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A longitudinal study of PTSD in a sample of adult mass-evacuated Kosovars, some of whom returned to their home country

Published online by Cambridge University Press:  16 April 2020

Göran Roth*
Affiliation:
Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Huddinge, M56, 141 86 Stockholm, Sweden
Solvig Ekblad
Affiliation:
Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Huddinge, M56, 141 86 Stockholm, Sweden National Institute for Psychosocial Medicine, Unit for Immigrant Environment and Health, Stockholm, Sweden
Hans Ågren
Affiliation:
Section of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Huddinge, M56, 141 86 Stockholm, Sweden
*
*Corresponding author. Tel.: +46 8 585 85755; fax: +46 8 33 0652. E-mail address: goran.roth@sll.se (G. Roth).
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Abstract

PTSD among a sample of mass-evacuated adults from Kosovo was studied using a prospective design with a baseline study and follow-ups at 3 and 6 months in Sweden, and with an additional follow-up after 1.5 years in both Sweden and Kosovo. Trauma events and PTSD-related symptoms were measured by the Harvard Trauma Questionnaire (HTQ). At the additional follow-up after 1.5 years the same measure (HTQ) was used as well as clinical diagnostic interviews with the SCID instrument and measurement of saliva cortisol levels. Thirty-seven percent had PTSD-related symptoms at baseline. Morbidity increased at the three follow-ups. About 80% of the participants had PTSD at the additional follow-up after 1.5 years. The HTQ results were confirmed by clinical diagnoses and the participants diagnosed with PTSD also had low saliva cortisol levels. The results are discussed in terms of trauma, time needed to develop PTSD, post-migration stress and selection mechanisms.

