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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. © 2021 Medicinska Naklada Zagreb. All rights reserved.

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.

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.

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.

Background Mental disorders are highly prevalent, placing an enormous burden on individuals, society and economy. Research shows that family members who provide care to individuals with chronic or disabling mental conditions are themselves at risk. As a response to this problem, the project ‘Family Caregiver Support - Strategies and tools to promote the mental and emotional health of caregivers’ emerged, funded by Erasmus + Program and carried out by 8 European partners including ESS|P.PORTO. Objectives To empower family members as caregivers and to give them access to relevant medical information and to psychological support for their own needs. Methods A Guide and a Resource Pack concerning 9 important mental health disorders were developed. An interactive e-platform and a mobile App were developed to make available these materials. Validation of the products was carried out, in each country, by caregivers and health/social care professionals through online questionnaires. Data were collected and processed in an anonymous manner, and the confidentiality was ensured. Results In Portugal, 98% of respondents (25 caregivers/citizens interested on subject, and 25 health/social care professionals), consider the accessibility and attractivity of the platform very good or excellent; and more than 90% consider materials very effective for the caregiver’s empowerment. Some issues were identified to add to Resource Pack. Conclusions Data from partners is being processed but there is already strong evidence of the usability and efficacy of the project’s outcome, and a strong contribution was done for adult education concerning physical, mental and emotional health promotion of family caregivers.

Psychotherapy through new media and technology is used increasingly and regardless of the personal attitudes of a psychotherapist it becomes an area of professional interest. But the use of new technologies requires special adaptation, additional skills and knowledge. This article focuses on the review of new aspects of psychotherapeutic set-up and the process to which attention should be taken when deciding on the use of new technologies in psychotherapy., Psihoterapija putem novih medija i tehnologija sve se više primjenjuje i bez obzira na osobne stavove psihoterapeuta, ona postaje područje profesionalnog interesa. No uporaba novih tehnologija traži i posebnu prilagodbu, dodatne vještine i znanja. U ovom je članku naglasak stavljen na pregled novih aspekata psihoterapijskog settinga i postupka na koje treba obratiti pozornost kada se odlučimo na korištenje novih tehnologija u psihoterapiji.

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.

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. Keywords: War; PTSD; civilian victims of war; female; personality traits (Published: 6 April 2016) Responsible Editor: Julian D. Ford, University of Connecticut Health Center, USA. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’) Citation: European Journal of Psychotraumatology 2016, 7 : 30964 - http://dx.doi.org/10.3402/ejpt.v7.30964

Modern war conflicts, evolutionizing from large-scale collisions of armed forces to local, low-intensity, surrogate, terroristic and information wars, are associated with less direct mortality but with growing and long-lasting mental health consequences. These consequences can be traced in not only combatants and other military contingents and veterans but even to greater extent in the civilian populations, given that many modern war conflicts have signs of civil wars or religious conflicts. While active duty military undergo preliminary selection and resilience training, civilians in the war zone or as refugees and asylum-seeking victims are even at higher risk with the greater probability of transgenerational transmission, which implies long-lasting (decades) effects. Both military and civilians suffer from a similar set of disorders and psychological consequences caused by extreme trauma, including PTSD, depression, anxiety, addictions, somatization with chronic pain, dissociation, psychosocial dysfunctions, suicidal behavior, etc. War conflicts, terroristic acts, and information wars, amplified by technologically developing mass media, the internet and social networks, seem to add to a general feeling of instability and promote more anxiety, covering even wider contingents worldwide. Military psychiatry has accumulated knowledge and practical experience that, though not always can be applied directly, are useful for identification, management, prevention, and treatment of mental health consequences of war in wider contingents. This knowledge is a one more relevant and strong reason for advocating lowering of international tension and reducing the probability of war conflicts worldwide for the sake of preserving mental health of the humanity. It also has a potential of lowering the burden of this type of diseases worldwide.

Psihoterapija putem novih medija i tehnologija sve se više primjenjuje i bez obzira na osobne stavove psihoterapeuta, ona postaje područje profesionalnog interesa. No uporaba novih tehnologija traži i posebnu prilagodbu, dodatne vještine i znanja. U ovom je članku naglasak stavljen na pregled novih aspekata psihoterapijskog settinga i postupka na koje treba obratiti pozornost kada se odlučimo na korištenje novih tehnologija u psihoterapiji., Psychotherapy through new media and technology is used increasingly and regardless of the personal attitudes of a psychotherapist it becomes an area of professional interest. But the use of new technologies requires special adaptation, additional skills and knowledge. This article focuses on the review of new aspects of psychotherapeutic set-up and the process to which attention should be taken when deciding on the use of new technologies in psychotherapy.

