Prevalent mental health problems three years after NATO bombing

Depression and post-traumatic stress disorder “remain a significant public health concern” three years after the 1999 NATO campaign in Serbia, according to an article published this week in BMC Medicine. Refugees and people living in remote areas are particularly vulnerable to suffering from mental health problems.

Almost half the people questioned had symptoms of depression and more than one in eight had symptoms of post-traumatic stress disorder (PTSD).

American researchers teamed up with doctors from a university hospital in Belgrade and a district hospital in a Serbian enclave in Laplje Selo, Kosovo to assess the mental state of patients visiting their accident and emergency departments. 562 patients, none of whom were suffering from acute conditions, completed a questionnaire about their exposure to traumatic events and their experience of a variety of symptoms of depression or PTSD.

Older patients, those with lower levels of social support, and those that were unemployed were more likely to have symptoms of depression. People who had been a refugee longer than 30 days and those living in remote Laplje Selo were more likely to be suffering from symptoms of PTSD. A large proportion of participants in this study had features of both mental health disorders.

It is perhaps not surprising that Serbian residents of Laplje Selo are at high risk of suffering from a mental health disorder. The researchers write, “despite the general improvement of conditions in the region, the Serb minority continues to lack freedom of movement and access to basic services including access to health care.”

The prevalence of mental health disorders may be overestimated in this study, as the sample is made up of patients in emergency departments who are more likely to be suffering from a mental health disorder than the general population. However, the study does show that physicians in emergency departments are frequently missing opportunities to diagnose mental health conditions.

“What this project tries to highlight is the burden that mental health dysfunction may have on patients that present for care in the aftermath of war,” said William Fernandez, one of the authors of the study. He says that the main aim of his project was to raise physicians’ awareness that patients in the acute care setting may also be suffering from mental health problems.

“We, as providers, should optimize our screening of persons at-risk for the mental health conditions arising as a consequence of war, such as PTSD and/or depression, and refer them to outpatient treatment,” said Fernandez. “Public health officials, clinicians, and others with an interest in humanitarian work should bear in mind that a considerable number of patients who visit emergency departments may still harbour the mental health consequences of war, even three years following the end of armed conflict.”

This release is based on the following article:

War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia
Brett D Nelson, William G Fernandez, Sandro Galea, Sarah Sisco, Kerry Dierberg, Gordana Subaric Gorgieva, Arijit K Nandi, Jennifer Ahern, Mihajlo Mitrovic, Michael VanRooyen, David Vlahov
BMC Medicine 2004, 2:23
To be published 1 June 2004