Health-Related Quality of Life of Ex-Prisoners of War Affected by Posttraumatic Stress Disorder 25 Years After Captivity

Abstract

Background: War captivity is one of the most difficult human experiences and can cause long-lasting effects on mental and physical health. Posttraumatic Stress Disorder (PTSD), as one of the frequent consequences of war trauma, is often associated with the psychiatric and/or somatic comorbidity. Therefore, PTSD results in impaired Health-Related Quality of Life (HRQoL). This study aimed to investigate the HRQoL in the Croatian Homeland War ex-POWs affected by PTSD, regarding the intensity of PTSD symptoms, sociodemographic characteristics and somatic comorbidity, and to identify predictors of poor HRQoL. Subjects and methods: The study sample consisted of two groups (45 participants each) based on whether they were POWs or not (control group). All study participants were diagnosed with PTSD according to the ICD-10 criteria and had combat experience as active participants in defence of the Republic of Croatia during the Homeland War. The subjects were evaluated using the sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. The data on participants' physical diseases were collected from medical anamnesis and medical records in the last five years. Results: In relation to ex-POWs, the control group had significantly smaller number of retirees, more unemployed persons, smaller number of married subjects, and higher number of divorced persons. Low socioeconomic status and intensity of PTSD symptoms has been confirmed as a significant predictor of impaired HRQoL in both subject groups. The most commonly PTSD associated physical diseases were musculosceletal, cardiovascular, and gastrointestinal diseases. Endocrine and metabolic diseases were more frequent in the ex-POWs' group. Conclusions: PTSD was associated with the HRQoL, whether the veterans were ex-POWs or not. The hypothesis that exposure of ex-POWs to the trauma of captivity experience impaired HRQoL to a greater extent, compared to the non-detained veterans, was not confirmed. Low socioeconomic status has proved to be the most significant predictor of poorer HRQoL.

Associations between hardiness, C-reactive protein, and telomere length among former prisoners of war.

“…Much empirical effort has been invested in the study of risk or vulnerability predictors of negative mental health (Xue et al, 2015) and deteriorated physical health (Jukic ´et al, 2019) outcomes among veterans. Our results are in line with the few studies that examined the protective role of resiliency factors, such as hardiness (Thomassen et al, 2018), on veterans' long-term adjustment.…”

“…A number of studies have documented the negative long-term sequelae of PTSD among ex-POWs (Jukić et al, 2019). Moreover, studies by our team revealed the close link between exposure to captivity trauma and varied medical morbidity and even mortality among ex-POWs (Solomon et al, 2014).…”

“…The accelerated aging process among individuals coping with PTSD has been speculated to result from chronic emotional and physiological reactivity, dysregulation of the hypothalamic-pituitary-adrenal axis (HPA), and risky health-related behaviors that take a biological toll in the form of accelerated cellular aging (Lohr et al, 2015). Specifically, ex-POWs have also been found to suffer from higher rates of medical conditions such as endocrine and metabolic diseases (Jukić, Filaković, Požgain, & Glavina, 2019), cardiovascular disease (Kang, Bullman, & Taylor, 2006), and chronic pain (Amris & Williams, 2015). Recently, our team found heightened CRP levels, higher rates of MetS, and shorter telomeres among Israeli ex-POWs compared with control veterans (Solomon et al, 2017; Stein, Levin, Uziel, Abumock, & Solomon, 2018).…”

Surviving the Inferno in Hopes of Reuniting with Family": Coping Strategies among Civilian Abductees Released from Captivity in Gaza

“…This environment engendered a pervasive atmosphere of fear and unpredictability, akin to complex trauma, in which abuse could occur without warning [1,11]. The interpersonal coping strategies employed by the abductees indicate that despite the severe conditions, they were occasionally successful in mitigating harm and enhancing their survival prospects [48][49][50]. Not only did this coping strategy provide certain bene ts, it also may have afforded them a degree of control and an escape from the absolute helplessness their captors intended to impose [51].…”

Inner Peace needs of male psychiatric patients in post-war Croatia are associated with their needs to clarify open issues in their life and their needs for forgiveness

“…According to official estimates of the Croatian government, at least one million people were exposed to the distress of the war, and approximately 7,600 Croatians—civil and active war participants—were detained in war prisons ( 4 ). At present, there are still a high number of people with symptoms of PTSD who feel persecuted by painful thoughts and memories ( 5 ).…”