S-13-01

Barriers to treatment for people suffering from posttraumatic stress: Quantitative and qualitative findings

J. lankovic Gavrilovic, M. Schuetzwohl, A. Matanov, M. Bogie, S. Priebe. Queen Mary, University of London, Academic Unit, London, United Kingdom

Objective: Many people experiencing mental health problems after a war do not seek treatment. Thus providing adequate mental health care for this group posses a special challenge for services. The aim of this study was to identify reasons for not seeking treatment from mental health services for people who are experiencing symptoms of Posttraumatic Stress Disorder (PTSD) and to explore whether these reasons are associated with predisposing, enabling and need factors for treatment seeking.

Methods: People experiencing symptoms of PTSD following war and migration in the Balkans were included in the study. We interviewed both people from the Balkans living in the UK and Germany as well as those who remained living in the region. Level of PTSD symptoms, life stressors, other psychopathology and coping strategies were assessed using standard questionnaires. Reasons for not seeking treatment were assessed by a posteriori categorised open questions.

Results: We present results on barriers to treatment and their association with predisposing, enabling and need factors.

Conclusion: In conclusion, a variety of barriers to treatment and factors associated with them should be considered in planning of mental health services for people suffering from posttraumatic stress.

S-13-02

A new instrument to assess health care and social interventions for patients with posttraumatic stress

G. M. Galeazzi, A. Kucukalic, M. Popovski, D. Ajdukovic, M. Bogie, T. Franciskovic, D. Lecic Tosevski, P. McCrone, M. Schuetzwohl, S. Priebe. Community Mental Health Service of Sassuolo, Sassuolo, Italy

Objective: To develop a new user-friendly mapping instrument, applicable in different national and local contexts, to gain a better understanding of the utilization, need and outcome of health care and community based interventions for people suffering from posttraumatic stress.

Methods: The new instrument has been developed in the frame of the CONNECT multi-center research project on “Components, organisation, costs and outcomes of health care and community based interventions for people with posttraumatic stress following war and conflict in the Balkans”. It builds on standardised mapping instruments for mental health services such as the European Service Mapping Schedule or the International Classification of Mental Health Care, integrating non-mental health care and community providers and initiatives. It was developed through a Delphi process consultation among CONNECT researchers, belonging to seven different exYugoslavian and EU members Countries.

Results: The draft-version of the instrument used in a pilot study is composed of the following nine categories: Primary Care, Mental health care, Specialist physical health care, Housing, Employment and training, Leisure and social support, Pensions and financial benefits, Legal support, Information and advocacy. 15 sub-headings complement the principal categories. Results of the pilot study will be briefly presented.

Conclusion: In its definitive version the new instrument will be used to map services in a defined region and to identify interventions that individuals have received in a given period of time. Furthermore, it can be used to identify changes over time and differences between regions.

S-13-03

Assessment for long-term outcomes following potentially traumatic events - the CONNECT study

S. Priebe, D. Lecic-Tosevski, T. Franciskovic, M. Schützwohl, D. Ajdukovic, M. Popovski, G., M. Galeazzi, M. Bogie, A. Kucukalic. Queen Mary, Univ. of London Newham Centre for Mental Healt, London, United Kingdom

Objective: There has been little systematic research on long-term clinical and social outcome of people who experienced potentially traumatic events in armed conflict. In particular, it is unclear how refugees differ from people who stayed in the area of conflict, and what the relativ impact of social and specific health care intervention on long-term outcome is. The CONNECT addresses the related research questions.

Methods: Description of the rationale, approach and methodology of the study.

Results: CONNECT is a collaborative study funded by the Research Directorate of the European Commission with centres in Bosnia-Herzegovina, Croatia, Germany, Italy, Mazedonia, Serbia and the United Kingdom. In each country people who experienced potentially traumatic events due to war and forced migration during the Balkan conflict will be screened and interviewed. The intended total sample will be more than 4000 people. History of potentially traumatic experiences, received social and health care interventions, current psychopathology and quality of life will be assessed. A subgroup of 800 people will be identified who suffer from ongoing symptoms of post-traumatic stress and followed up over a one year period.

Conclusion: CONNECT is the largest project of its kind that has been initiated in Europe. It is unusual in several respects and carries significant risks. The study aims to deliver important results and strengthen the collaborative academic links between the participating countries.

S-13-04

Outcomes of specialised treatments for posttraumatic stress in specialised centres in three Balkans countries

T. Franciskovic. Psychiatric Clinic, Rijeka, Croatia

Objective: Conflict and the war in the Balkans results in huge number of all kinds of war victims in need of psychological help. Professionals tried to meet these growing demands by developing treatment programs within official health care system or within nongovernmental organisations. Tretament approaches were developed according possibilities, number of clients, number of professionals and their educational background. In addition the professionals themselves were living in the war circumstances and often overwhelmed with traumatised clients. All these influenced the treatment approaches and outcomes.The studies of outcomes and effectiveness of such treatments are still rare.

“Method: Within the STOP-study (Priebe et al., 2003), 400 clients suffering from PTSD in 4 specialised tretament centres in Croatia, BiH and Serbia were included in assessment of treatment effectivness. The specialised treatment strategies differed from individual therapy, group therapy to combined treatments programs. They were assessed using several standardised instruments on posttraumatic stress (CAPS), general psychopathology (BSI), and quality of life (MANSA) before starting the treatment program, after three months and after one year. In the second and the third assessment the structured questionnaire on the satisfaction with treatment on the side of client and on the side of therapist was added.

Results: The findings on outcomes of presented specialised treatment strategies will be presented, and the results will be discussed in the frame of organisational possibilities and social circumstances within which the post-war recovery take place.

S-13-05

Characteristics of non-treatment seekers with posttraumatic stress: Differences between groups in former Yugoslavia and refugees in Western Europe

M. Schützwohl. Universitätskrankenhaus, Dresden, Germany

Objective: Patients suffering from symptoms of posttraumatic stress often do not seek or do not get into specialized treatment which promises improvement of symptoms and social functioning. Given that mental health services provision in post-conflict countries differs from that in countries that accepted refugees, the presentation aims to find reasons for this by searching for differences in war traumatized non-treatment seekers in former Yugoslavia and refugees from former Yugoslavia having been accepted in two EU member states.

Methods: Within the STOP-study (Priebe et al., 2003), about 600 participants suffering from posttraumatic stress following conflicts in the former Yugoslavia were recruited in four sites in Croatia, England, Germany, and Serbia. They were assessed using several standardised instruments on socio-demographic features, posttraumatic stress (e.g. CAPS), general psychopathology (BSI), and quality of life (MANSA). Structured questions on coping strategies and barriers to treatment complemented the interview. Status of mental health treatment was rated on a 4-point scale differentiating “no treatment at all”, “primary care inch medication and talks with a GP”, “secondary care inch psychiatrists and clinical psychologists” and “tertiary services and specialised treatment for symptoms of posttraumatic stress.”

Results: We will compare non-treatment seekers to treatment seekers and focus on findings on the differences between nontreatment seekers in the two post-conflict countries and the two countries that accepted refugees.

Conclusion: Findings will be discussed with respect to mental health services planning.