Title Kumulativni utjecaj ratnih stresora i kontekstualnih čimbenika na duševno zdravlje ratom pogođene populacije : doktorski rad Author Marina Letica-Crepulja Mentor Tanja Frančišković (mentor)Committee member Tanja Frančišković (član povjerenstva)Committee member Ika Rončević-Gržeta (predsjednik povjerenstva)Committee member Vera Folnegović-Šmalc (član povjerenstva)Committee member Eris Materljan (član povjerenstva)Granter University of Rijeka Defense date and country 2012-01-01, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616 - Pathology. Clinical medicine Abstract Cilj istraživanja Cilj istraživanja je utvrditi utjecaj pojedinačnih, akutnih stresora, te dugotrajnijih kontekstualnih bioloških, psiholoških i socijalnih čimbenika koji su prethodili (sociodemografski čimbenici, religijska uvjerenja, psihološka pripremljenost, ranije obolijevanje od duševnih bolesti, te psihijatrijski hereditet), djelovali tijekom (vrste ratnih stresora, stupanj distresa tijekom izlaganja i njihov kumulativni utjecaj) i nakon rata
... More (izravni utjecaj rata na obiteljsko, radno, socijalno i prihodovno i obrazovno funkcioniranje, obiteljska podrška, osjećaj zadovoljenja pravde) na duševno zdravlje osoba koje su izložene ratnim stresorima. Ispitanici i metode Istraživanje je bilo terensko, prema vrsti, radi se o istraživanju parova (case-control study) u koje je uključeno 512 ispitanika (256 ispitanika u skupni osoba izloženih ratnim stresorima i isto toliko u kontrolnoj skupini). Klinički psihometrijski instrumenti koji su primijenjeni su: Polustrukturirani intervju za osobe koje su prošle rat (SISOW), Strukturirani klinički intervju za DSM-IV (SCID-I/NP, version 2), Klinička ljestvica za posttraumatski stresni poremećaj (PTSP) (CAPS), Upitnik o naknadi za osobe koje su preživjele traumu (RTSQ).Rezultati Subjektivni doživljaj peritraumatskog stresa je najvažniji pretkazatelj PTSP-a i depresije koji su najčešći duševni poremećaji u osoba koje su izložene ratnim stresorima što ukazuje na pristup usredotočen na traumu kao metodu izbora u liječenju osoba koje su oboljele od posttraumatskih duševnih poremećaja. Adekvatna podrška bliskih osoba također, umanjuje pojavnost PTSP-a i depresije vjerojatno pomažući emocionalnoj regulaciji u situacijama kada zahtjevi nadilaze kapacitet pojedinca. Osjećaj zadovoljenja pravde je negativno povezan s ovim duševnim Vporemećajima što implicira veći značaj pravosudnih institucija na nacionalnoj i međunarodnoj razini nego na planu individualnog ozdravljenja. Broj ratnih traumatskih događaja je pozitivno povezan s pojavom duševnih poremećaja što potvrđuje „učinak doze“ na učestalost PTSP-a i depresije tj. postoji korelacija većeg broja traumatskih događaja s većom učestalošću ovih poremećaja. Čimbenici koji su povezani s obolijevanjem od PTSP-a, a nisu povezani s depresijom su muški spol što je vjerojatno posljedica veće izravne izloženost borbi u odnosu na ženski spol, starija dob u vrijeme istraživanja, te starija dob u vrijeme traume što ukazuje na važnost istraživanja rizika za PTSP tijekom različitih životnih razdoblja. Jedini pretkazatelj depresivnog poremećaja, a koji nije povezan s PTSP-om je povijest psihijatrijskih poremećaja u obitelji što ukazuje na važnost obiteljskog prijenosa sklonosti depresivnom poremećaju. Zaključak PTSP i depresija su najčešći duševni poremećaji u ratom pogođenoj populaciji, a posljedica su djelovanja pojedinačnih, akutnih traumatskih stresora, ali i dugotrajnijih kontekstualnih čimbenika koji su prethodili, djelovali tijekom i nakon izlaganja ratnim stresorima. Među tim čimbenicima najveću ulogu u nastanku poremećaja ima subjektivni doživljaj peritraumatskog stresa. Identificiranje ovih čimbenika je važno jer se utjecaj nekih od njih na duševno zdravlje može prevenirati, dok su drugi važni radi usmjeravanja metoda probira na rizične skupine osoba koje su pogođene ratnim stresorima. Less Abstract (english) The aim of this study is to examine the role of single, acute stressors as well as long-term contextual biological, psychological and social factors which precede exposure to war-stressors (sociodemografic factors, religious beliefs, psychological preparedness, past psychiatric illness and family history of psychiatric illness), affect the population during the exposure (type of war-stressors, level of the peritraumatic distress, cumulative exposure to
... More potentially traumatic events) and postdate experiences related to war (direct impact of war on economic, social, occupational, educational, and familial functioning, social and family support, appraisal of redress for trauma) in mental health outcomes of the population exposed to war-stressors. Patients and Methods A case-control study included population-based sample of 512 participants (256 war survivors who had experienced at least 1 war-related stressor and 256 participans in control group). Clinical measures included Semi-structured Interview for Survivors of War (SISOW), Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Clinician-Administered PTSD (posttraumatic stress disorder) Scale and Redress for Trauma Survivors Questionnaire (CAPS) and Redress for Trauma Survivors Questionnaire (RTSQ). Results Subjective appraisal of peritraumatic distress is the most prominent predictor of PTSD and depression which are the most common psychiatric disorders in population exposed to war-stressors. That indicates that trauma-focused approach is the best method for treatment of patients with posttraumatic stress disorders. Perceived support from close relatives and friends show strong predictions on PTSD and depression probably improving emotional regulation in VIIsituations when demands exceed the individual'scapacity for self-regulation. Sense of injustice arising from appraisal of redress for trauma is associated with PTSD and depression what indicates that retributive justice processes influences healing processes on national and international level much more than on individual level. Number of traumatic events is positively associated with PTSD and depression. This is consistent evidence of a dose-effect relationship between diverse forms of cumulative war-trauma and PTSD and depression. Male gender predicted only PTSD and not depression probably as the consequence of predominant direct exposure to combat comparing with female participants. Higher rates of PTSD are associated with being older suggesting the importance of research of risk for PTSD during different life stages. The only predictor of depression and not PTSD is family history of psychiatric disorders indicating the importance of family transmission of diathesis for depression. Conclusions Posttraumatic stress disorder and depression are the most common psychiatric disorders in population exposed to war-stressors. They are consequences of exposure to acute stressors as well as long-term contextual factors which precede exposure, affect victims during exposure and postdate exposure to war-stressors. Among other significant factors, the most prominent factor is subjective appraisal of peritraumatic distress. Identification of these factors is important because influence of some factors on mental health can be prevented and on the other hand, it can provide insight into needs of survivors with higher risk for adverse mental health consequences after exposure to war-stressors. Less Keywords
Duševno zdravlje
Podržavajući čimbenici
Psihološki stres
Rat
Socioekonomski čimbenici
Višestruka uzročnost.
Keywords (english)
Mental health
Multiple Causation
Psychological Stress
Reinforcing Factors
Socioeconomic Factors
War.
Language croatian URN:NBN urn:nbn:hr:188:313930 Promotion 2012 Study programme Title: Biomedicine Postgraduate (doctoral) study programme Catalog URL https://libraries.uniri.hr/cgi-bin/ucat/unilib.cgi?form=D1121216047 Type of resource Text Extent 174 str; 30 cm File origin Born digital Access conditions Open access Terms of use Created on 2017-01-19 18:50:38
