War's Toll: Posttraumatic Stress Disorder

Aug. 2, 2005 -- "War is hell," as U.S. Civil War general William T. Sherman famously said more than a century ago.

That "hell" can linger after the guns fall silent. In The Journal of the American Medical Association, researchers paint a picture of the mental wounds in war survivors in the former Yugoslavia.

Posttraumatic stress disorder, a sense of injustice, and depression were common. Healing those hurts could help countries -- and people -- recover, write Metin Basoglu, MD, PhD, and colleagues.

Basoglu works in the trauma studies unit of the Institute of Psychiatry at King's College London.

Inside War Survivors' Minds

The study included more than 1,300 men and women who had directly experienced at least one aspect of war in the former Yugoslavia.

Some had lived through combat or torture. Others had been forced out of their homes, endured sieges, and/or survived aerial bombardment. They had been directly touched by the war 13 times, on average.

The war survivors were interviewed by psychiatrists and psychologists about their experiences, opinions, and mental health. For comparison, the study also included residents of the former Yugoslavia who hadn't been directly affected by the war (though they had seen the war on TV and/or knew people who had been directly affected).

Posttraumatic Stress, Depression Common

Nearly a quarter of the war survivors currently had posttraumatic stress disorder.posttraumatic stress disorder. About a third had had posttraumatic stress disorder in the past.

Posttraumatic stress disorder (PTSD) is a type of anxiety disorder that can develop after a very traumatic or life-threatening event. It can be terrifying or even disabling for some people.

People with PTSD may experience flashbacks, sleep problems, nightmares, feelings of isolation, guilt, paranoia, and panic attacks.

Ten percent of the war survivors had major depression.major depression. Fear of threat to safety and loss of control over life seemed to be the most important factors linked to PTSD and depression, write the researchers.

War Survivors Look for Justice

Nearly eight out of 10 war survivors expressed a sense of injustice because they felt the wrongs of the war had not been made right.

"Seventy-nine percent were dissatisfied because they believed justice had not been served in their case," write the researchers.

Half of the war survivors stated that they hadn't been properly compensated for their losses. Some weren't satisfied with their compensation; others said they hadn't gotten any compensation at all.

Some war survivors voiced disillusionment with the war's cause and with their fellow human beings. Some stated that the war had strengthened their faith in God and religion, while others described losing faith due to the war.

Restoring Justice

What would set things right? Half of the survivors stated that money would help. Others wanted medical care, their old homes, or punishment for the war's leaders. Another 28% didn't want any compensation.

Distress about injustice and compensation have also been seen in other studies of war survivors in the former Yugoslavia, as well as the African nation of Rwanda, the researchers note.

The findings suggest that "justice for survivors is much more than criminal trials," write the researchers.

Binding War's Mental Wounds

There's evidence that behavioral interventions to ease fear and PTSD might make a difference, leading to "a change in beliefs about self, others, and the world," write the researchers.

"This is a promising area of future research that may have important implications for reconciliation efforts in post-war countries," they write.