title: Factors associated with posttraumatic stress disorder and depression in war-survivors displaced in Croatia.
abstract: OBJECTIVE
  To examine the role of perceived stressfulness of trauma exposure and economic, social, occupational, educational, and familial adaptation after trauma in posttraumatic stress disorder (PTSD) and depression in displaced war survivors.
  
  
  METHODS
  A cross-sectional survey was conducted between March 2000 and July 2002 with a sample of 173 internally displaced persons or refugees and 167 matched controls in Croatia. Clinical measures included Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale.
  
  
  RESULTS
  Displaced war survivors reported the exposure to a mean±standard deviation of 13.1±8.3 war stressors, including combat, torture, serious injury, death of close persons, and loss of property. Compared to controls, they reported higher rates of marked to severe impact of war on family (16.2% vs 51.6%), social (7.2% vs 43.5%), economic (12.6% vs 55.4%), occupational (1.8% vs 15.9%), and educational (2.4% vs 8.8%) adaptation. In two logistic regression analyses, the strongest predictor of PTSD and depression was high level of perceived distress during trauma exposure. PTSD but not depression was associated with economic, social, occupational, educational, and familial adaptation after trauma.
  
  
  CONCLUSIONS
  Displaced survivors who experienced multiple war events perceived greater negative impact of war on their life domains compared to individuals who lived in a war setting but had no trauma exposure. The most important determinant of psychological outcomes was perceived stressfulness of war stressors. Although post-trauma adaptation in different life spheres had an impact, its effect was not robust and consistent across disorders. These findings suggest that it would be effective to use a trauma-focused approach in rehabilitation of war survivors.
authors.affiliation: Regional Psychotrauma Centre, Rijeka and Department of Psychological Medicine, Psychiatric Clinic, Clinical Hospital Centre Rijeka, Cambierieva 17, Rijeka, Croatia. leticacrepulja@yahoo.com
authors.forename: Marina
authors.initials: M
authors.lastname: Letica-Crepulja
authors.forename: Ebru
authors.initials: E
authors.lastname: Salcioglu
authors.forename: Tanja
authors.initials: T
authors.lastname: Francisković
authors.forename: Metin
authors.initials: M
authors.lastname: Basoglu
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D017523:Croatia; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D011569:Psychiatric Status Rating Scales; D012036:Refugees / Q000523:psychology*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D014104:Torture / Q000523:psychology; D014857:Warfare