Use of healthcare services 8 years after the war in Kosovo: role of post-traumatic stress disorder and depression

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All rights reserved. doi:10.1093/eurpub/ckr096 Advance Access published on 11 July 2011 ................................................................................................................................. Use of healthcare services 8 years after the war in Kosovo: role of post-traumatic stress disorder and depression Ariel Eytan, Marianne Gex-Fabry Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland Correspondence: Ariel Eytan, MD, University Hospitals of Geneva, Department of Mental Health and Psychiatry, 2 Chemin du Petit-Bel-Air, CH-1225 Geneva, Switzerland, tel: +41 22 305 47 55, fax: +41 22 305 50 40, e-mail: Background: The aim of the present study was to examine the use of health-care services and medication, as well as health risk behaviours such as smoking, in relation with post-traumatic stress disorder (PTSD) and major depressive episode (MDE) in post-war Kosovo. Methods: A sample of 864 adults was interviewed in 2007 of which 551 took part in a 2001 survey. They were assessed using the PTSD and MDE sections of the Mini International Neuropsychiatric Interview (MINI) and the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Use of health-care services, alcohol and tobacco were also recorded. Results: Respondents were predominantly female (56.6%) with a median age of 36 years and a primary educational level (44.6%). While 11.9% of participants met diagnostic criteria for PTSD, MDE prevalence was 30.6%. Both PTSD and MDE were significantly associated with lower scores on the SF-36 physical component summary. After adjustment for sex, age, education, unemployment, municipality and SF-36 perceived physical health, no significant association was observed between PTSD and medical visits in the past 12 months, hospitalizations in the past 12 months and use of medication in the past 7 days. Results were similar for MDE, except for a significantly higher frequency of medication use that included psychotropic and other drug classes. Conclusion: Eight years after the war in Kosovo, poor perceived physical health displayed a long-lasting association with PTSD and MDE and was a major determinant of increased use of health-care services without additional contribution of PTSD per se. ................................................................................................................................. Introduction onsequences of collective trauma on the mental health of civilian C populations have been studied in various settings. A systematic review and meta-analysis of the prevalence rates of post-traumatic stress disorder (PTSD) and depression in the refugee and post-conflict mental health field included 161 articles.1 Noteworthy, only a third addressed long-term outcome (6 years or more after the conflict) and, among these, most were conducted in countries of asylum rather than in post-war countries. The scarcity of long-term follow-up studies probably reflects the time-frame of humanitarian and crisis intervention programmes, which are too often designed on a short-term basis. PTSD, which can be understood as the inability to recover from a stress reaction to a traumatic ev (...truncated)