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.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.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.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.

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.

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.

U članku se naglašava da postojanje društvenih mreža mijenja način rada u psihoterapiji i da bi o tome trebalo raspracvljati.Dano je nekoliko problema psihoterapeuta koji su proizašli iz činjenice rasprostranjenosti društvenih mreža.

BackgroundPrevalence rates of mental disorders are frequently increased in long-settled war refugees. However, substantial variation in prevalence rates across studies and countries remain unexplained.AimsTo test whether the same sociodemographic characteristics, war experiences and post-migration stressors are associated with mental disorders in similar refugee groups resettled in different countries.MethodMental disorders were assessed in war-affected refugees from the former Yugoslavia in Germany, Italy and the UK. Sociodemographic, war-related and post-migration characteristics were tested for their association with different disorders.ResultsA total of 854 war refugees were assessed (≥255 per country). Prevalence rates of mental disorders varied substantially across countries. A lower level of education, more traumatic experiences during and after the war, more migration-related stress, a temporary residence permit and not feeling accepted were independently associated with higher rates of mood and anxiety disorders. Mood disorders were also associated with older age, female gender and being unemployed, and anxiety disorders with the absence of combat experience. Higher rates of post-traumatic stress disorder (PTSD) were associated with older age, a lower level of education, more traumatic experiences during and after the war, absence of combat experience, more migration-related stress, and a temporary residence permit. Only younger age, male gender and not living with a partner were associated with substance use disorders. The associations did not differ significantly across the countries. War-related factors explained more variance in rates of PTSD, and post-migration factors in the rates of mood, anxiety and substance use disorder.ConclusionsSociodemographic characteristics, war experiences and post-migration stressors are independently associated with mental disorders in long-settled war refugees. The risk factors vary for different disorders, but are consistent across host countries for the same disorders.

Background: Posttraumatic stress disorder (PTSD) in war veterans and its complex emotional and behavioral characteristics affect veterans’ partners and the quality of their relationships. Although most research focuses on the effects of veterans’ PTSD on their partners/wives and their relationships, not many findings have been established on partner adjustment and marriage quality when wives suffer from PTSD as well. Objective: The aim of the research was to examine the relationship between war-related posttraumatic stress symptoms and partner’s marital satisfaction in couples where one or both partners suffer from PTSD. Design: The Harvard Trauma Questionnaire and Dyadic Adjustment Scale encompassed 154 war veterans and their wives who had been treated at Mostar Clinical Hospital in Bosnia and Herzegovina for combatrelated PTSD as well as 77 veterans who did not suffer from PTSD and their wives. Results: Veterans’ PTSD is related to lower levels of marital adjustment of their wives. Marital adjustment was significantly lower in couples where both partners had PTSD compared with couples where only the veteran had PTSD or neither partner had PTSD. Female partner’s marital adjustment is best explained by his avoidance symptoms and her own level of depressiveness and re-experiencing symptoms. Conclusions: The results highlight the importance of recognizing PTSD in wives of traumatized veterans as well as the importance of family approach in the treatment of PTSD. Keywords: marital quality; relationship satisfaction; war veterans; wives; PTSD (Published: 5 December 2011) Citation: European Journal of Psychotraumatology 2011, 2 : 8077 - DOI: 10.3402/ejpt.v2i0.8077 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Reading Tools).

Objective: The study aimed at establishing the factor structure of the Impact of Event Scale-Revised (IES-R) in survivors of war. Methods: A total sample of 4.167 participants with post-traumatic stress symptoms following the war in Ex-Yugoslavia were split into three samples: Two independent samples of people who stayed in the area of conflict and one sample of refugees to Western European countries. Alternative models with 3, 4, and 5 factors of posttraumatic symptoms were tested in one sample. The findings were cross-validated in the other two samples. Results: The model of best fit had 5 factors, i.e. intrusion, avoidance, hyperarousal, numbing, and sleep disturbance. Model superiority was cross-validated in two other samples. Conclusions: These findings suggest a 5 factor model of posttraumatic stress symptoms in war survivors with numbing and sleep disturbance as separate factors in addition to intrusion, avoidance and hyperarousal.

