Vibor Milunović

Quality of life in Croatian Homeland war (1991- 1995) veterans who suffer from post-traumatic stress disorder and chronic pain

BackgroundThe aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP).MethodsA total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering.ResultsThe results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator.ConclusionsThe results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.

The founding of the Centre for Palliative Medicine, Medical Ethics and Communication Skills: a new step toward the development of patient-oriented medicine in Croatia.

One of the main conceptual changes in the 20th century medicine is the inclusion of social dimension. The “golden era” of Parson’s medical model (1), which uses the “active-passive” dichotomy to describe the positions and expectations of physicians and patients, is over. Physicians’ supremacy has slowly and systematically been challenged by the emergence of third party stakeholders, development of new media sources, strengthening of the civil society, and democratization of information, which all have contributed to the development of the patients’ active role in the healing processes (2). The rise of medical consumerism has stimulated the medical authorities to react with a new ideological policy: the patient-oriented medicine, insisting on the partnership in the diagnostic and therapeutic processes, and viewing the patient as a person with biological, psychological, social, and spiritual needs (2).

Psychosocial Determinants of Satisfaction with Hospital Care in Adult Patients Suffering from Advanced Cancer

In this observational study, direct and indirect (moderator and mediator) relationships between sociodemographic (age, gender, life partner, education level, income and length of treatment) and psychological (Hospital Anxiety and Depression Scale, HADS) variables and satisfaction with hospital care (EORTC INPATSAT32) in adult (advanced cancer) patients were investigated. Study sample consisted of 75 hospitalized advanced cancer patients recruited at the Zagreb University Hospital Centre and Sestre milosrdnice University Hospital Centre in 2015. Statistically significant negative correlations were found between HADS and elementary school education level, as well as with all satisfaction variables (satisfaction with physicians, nurses and organization). Moderate to high and statistically significant positive correlations were found between elementary school level and all satisfaction variables. Gender and level of education appeared as significant moderator variables in the relationship between HADS and satisfaction with nurse care. There were no significant mediator effects of sociodemographic variables on the correlation between HADS and satisfaction with care. Male participants who were more disturbed emotionally were more satisfied with nurses. Participants with elementary and high school levels of education and lower scores on HADS were more satisfied with nurses, while participants with university level of education had higher HADS scores and lower level of satisfaction with nurses.

P01-265 - Chronic low back pain in chronic combat related posttraumatic stress disorder

Objectives Chronic pain disorders have been accepted as one of major comorbid disorder in chronic posttraumatic stress disorder (PTSD). The main purpose of this research was to evaluate subjective processing of the pain in war veterans suffering from chronic PTSD and low back pain. Methods 227 Croatian war veterans participated in this study. Based on their personal history, psychiatric and surgical assessment they were divided in three groups: subjects suffering from PTSD and chronic low back pain (N=88), subjects suffering from chronic low back pain (N=50) and healthy controls (N=89). The following questionnaires were used in assessment of PTSD, depressive disorders and pain: Trauma Symptom Inventory, Hospital Anxiety and Depression Scale and the short-form McGill Pain Questionnaire. Results We have shown the significant differences between three groups. The group of PTSD patients experience the higher level of the intensity of pain and have an altered perception of pain complaining more of the affective and sensory pain than the group suffering from the chronic low back pain only. Both groups suffering from pain show depressive pattern rather than the the control group. We have shown that the affective and sensory pain is in the strong positive correlations with the specific PTSD symptoms and depression. Conclusion Patients suffering from PTSD seem to have an altered processing of the pain, especially the affective component of pain, probably because of functional pain disorders in many those patients. However, the neurobiological mechanism is needed to thoroughly understand the processing of pain in chronic PTSD.

PW01-197 - Social support in patients with chronic combat related PTSD in Croatia

Objective The main aim of this research is to evaluate the connection of various components of social support with chronic posttraumatic stress disorder (PTSD). We set up hypothesis that the level of the perceived social support mediates beneficial effects on various PTSD symptoms. Second hypothesis states that perceived social support is in positive connection with quality of life. Methods 246 outpatients with chronic combat related PTSD participated in this study. On the base of different questionnaires we examined social support, quality of life and PTSD symptomatology (Multidimensional Scale of Perceived Social Support- MSPSS, Trauma symptoms inventory -TSI-A, World Health Organization Quality Of Life-BREF). We tried to identify three main factors of social support by factor analysis of MSPSS. Those factors were used in logistic and multiple regression analysis in order to prove our hypothesis. Results In contrast to other researchers, we defined only two factors in MSPSS: “family support” explaining 52.9% of total variability and “peer support” explaining 18.5% of total variability. These factors used as predictors were not shown significant in multiple regression analysis predicting the PTSD symptoms defined by TSI-A. However, the levels of perceived social support were positively correlated with all four domains of quality of life. Conclusion Our research shows that role of social support in chronic course of PTSD is questionable, possibly due to personality changes and secondary traumatization, which is being supported by other researchers emphasizing its importance in the early course of PTSD.