title: Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war.
abstract: BACKGROUND
  The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war.
  
  
  METHODS
  100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used.
  
  
  RESULTS
  Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology.
  
  
  CONCLUSIONS
  War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018, XA, Amsterdam, The Netherlands. n.morina@uva.nl
authors.forename: Nexhmedin
authors.initials: N
authors.lastname: Morina
authors.forename: Paul M G
authors.initials: PM
authors.lastname: Emmelkamp
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006117:Grief; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D010549:Personal Satisfaction; D011788:Quality of Life / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D014857:Warfare; D017805:Widowhood / Q000523:psychology*; D014930:Women / Q000523:psychology; D015022:Yugoslavia