Exposure to war-related trauma has long been recognised to have an adverse effect on mental health. We attempted to investigate whether people who have clinically significant personality-related problems 15 years after a war are more likely to have been exposed to severe war-related trauma than those who do not have significant personality difficulties.
A case –control study was conducted in southern Croatia, fifteen years after the 1991–1995 war. We recruited 268 participants: 182 cases who scored positively on the International Personality Disorder Examination scale (IPDE), and 86 controls who were IPDE negative. Severity of war-related trauma was assessed according to the 17 items on the Harvard Trauma Questionnaire (HTQ) trauma event scale, which were considered to be of severe (catastrophic) nature based on the ICD-10 description of catastrophic trauma and the opinion of trauma experts. All participants also completed measures of mental health (depression, anxiety and PTSD), social functioning and current substance misuse.
Cases (IPDE positive) were eight times more likely to report exposure to severe war-related trauma than controls. This association increased after adjustments for demographic factors (OR = 10.1, 95% CI 5.0 to 20.4). The types of severe trauma most frequently reported were either the participants’own life being in direct danger or witnessing extreme violence inflicted on others or the result of violence towards others (murder, torture, seeing burned or disfigured bodies). Prevalences of depression, anxiety and PTSD were high among IPDE positive participants 15 years after exposure to war trauma. Their level of interpersonal dysfunction was considerably higher than that in controls (OR = 10.39, 95% CI 3.51 to 30.75). Alcohol consumption in cases was significantly higher with a mean of 14.24 units per week (sd = 11.03) when compared to controls whose mean number of alcohol units was 9.24 (sd = 7.25), t (73) = 2.16, p < 0.05, mean difference 4.99 (95% CI = 0.39 to 9.60). Similarly, a significantly higher number of cases reported current substance misuse (8.2% vs. 0.0%) X2 (1, n = 268) = 7.51, p < 0.05).
Exposure to severe war-related trauma is a risk factor for interpersonal dysfunction15 years after people were exposed to an armed conflict. These findings have implications for assessing and meeting the long-term mental health needs of people in war-affected regions. Further research needs to be done to increase our understanding about the relationship between severe war trauma and personality related problems.
Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss D.S. Trauma and the Vietnam war generation: Report of findings from the National Vietnam veterans readjustment stud y. Brunner/Mazel Psychological Stress Series, 1990.
Britvic D, Anticevic V, Kaliterna M, Lusic L, Beg A, Brajevic-Giszic I, Kudric M, Stupalo Z, Krolo V, Pivac N. Comorbidities with Posttraumatic Stress Disorder among combat veterans 15 years post-war analysis. Int J Clin Health Psychol. 2015; http://dx.doi.org/10.1026/j.ijchip.2014.11.002
Franciskivic T, Tovilovic Z, Sukovic Z, Stevanovic A, Ajdukovic D, Kraljevic R, Bogic M, Priebe S. Health care and community-based study of service use and mental health. Croatian Medical Journal. 2008;49:483–90. CrossRef
Herman J. Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress. 1992;5:377–91. CrossRef
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington: American Psychiatric Association; 1994.
Barrett DH, Resnick HS, Foy DW, Dansky BS, Flanders WD, Stroup NE. Combat exposure and adult psychosocial adjustment among U.S. Army veterans serving in Vietnam, 1965-1971. J Abnorm Psychiatry. 1996;105(4):575–81. CrossRef
World Health Organisation. World report on violence and health. Geneva: World Health Organisation; 2002.
Young K. UNHCR and ICRC in the former Yugoslavia. IRRC. 2001;83:781–805.
Loranger AW, Susman VL, Oldham JM, Rissakoff LM. Personality disorder examination (PDE): A structured interview for DSM_IV_R and ICD-9 personality disorders. White Plains: WHO/ADAMHA pilot version, New York Hospital- Cornell Medical Center; 1985.
Loranger AW, Sartorius N, Andreolli A, Berger P, Buchheim P, Channabasavanna SM, Coid B, Dahl A, Diekstra R, Ferguson B, Jacobsberd L, Mombour W, Pull C, Ono Y, Regier D. The International Personality Disorder Examination The World Health Organisation/alcohol, drug abuse and mental health administration – international pilot study of personality disorders. Arch Gen Psychiatry. 1994;51:215–24. CrossRefPubMed
Mollica RF, Caspy-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma and post-traumatic stress disorder in Indochinese refugees. J. Nerv. Ment. Disord. 1992;180:111–6. CrossRef
Mollica RF, McDonald LS, Massagli M, Silove D. Measuring trauma, measuring torture: Instruction and guidance on the utilisation of the Harvard Program in Refugee Trauma’s Version of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard trauma Questionnaire (HTQ). Harvard Program in Refugee Trauma, 2004.
Silove D, Manicavasagar V, Mollica R, Thai M, Khiek D, Lavelle J, Tor SP. Screening for depression and PTSD in a Cambodian population unaffected by war: comparing the Hopkins Symptom Checklist and Harvard trauma Questionnaire with the Structured Clinical Interview. J Nerv Ment Dis. 2007;195(2):152–7. CrossRefPubMed
Mollica RF, McInnes K, Sarajlic N, Lavelle J, Sarajlic I, Massagli M. Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA. 1999;281(5):433–9. CrossRef
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic criteria for research. Geneva: World Health Organisation; 1992.
Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kessler J, et al. Measuring trauma and health status in refugees: A critical review. J. Am. Med. Assoc. 2002;288:611–21. CrossRef
Tyrer P. Personality disorder and social functioning. In: Peck DF, Shapiro CM, editors. Measuring Human Problems: A Practical Guide. Chichester: John Wiley & Sons; 1990. p. 119–42.
Tyrer P, Nur U, Crawford M, Karlsen S, Mclean C, Rao B, Johnson T. The Social Functioning Questionnaire: A Rapid and Robust Measure of Perceived Functioning. Int J Soc Psych. 2005;51(3):265–75. CrossRef
Priebe S, Matanov A, Jankovic-Gavrilovic J, McCrone P, Ljubotina D, Knezevic G, Kucukalic A, Franciskovic T, Schutzwohl M. Consequences of untreated Post-traumatic Stress Disorder following war in former Yugoslavia: morbidity, subjective quality of life and care costs. Croat. Med. J. 2009;50:465–75. CrossRefPubMedPubMedCentral
Huang Y, Kotov R, de Girolamo G, Pret A, Angermeyer M, Benjet C, Demyttenaere K, de Graaf R, Gureje O, Nasser Karma A, Lee S, Lepine JP, Matschinger H, Posad-Villa J, Sullman S, Vilagut G, Kessler RC. DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry. 2009;194:1–8. CrossRef
- Severe war-related trauma and personality pathology: a case-control study
Mike J. Crawford
- BioMed Central
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