Predictors of Depression in Primary Care Physicians in Kosovo Ten Years after the End of the Balkan Conflict Open Access

Abstract

Predictors of Depression in Primary Care Physicians in Kosovo Ten Years after the End of the
Balkan Conflict

By Teresa I. Sivilli
Complex humanitarian emergencies (CHEs) result from war or conflict; they are massive public
health disasters in which social structures break down and civilians are the majority of the
affected. CHEs have significant impact on mental health; morbidity can persist years after the
event is over. Little is known about the mental health consequences for aid workers who respond
to a CHE. One group at particular risk is "national staff", individuals from the affected
population who respond to an emergency.

Methods
A survey of primary health care doctors and nurses in Kosovo in May 2010 measured prevalence
of stress- and trauma-related symptoms. The stratified sampling frame comprised 361 physicians
and 972 nurses; the CDC assessment team attempted to include every eligible physician and a
systematic random sample of 50% of nurses. Participants completed a questionnaire capturing
demographics, chronic stressors, trauma experiences, secondary trauma transmission, social
support, and coping strategies.

Overall response was 85%; 716 staff participated including 286 physicians (79.2%) and
430 nurses (88.5%). 30.1% of participants reported elevated anxiety symptoms and
28.5% reported elevated depression symptoms, while 15.8% met criteria for PTSD. Factors most
strongly associated with depression among physicians were chronic stressors, secondary trauma,
maladaptive coping, and being imprisoned during the war.

Physicians are experiencing moderate to severe problems with depression, anxiety, and PTSD
symptoms, primarily from their war experiences. Levels of secondary trauma are high. This has
potential impacts on their work, because of difficulties with concentration and decision-making;
on inter-personal relationships due to irritability; and on their own health, due to long-term
consequences of stress and risks associated with negative coping behaviors.

Depression, anxiety, and other stress-related physical and mental illnesses impede societies as
they work to recover from conflict. Results from this survey will guide psychosocial
interventions for the population. Understanding the determinants of negative mental health
outcomes will increase knowledge of long-term mental health effects of CHEs on national staff.
Innovative, results-oriented, cost-effective approaches to treat stress-related illness are badly
needed.

Table of Contents

Chapter 1: Introduction.................................................................1

Chapter 2: Review of the Literature.................................................5

Chapter 3: Manuscript.................................................................14

Contribution of Student.......................................................15

Abstract...........................................................................16

Methods...........................................................21

Sample Population..............................................21

Ethical Approvals................................................22

Survey Instrument..............................................22

Study procedures...............................................25

Results.....................................................................28

Discussion.................................................................38

Chapter 4: Discussion, Conclusion and Recommendations ..................42

Tables and Figures..................................................................... 45

References............................................................................... 71

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health
Keyword	depression staff support mental health psychological stress psychological trauma CHE Kosovo
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University Lopes Cardozo, Barbara, CDC
Committee Members	Blanton, Curtis, CDC
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.) CDC

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