War Experience and War Related Distress in Bosnia

7232019 War Experience and War Related Distress in Bosnia

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Bosnia and Herzegovina is a multi-ethnic state with Bosni-acs (40) Serbs (33) and Croats (20) as the largest ethnic

groups Teir separate ethnic identities partly stem rom differ-ent religious affiliations Bosniacs belong to the Islamic Croatsto the Roman Catholic and Serbs to the Orthodox traditionTe Bosnian war (1992-1995) was one o the most devastat-ing wars in Europe since World War II Te most recent figuresindicate that about 100 000 out o a population o 44 million

were killed and at least as many were injured (12)Tousands were killed in many massacres throughout Bos-

nia Te worst one took place in Srebrenica where as many as

War Experiences and War-related Distress in Bosnia and Herzegovina

Eight Years after War

Aim o examine the relationship between war experiences and war-related

distress in Bosnia and Herzegovina

Methods Te survey was perormed in the late 2003 on a representative

sample o 3313 respondents Te ace-to-ace interviews included 15 items

on war-related distress and 24 items on war experiences From these items

we developed the War-related Distress Scale the Direct War Experiences

Scale and the Indirect War Experiences Scale Regression analysis was used

to examine the relationship between war-related distress symptoms and war

experiences variables controlling or a range o other variables

Results Almost hal o the respondents did not report any war-related dis-

tress symptoms while about 13 reported 7 or more symptoms Direct war

experiences had a significant effect on war-related distress even eight years

afer the war while indirect war experiences showed no significant effect on

war-related distress We ound that marital status weakly decreased war-re-

lated distress while household size increased it

Conclusion Direct war experiences seem to have a long-lasting traumatic e-

ect on a substantial number o residents o Bosnia and Herzegovina

1Department of Psychology

Norwegian University of

Science and Technology

Trondheim Norway2Department of Sociology

and Political Science

Norwegian University of

Science and Technology

Trondheim Norway

Gerd Inger Ringdal1 Kristen Ringdal2 Albert Simkus2

75wwwcmjhr

Gerd Inger Ringdal

Department of Psychology

Norwegian University of S cience and

Technology

NO-7491 Trondheim Norway

gerdingerringdalsv tntnuno

gt Received June 28 2007

gt Accepted November 19 2007

gt Croat Med J 20084975-86

gt Correspondence to

gt doi103325cmj2008175

Public Health Public Health



Croat Med J 20084975-86

76

8000 Bosniac men and boys were killed bySerbian orces Tis massacre was later de-scribed as genocide by the International

Criminal ribunal or Yugoslavia (ICY)in Te Hague (34) More than two million

people were driven away rom their homesin the process o ethnic cleansing Accordingto the World Bank estimates about 60 oall houses in Bosnia and Herzegovina hal othe schools and a third o the hospitals weredamaged or destroyed (5) War o such an in-tensity can leave no inhabitants untouchedthough some were harmed ar more than oth-ers (67)

Such traumatic ofen lie-threateningevents have been reported to be the main ac-tor predicting posttraumatic stress disorder(PSD) (8-11) Research has also shown thatthe effects o war experiences may be pres-ent many years afer the exposure to traumat-ic events (12-15) We will use the concept o

war-related distress since our instrument mea-sures war-related symptoms

Our main explanatory variables are based

on reported war experiences In additionthere are many actors that may affect war-re-lated distress such as social support as well ascontrol variables including sex age educationsocio-economic status and ethnicity

A number o studies showed that multipleexposures to traumatic events or cumulativetraumas were associated with higher levels o

psychological problems (16-21)Studies among Cambodian and Bosnian

reugees have shown that the exposure to a

variety o adverse events was associated withan increasing risk o PSD (1122) Similarfindings were obtained among asylum seekers(23) and reugees rom diverse cultural back-grounds (24)

