at Arlington, Arlington, USA
| | - Amarnath Yennu
- Department of Bioengineering, The University of Texas at Arlington, Arlington, USA
| | | | - F. Gonzalez-Lima
- Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Carol S. North
- VA North Texas Health Care System, Dallas, TX, USA
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hanli Liu
- Department of Bioengineering, The University of Texas at Arlington, Arlington, USA
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Müller M, Vandeleur C, Rodgers S, Rössler W, Castelao E, Preisig M, Ajdacic-Gross V. Factors associated with comorbidity patterns in full and partial PTSD: findings from the PsyCoLaus study. Compr Psychiatry 2014; 55:837-48. [PMID: 24560408 DOI: 10.1016/j.comppsych.2014.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/03/2014] [Accepted: 01/13/2014] [Indexed: 12/21/2022] Open
Abstract
Subtypes of comorbid conditions and their associated trauma and clinical characteristics in full and partial PTSD were examined. Data from 289 subjects from the general population that met criteria for full or partial PTSD were analyzed. Latent class analyses (LCA) were performed to derive homogeneous patterns of DSM-IV Axis-I disorders and anti-social personality comorbid to PTSD. Logistic regression models were conducted to characterize these classes by trauma-related and clinical features. The LCA revealed three classes: (1) low comorbidity; (2) high comorbidity with primarily substance-related disorders and a higher proportion of males; and (3) more severe PTSD-symptomatology and higher comorbid anxiety disorders and depression, almost entirely represented by females. Exposure to sexual abuse was more likely in the substance-dependent class and contributed strongly to the distinction between classes. Affective disorders tended to precede the onset of PTSD in the substance-dependent class, whereas phobias were more likely to follow PTSD in the depressed-anxious class. Posttrauma onset of alcohol use disorders in the substance dependent class confirmed the self-medication hypothesis. The three classes of comorbidity and their sequence of onset with PTSD suggest different mechanisms involved in their development. Our findings suggest that PTSD-related comorbidity subtypes also apply to individuals with partial PTSD.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland.
| | | | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland; Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland; Institute of Psychiatry, University of Sao Paulo, Brasil
| | | | | | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Switzerland
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Friborg O, Martinussen M, Kaiser S, Overgård KT, Rosenvinge JH. Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. J Affect Disord 2013; 145:143-55. [PMID: 22999891 DOI: 10.1016/j.jad.2012.07.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/02/2012] [Accepted: 07/05/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. METHODS A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. RESULTS The rate of any comorbid PD was high across all ADs, ranging from .35 for PTSD to .52 for OCD. Cluster C PDs occurred more than twice as often as cluster A or B PDs. Within cluster C the avoidant PD occurred most frequently, followed by the obsessive-compulsive and the dependent PD. PTSD showed the most heterogeneous clinical picture and social phobia was highly comorbid with avoidant PD. A range of moderators were examined, but most were non-significant or of small effects, except an early age of onset, which in social phobia increased the risk of an avoidant PD considerably. Gender or duration of an AD was not related to variation in PD comorbidity. LIMITATIONS Blind rating of diagnoses was recorded from the papers as an indication of diagnostic validity. However, as too few studies reported it the validity of the comorbid estimates of PD was less strong. CONCLUSIONS The findings provided support to several of the proposed changes in the forthcoming DSM-5. Further comorbidity studies are needed in view of the substantial changes in how PDs will be diagnosed in the DSM-5.
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Affiliation(s)
- Oddgeir Friborg
- Faculty of Health Sciences, Department of Psychology, University of Tromsø, Norway.
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Nemcić-Moro I, Francisković T, Britvić D, Klarić M, Zecević I. Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study. Croat Med J 2012; 52:505-12. [PMID: 21853545 PMCID: PMC3160697 DOI: 10.3325/cmj.2011.52.505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991-1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following self-assessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes.
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Affiliation(s)
- Iva Nemcić-Moro
- Department of Psychological Medicine, University Hospital Center Zagreb, Kispatićeva 12, 10 000 Zagreb, Croatia.
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Shejbal D, Vagić D, Stevanović S, Koić E, Kalogjera L. Impact of posttraumatic stress disorder on sinonasal symptoms and quality of life in patients with chronic rhinosinusitis. Patient Prefer Adherence 2012; 6:847-52. [PMID: 23233797 PMCID: PMC3516465 DOI: 10.2147/ppa.s37816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Severity of chronic rhinosinusitis (CRS), measured by disease-specific health-related quality-of-life questionnaires, is expected to increase in patients who also suffer from posttraumatic stress disorder (PTSD). Altered pain perception, sleep disorders, and fatigue may be associated with this comorbidity. METHODS Severity of CRS was compared between a group of 28 patients with CRS and a group of 28 patients with CRS and concomitant PTSD using different disease-specific and generic instruments, such as visual analog scale (VAS), Short Form-36 test (SF-36), and Sino-Nasal Outcome Test-22 (SNOT 22). RESULTS SNOT-22 test showed significantly higher CRS severity in patients with CRS and PTSD, compared to patients with CRS without PTSD. CONCLUSION Patients with less severe CRS, measured by objective outcome measures, due to the impact of comorbid PTSP, are classified as having severe rhinosinusitis, and are exposed to the risk of unnecessary diagnostic and therapeutic procedures. In patients with difficult-to-treat rhinosinusitis, diagnosis should be revised, and one item that should be evaluated is whether they suffer from PTSD.
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Affiliation(s)
- Dražen Shejbal
- Division of Otorhinolaryngology, Pakrac City Hospital, Pakrac, Croatia
- Correspondence: Dražen Shejbal, Pakrac City Hospital, Bolnička 68, 34550 Pakrac, Croatia, Tel +385 911 515 929, Fax +385 433 330 91, Email
| | - Davor Vagić
- Department of Otorhinolaryngology and Head and Neck Surgery, Sisters of Mercy Hospital, Zagreb, Croatia
| | - Siniša Stevanović
- Division of Otorhinolaryngology, Virovitica General Hospital, Virovitica, Croatia
| | - Elvira Koić
- Division of Psychiatry, Virovitica General Hospital, Virovitica, Croatia
| | - Livije Kalogjera
- Department of Otorhinolaryngology and Head and Neck Surgery, Sisters of Mercy Hospital, Zagreb, Croatia
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Braš M, Milunović V, Boban M, Brajković L, Benković V, Dorđević V, Polašek O. Quality of life in Croatian Homeland war (1991-1995) veterans who suffer from post-traumatic stress disorder and chronic pain. Health Qual Life Outcomes 2011; 9:56. [PMID: 21798076 PMCID: PMC3157409 DOI: 10.1186/1477-7525-9-56] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 07/29/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP). METHODS A total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering. RESULTS The results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator. CONCLUSIONS The results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.
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Affiliation(s)
- Marijana Braš
- Centre for Palliative Medicine, Medical Ethics and Communication Skills, Medical School, University of Zagreb, Croatia.
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