A prospective study of mental health among mass-evacuated Kosovo Albanians

Abstract

Mental health outcomes among traumatised refugees have been of interest to researchers for decades. However, so far little is known about specific refugee groups such as asylum seekers and temporary mass-evacuees although they are supposed to have worse health outcomes.

The aim of the thesis was to study trauma and mental health outcomes in a refugee population from Kosovo that was temporarily mass-evacuated to Sweden. Experiences from a preceding out-patient clinic study in a multicultural refugee population were used.

Subjects and methods: A sample of 402, (one in five) Kosovars that in June 1999 had participated in a massevacuation to Sweden and were between 18 and 65 years old was randomly selected from airline passenger lists. Two hundred and eighteen participated in the study. The study was prospective and longitudinal in design, with a baseline study and follow-ups after 3, 6 and 18 months. Self-rating instruments measuring PTSD, depression, Sense of Coherence and aggression were used. The final follow-up conducted both in Sweden and in Kosovo also included clinical diagnosing with SCID and sampling of the stress hormone cortisol in saliva.

Results: The prevalence of PTSD was 37% at baseline and increased to an extremely high prevalence (80%) at the 18 month follow-up. Participants with PTSD had significantly lower cortisol levels. Depressive symptoms and aggression followed the same pattern as PTSD while SOCscores decreased. Women had worse outcomes both regarding PTSD and depression. Depression scores were correlated with suicidal thoughts and social dysfunction. SOC scores were negatively correlated with depression scores. Aggression was associated with torture and correlated with both PTSD and depression. Aggression scores were higher among participants with PTSD and comorbid depression.

Conclusions: Trauma-related syndromes among refugee populations, such as PTSD, are both important and difficult to diagnose and need targeted approaches. Vulnerable groups among migrants are refugees in general and in particular asylum seekers, temporary mass-evacuees, women and those with comorbid PTSD and depression. Pre-migration trauma and post-migration stress are both of great importance regarding mental health outcomes in migrant populations. The results have research, clinical, educational, political and ethical implications. Aggression in traumatised populations, especially its consequences, needs to be evaluated in more detail.