Some studies have shown that experienc-ing direct war violence is a stronger predictoro war-related distress than indirect war expe-riences (2526) Another study ound howev-

er high rates o war-related distress despite di-erent degrees o direct exposure (27) We willargue that the distinction between direct and

indirect war experiences influences the seri-ousness o the war distress Our questionnaireincluded questions on events the respondentsexperienced directly ie witnessed personal-ly or that happened to their amily or in theircommunity as well as questions on events therespondents experienced indirectly ie about

which they were told but did not personally witness

Lack o social support may have a negativeimpact on physical and psychological health

while availability o social support may havea positive impact (28-31) So ar only a ewstudies have examined the relationship be-tween social support and mental health in so-cial systems which have experienced serioustraumatic events (26) Although there are sev-eral components o social support (28) we o-cused on social support rom close amily rela-tions which is why we examined respondentsrsquomarital status and number o household mem-

bersEarlier research has identified a range orisk actors or developing posttraumatic stresssymptoms such as emale sex (20263233)age (3435) socioeconomic status (2636)level o education (263335) and urban resi-dence (26) o estimate the effects o war ex-

periences on war-related distress we controlledor several socio-demographic variables In ad-dition we also controlled or belonging to di-erent ethnic groups (Bosniacs Croats and

Serbs) and ethnic heterogeneous neighbor-hoods Te aim o this study was to exam-ine whether war experiences have an effect on

war-related distress even eight years afer theend o the Bosnian war whether direct warexperiences have a stronger effect on war-relat-ed distress than indirect war experiences and

whether social support such as marital statusand household size buffers war-related distress



Ringdal et al War Experiences and War-related Distress in Bosnia and Herzegovina

77

Participants and methods

Study sample

Te data source is the South-East EuropeanSocial Survey Project (SEESSP) which took

place in the period between December 2003and January 2004 and covered most o the or-mer Yugoslavia with a total o 21 000 respon-dents Te SEESSP surveys measured socio-demographic and attitudinal variables romethnic relations to gender roles Te fieldworkor the survey was conducted by private surveyorganization PULS

Te survey in Bosnia and Herzegovina hadan aim to provide the samples o the threemain ethnic groups which were large enoughto allow ethnic group comparisons with a min-imum o sampling errors For this reason threeseparate samples were chosen as ollows onerom the Federation municipalities with pre-dominantly Bosniac population one rom theFederation municipalities with predominantlyCroat population and one rom the Republico Srpska Also a sample rom the municipal-ity o Brčko was chosen Te predominantlyCroat municipalities were oversampled rela-tive to their share in the population to yieldestimates or Croats with smaller standard er-rors Bosniac and to a lesser extent Serb mu-nicipalities were relatively under-sampled Asa result the ethnic composition o our samplediffers rom the 1991 Census in which there

were 43 o Bosniacs 17 o Croats and43 o Serbs (able 1) It also differs rom

more current estimates rom the Central In-telligence Agency World Factbook or the year2000 which state that there are 48 o Bosni-acs 14 o Croats and 37 o Serbs (37)

When these samples are combined and properly weighted we may obtain correct es-timates o the national composition o thecountry as a whole However without a post-

war census and with ambiguities in the defini-

Table 1 Characteristics of the respondents in the net sample

Characteristic No ()

Geographical stratication Bosniac municipalities 1300 (39)

C roat municipalities 1000 (30)

Republic of Srpska 1013 (31)

Place of residencedagger

large city ndash 100 000 or more inhabitants 587 (18)

big town ndash 10 000 or more inhabitants 904 (28)

small townvillage inhabitants 1793 (55)

Ethnicity Bosniac 1304 (39)

C roat 831 (25)

Serb 1022 (31)

other 156 (5)

Sex male 1515 (46)

female 1798 (54)

Age group (years) 18-29 1066 (32)

30-49 1242 (38)

50-86 997 (30)

Marital status s ingle 1068 (33)

married 1807 (55)

divorced 106 (3)

w idowed 303 (9)

Household size 1 320 (10)

2-3 1372 (42)

4 or more 1573 (48)

Education levelDagger

p rimary 656 (20)

v ocational 882 (27)

secondary 1180 (36)

tertiary 595 (18)

Social classsect

service 572 (18)

routine non-manual 322 (10)

skilled workers 847 (27)

unskilled workers 382 (12)

no class 1025 (33)

