RT Journal
A1 Mollica RF, McInnes K, Sarajlić N, Lavelle J, Sarajlić I, Massagli MP
T1 DIsability associated with psychiatric comorbidity and health status in bosnian refugees living in croatia
JF JAMA
JO JAMA
YR 1999
FD August 4
VO 282
IS 5
SP 433
OP 439
DO 10.1001/jama.282.5.433
UL http://dx.doi.org/10.1001/jama.282.5.433
AB Context 
                  The relationship between psychiatric symptoms and disability in refugee
survivors of mass violence is not known.Objective 
                  To determine if risk factors, such as demographics, trauma, health status,
and psychiatric illness, are associated with disability in Bosnian refugees.Design, Setting, and Participants 
                  Cross-sectional survey conducted in 1996 of Bosnian refugee adults living
in a camp established by the Croatian government near the city of Varaždin.
One adult aged 18 years or older was randomly selected from each of 573 camp
families; 534 (93%) agreed to participate (mean age, 50 years; 41% male).Main Outcome Measures 
                  Culturally validated measures for depression and posttraumatic stress
disorder (PTSD) included the Hopkins Symptom Checklist 25 and the Harvard
Trauma Questionnaire, respectively. Disability measures included the Medical
Outcomes Study Short-Form 20, a physical functioning scale based on World
Health Organization criteria, and self-reports of socioeconomic activity,
levels of physical energy, and perceived health status.Results 
                  Respondents reported a mean (SD) of 6.5 (4.7) unduplicated trauma events;
18% (n=95) had experienced 1 or more torture events. While 55.2% reported
no psychiatric symptoms, 39.2% and 26.3% reported symptoms that meet DSM-IV criteria for depression and PTSD, respectively;
20.6% reported symptoms comorbid for both disorders. A total of 25.5% reported
having a disability. Refugees who reported symptoms comorbid for both depression
and PTSD were associated with an increased risk for disability compared with
asymptomatic refugees (unadjusted odds ratio [OR], 5.02; 95% confidence interval
[CI], 3.05-8.26; adjusted OR, 2.06; 95% CI, 1.10-3.86). Older age, cumulative
trauma, and chronic medical illness were also associated with disability.Conclusions 
                  In a population of Bosnian refugees who had recently fled from the war
in Bosnia and Herzegovina, psychiatric comorbidity was associated with disability
independent of the effects of age, trauma, and health status.