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Factors associated with mental disorders in long-settled war refugees: refugees from the former Yugoslavia in Germany, Italy and the UK
- Marija Bogic, Dean Ajdukovic, Stephen Bremner, Tanja Franciskovic, Gian Maria Galeazzi, Abdulah Kucukalic, Dusica Lecic-Tosevski, Nexhmedin Morina, Mihajlo Popovski, Matthias Schützwohl, Duolao Wang, Stefan Priebe
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- Journal:
- The British Journal of Psychiatry / Volume 200 / Issue 3 / March 2012
- Published online by Cambridge University Press:
- 02 January 2018, pp. 216-223
- Print publication:
- March 2012
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Background
Prevalence rates of mental disorders are frequently increased in long-settled war refugees. However, substantial variation in prevalence rates across studies and countries remain unexplained.
AimsTo test whether the same sociodemographic characteristics, war experiences and post-migration stressors are associated with mental disorders in similar refugee groups resettled in different countries.
MethodMental disorders were assessed in war-affected refugees from the former Yugoslavia in Germany, Italy and the UK. Sociodemographic, war-related and post-migration characteristics were tested for their association with different disorders.
ResultsA total of 854 war refugees were assessed (≥255 per country). Prevalence rates of mental disorders varied substantially across countries. A lower level of education, more traumatic experiences during and after the war, more migration-related stress, a temporary residence permit and not feeling accepted were independently associated with higher rates of mood and anxiety disorders. Mood disorders were also associated with older age, female gender and being unemployed, and anxiety disorders with the absence of combat experience. Higher rates of post-traumatic stress disorder (PTSD) were associated with older age, a lower level of education, more traumatic experiences during and after the war, absence of combat experience, more migration-related stress, and a temporary residence permit. Only younger age, male gender and not living with a partner were associated with substance use disorders. The associations did not differ significantly across the countries. War-related factors explained more variance in rates of PTSD, and post-migration factors in the rates of mood, anxiety and substance use disorder.
ConclusionsSociodemographic characteristics, war experiences and post-migration stressors are independently associated with mental disorders in long-settled war refugees. The risk factors vary for different disorders, but are consistent across host countries for the same disorders.
TENTS guidelines: development of post-disaster psychosocial care guidelines through a Delphi process
- Jonathan I. Bisson, Behrooz Tavakoly, Anke B. Witteveen, Dean Ajdukovic, Louis Jehel, Venke J. Johansen, Dag Nordanger, Francisco Orengo Garcia, Raija-Leena Punamaki, Ulrich Schnyder, A. Ufuk Sezgin, Lutz Wittmann, Miranda Olff
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- Journal:
- The British Journal of Psychiatry / Volume 196 / Issue 1 / January 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 69-74
- Print publication:
- January 2010
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Background
How best to plan and provide psychosocial care following disasters remains keenly debated.
AimsTo develop evidence-informed post-disaster psychosocial management guidelines.
MethodA three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds.
ResultsA total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive–behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated.
ConclusionsThe Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.