Net monthly household income (KM)

up to 500 1147 (35)

501 to 1500 1274 (38)

1501 and more 193 (6) do not knowno income 699 (21)

Bosniac municipalities Banovići Bihać Bosanska Krupa Breza Bugojno Bužim CazinČelić Centar Sarajevo Doboj istok Donji Vakuf Fojnica Goražde Gornji Vakuf-UskopljeGradačac Gračanica Hadžići Ilidža Ilijaš Jablanica Kakanj Kalesija Kladanj KljučKonjic Lukavac Maglaj Mostar-Bosniac Novi Grad Sarajevo Novo Sarajevo NoviTravnik Olovo Sanski Most Sapna Srebrenik Stari Grad Sarajevo Tešanj TravnikTuzla Vareš Velika Kladuša Visoko Vitez Vogošća Zavidovići Zenica Živinice Croat municipalities Busovača Čapljina Čitluk Dobretići Domaljevac-Šamac DrvarGlamoč Grude Jajce Kiseljak Kreševo Livno Ljubuški Mostar-Croat Neum OdžakOrašje Posušje Prozor-Rama Široki Brijeg Stolac Tomislavgrad Usora Žepče Republic of Srpska municipalities Banja Luka Bijeljina Bileća Bosanski Brod (Srpskibrod) Bratunac Čajniče Čelinac Derventa Doboj Foča (Srbinje) Gacko GradiškaIstočna Ilidža (Srpska Ilidža) Kneževo Kotor Varoš Kozarska Dubica Laktaši Lopare

Modriča Mrkonjić-Grad Nevesinje Novi Grad Novo Goražde (Srpsko Goražde) OsmaciPale Petrovo Prijedor Prnjavor Rogatica Samac Šekovići Šipovo Sokolac SrbacSrebrenica Lukavica (Srpsko Novo Sarajevo) Teslić Trebinje Ugljevik VišegradVlasenica Zvornik Brčko (neither in the Federation nor in the Republika Srpska)daggerPlace of living is based on the question about the population density of the place wherethe respondents were living at the time of the interview The original 8 categories on thecard shown to the respondents were collapsed into the 3 categories shown in the tableDaggerEducational level is a collapsed version of 14 categories on the card shown to therespondentssectSocial class is constructed from a classification of respondentrsquos main occupation basedon the present or former occupation The original 17 categories were collapsed into a set of

four classes to simulate the Erikson and Goldthorpe class schema (41) In addition the fifthldquoclassrdquo consists of respondents with no class assigned ie persons that had never had anoccupation or who did not answer the question

IINet monthly household income is collapsed from 28 categories on a card of incomeintervals shown to the respondents



Croat Med J 20084975-86

78

tion o residence such estimates especially ormunicipalities are imprecise and subject todebate In these analyses we used combined

samples without weights We did this to im- prove the standard errors or ethnic Croatsand to keep our tests o significance as accu-rate as possible Since we used multivariatemodels in which ethnic group was a control

variable the ethnic composition o the sample does not directly bias the effects o other variables

All o the large and medium sized BosniacCroat and Serb municipalities were includ-ed as well as a random sample o smaller mu-

nicipalities making it a total o 114 municipalities rom all cantons (including Brčko)Tis sample o municipalities was drawn upby two o the largest survey sampling organi-zations in Bosnia and Herzegovina MarecoIndex Bosnia and PULS Within the selectedmunicipalities households were selected pro-

portional to the estimated municipality sizeso the unweighted sample is representative othe distribution o persons across municipali-

ties within each o the three major sample re-gionsTe geographical starting points were cho-

sen by the survey agency on the basis o mapso the settlements (divided into urban and ru-ral areas) and clusters o eight respondents

were interviewed or each starting point Asingle respondent rom each household wasinterviewed with households selected as ap-

proximately every ourth household in a spec-ified walking pattern beginning with the start-

ing point Within households the respondent was selected rom household members aged18-90 using the ldquonearest birthdayrdquo methodAfer the initial survey analyses it was esti-mated that local minorities within municipal-ities predominantly inhabited by one ethnicgroup (or example Bosniacs within predom-inantly Croat municipalities) were underrep-resented However there are relatively ew

such persons o correct or this small sup- plemental samples were taken rom residen-tial enclaves o such minorities