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Original articles

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References

Aardal, E., Holm, A.-C.Cortisol in saliva—reference ranges and relation to cortisol in serum. Eur. J. Clin. Biochem 1995;33:927932.Google ScholarPubMed
Agovino, T.Caring for ethnic Albanians in Macedonia’s refugee camps. Lancet 1999;353:17011703.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC. 1995.Google Scholar
Amy, L., Ai, , Peterson, C., Ubelhor, D.War-related trauma and symptoms of posttraumatic stress disorder among adult Kosovoar refugees. J. Traumat. Stress 2002;15:157160.Google Scholar
Antonovsky, A.The structure and properties of the sense of coherence scale. Soc. Sci. Med 1993;36:725733.CrossRefGoogle ScholarPubMed
Basco, M.R., Bostic, J.Q., Davies, D., Rush, A.J., Witte, B., Mendrickse, W.et al. Methods to improve diagnostic accuracy in a community mental health setting. Am. J. Psychiatry 2000;157:15991605.CrossRefGoogle Scholar
Beiser, M., Hou, F.Language acquisition, unemployment and depressive disorder among Southeast Asian refugees: a 10-year study. Soc. Sci. Med 2001;53:13211334.CrossRefGoogle ScholarPubMed
Boscarino, J.A.Posttraumatic stress disorder, exposure to combat, and lower plasma cortisol among Vietnam veterans: findings and clinical implications. J. Consult. Clin. Psychol 1996;64:191201.CrossRefGoogle ScholarPubMed
Brislin, R., Lower, W., Thorndike, R.Cross-Cultural Research Methods. New York: John Wiley; 1973.Google Scholar
Carlsson, E.B., Rosser-Hogan, R.Cross-cultural response to trauma: a study of traumatic experiences and posttraumatic symptoms in Cambodian refugees. J. Traumat. Stress 1994;7:4358.CrossRefGoogle Scholar
Ekblad, S.A survey of somatic, psychological and social needs of mass displaced refugees from the Kosovo province while in Sweden. National Institute of Psychosocial Factors and Health, Division of Psychosocial Factors and Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm: Stress Research Reports nr 293, 2000.Google Scholar
Ekblad, S., Eriksson, N-G., Klefbeck, E-L., Flygare, K.,Basgul, Y., Sunnman, S., et al.Ett hälsoblad som screeninginstrument för nyanlända flyktingar. Del 1-3 (rapport, handbok, frågeformulär Hälsobladet). National Institute of Psychosocial Factors and Health, Division of Psychosocial Factors and Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm: Stressforskningsrapport nr 273, 1997.Google Scholar
Ekblad, S., Prochazka, H., Roth, G.Psychological impact of torture: a 3-month follow-up of mass-evacuated Kosovan adults in Sweden. Lessons learnt for prevention. Acta Psychiatr. Scand 2002;106(Suppl 412):3036.CrossRefGoogle Scholar
Fennig, S., Naisberg-Fennig, S., Craig, T.J., Tamenberg-Karant, M., Bremet, E.J.Comparison of clinical and research diagnoses of substance use disorders in a first-admission psychotic sample. Am. J. Addict 1996;5(1):4048.CrossRefGoogle Scholar
Kranzler, H.R., Kadden, R.M., Babor, T.F., Tennen, H., Rounsaville, B.J.Validity of the SCID in substance abuse patients. Addiction 1996;91(6):859868.CrossRefGoogle ScholarPubMed
Lie, B.A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatr. Scand 2002;106:415425.CrossRefGoogle ScholarPubMed
Lopes Cardozo, B., Talley, L., Burton, A., Crawford, C.Karenni refugees living in Thai-Burmese border camps: traumatic experiences, mental health outcomes, and social functioning. Soc. Sci. Med 2004;58:26372644.CrossRefGoogle ScholarPubMed
Lopes Cardozo, B., Vergara, A., Agani, F., Gotway, C.A.Mental health, social functioning and attitudes of Kosovar Albanians following the war in Kosovo. JAMA 2000;284:569577.CrossRefGoogle ScholarPubMed
Mollica, R.F.Special problems. Gelder, M.G., López-Ibor, J.J., Andreasson, N., editors. New Oxford textbook of psychiatry, 2nd volume. Oxford: University Press; 2000. p. 15951601.Google Scholar
Mollica, R.F., Caspi-Yavin, Y.Measuring torture and torture-related symptoms. Psychol. Assess 1991;3:17.CrossRefGoogle Scholar
Mollica, R.F., Caspi-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. Dis 1992;180:111116.CrossRefGoogle ScholarPubMed
Mollica, R.F., McInnes, K., Sarajlic, N., Lavelle, J., Sarajlic, I., Massagli, M.P.Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA 1999;281:433439.CrossRefGoogle Scholar
Mollica, R.F., Wyshak, G., Lavelle, J.The psychosocial impact of war trauma and torture on Southeast Asian refugees. Am. J. Psychiatry 1987;144:15671572.Google ScholarPubMed
Newport, D.J., Nemeroff, C.B.Neurobiology of post traumatic stress disorder. Curr. Opin. Neurol 2000;10:211218.CrossRefGoogle Scholar
Ogata, S., Sen, A., editors. Human security now. New York: Commission on Human Security; 2003.Google Scholar
Physicians for Human Rights. A population-based assessment of human rights violations of Kosovar Albanians by Serb forces. New Archives 1999; June 15.Google Scholar
Silove, D.The psychological effects of torture, mass human rights violations, and refugee trauma. J. Nerv. Ment. Dis 1999;187:200207.CrossRefGoogle ScholarPubMed
Silove, D.Trauma and forced relocation. Curr. Opin. Psychiatry 2000;13:231236.CrossRefGoogle Scholar
Silove, D., Ekblad, S.How well do refugees adapt after resettlement in Western countries. Acta Psychiatr. Scand 2002;106:401402.Google ScholarPubMed
Silove, D., Ekblad, S., Mollica, R.F.Health and human rights. The right of the severely mentally ill in post-conflict societies. Invited Lancet commentary. Lancet 2000;29:15481549.CrossRefGoogle Scholar
Silove, D., Sinnerbrink, I., Field, A., Manicavasagar, V., Steel, Z.Anxiety, depression and PTSD in asylum-seekers: associations with pre-migration trauma and post-migration stressors. Br. J. Psychiatry 1997;170:351357.CrossRefGoogle Scholar
Silove, D., Steel, Z., McGorry, P., Miles, V., Drobny, J.The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants. Compr. Psychiatry 2002;43:4955.CrossRefGoogle ScholarPubMed
Silove, D., Steel, Z., McGorry, P., Mohan, P.Trauma exposure, post-migration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum seekers: comparison with refugees and immigrants. Acta Psychiatr. Scand 1998;97:175181.CrossRefGoogle Scholar
Smith-Fawzi, M.C., Pham, T., Lin, L., Ngyuen, T.V., Murphy, E., Mollica, R.E.The validity of posttraumatic stress disorder among Vietnamese refugees. J. Traumat. Stress 1997;10:101108.CrossRefGoogle Scholar
Søndergaard, H.P.Posttraumatic stress disorder and life events among recently resettled refugees. Stockholm, Sweden: Karolinska Institutet, Dep of Public Health Sciences, Division of Psychosocial Factors and Health; 2002. p. 1722.Google Scholar
Søndergaard, H.P., Ekblad, S., Theorell, T.Screening for post-traumatic stress disorder among refugees in Stockholm. Nord. J. Psychiatry 2003;57:185189.CrossRefGoogle ScholarPubMed
Søndergaard, H.P., Theorell, T.A longitudinal study of hormonal reactions accompanying life events in recently resettled refugees. Psychother. Psychosom 2003;72(1):4958.CrossRefGoogle ScholarPubMed
Steel, Z., Silove, D., Phan, T., Bauman, A.Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. Lancet 2002;360:10561062.CrossRefGoogle ScholarPubMed
Turner, S.W., Cameron, B., Dunn, G., Ahapo, L., Yule, W.Mental health of Kosovan Albanian refugees in the UK. Br. J. Psychiatry 2003;182:444448.CrossRefGoogle ScholarPubMed
UNHCR. Update: Kosovo emergency 1999; June 7.Google Scholar
Westermeyer, J., Neider, J., Callies, A.Psychosocial adjustment of Hmong refugees during their first decade in the United States. J. Nerv. Ment. Dis 1989;177:132139.CrossRefGoogle ScholarPubMed
Yehuda, R., Kahana, B., Binder-Brynes, K., Southwick, S.M., Mason, J.W., Giller, E.L.Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder. Am. J. Psychiatry 1996;153:846.Google Scholar
Zanarini, M.C., Frankenburg, F.R.Attainment and maintenance of reliability of axis I and axis II disorders over the course of a longitudinal study. Comprehensive Psych 2001;42(5):369374.CrossRefGoogle ScholarPubMed
Zanarini, MC, Skodol, AE, Bender, D, Dolan, R, Sanoslow, C, Schaefer, Eet al. The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses. J. Personal. Disord 2000;14(4):291299.CrossRefGoogle ScholarPubMed
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