Posttraumatic stress disorder (PTSD) is one of the most frequently reported mental health consequences of exposure to war experience, although studies on both refugees and war veterans yielded inconsistent findings on the exact prevalence rates (1-5). Some evidence suggests that a higher degree of exposure to both war-related traumatic events and the pressures of the post-migration environment can lead to higher rates of PTSD over many years (6-9). Evidence based treatments for PTSD exist and are – at least to some extent – available in most post conflict contexts in the Western world. In such contexts, it can be assumed that a significant number of people with war-related PTSD receive treatment from psychiatrists or psychologists or are prescribed anti-depressants by their general practitioner. For various reasons, however, many people with serious and distressing levels of PTSD following war do not receive psychiatric or psychological treatment (10), and not much is known about their long term outcomes. It is not clear whether most of them recover from PTSD without treatment or the symptoms are likely to take a persistent course. Another question is what their subjective quality of life (SQOL) is, and what costs of formal and informal care they generate. Finally, it is not clear what factors are associated with more or less favorable outcomes in such populations, and whether current PTSD is associated with poorer SQOL. The present study addressed these questions and assessed long term outcomes in people who suffered from PTSD at some point of time following the war in former Yugoslavia in the 1990s, but never received psychiatric or psychological treatment in either primary or secondary care. Current PTSD, SQOL, and care costs were assessed as outcomes in refugees in Western Europe and in people who stayed in the area of conflict. Socio-demographic characteristics, the level of exposure to war stressors, and aspects of the post-war situation were tested for their association with more or less favorable outcomes.

The presence of psychotic symptoms in post-traumatic stress disorder (PTSD) has already been recognized. Using the Structured Clinical Interview Diagnostic and Statistical Manual, we searched for and assessed psychotic symptoms in 91 males suffering from combat-related PTSD. Hallucinations and delusions were present in 20% of patients. We divided all patients into three groups: the group with hallucinations and delusions, the group without these symptoms, and the group with “subthreshold” psychotic symptoms. Using the Harvard Trauma Questionnaire, Clinician-Administered PTSD Scale, and Structured Clinical Interview Diagnostic and Statistical Manual, we investigated differences between groups in the intensity of traumatization, severity of PTSD symptoms, and the frequency of depression. There were no significant differences between groups; however, there was one exception: severity of hyperarousal symptoms was positively correlated with occurrence of psychotic symptoms.

Depressive disorders are among the five most frequent complaints seen in primary care settings and, in many cases, go unrecognised. The aim of this research was to examine the prevalence of depression in a Croatian primary care setting, and to investigate the proportion of depressive patients recognised and treated by either family physicians or psychiatrists respectively. Five hundred consecutive adult attenders at four general practices in Rijeka, Croatia were screened using the Beck Depression Inventory (BDI) and a proforma designed for this study. The results showed that 48.1% of investigated subjects had mild, moderate or severe depression on the BDI. Associations were found between depression and gender, age, marital status, parity and level of education. Detection of depression by primary care physicians was low: only 13.1% were recognised and treated within primary care or by psychiatrists. The Prevalence of depression among Croatian primary care attenders is high and recognition is low. This the first study of its kind from Croatia.

Our clinical observations along with data in the literature have shown an increased incidence of alcohol use disorder in persons who suffer from post-traumatic stress disorder. In this work we examined alcohol use disorder in war veterans who were suffering from post-traumatic stress disorder (group 1) (n=52) and compared them with veterans who were traumatized but who had not developed a clinical picture of post-traumatic stress disorder (group 2) (n=29) and a sample from the general population (group 3) (n=30). The objective of this work was to establish the cluster symptoms of post-traumatic stress disorder that are related to alcohol use disorder and connected with depression. All of the respondents were males. The methods used were structured clinical interviews for the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders axis I disorders for addiction and post-traumatic stress disorder and Beck's scale for depression. The results obtained showed that there were no statistically significant differences in the incidence of alcohol use disorders between traumatized patients who had and those who had not developed post-traumatic stress disorder, but there was a significant statistical differencefor both groups 1 and 2 in relation to the control group. The variables that correlated positively with alcohol use disorder were the cluster symptoms of re-experiencing and the arousal symptom of the traumatized group and there was also increased depression in both groups examined (groups 1 and 2).

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.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 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, p0.001) on auto-aggression in subjects of both genders. In both genders, moderately depressed show more auto destructiveness than those without depression symptoms (p0.01). In the group of heavily depressed (n=30), significantly higher self-destructiveness is shown by girls (p0.01).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.