In the absence o a complete populationregister or a post-war census this is the bestsample method possible used in the bestavailable large representative social surveysor Bosnia and Herzegovina Migration em-igration mortality and ertility have clearlychanged the demographic structure since thelast 1991 census Even the basic demographicdistributions are not precisely known partic-ularly or geographical areas within the coun-try Tus we cannot compare our sample by

education or proession with other estimatesor 2003-2004 based on substantially larg-er samples and better sampling methods Ac-cording to United Nations Population Di-

vision estimates o the overall age and sexdistribution or persons in the age range 20-89 in Bosnia and Herzegovina or 2005 there

were 48 o men and 52 o women compared with 46 o men and 54 o womenin our unweighted sample United Nations

estimated (38) that the percentage o pop-ulation in the age groups 20-34 35-59 and60-89 was 30 45 and 25 respectively

while according to our estimates there weremore young people and ewer old people (a-ble 1) In our analyses we controlled or ageand sex Re-weighting to match the UN esti-mates did not substantially change our esti-mates and decreased the accuracy o our sig-nificance tests

Respondents were told that participation

was voluntary and provided verbal inormedconsent Te overall reusal rate was approxi-mately 30 Te ace-to-ace interviews wereconducted by survey organization employeesTe names and addresses o the respondentsas well as the original questionnaire werestrictly confidential We were concerned thatsome questions were somewhat ldquodisturbingrdquobut according to pre-tests the respondents did




79

not find this to be a problem Moreover theyreported that they appreciated being able toreport what they had witnessed

The War-related Distress Scale

We employed the War-related Distress Scaleconsisting o 15 dichotomous items alreadyused in a survey in Croatia in 1996 (26) Tesequence o identically ormatted questions

was preceded by a brie introduction (able2) Te items are presented in the order they

were posed to the respondents with ldquoYesrdquo andldquoNordquo as response categories Te percentageso respondents who reported the various types

o war-related distress symptoms are shown inthe ldquoYesrdquo column

o check whether the 15 items orm aone-dimensional War-related Distress Scale

with desirable psychometric properties weused the Mokken scaling model (39) as im-

plemented in the computer program MokkenScaling Program version 5 or Windows (40)A Loevingerrsquos coefficient H o 055 indicates astrong Mokken scale Tis means that the re-

sponse to the items displays a cumulative pat-tern Te reliability as measured by ρ in theMokken scaling model is 092 Te War-re-

lated Distress Scale was computed as the sumo valid answers 0 or 1 or the 15 items Re-spondents with less than 13 valid answers wereset to a missing value or the scale and exclud-ed rom the analyses involving the War-relat-ed Distress Scale Te distribution o the scaleshowed a strong clustering at the lower endTe skewness o the scale led us to the ques-tion whether it was suitable to apply ordinaryleast squares regression analysis Rather thanabolishing our intent to use this technique

we decided to supplement it by dichotomizingthe scale based on the threshold o seven ormore reported war-related distress symptomsAbout 13 o the respondents exceeded thisthreshold

The war experiences scales

Te war experiences section in the interviewincluded 24 identically ormatted questions intwo blocks which were the basis or deriving

Table 2 War-related distress in Bosnia and Herzegovina in 2003-2004 percentages n = 3313 for percentages n = 2893 for the Mokken scaling analysis

No () of total sample

War-related distress items yes nodonrsquot knowno answer Hi

dagger

1 Recurrent and bothersome thoughts or memories about a traumatic war-related event 1030 (31) 2167 (65) 116 (4) 062

2 Recurrent distressing dreams about a traumatic war-related event 685 (21) 2502 (76) 126 (4) 054

3 Recurrent sense of reliving past war-related distress in the present such as ashbacks 537 (16) 2621 (79) 155 (5) 051

4 Persistent intense emotional or physical distress at exposure to cues that symbolize or resemble an aspect ofwar-related distress (within you or outside)

