Barts' and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
Soc Sci Med. 2010 Dec;71(12):2170-7. doi: 10.1016/j.socscimed.2010.09.029. Epub 2010 Oct 30.
War experiences are associated with substantially increased rates of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD) and Major Depression (MD). There is limited evidence on what type of war experiences have particularly strong associations with subsequent mental disorders. Our objective was to investigate the association of violations of human rights, as indicated in the 4th Geneva Convention, and other stressful war experiences with rates of PTSD and MD and symptom levels of intrusion, avoidance and hyperarousal. In 2005/6, human rights violations and other war experiences, PTSD, post-traumatic stress symptoms and MD were assessed in war affected community samples in five Balkan countries (Bosnia-Herzegovina, Croatia, Kosovo, Macedonia, and Serbia) and refugees in three Western European countries (Germany, Italy, United Kingdom). The main outcome measures were the MINI International Neuropsychiatric Interview and the Impact of Event Scale-Revised. In total 3313 participants in the Balkans and 854 refugees were assessed. Participants reported on average 2.3 rights violations and 2.3 other stressful war experiences. 22.8% of the participants were diagnosed with current PTSD and also 22.8% had MD. Most war experiences significantly increased the risk for both PTSD and MD. When the number of rights violations and other stressful experiences were considered in one model, both were significantly associated with higher risks for PTSD and were significantly associated with higher levels of intrusion, avoidance and hyperarousal. However, only the number of violations, and not of other stressful experiences, significantly increased the risk for MD. We conclude that different types of war experiences are associated with increased prevalence rates of PTSD and MD more than 5 years later. As compared to other stressful experiences, the experience of human rights violations similarly increases the risk of PTSD, but appears more important for MD.
战争经历与精神障碍的发生率显著相关，尤其是创伤后应激障碍（PTSD）和重度抑郁症（MD）。关于哪些类型的战争经历与随后的精神障碍有特别强的关联，证据有限。我们的目的是调查违反人权的情况（如日内瓦第四公约所规定的）以及其他压力性战争经历与 PTSD 和 MD 的发生率以及入侵、回避和过度警觉症状水平之间的关联。在 2005/6 年，在五个巴尔干国家（波斯尼亚和黑塞哥维那、克罗地亚、科索沃、马其顿和塞尔维亚）和三个西欧国家（德国、意大利和联合王国）的受战争影响的社区样本和难民中评估了侵犯人权行为和其他战争经历、PTSD、创伤后应激症状和 MD。主要结局指标是 MINI 国际神经精神病学访谈和事件影响量表修订版。在巴尔干地区共有 3313 名参与者和 854 名难民接受了评估。参与者报告平均经历了 2.3 次侵犯人权行为和 2.3 次其他压力性战争经历。22.8%的参与者被诊断为当前患有 PTSD，也有 22.8%的参与者患有 MD。大多数战争经历显著增加了 PTSD 和 MD 的风险。当在一个模型中考虑侵犯人权行为和其他压力性经历的数量时，两者都与 PTSD 风险增加显著相关，与入侵、回避和过度警觉水平升高显著相关。然而，只有侵犯人权行为的数量，而不是其他压力性经历的数量，显著增加了 MD 的风险。我们的结论是，不同类型的战争经历与 5 年多后 PTSD 和 MD 的患病率增加相关。与其他压力性经历相比，侵犯人权的经历同样增加了 PTSD 的风险，但对 MD 似乎更为重要。