– Daily clinical practice, as well as numerous studies, shows that the problem of auto-aggression, and with that the problem of alcohol consumption among youth, is increasing and at the present time, is very actual. The aim of this study was to determine the frequency of alcohol use among adolescents in the city of Zagreb, and if the presence of alcoholism in their families was a risk factor for the development of tendency for excessive alcohol consumption. The study was conducted on 701 subjects – both genders. Subjects were students of high schools in the city of Zagreb from the ages 14 to 19. For the data collection, we used a structured questionnaire which included questions about demographic and family information and a standardized questionnaire, Autodestruction Scale (ADS). ADS is an instrument that measures the self-destructive tendencies in the personality of the individual and consists of 107 statements (questions). According to the results of our study, from the total number of high school students 56.6% had consumed alcohol without the knowledge of their parents, 22.3% of them had experience in excessive alcohol consumption whereby boys were significantly more often inclined to do so compared to girls. In addition, this study has shown that 21.8% of adolescents have fathers who drink alcohol often or very often, while alcohol consumption among mothers of adolescents is not statistically significant.

A series of studies have demonstrated that post-traumatic stress disorder in war veterans may cause serious problems in husband–wife relationships. These problems reduce the relationship satisfaction in both partners and may cause redistribution of family roles. The increased burden placed on the wives may lead to burnout, transmission of post-traumatic symptoms and development of other mental disorders. In addition, PTSD symptoms have an immediate effect on the veterans’ ability to fulfill their parental roles, which certainly affects the children’s development. The 1991–1995 war in Croatia had many consequences on the war veterans, their families and civilians. For nearly two decades, the Regional Psychotrauma Center, in Rijeka, Croatia has been providing psychological help to war victims, majority of which are war veterans. Our clinical experiences, as well as the results of our studies, indicate that treatment of the traumatized veterans needs to include the wives. A systemic approach in treating the traumatized persons can improve individual functioning and couple functioning. Furthermore, it can minimize potential psychological effects on the children.

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.

ObjectiveThe study explored factors to which people traumatized by war attribute their recovery from posttraumatic symptoms and from war experiences.MethodsIn-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.ResultsEight 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.ConclusionsThe 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.

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.

PurposeThe aim was to assess whether experiences of war trauma remain directly associated with suicidality in war affected communities when other risk factors are considered.Materials and methodsIn the main sample 3313 participants from former Yugoslavia who experienced war trauma were recruited using a random sampling in five Balkan countries. In the second sample 854 refugees from former Yugoslavia recruited through registers and networking in three Western European countries. Sociodemographic and data on trauma exposure, psychiatric diagnoses and level of suicidality were assessed.ResultsIn the main sample 113 participants (3.4%) had high suicidality, which was associated with number of potentially traumatic war experiences (odds ratio 1.1) and war related imprisonment (odds ratio 3) once all measured risk factors were considered. These associations were confirmed in the refugee sample with a higher suicidality rate (10.2%).Discussion and conclusionsNumber of potentially traumatic war experiences, in particular imprisonment, may be considered as a relevant risk factor for suicidality in people affected by war.

BackgroundPrevalence 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.MethodWe 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.ResultsDuring 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.ConclusionsSeveral 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.

Due to the long-lasting and resistant symptoms characteristic of chronic combat posttraumatic stress disorder (PTSD), its treatment is complex and often requires a tailored therapeutic approach incorporating both psychotherapy and pharmacotherapy. A multimodal approach of psychoeducative, sociotherapeutic, and dynamically oriented trauma-focused groups is described. We assessed the short- and long-term effectiveness of this therapeutic program by monitoring its impact on PTSD symptoms, depression, neurotic symptoms, coping skills, and quality of life for three years. The findings revealed short-term reduction in the symptoms of PTSD and depression, while the long-term results were manifested as the increased use of all coping mechanisms and a greater level of obsession.

Numbers of general psychiatric and forensic psychiatric beds, supported housing capacities and the size of the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to an increase of the prison population. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change of the year 1989, and to explore whether the data are consistent with the Penrose hypothesis in that historical context. Data on general psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989-1999, 1999-2009 and the whole period of 1989-2009 and correlations between changes of different indicators were calculated. Results Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from -11% in Croatia to -51% in East Germany, and led to bed numbers per 100, 000 population that ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989-2009, trends in the prison population were inconsistent and ranged from a decrease of -58% in East Germany to an increase of 43% in Belarus and Poland. Trends over time in different indicators of institutionalised care did not show statistically significant associations. Discussion After the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in the given historical context as a general rule for most of the countries. More accurate data and wider research are required for a better understanding of historical trends in institutionalised care and their drivers.

