Treatment Outcomes and Costs at Specialized Centers for the Treatment of PTSD After the War in Former Yugoslavia

Priebe, Stefan; Gavrilović, Jelena; Matanov, Aleksandra; Frančišković, Tanja; Knežević, Goran; Ljubotina, Damir; Mehmedbasic, Alma Bravo; Schützwohl, Matthias

doi:10.1176/ps.2010.61.6.598

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…Indeed, in analyses excluding the combat involvement variable, the gender of the individuals became significant (available from authors). In a previous study from the area, age was found to have a positive impact on resource use [23]. Neither war-related traumatic experiences nor mental health status were related to use of healthcare services.…”

Section: Discussionmentioning

confidence: 67%

“…The data presented here, relating to the countries of former-Yugoslavia, on the recent use and costs of healthcare services and the factors that influence them highlight these long-term implications of wars. Based on smaller and more selective samples, we have previously reported the costs of services for those who have not actively sought specialist treatment and those who have been in receipt of such care [23], [24]. This is the largest study we are aware of to assess the healthcare service use and costs for populations affected by war, regardless of whether they actively participated in the war or not and if they stayed in the conflict zone or migrated.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Impact of War on Healthcare Costs: An Eight-Country Study

et al. 2012

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ObjectiveExposure to war can negatively affect health and may impact on healthcare costs. Estimating these costs and identifying their predictors is important for appropriate service planning. We aimed to measure use of health services in an adult population who had experienced war in the former-Yugoslavia on average 8 years previously, and to identify characteristics associated with the use and costs of healthcare.MethodWar-affected community samples in Bosnia-Herzegovina, Croatia, Kosovo, FYR Macedonia, and Serbia were recruited through a random walk technique. Refugees in Germany, Italy and the UK were contacted through registers, organisations and networking. Current service use was measured for the previous three months and combined with unit costs for each country for the year 2006/7. A two-part approach was used, to identify predictors of service use with a multiple logistic regression model and predictors of cost with a generalised linear regression model.Results3,313 participants were interviewed in Balkan countries and 854 refugees in Western European countries. In the Balkan countries, traumatic events and mental health status were related to greater service use while in Western countries these associations were not found. Participants in Balkan countries with post traumatic stress disorder (PTSD) had costs that were 63% higher (p = 0.005) than those without PTSD. Distress experienced during the most traumatic war event was associated with higher costs (p = 0.013). In Western European countries costs were 76% higher if non-PTSD anxiety disorders were present (0.027) and 63% higher for mood disorders (p = 0.006).ConclusionsWar experiences and their effects on mental health are associated with increased health care costs even many years later, especially for those who stayed in the area of conflict. Focussing on the mental health impact of war is important for many reasons including those of an economic nature.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Long-Term Impact of War on Healthcare Costs: An Eight-Country Study

et al. 2012

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“…Patients are more satisfied with their mental health than with their financial situation, and the experience of unemployment has a dominating influence on their SQOL and treatment satisfaction. An association between employment and SQOL has been well documented in other studies for patients with schizophrenia, mood disorders and neurotic disorders (Priebe et al 2010b). At the same time patients value the therapeutic relationships with staff in the centres.…”

Section: Patient Reported Outcomesmentioning

confidence: 64%

Community Mental Health Centres Initiated by the South-Eastern Europe Stability Pact: Evaluation in Seven Countries

Priebe

Matanov

Demi

et al. 2011

Community Ment Health J

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Eight community mental health care centres (initiated by the South-Eastern Europe Stability Pact) in Albania, Bosnia-Herzegovina, Croatia, Macedonia, Moldova, Montenegro and Romania were evaluated. Characteristics of patients, patient reported outcomes and patient views of care were assessed in 305 psychiatric patients. Patient characteristics varied across centres, with most patients having long term psychotic disorders. Treatment satisfaction and therapeutic relationships were rated favourably. Subjective quality of life mean scores were rather low, with higher satisfaction with health and dissatisfaction with the financial and employment situation. Being unemployed was the only factor associated with poor quality of life and lower treatment satisfaction. Most developing centres target patients with persistent psychotic disorders. Care appears highly valued by the patients. The findings encourage establishing more centres in the region and call for employment schemes for people with mental illnesses.

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“…In a study that compared the medical cost of PTSD patients with patients with other depressive or anxiety disorders, PTSD was associated with the greatest cost, which was 60% higher than patients with no psychiatric diagnosis (Marciniak et al, 2005), findings that are supported in an HMO setting (Walker et al, 2003) and in male veterans (Chan, Cheadle, Reiber, Unutzer, & Chaney, 2009). Yet in samples of acute PTSD (O'Donnell, Creamer, Elliott, & Atkin, 2005;Priebe et al, 2010), there is no evidence of increased health care-related costs. Therefore, PTSD is associated with greater medical costs, especially when it is chronic, indicating that there are substantial societal consequences to PTSD.…”

Section: Medical Care Use In and The Cost Associated With Ptsdmentioning

confidence: 99%

“…We also suggest that resilience of psychological and physical health is best attained through integrative interventions that initiate change in multiple factors, resulting in substantial change that promotes health of the individual, as well as the social systems in which they reside, resulting in sustainable changes. Last, we assert that interventions at the physiological and cellular levels that reduce PTSD will also have lasting positive effects on families, communities, and society as a whole, which incurs the associated elevated medical costs (Marciniak et al, 2005;O'Donnell et al, 2005;Priebe et al, 2010;Walker et al, 2003), reduced employment productivity (Kimerling et al, 2009;Nandi et al, 2004), and parental and marital difficulties associated with PTSD (Fontana & Rosenheck, 2010;Gangi, Talamo, & Ferracuti, 2009;Kelley et al, 2010). In this article, we highlight the physiological and cellular factors that contribute to resilience and risk following trauma and describe how regulation of inflammation through these mechanisms results in resilience (see Tables 1 and 2).…”

Section: The Cells To Society Resilience Model To Design Novel Intervmentioning

confidence: 99%