451 (14) 2708 (82) 154 (5) 057

5 Persistent avoidance behaviors thoughts or feelings related to war-related distress such as avoiding certain conversations ideas or activities that arouse painful memories

541 (16) 2612 (79) 160 (5) 050

6 Persistent loss of memory for important parts of a war-related distress 303 (9) 2856 (86) 154 (5) 050

7 Markedly diminished interest or participation in usual activities 287 (9) 2879 (87) 147 (4) 059

8 Persistent feelings of being detached or estranged from others such as family members with whom you havefelt close

275 (8) 2905 (88) 133 (4) 059

9 Pers isten t reducti ons in t he abilit y to feel y ou r emot ions o r f eel ings o f emot ional numbnes s 404 (12) 2759 (83) 150 (5 ) 0 53

10 A persistent sense of a foreshortened future 1119 (34) 2047 (62) 147 (4) 05811 Persistent difculty falling or staying asleep 493 (15) 2691 (81) 129 (4) 050

12 Persistent irritability or outbursts of anger 444 (13) 2740 (83) 129 (4) 054

13 Diminished ability to concentrate 563 (17) 2610 (79) 140 (4) 055

14 Being easily startled or panicked frequently 603 (18) 2572 (78) 138 (4) 054

15 Signicant impairment in social occupational or other important areas of functioning (as a result of emotional distress)

288 (9) 2851 (86) 174 (5) 060

Scalability H 055

Reliability ρ 092

Introduction to war-related distress questions ldquoNow we want to ask you some questions about your thoughts and feelings some maybe due to the war others about your feelings ingeneral We appreciate that these are private feelings But we definitely will not reveal anything about your answers personally You will see that it should be interesting and importantto know how many people feel the kinds of feelings and thoughts that you do Or how many do not There are no ldquorightrdquo or ldquowrongrdquo answers we only want to find out how many peoplehave these kinds of feelings or experiencesrdquodaggerHi ndash Loevingerrsquos H the measure of scalability in the Mokken Scaling Program The coefficient is computed for each item (H i) and for the total scale (H) ρ ndash the measure of reliabilityin the Mokken scaling model



Croat Med J 20084975-86

80

our scales Te first block with 13 questionsdealt with personal direct experiences o vio-lence Te second block with 11 questions

dealt with indirect experiences o violence iethose that happened to the amily and riendso the respondent and in the respondentrsquoscommunity

We argued that direct war experiences mayhave a more powerul effect than indirect warexperiences Initial analyses supported this byindicating that the two blocks o items tap di-erent dimensions Tereore we decided tosearch or scales among the items within eachblock by means o the Mokken Scaling Pro-

gram (able 3) Tere were 13 questions ondirect experiences Only one o them the item13 ldquoYou having to leave the countryrdquo did notscale Te remaining items ormed a strong

Mokken scale indicated by a scalability co-efficient o 049 and a reliability coefficiento 086 Looking at individual items the Hi

showed more variation than or the War-relat-ed Distress Scale Te poorest item in terms othe scalability was the item 12 ldquobeing orcedto leave onersquos homerdquo with H12 = 031 justabove the minimum inclusion criteria o 030(able 3)

Questions on indirect exposure to vio-lence were analyzed in the same manner asthe questions on direct exposure Te out-come o the scaling analysis was even betterthe overall H was 056 and the reliability was

088 Te individual items showed better scal-ability than in the previous analysis the low-est coefficient was H13 = 045 and no itemshad to be rejected

Table 3 War experiences in Bosnia and Herzegovina in retrospect from the interviews in 2003-2004 p ercentages n = 3313 for percent-ages n = 2848 for the Mokken scaling analysis


Direct war experiences of yes nodonrsquot knowno answer Hi

dagger

1 Shooting (even if no one was hurt) 2649 (80) 584 (18) 80 (2) 077

2 Artillery bombardment (even if no one was hurt) 2445 (74) 781 (24) 87 (3) 071

3 Bombing from airplanes or missiles (even if no one was hurt) 1932 (58) 1276 (39) 105 (3) 047

4 Attacks with knives or clubs 667 (20) 2523 (76) 123 (4) 036 5 Your family or friends being seriously wounded 1334 (40) 1866 (56) 113 (3) 048