Displaced persons are a special, threatened group of people, participants in this war, who were suddenly forced to abandon their homes. The majority of them were, “overnight,” left without anything they had, some even without their closest family. They all have one thing in common: they have all lost so much. Work with such people is directed toward overcoming their feelings of loss and abandonment and preventing psychical decompensation. Groups of displaced persons temporarily sheltered in the Rijeka region have been observed to be markedly regressed, with increased sensitivity, a low degree of tolerance, great demands on society and strongly expressed projective tendencies. Therapists suffer personal traumatization in working with displaced persons. This paper describes the reactions and feelings of group leaders caused by manifestations of group dynamics in different phases of exile.

The effects of psychological factors in alcoholics with malignant tumor of the oral cavity and oropharynx are scarcely explored. The aim of the research was to examine early family relations and investigate differences in the use of defense mechanisms in alcohol dependent patients suffering from malignant tumor of the oral cavity and oropharynx compared to alcohol dependent persons without malignant tumors and healthy controls. The research included 51 alcohol dependent patients treated for malignant tumor of the oral cavity and oropharynx at the University Hospital Center Rijeka from 2005 to 2009. The control groups corresponded to the experimental group in age, sex and education level. The research used a general demographic questionnaire, the Mini International Neuropsychiatric Interview and the Revised Questionnaire of Life Style and Defense Mechanisms. The research groups showed significant differences in difficult childhood (p0.001) including abuse (p = 0.004). The alcohol dependent persons suffering from malignant tumors of the oral cavity and oropharynx significantly less frequently used primitive defense mechanisms of regression (p = 0.004) and displacement (p = 0.013) compared to alcoholics without malignant tumors who significantly more often used neurotic defense mechanisms - compensation (p = 0.005) and intellectualization (p0.001). The earliest emotional experiences and quality of family relations affect the development of defense mechanisms. These are the psychological factors in the development of oropharyngeal cancer in alcohol addicts.

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.

The media have an important role in maintaining and creating social relations and social environment. This especially refers to the war and post-war period in which the media can form a part of the prevention context, i.e., the media can facilitate the process of recovery from war trauma, but they can also contribute to stigmatization and retraumatization. Our aim was to analyze Croatian newspaper reports about Croatian war veterans and to determine the differences in ways of dealing with the subject during 1996 and 2006.The data were gathered by reviewing two daily papers, Novi list and Ve?ernji list and Globus weekly. The analysis included newspaper reports related to the subject of Croatian war veterans, published in the first six months of 1996 and 2006. Quantitative and qualitative methods were used to analyze both the form and the content of the reports.A total of 538 newspaper reports were published in the above-stated periods. In the first half of 2006 the number of reports related to the subject of Croatian war veterans dropped 6.5 percent compared to the first half of 1996. Topics prevalent at the end of the war were different from those ten years later. The 1996 articles mostly reported on activities organized by various associations, medal-awarding ceremonies, military operations etc. Ten years later the topics focused on war crimes, trials of Croatian war generals and dissatisfaction with veterans' rights and legislation. Moreover, articles relating to crime and reports about suicides and attempts of suicide increased significantly in 2006.During the ten-year period, the media image of Croatian war veterans significantly changed, which was expected owing to different social circumstances immediately after the war and ten years later. The prevalence of topics negative in tone and a lack of proactive stories reflect, but also create, a social context which can affect the process of recovery from traumatization.

Aim To examine the role of perceived stressfulness of trauma exposure and economic, social, occupational, educational, and familial adaptation after trauma in posttraumatic stress disorder (PTSD) and depression in displaced war survivors. Methods A cross-sectional survey was conducted between March 2000 and July 2002 with a sample of 173 internally displaced persons or refugees and 167 matched controls in Croatia. Clinical measures included Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale. Results Displaced war survivors reported the exposure to a mean ± standard deviation of 13.1 ± 8.3 war stressors, including combat, torture, serious injury, death of close persons, and loss of property. Compared to controls, they reported higher rates of marked to severe impact of war on family (16.2% vs 51.6%), social (7.2% vs 43.5%), economic (12.6% vs 55.4%), occupational (1.8% vs 15.9%), and educational (2.4% vs 8.8%) adaptation. In two logistic regression analyses, the strongest predictor of PTSD and depression was high level of perceived distress during trauma exposure. PTSD but not depression was associated with economic, social, occupational, educational, and familial adaptation after trauma. Conclusion Displaced survivors who experienced multiple war events perceived greater negative impact of war on their life domains compared to individuals who lived in a war setting but had no trauma exposure. The most important determinant of psychological outcomes was perceived stressfulness of war stressors. Although post-trauma adaptation in different life spheres had an impact, its effect was not robust and consistent across disorders. These findings suggest that it would be effective to use a trauma-focused approach in rehabilitation of war survivors.