Aleksandra Stevanović

Marital quality and relationship satisfaction in war veterans and their wives in Bosnia and Herzegovina.

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 partners 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 combat-related 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 partners 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. For the abstract or full text in other languages, please see Supplementary files under Reading Tools online

Relationship of early-life trauma, war-related trauma, personality traits, and PTSD symptom severity: a retrospective study on female civilian victims of war.

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.

Combat-Related Posttraumatic Stress Disorder and Families

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.

P-982 - Secondary traumatic stress among wives of war veterans with PTSD

Rezultati dosadasnjih istraživanja ukazuju na to da supruge ratnih veterana imaju niz psihickih i tjelesnih simptoma ukljucujuci i simptome sekundarnog traumatskog stresa. S obzirom na broj veterana Domovinskog rata oboljelih od PTSP-a postavlja se pitanje psiholoskog zdravlja njihovih supruga. Cilj ovog istraživanja bio je ispitati razinu simptoma sekundarnog traumatskog stresa (STS), trenutnih psiholoskih simptoma i percipirane kvalitete života i usporedbu između skupina ispitanica ciji su muževi oboljeli od PTSP-a (KS1, N=50), ispitanica ciji muževi nemaju PTSP (KS2, N=50) i ispitanica ciji muževi nisu sudjelovali u Domovinskom ratu (US, N=50). Također, cilj je bio i ispitati povezanost simptoma STS-a, psiholoskih simptoma i percipirane kvalitete života. Istraživanje je provedeno u Centru za psihotraumu Rijeka gdje je sa svim ispitanicama proveden je strukturirani intervju iz kojeg su dobiveni sociodemografski podaci. Sve ispitanice su ispunile upitnik Kratki inventar simptoma i MANSA upitnik za procjenu kvalitete života. Modificirani upitnik za posrednu traumatizaciju ispunjavale su samo supruge ratnih veterana. Dobiveni rezultati govore da 36% supruga veterana oboljelih od PTSP-a zadovoljava kriterij za sekundarni traumatski stresni poremecaj. Ispitanice iz skupine KS1 postižu i znacajno vecu razinu simptoma STS-a, svih ispitivanih simptoma emocionalnog funkcioniranja te znacajno manju percipiranu kvalitetu života u odnosu na ispitanice iz skupina KS1 i US. Rezultati ispitivanja povezanosti pokazuju da supruge veterana koje imaju vecu razinu simptoma STS imaju i vecu razinu svih ispitivanih psiholoskih simptoma te manju razinu percipirane kvalitete žiivota. Klinicari koji se bave psihotraumom trebali bi imati na umu da život s traumatiziranom ratnim veteranom može dovesti do sekundarnih stresnih reakcija kod njihovih supruga. Sistemski psihoterapijski pristup u radu s veteranima Domovinskom rata mogao bi ne samo prevenirati simptome sekundarnog traumatskog stresa vec i poboljsati funkcioniranje primarne žrtve traume i partnersko funkcioniranje.

Quality of Life in a Hospice: A Validation of the Croatian Version of the EORTC QLQ-C15-PAL

Purpose: Quality of life is the cornerstone of palliative care, and assessing it requires validated and standardized questionnaires. However, the majority of questionnaires are not tested in a hospice setting. The purpose of this study is to evaluate the quality of life in a hospice using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 for Palliative Care (PAL) (EORTC QLQ-C15-PAL) questionnaire and validating it in Croatian language. Methods: The study was conducted prospectively on 151 consecutive patients who were evaluated at the admittance to the hospice and after 7 days. Along with the EORTC QLQ-C15-PAL, both evaluations included the Edmonton Symptom Assessment System (ESAS) and the Palliative Performance Score (PPS) version 2. Cronbach α coefficient was used to test the reliability of multi-item scales, while construct and concurrent validity was tested using the Pearson correlation coefficients. Known-group validity was evaluated using the Student t test. Results: Physical functioning, pain, and emotional functioning scales all exhibited high reliability on both assessments and met the criteria of Cronbach α ≥.70, while fatigue scale met the predetermined criteria in the follow-up assessment (α = .90). Adequate validity was also displayed, with the highest correlation coefficients between the EORTC QLQ-C15-PAL and ESAS scales recorded for the corresponding items. The EORTC QLQ-C15-PAL was also able to distinguish patients with different PPS scores, exhibiting excellent clinical validity. Conclusions: The EORTC QLQ-C15-PAL can be used successfully in Croatian palliative care. However, inevitable issues such as low retest percentage due to short survival and low physical functioning scores need to be acknowledged in further formulations of quality of life questionnaires specific to hospice care.