Quality of life in Croatian Homeland war (1991-1995) veterans who suffer from post-traumatic stress disorder and chronic
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RESEARCH
Open Access
Quality of life in Croatian Homeland war (19911995) veterans who suffer from post-traumatic stress disorder and chronic pain Marijana Braš1*, Vibor Milunović2, Maja Boban3, Lovorka Brajković1, Vanesa Benković4, Veljko Đorđević1 and Ozren Polašek5
Abstract Background: The aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP). Methods: A total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering. Results: The results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator. Conclusions: The results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.
Background Posttraumatic stress disorder (PTSD) is an extreme response to a traumatic event characterized with persistent re-experiencing of the trauma through recurrent and intrusive recollections or dreams, persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness and persistent symptoms of increased arousal [1]. The net result of all these changes includes a wide range of dysfunctions and personal maladjustments [2-4], as well as a reduction of the overall quality of life [5]. PTSD most frequently occurs among combat * Correspondence: [email protected] 1 Centre for Palliative Medicine, Medical Ethics and Communication Skills, Medical School, University of Zagreb, Zagreb, Croatia Full list of author information is available at the end of the article
veterans who experienced wartime-related psychological traumas [6-8]. However, it seems that a simple exposure to a stressful event is not crucial for the disease development, although the amount of stress is proportional to the chances of developing the disease. A study on Vietna
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