Psychological consequences of war trauma and postwar social stressors in women in Bosnia and Herzegovina.

AIM: To assess the consequences of psychotrauma in civilian women in Herzegovina who were exposed to prolonged and repetitive traumatic war events and postwar social stressors.

METHODS: The study included a cluster sample of 367 adult women, divided into two groups. One group (n=187) comprised women from West Mostar who were exposed to serious war and posttraumatic war events. The other group (n=180) comprised women from urban areas in Western Herzegovina who were not directly exposed to war destruction and material losses, but experienced war indirectly, through military drafting of their family members and friends. Demographic data on the women were collected by a questionnaire created for the purpose of this study. Data on trauma exposure and posttraumatic stress disorder (PTSD) symptoms were collected by Harvard Trauma Questionnaire (HTQ)--Bosnia-Herzegovina version. General psychological symptoms were determined with Symptom Check List-90-revised (SCL-90-R). Data on postwar stressors were collected by a separate questionnaire.

RESULTS: In comparison with the control group, women from Western Mostar experienced significantly more traumatic events (mean+/-standard deviation [SD], 3.3+/-3.2 vs 10.1+/-4.9, respectively, t=15.91; P<0.001) and had more posttraumatic symptoms (12.3+/-10.3 vs 21.2+/-10.9, respectively, t=8.42; P<0.001). They also had significantly higher prevalence of PTSD (4.4% vs 28.3%, respectively; chi(2)=52.56; P<0.001). The number of traumatic events experienced during the war was positively associated with postwar stressful events both in the West Mostar group (r=0.223; P=0.002) and control group (r=0.276; P<0.001). Postwar stressful events contributed both to the number and intensity of PTSD symptoms and all general psychological symptoms measured with SCL-90 questionnaire, independently from the number of experienced traumatic war events.

CONCLUSION: Long-term exposure to war and postwar stressors caused serious psychological consequences in civilian women, with PTSD being only one of the disorders in the wide spectrum of posttraumatic reactions. Postwar stressors did not influence the prevalence of PTSD but they did contribute to the intensity and number of posttraumatic symptoms.