Predictors of Depression in Primary Care Physicians in Kosovo Ten Years after the End of the Balkan Conflict Open Access
Sivilli, Teresa (2011)
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
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