11 - Public education and social reconstruction in Bosnia and Herzegovina and Croatia
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- By Sarah Warshauer Freedman, Professor of Education and Research Fellow of the Human Rights Center, The University of California, Berkeley, USA, Dinka Corkalo, Assistant Professor in the Department of Psychology, Faculty of Philosophy, The University of Zagreb, Croatia, Naomi Levy, Graduate student in the Department of Political Science, University of California, Berkeley, USA, Dino Abazovic, Member of the Faculty of Political Sciences and Director of the Center for Human Rights, University of Sarajevo, Bosnia and Herzegovina, Bronwyn Leebaw, Assistant Professor in the Department of Political Science, University of California, Riverside, USA, Dean Ajdukovic, Professor of Psychology and Director of the Postgraduate Psychology Program, University of Zagreb, Croatia, Dino Djipa, Research Director of Prism Research, Sarajevo, Bosnia and Herzegovina, Harvey M. Weinstein, Associate Director of the Human Rights Center and Clinical Professor of Public Health, University of California, Berkeley, USA
- Edited by Eric Stover, University of California, Berkeley, Harvey M. Weinstein, University of California, Berkeley
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- Book:
- My Neighbor, My Enemy
- Published online:
- 05 May 2010
- Print publication:
- 02 December 2004, pp 226-247
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Summary
Throughout history, governments of all political stripes have used history and literature curricula to reinforce national ideologies and identities. The promulgation of official memory through the school system can be an effective form of propaganda. The educational setting can become a conduit for the government or leaders' views, presenting political ideas and beliefs as either “correct” or “incorrect.” Textbooks and curricula can be used to justify or deny past state crimes, create revisionist history, present on-going injustices as natural, or perpetuate attitudes that replicate the conditions under which injustices are committed. Where school systems remain segregated and unequal, education can be manipulated to perpetuate inequalities that are a legacy of past conflicts, dispossession, or repression.
If public education can function to inflame hatreds, mobilize for war, and teach acceptance of injustice, it can be used also as a powerful tool for the cultivation of peace, democratic change, and respect for others. This premise has been a prominent focus of the United Nations (UN) Office of the High Representative (OHR) in Bosnia and Herzegovina (BiH), as well as numerous non-governmental organizations (NGOs) throughout the Balkans and in conflict zones around the world. If children living in divided societies can come together in the schools, this contact can be used to help them question the prejudices and stereotypes in their surrounding environment.
9 - Attitudes toward justice and social reconstruction in Bosnia and Herzegovina and Croatia
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- By Miklos Biro, Professor of Psychology, University of Novi Sad, Serbia and Montenegro, Dean Ajdukovic, Professor of Psychology and Director of the Postgraduate Psychology Program, University of Zagreb, Croatia, Dinka Corkalo, Assistant Professor in the Department of Psychology, Faculty of Philosophy, University of Zagreb, Croatia, Dino Djipa, Research Director of Prism Research, Sarajevo, Bosnia and Herzegovina, Petar Milin, Assistant in the Department of Psychology, University of Novi Sad, Serbia and Montenegro; Research Fellow, Laboratory for Experimental Psychology, University of Belgrade, Serbia and Montenegro, Harvey M. Weinstein, Associate Director of the Human Rights Center and Clinical Professor of Public Health, University of California, Berkeley, USA
- Edited by Eric Stover, University of California, Berkeley, Harvey M. Weinstein, University of California, Berkeley
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- Book:
- My Neighbor, My Enemy
- Published online:
- 05 May 2010
- Print publication:
- 02 December 2004, pp 183-205
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Summary
In this chapter, we examine the factors that may contribute to or prevent the rebuilding of war-torn societies based on two surveys of attitudes and beliefs of the inhabitants of three cities – Vukovar, Mostar, and Prijedor – in Croatia and Bosnia and Herzegovina (BiH) in 2000 and 2001. Prior to the war, these three cities were integrated societies where different nationalities had intermarried and lived together in relative harmony for centuries. Since the end of hostilities in 1995, the cities have remained fairly peaceful, although conflicts between national and civic identity still continue among the three principal national groups. While the war experience of these cities may have been unique in its ferocity, it also is true that the manifestations of enmity that persist can be found in similar towns and villages throughout BiH and Croatia.
The principal goals of our survey were: to investigate some of the underlying attitudes and beliefs of the population of Mostar, Prijedor, and Vukovar toward the (re)building of community; to investigate attitudes toward reconciliation and members of other national groups; and finally, to investigate attitudes toward war crimes, war crimes trials and, specifically, the International Criminal Tribunal for the former Yugoslavia (ICTY).
Background
Psychological and social origins
The 1991–1995 wars in the former Yugoslavia will be remembered for their cruelty, including widespread war crimes, ethnic cleansing, and genocide.
