Posttraumatic stress disorder among Croatian veterans: A causal model

Abstract

The present study investigates the etiological roles of premilitary risk factors, military entry conditions, war zone experiences, dissociative reactions to war zone experiences and homecoming reception in the development of chronic posttraumatic stress disorder (PTSD) among Croatian veterans. A total of 150 Croatian war veterans with the diagnosis of chronic combat-related PTSD, who sought treatment at Psychiatric Clinic, Osijek, Croatia, in the period 1993-1998, and who provided complete data, were selected as the sample for the present study from the treatment-seeking group of the ex-soldier population. Structural equation modeling is used to develop an etiological model concerning the relationships of premilitary risk factors, military entry conditions, war zone experiences, dissociative reactions, and homecoming reception with current symptoms of PTSD. An etiological model with satisfactory fit and parsimony was developed. In terms of the magnitude of variables' total contributions to the development of PTSD, war zone experiences are the most influential contributor which is followed by dissociative reactions, homecoming reception, military entry conditions and premilitary risk factors. Statistical significant direct effects to the development of PTSD were found for dissociative reactions and low family postwar support. The etiology of combat-related PTSD among Croatian veterans remains largely unexplained. Partial explanations are omission of other etiological factors, retrospective nature of the data and small study sample. The results are the source of questions for further research.

Mental Health Impact of Homecoming Experience Among 1730 Formerly Deployed Veterans From the Vietnam War to Current Conflicts: Results From the Veterans' Health Study

“…There have been previous studies that have examined the impact of homecoming on mental health outcomes among veterans (Fontana and Rosenheck. 1994,Johnson et al 1997,Koenen et al 2003,Vuksic-Mihaljevic et al 2000,Neria et al 1998), but these mostly assessed the support of family and friends, which may be confounded.…”

“…However, more recent studies have confirmed that the homecoming experiences of Vietnam (Steenkamp et al 2017,Fontana and Rosenheck. 1994,Johnson et al 1997,Koenen et al 2003,Schnurr et al 2004), Croatian (Vuksic-Mihaljevic et al 2000) and Israeli veterans (Neria et al 1998), as well as the homecoming experiences of peace-keepers (Bolton et al 2002), has had an adverse impact on the mental health of veterans. A limitation of past research has been that these studies have primarily assessed the support of family and friends, which may be confounded.…”

PTSD as a consequence of past conflict experience, recent exposure to violence and economic marginalization in post-conflict contexts: A study from Nepal, Guatemala and Northern Ireland

“…War veterans have also been shown to have higher risk of developing mental health problems (Laufer et al 1984, Vukšíc-Mihaljevíc et al 2000. Moreover, the distinction between combatants and victims may not always be clear-cut, as in the case of former child soldiers and others who were forcibly recruited (García-Godos 2016, Moffett 2016).…”

“…There is solid evidence in the literature that refugees and internally displaced people fleeing from war, internal armed conflict and other forms of organized violence have a higher risk of developing mental health problems compared to people who have not been exposed to such negative events (Fazel, Wheeler, & Danesh 2005;Scholte et al, 2004). War veterans have also been shown to have higher risk of developing mental health problems (Laufer, Gallops, & Frey-Wouters, 1984;Vukšíc-Mihaljevíc, Mandic, Benšíc, & Mihaljevíc, 2000). Moreover, the distinction between combatants and victims may not always be clear-cut, as in the case of former child soldiers and others who were forcibly recruited (García-Godos, 2016;Moffett, 2016).…”

Increased prevalence of oral potentially malignant lesions among Croatian War invalids, a cross-sectional study

“…Croatian war-disabled veterans are a specific risk group due to long-term exposure to stress and traumatic events during the Homeland War, which, in addition to frequent bad daily habits of alcohol consumption and cigarette smoking, has been proven to lead to more frequent development of post-traumatic stress disorder (PTSD) ( 4 , 12 ). Searching the literature, we did not find published results of scientific research on the same topic, and it seems that this is the only research that covered the knowledge and attitudes of this specific group in the Republic of Croatia about oral cavity cancer.…”