title: Course of post-traumatic stress disorder following war in the Balkans: 1-year follow-up study.
abstract: BACKGROUND
  Prevalence rates of post-traumatic stress disorder (PTSD) following the experience of war have been shown to be high. However, little is known about the course of the disorder in people who remained in the area of conflict and in refugees. Method We studied a representative sample of 522 adults with war-related PTSD in five Balkan countries and 215 compatriot refugees in three Western European countries. They were assessed on average 8 years after the war and reinterviewed 1 year later. We established change in PTSD symptoms, measured on the Impact of Events Scale - Revised (IES-R), and factors associated with more or less favourable outcomes.
  
  
  RESULTS
  During the 1-year period, symptoms decreased substantially in both Balkan residents and in refugees. The differences were significant for IES-R total scores and for the three subscales of intrusions, avoidance and hyperarousal. In multivariable regressions adjusting for the level of baseline symptoms, co-morbidity with depression predicted less favourable symptom change in Balkan residents. More pre-war traumatic events and the use of mental health services within the follow-up period were associated with less improvement in refugees.
  
  
  CONCLUSIONS
  Several years after the war, people with PTSD reported significant symptom improvement that might indicate a fluctuating course over time. Co-morbid depression may have to be targeted in the treatment of people who remained in the post-conflict regions whereas the use of mental health services seems to be linked to the persistence of symptoms among refugees.
authors.affiliation: Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK. s.priebe@qmul.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Priebe
authors.forename: J
authors.initials: J
authors.lastname: Gavrilovic
authors.forename: S
authors.initials: S
authors.lastname: Bremner
authors.forename: D
authors.initials: D
authors.lastname: Ajdukovic
authors.forename: T
authors.initials: T
authors.lastname: Franciskovic
authors.forename: G
authors.initials: G
authors.lastname: Neri
authors.forename: A
authors.initials: A
authors.lastname: Kucukalic
authors.forename: D
authors.initials: D
authors.lastname: Lecic-Tosevski
authors.forename: N
authors.initials: N
authors.lastname: Morina
authors.forename: M
authors.initials: M
authors.lastname: Popovski
authors.forename: M
authors.initials: M
authors.lastname: Schützwohl
authors.forename: M
authors.initials: M
authors.lastname: Bogic
authors.forename: A
authors.initials: A
authors.lastname: Matanov
mesh_terms: D000328:Adult; D063368:Balkan Peninsula; D003866:Depressive Disorder / Q000523:psychology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012036:Refugees / Q000523:psychology*; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D014857:Warfare