Miro Klarić

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

Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study

Aim To determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD). Methods The research included 247 veterans of the 1991-1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following self-assessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI) Results Based on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015). Conclusion Our results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes.

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.

Outcome of treatment with antidepressants in patients with hypertension and undetected depression

Objective: The objective of the research was to determine whether the administration of antidepressants, concurrently with antihypertensive therapy, leads to the better regulation of blood pressure in patients with hypertension and increased depressiveness. Methods: Research was conducted in two outpatient family clinics in Rijeka, Croatia, on 452 patients with arterial hypertension who had not been diagnosed with depression prior to the study. The diagnosis of hypertension was made in accordance with the European Society of Hypertension and the European Society of Cardiology Guidelines for the Management of Arterial Hypertension. Using the Beck Depression Inventory and the ICD-10 criteria for depression, a group of depressed hypertensive patients (N = 134) was selected. Out of a total of 134 selected patients, 73 patients (N = 73) were receiving antidepressants together with antihypertensives for 24 weeks. They formed the experimental group. The rest of the patients (N = 61) continued to receive only antihypertensives and they formed the control group. Results: After the end of the 24-week therapy, the experimental group of patients had significantly lower levels of both systolic and diastolic blood pressure (Z = 7.42; P < 0.001; and Z = 7.36; P < 0.001). The control group saw no significant difference between the level of blood pressure (both systolic and diastolic) prior to and after this period. Conclusion: The application of antidepressant therapy in patients with hypertension who are also depressed may be associated with the better control of blood pressure, which reduces the risk of cardiovascular disease in addition to alleviating depressive symptoms.

P02-477 - Posttraumatic stress disorder and and concomitant comorbidity in BIH war veterans 12 years after war

Introduction PTSD is dominant, but rarely the only psychological disorder that is present among individuals who have a history of exposure to traumatic event. Objectives To examine morbidity in veterans 12 years after the war, with special emphasis on comorbidity of PTSD and other psychiatric disorders. Methods The study population consisted of 154 veterans who sought psychiatric treatment due to PTSD. The control group consisted of 77 war veterans who do not have PTSD, collected by snow balling method through veteran associations. The study used a general demographic questionnaire, the HTQ-version for BiH, and the MINI. Results Veterans who sought psychiatric treatment due to PTSD, were experienced a significantly greater number of traumatic events (t=5.66; P 2 =17.988; P 2 =36.297; P 2 =29.356; P 2 =29.356; P 2 =9.959; P=0.007), the criteria for the diagnosis of panic disorder with agoraphobia (X 2 =5.490; P=0.019), PTSD (X 2 =102.018; P 2 =89.755; P Conclusion Although PTSD is the dominant cause for seeking psychiatric treatment in veterans, PTSD promotes a comprehensive psychiatric and somatic comorbidity, and predominated are anxious and affective disorders.