6 Other people not family or friends being seriously wounded 1581 (48) 1620 (49) 112 (3) 055

7 Persons being raped 245 (7) 2920 (88) 148 (4) 046

8 Family members or friends being killed or taken away and never seen again 767 (23) 2411 (73) 135 (4) 047

9 Other persons being killed 1186 (36) 2005 (61) 122 (4) 052

10 The destruction of your home farm or business 969 (29) 2239 (68) 105 (3) 045

11 Being captured and held prisoner by enemy forces 277 (8) 2932 (88) 104 (3) 049

12 Being forced to leave your home and move to another part of the country 918 (28) 2306 (70) 89 (3) 031

13 Having to leave the country and live in a country abroad as a refugee 514 (16) 2707 (82) 92 (3) 015

Scalability H 049

Reliability ρ 086

Indirect war experiences of Dagger




4 Attacks with knives or clubs 1304 (39) 1803 (54) 206 (6) 052

5 Seriously wounding 2089 (63) 1076 (32) 148 (4) 050

6 Being killed 2003 (60) 1168 (35) 142 (4) 052 7 Being raped 519 (16) 2539 (77) 255 (8) 070


9 Homes farms or businesses being destroyed 2254 (68) 917 (28) 142 (4) 058

10 Being forced to leave homes and move to another part of the country 2293 (69) 882 (27) 138 (4) 055

11 Being forced to leave the country and live in a foreign country as refugees 1903 (57) 1247 (38) 163 (5) 053

Scalability H 056

Reliability ρ 088

Introduction to the questions on direct war experiences ldquoThe next set of questions is about things you yourself experienced directly During the period of war from 1992 to 1995which of the following things did you actually personally directly see or witness with your own eyes and ears directed at you your family or communityrdquo Note that question 13 was excluded from the scale because of an H-value below 030daggerHi ndash Loevingerrsquos H the measure of scalability in the Mokken Scaling Program The coefficient is computed for each item (H i) and for the total scale (H) ρ the measure of reliability inthe Mokken scaling model

DaggerIntroduction to the questions on indirect war experiences ldquoDuring the war which of the following things happened to any members of your family or friends as victims even if theyhappened when they were away from you and you did not personally see it happening while it was going onrdquo




81

Tese scaling analyses were the basis orconstructing two summated scales or directand indirect war experiences Te Direct War

Experiences Scale had an almost normallyshaped distribution whereas the Indirect WarExperiences Scale was lef skewed with higher

percentages toward the high end o the scaleTe two scale were positively correlated as ex-

pected (r = 057)

Other variables

In addition to the two war experiences scalesthe ollowing explanatory variables or con-trols were included in the regression analyses

sex age in years age squared our categorieso ethnicity with Bosniacs as the reerence cat-egory indicator o ethnic heterogeneity townor city location years o education indicatorso social class income marital status and thenatural logarithm o household size

Te ethnic heterogeneity indicator assess-es the ethnic heterogeneity o the neighbor-hood where the respondent had lived beorethe war Te value o ldquo1rdquo stands or a neigh-borhood with many members o different na-tionalities and ldquo0rdquo or the remaining answers(some a ew none) Te towncity indicatoris a collapsed version o the question about the

population density o the place o residence(able 1) Te value o ldquo1rdquo stands or those

who live in a town or city with a populationo 10 000 or more while ldquo0rdquo stands or those

who live in smaller towns or villages Te re-spondents were asked two questions about ed-ucation In able 1 results rom the question

on educational levels are presented but themeasure in the regression analyses are based onthe other question about the total years o ed-ucation ranging rom 0 to 23

