Final Report Summary - CONNECT (Components, organisation, costs and outcomes of health care and community based interventions for people with posttraumatic stress following war and conflict ...) CONNECT was a Specific Targeted Research Project (STREP) involving eight participating universities located in seven European countries. A scientific partnership of research expertise in posttraumatic stress has been created between institutions in Bosnia and Herzegovina, Croatia, Serbia and Montenegro, FYROM, Germany, Italy and the United Kingdom. It includes psychiatrists, psychologists and psychotherapists. The Balkan countries have gathered almost unique expertise in treatment of people with posttraumatic stress, while academic departments in the member states have a specific background in research on posttraumatic stress covering scientific, as well as, practical aspects of conducting cross sectional and longitudinal studies. Together, the partners have the conceptual and methodological expertise necessary to develop a model of long-term clinical and social outcomes for people with war experience, and to identify the impact of social and health care interventions on these outcomes. CONNECT had two main general objectives. The first one was to investigate long-term mental health and social outcomes of people who experienced war in the countries of former Yugoslavia, and in refugees across Western Europe. The second main objective was to provide empirical evidence on the impact of different health care and community-based interventions on clinical and social outcomes for people affected by war. More specifically, during its lifetime the CONNECT project aimed to achieve the following five main objectives: 1. to identify the components and organisation of health care and community-based interventions for people with posttraumatic stress; 2. to develop a model predicting long-term service use and outcome in people who experienced potentially traumatic events; 3. to assess components, costs and subjective outcomes of health care and community-based interventions in people with persistent posttraumatic stress; 4. to identify factors influencing change in people with persistent posttraumatic stress; 5. to estimate whether and, if so, to what extent, results gained in refugee populations can be generalised to people who stayed in the area ofthe conflict and vice versa. To achieve previously cited objectives, the methods included three major and interlinked pieces of research: a) the development and application of a new instrument to identify health care and community-based interventions for people with posttraumatic stress in all seven participating countries; b) a survey conducted in each country to identify and assess people who experienced potentially traumatic events related to war in the Balkans; c) within the survey people with persistent symptoms of posttraumatic stress were identified and re-interviewed after a one year follow-up period. The CONNECT project addressed several related research issues that have not been previously investigated in a comprehensive manner and on a similar methodological level. Thus, the provided research results that are substantially new. The innovative aspects in particular were: - This is the first study to assess and compare health care and community-based interventions for people with posttraumatic stress in different countries. The assessment of health care practice in the Balkan countries and the comparative analysis between all seven participating countries will yield insights into strengths and weaknesses of different organisations of health care and community interventions for people with posttraumatic stress. - This is the first study to develop a predictive model for long-term service use and outcome of posttraumatic stress in different countries. Such models are needed to predict service needs of people with posttraumatic stress in the future, and the comparison between countries will allow a testing of the overall applicability of the model as well as the identification of influential factors that are specific to the given context and population. - This is the first study that, on a large scale, empirically tests the relative contribution of health care interventions and community based interventions to long-term outcome of posttraumatic stress. The result will be essential not just for policy planning, but also for directing future research activities. Such activities will be supported by a new categorisation system for health care and community-based interventions that have been developed in the first phase of the project. - This is the first study focussing on people with persistent posttraumatic stress that investigates costs of on-going interventions, subjective outcome and their association. As care for people with persistent symptoms of posttraumatic stress is a special challenge to health care services, such a study conducted in different countries might stimulate further research targeted at that very distressed and challenging population. - Finally, this is the first study that prospectively assesses change of symptoms in those people who already have developed persistent symptoms, and identifies factors influencing change after many years. Again, this is a highly relevant and innovative aspect of the study emphasising a group of patients that is often excluded from research, but generates high costs for health care services. The project addressed a subject that is not only of utmost practical relevance to western Balkan countries, but also of increasing interest to member states. Balkan countries need systematic empirical data to advance their mental health and social care systems in order to care for patients with posttraumatic stress and other disorders. The project has provided the data on long-term service use of people affected by war. The ongoing analyses will lead to the development of guidelines for best practice in western Balkan countries. Yet, people with posttraumatic stress following war and migration are not just a challenge to western Balkan countries, but also to member states. ln the ongoing analyses, we are developing models for predicting service use and outcome in refugee populations over a long period of time. The model can form a basis to anticipate service needs and costs as well as long-term outcome in future refugee populations in Member States and possibly elsewhere. The comparison of predictor models between countries is aimed to provide information on whether and, if so, to what extent the prediction of needs in refugee populations can indeed be generalised from one country to another. The preliminary results show that, in line with the variation of the prevalence rates of mental disorders, there is a great variation in the service use (and therefore, costs) between the participating countries, and in particular between people who stayed in the area of conflict and those who found a refugee in one of the member states. These results will be important for further policy planning and implementation of health care systems. ln order to use data for further planning, Balkan countries will benefit from comparisons with other countries and interpreting their own data against the background of mental health and social care systems that have been established in different Member States. ln CONNECT, data from the four western Balkan countries will be contrasted with those from Germany, ltaly and the United Kingdom. These latter countries have very distinct mental health and social care systems, representing different traditions, approaches and funding levels. The comparative analysis in the study will help policy planners in the Balkan countries to model their plans and implementation policies of future mental health care against the practice in member states and learning from their experience. Thus, the study is intended to contribute to the establishment of effective health and social care in western Balkan countries, which should be a major step towards a sustainable democratic system. Documents connexes Final Report - CONNECT (Components, organisation, costs and outcomes of health care and community based interventions for people with posttraumatic stress following war and conflict in the Balkans)
