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Components, organisation, costs and outcomes of health care and community based interventions for people with posttraumatic stress following war and conflict in the Balkans

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The stress connection of war

The EU-funded Connect project is the largest community based study assessing mental disorders in people directly exposed to war. The study was conducted several years after the occurrence of traumatic war events and used consistent methods across eight countries.

Climate Change and Environment

Researchers assessed 3313 war-affected residents from five Balkan countries (Bosnia and Herzegovina, Croatia, FYR Macedonia, Serbia and Kosovo) and 854 compatriot refugees in three European Union states (Italy, Germany and the United Kingdom). Linking the unique expertise of psychiatrists, psychologists and psychotherapists from the participating Balkan countries with experts from the European Union, the Connect project explored mental health consequences of Balkan wars. The initiative assessed long-term clinical and social outcomes following the exposure to potentially traumatic war-related events, and identified the impact of social factors and a range of health and social care interventions on these outcomes. The associated costs of care were also assessed and compared across different countries. The project identified high prevalence rates of mental health disorders in both war-affected communities in the Balkans and amongst refugees in the West. In Balkan countries the reported rates of anxiety disorders were 33.5% (range 15.6% to 41.8%), and of mood disorders 28.3% (range 12.1% to 47.6%). Amongst the refugees the respective rates were 43.7% (range 30.3–60.7) for anxiety disorders and 43.4% (range 30.0–57.4) for mood disorders. The most frequent individual disorders were posttraumatic stress disorder and depression. Overall, these rates were substantially higher than those previously reported for non-war affected populations in Western countries. Exposure to more traumatic war events was associated with higher rates of mood and anxiety disorders in both the Balkan residents and the refugees. However, social factors such as unemployment, and migration related problems in refugees (e.g. temporary legal status and feelings of not being accepted) were also found to be linked to higher prevalence of these disorders. Consequently, the findings have highlighted not only the effects of exposure to war trauma, but also the importance of the post-war environment for mental health of war-affected populations. With regard to associated costs, war experiences and their effects on mental health were associated with increased health care costs even many years later, especially for those who stayed in the area of conflict. The study also followed-up participants diagnosed with PTSD over the period of one year. They reported significant symptom improvement over time; however, among refugees, using mental health services appeared to be linked to the persistence of symptoms. Finally, the CONNECT project also helped to establish a leading research network on post-traumatic stress in Europe and enhanced mental health research in the Balkan countries. In identifying factors associated with mental health outcomes following war and war-related migration, the findings of the project will assist policy planning and guide future research activities.

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