Social class was defined as respondentrsquos present or ormer occupation Te original 17categories were collapsed into a set o 4 class-es according to Erikson and Goldthorpe classschema (41) In addition the fifh ldquoclassrdquo con-

sisted o respondents who have never had anoccupation or who did not answer the ques-tion Te 5-category version is ound in a-

ble 1 but in the regression analysis we onlyincluded a dummy variable distinguishing be-tween the service class (value ldquo1rdquo) and otherclass locations (value ldquo0rdquo) Te dummy vari-able where ldquo1rdquo stands or respondents livingin a low income household and ldquo0rdquo or oth-ers is based on the net monthly household in-come Low monthly income is defined as anincome o maximum KM 400 Te dummy

variable that distinguishes between the mar-ried and others was based on a question about

marital status reported in detail in able 1

Results

Te most requent symptoms o distress were ldquoA persistent sense o oreshortened u-turerdquo (34) and ldquoRecurrent and bothersomethoughts or memories about a traumatic warrelated eventrdquo (31) (able 2)

In the first block o experience section80 o respondents reported that they had ex-

perienced shooting and almost as many hadexperienced artillery bombardment Aroundone in three persons reported to have experi-enced people being killed in the war and 7had experienced or witnessed rape Around8 were captured and held prisoners by ene-my orces Te percentages in the second blockare generally much higher but the possibili-ties or exaggeration or distortion o the ac-tual events are greater or indirect experiences

(eg being told about an event through a longchain o persons) (able 3)

In two multiple regression analyses the re-lationship between the War-related DistressScale and the war experience variables was ex-amined controlling or a range o other vari-ables (able 4) Te multiple correlation coe-ficient (R 2) indicated that more than 20 othe variance in the War-related Distress Scale



Croat Med J 20084975-86

82

was explained by the ordinary least squares re-gression model whereas the Nagelkerke pseu-do R-square was 024 in the binary (logistic)regression analysis Women reported signi-icantly more war-related distress than men(B = 060 P lt0001) and the odds or report-

ing a high level o war-related distress was al-most 50 higher or women than or menBoth analyses showed a weakly positive butnot significant relationship between age and

war-related distressTe results or the ethnic categories were

interpreted as differences rom the reerencecategory the Bosniacs All regression coeffi-cients or ethnicity were negative indicating

that Croats and Serbs scored lower than Bos-niacs on the War-related Distress Scale evenafer controlling or the measures o war expe-riences For Serbs and Others the differencesare however not significant Te binary re-gression analysis gave similar results Te Cro-

ats were the only ethnic group that reportedsignificantly lower levels o war-related distressthan the Bosniacs Looking at the zero-orderrelationship the Bosniacsrsquo mean War-relat-ed Distress Scale score was twice higher thanthat o the Croats and the odds o reportinghigh War-related Distress Scale scores were al-most 50 lower or Croats than or the Bos-niacs Te main reason or this are much high-

Table 4 Ordinary least squares regression analysis of the War-Related Distress Scale and binary regression analysis of the thresholddened by 7 or more war experiences n = 2371

Ordinary regression analysis Binary regression analysis

Variables B Se P OR (95 CI)

Regression constant -0755 0670 0260 ndash

Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)

Ethnicity Bosniac (ref category) 0000 ndash ndash (1000-)

Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)

Ethnic heterogeneityDagger -0374 0145 0010 0776 (0584-1031)

Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

Years of education -0093 0025 0000 0947 (0905-0992)

Service classpara 0174 0188 0356 0885 (0596-1313)

Low monthly household income 0738 0166 0000 1489 (1101-2014)

Marrieddaggerdagger -0318 0161 0049 0876 (0637-1205)

Natural log of household sizeDaggerDagger 0631 0157 0000 1525 (1115-2087)

Direct War Experiences Scalesectsect 0467 0028 0000 1452 (1364-1545)

Indirect War Experiences Scale -0016 0026 0533 0965 (0907-1026)R2 Nagelkerke pseudo R2 for binary regression analysisparapara 0217 0243

