Consequences of Untreated Posttraumatic Stress Disorder Following War in Former Yugoslavia: Morbidity, Subjective Quality of Life, and Care Costs

Aim To assess long-term mental health outcomes in people who suffer from war-related posttraumatic stress disorder (PTSD) but do not receive appropriate treatment. Methods We interviewed 264 subjects from former Yugoslavia, who lived in Croatia, Serbia, Germany, and the United Kingdom. All of them had suffered from PTSD at some point following the war, but never received psychiatric or psychological treatment. The interviews took place on average 10.7 ± 3.0 years after the war-related trauma. Outcomes were current PTSD on the Clinician Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders-IV, subjective quality of life (SQOL) on the Manchester Short Assessment of Quality of Life, and care costs. Socio-demographic characteristics, the level of traumatic war-events, and aspects of the post-war situation were tested for association with outcomes. Results Current PTSD was diagnosed in 83.7% of participants, the mean SQOL score was 4.0 ± 0.9, and mean care costs in the last 3 months exceeded €1100 in each center. Older age, more traumatic war-events, lower education, and living in post-conflict countries were associated with higher rates of current PTSD. Older age, combat experience, more traumatic war-events, being unemployed, living alone, being housed in collective accommodation, and current PTSD were independently associated with lower SQOL. Older age and living in Germany were linked to higher costs of formal care. Conclusion People with untreated war-related PTSD have a high risk of still having PTSD a decade after the traumatic event. Their SQOL is relatively low, and they generate considerable care costs. Factors that have been reported as influencing the occurrence of PTSD also appear relevant for recovery from PTSD. Current PTSD may impair SQOL independently of social factors

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities

This 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

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

This research was financially supported by DG-Sanco (contract: 800197; 2007-2010). The authors would like to thank all of the professionals and services who participated in the PROMO assessment of services. A PhD grant from Fundação para a Ciência e Tecnologia–Portugal (SFRH/BD/66388/2009) to the first author is acknowledged

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities

Abstract Background: Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities

Mental health care for irregular migrants in Europe: Barriers and how they are overcome

This 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

Summary of recruitment and follow-up in each country.

a<p>10 participants were excluded from the analysis due to duplicate ID numbers;</p>b<p>5 Albanian-speaking participants were excluded because no bi-lingual researcher was available.</p

Univariable^a and multivariable linear regression models^b,c,d describing the relationship between subjective quality of life and PTSD symptoms in residents in war-affected countries (n = 530).

a<p>Controlled for MANSA score at baseline and specific IES-R subscale at baseline.</p>b<p>Dependent variable: MANSA score at follow-up.</p>c<p>Independent variables: IES-R subscales (intrusion, hyperarousal, avoidance) at follow-up.</p>d<p>Variables controlled for in the multivariable model: MANSA and IES-R subscales score at baseline, gender, years elapsed since the end of the conflict.</p

Univariable^a and multivariable^b,c,d linear regression models describing the relationship between subjective quality of life and PTSD symptoms in refugees in western countries (n = 215).

a<p>Controlled for MANSA score at baseline and specific IES-R subscale at baseline.</p>b<p>Dependent variable: MANSA score at follow-up.</p>c<p>Independent variables: IES-R subscales (intrusion, hyperarousal, avoidance) at follow-up.</p>d<p>Variables controlled for in the multivariable model: MANSA and IES-R subscales score at baseline, gender, years elapsed since the end of the conflict.</p