7 - Neighbors again? Intercommunity relations after ethnic cleansing
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- By Dinka Corkalo, Assistant Professor in the Department of Psychology, Faculty of Philosophy, University of Zagreb, Croatia, Dean Ajdukovic, Professor of Psychology and Director of the Postgraduate Psychology Program, University of Zagreb, Croatia, Harvey M. Weinstein, Director of the Human Rights Center and Adjunct Professor of Public Health, University of California, Berkeley, USA, Eric Stover, Director of the Human Rights Center and Adjunct Professor of Public Health, University of California, Berkeley, USA, Dino Djipa, Research Director of Prism Research, Sarajevo, Bosnia and Herzegovina, Miklos Biro, Professor of Psychology, University of Novi Sad, Serbia and Montenegro
- Edited by Eric Stover, University of California, Berkeley, Harvey M. Weinstein, University of California, Berkeley
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- Book:
- My Neighbor, My Enemy
- Published online:
- 05 May 2010
- Print publication:
- 02 December 2004, pp 143-161
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Summary
How can survivors of wars inflamed by ethnic hatred rebuild their lives? How do they describe their former enemies, now their neighbors? What role does justice play in the process of rebuilding communities? And what will it take to re-establish trust among former neighbors torn apart by communal violence?
In the summer of 2000, we set out to answer those questions through a series of long-term studies in three war-ravaged cities in Bosnia and Herzegovina (Mostar and Prijedor) and Croatia (Vukovar). As Weinstein and Stover have noted in the Introduction to this volume, these cities, once vibrant and thriving urban centers, are now deeply divided along ethnic lines. While the “ethnic divide” in Mostar is facilitated by the River Neretva, with Bosniaks living on the east bank and Croats living on the west bank, neither Vukovar nor Prijedor has such a physical demarcation. Instead, a “psychological wall” exists in both these cities, separating Croats from Serbs in Vukovar, and Bosniaks from Serbs in Prijedor. In all three cities, people from opposing ethnic groups who once lived together peacefully now harbor deep-seated resentments and suspicions of one another, making it difficult to renew social relationships or to form new ones.
Our studies examined the views of residents in these three cities regarding war, justice, and the prospects for reconciliation. In Mostar and Vukovar, we studied the daily lives of residents over a two-year period.
14 - Trust and betrayal in war
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- By Dean Ajdukovic, Professor of Psychology and Director of the Postgraduate Psychology Program, University of Zagreb, Croatia, Dinka Corkalo, Assistant Professor in the Department of Psychology, Faculty of Philosophy, University of Zagreb, Croatia
- Edited by Eric Stover, University of California, Berkeley, Harvey M. Weinstein, University of California, Berkeley
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- Book:
- My Neighbor, My Enemy
- Published online:
- 05 May 2010
- Print publication:
- 02 December 2004, pp 287-302
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Summary
Today, eleven years after the end of the war, Vukovar remains a ravaged and ethnically divided city. Indeed, when Croats and Serbs talk about the 1991 war within their own ethnic group, they invariably ask: “How could we have trusted them?” That such deep feelings of distrust and suspicion can exist in Vukovar, a city that once boasted one of the highest interethnic marriage rates in the former Yugoslavia, seems hard to fathom. So what happened? What caused neighbor to turn against neighbor? How could feelings of betrayal and distrust spread through a once harmonious community like a virulent cancer? And will it ever be possible for the residents of Vukovar to overcome a basic lack of trust and reconcile their differences?
In 2002, we set out to find answers to these questions through an interview study of forty-eight Croat and Serb residents of the city. We approached potential participants through two local recruiters who solicited participation on the basis of recommendations from one person to another, a recruiting process known as “snowball sampling.” Participants had to meet the following criteria: first, they must have lived in Vukovar for at least fifteen years prior to the outbreak of war in 1991. Second, during this time, they must have had close friends from the other ethnic group. Third, this relationship must have been severed or seriously threatened since 1991. The final sample consisted of an equal number of Serbs and Croats, from three age categories and three levels of education.