Subjective quality of life in war-affected populations

PMCID: PMC3716711This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Recovery from Posttraumatic Stress Symptoms: A Qualitative Study of Attributions in Survivors of War

This study was funded by a grant from the European Commission, contract number INCO-CT-2004-50917

Long-term impact of war on healthcare costs: an eight-country study

ObjectiveExposure to war can negatively affect health and may impact on healthcare costs. Estimating these costs and identifying their predictors is important for appropriate service planning. We aimed to measure use of health services in an adult population who had experienced war in the former-Yugoslavia on average 8 years previously, and to identify characteristics associated with the use and costs of healthcare.MethodWar-affected community samples in Bosnia-Herzegovina, Croatia, Kosovo, FYR Macedonia, and Serbia were recruited through a random walk technique. Refugees in Germany, Italy and the UK were contacted through registers, organisations and networking. Current service use was measured for the previous three months and combined with unit costs for each country for the year 2006/7. A two-part approach was used, to identify predictors of service use with a multiple logistic regression model and predictors of cost with a generalised linear regression model.Results3,313 participants were interviewed in Balkan countries and 854 refugees in Western European countries. In the Balkan countries, traumatic events and mental health status were related to greater service use while in Western countries these associations were not found. Participants in Balkan countries with post traumatic stress disorder (PTSD) had costs that were 63% higher (p = 0.005) than those without PTSD. Distress experienced during the most traumatic war event was associated with higher costs (p = 0.013). In Western European countries costs were 76% higher if non-PTSD anxiety disorders were present (0.027) and 63% higher for mood disorders (p = 0.006).ConclusionsWar experiences and their effects on mental health are associated with increased health care costs even many years later, especially for those who stayed in the area of conflict. Focussing on the mental health impact of war is important for many reasons including those of an economic nature

When the world collapses : Changed worldview and social reconstruction in a traumatized community

Background: Traumatic experience can affect the individual’s basic beliefs about the world as a predictable and safe place. One of the cornerstones in recovery from trauma is reestablishment of safety, connectedness, and the shattered schema of a worldview. Objective: This study explored the role of negatively changed worldview in the relationship between war-related traumatization and readiness for social reconstruction of intergroup relations in a post-conflict community measured by three processes: intergroup rapprochement, rebuilding trust, and need for apology. It was hypothesized that more traumatized people are less supportive of social reconstruction and that this relationship is mediated by the changed worldview. Method: The study included a community random sample of 333 adults in the city of Vukovar, Croatia, that was most devastated during the 1991–1995 war. Six instruments were administered: Stressful Events Scale, Impact of Event Scale-Revised, Changed Worldview Scale, and three scales measuring the post-conflict social reconstruction processes: Intergroup Rapprochement, Intergroup Trust and Need for Apology. Results: Mediation analyses showed that the worldview change fully mediated between traumatization and all three aspects of social reconstruction. Conclusions: In a population exposed to war traumatization the worldview change mediates post-conflict social recovery of community relations

Complexity of Risk: Mixed-Methods Approach to Understanding Youth Risk and Insecurity in Postconflict Settings

In settings of intergroup conflict, identifying contextually relevant risk factors for youth development is an important task. In Vukovar, Croatia, a city devastated during the war in former Yugoslavia, ethno-political tensions remain. The current study utilized a mixed-methods approach to identify two salient community-level risk factors (ethnic tension and general antisocial behavior) and related emotional insecurity responses (ethnic and nonethnic insecurity) among youth in Vukovar. In Study 1, focus group discussions (N = 66) with mothers, fathers, and adolescents of age 11 to 15 years old were analyzed using the constant comparative method, revealing two types of risk and insecurity responses. In Study 2, youth (N = 227, 58% male, M = 15.88, SD = 1.12 years) responded to quantitative scales developed from the focus groups, discriminate validity was demonstrated, and path analyses established predictive validity between each type of risk and insecurity. First, community ethnic tension (i.e., threats related to war/ethnic identity) significantly predicted ethnic insecurity for all youth (β = .41, p < .001). Second, experience with community antisocial behavior (i.e., general crime found in any context) predicted nonethnic community insecurity for girls (β = .32, p < .05) but not for boys. These findings are the first to show multiple forms of emotional insecurity at the community level; implications for future research are discussed