-2Log likelihood ndash 15221

The dependent variable in the ordinary regression analysis is the War-Related Distress Scale with scores ranging from 0 to 15 The dependent variable in the binary regressionanalysis takes the value of ldquo1rdquo if the respondents score 7 or higher on the War-Related Distress Scale and ldquo0rdquo for respondents with lower scores B ndash ordinary (unstandardized)regression coefficient Se ndash the standard error of B P ndash probability value of the t ratio for B OR ndash odds ratio CI ndash confidence intervaldaggerFemale is a dummy variable that takes the value of ldquo1rdquo for women and ldquo0rdquo for menDaggerThe ethnic heterogeneity indicator is based on a question about the neighborhood of the respondent before the war It takes the value of 1 for those who lived in the neighborhoodwith many people of different nationalities and 0 for the remaining answers (some a few none)sectThe towncity dummy variable takes the value of ldquo1rdquo if the respondent at the time of the interview lived in a town or city with a population of 10 000 or more Respondents living insmaller towns and villages are given the value of ldquo0rdquo on the dummy variable

IIThe respondents were asked questions about the highest level of education completed and the years of education In the regression analysis years of education is used as acontinuous variableparaThis variable takes the value of ldquo1rdquo for respondents whose present or former main occupation is classified in the service class according to the Erikson and Goldthorpe class schemaThe remaining respondents are given the value of ldquo0rdquo A more complete version of the variable is presented in Table 1

The dummy variable takes the value of ldquo1rdquo for respondents belonging to a household with a monthly income of at most 400 KM and ldquo0rdquo for others A more detailed version of thisvariable is presented in Table 1

daggerdaggerThe dummy variable that takes the value of ldquo1rdquo for married persons and ldquo0rdquo for others is based on a question about marital status more fully reported in Table 1DaggerDaggerThe variable is the natural logarithm (base = e) of household sizesectsectThe scale of direct war experiences was developed in the Methods section It has scores ranging from 0 to 12

IIIIThe scale of indirect war experiences was developed in the Methods section It has scores ranging from 0 to 11paraparaR2 ndash In ordinary regression analysis the multiple correlation coefficient shows the proportion of the variance in the dependent variable that is explained by the explanatory variablesin the model In binary regression analysis the R2 cannot be defined because the estimation method is based on maximum likelihood estimation The Nagelkerke pseudo R2 is basedon the proportional improvement in the -2 log likelihood statistic of the final model compared to a model without explanatory variables-2 log likelihood is the fit measure in the maximum likelihood estimation procedure used in the binary (logistic) regression analysis




83

er scores o the Bosniacs than the other ethnicgroups on the two war experiences scales Fordirect war experiences the mean score or Cro-

ats was 37 compared with 53 or the Bosni-acs ( P lt0001) Tis could be explained by theact that the Bosniacs were the victims o warin Bosnia and Herzegovina to a larger extentthan other nationalities

Te indicator o ethnic heterogeneity oneighborhoods beore the war showed a nega-tive and significant coefficient in the regressionanalysis Tis shows that having lived in ethni-cally heterogenic neighborhoods may reducethe war-related distress Te binary regression

analysis showed a similar tendency but the e-ect was not significant Living at present in anurban setting seems to be irrelevant to experi-encing war-related distress

Among the socioeconomic indicators so-cial class was not ound to have any effect

when controlling or the two other socioeco-nomic indicators in any o the analyses Botheducation level and low income are related to

war-related distress en years o educationdecreased the war-related distress score orabout 1 point Persons with low reported in-come had 06 point higher war-related distressscore than others Both these coefficients weresignificant beyond any conventional level Tebinary regression analysis showed quite similarresults

Married persons scored slightly lower thanthe unmarried on the War-related DistressScale but this effect did not show up in the bi-nary regression analysis Household size was

positively and significantly related to war-re-lated distress in both analyses

Our main explanatory variables were thetwo scales o direct and indirect war experi-ences Only direct experiences seem to be im-

portant or war-related distress One pointincrease in the Direct War Experiences Scaleraised the War-related Distress Scale score by

just below 05 points which means that the

maximum effect contrasting those with no exposure to violence with those maximum exposed is more than 5 points Indirect exposure

to violence had no effect at all on war-relateddistress (B = -002 P lt0600) In the binaryregression analysis the model predicted thatone extra point on the direct war experiencescale would increase the odds on having sevenor more symptoms with 45 Tose with themaximum score on the Direct War Experienc-es Scale were expected to have more than 80times higher odds o having 7 or more traumasthan those scoring zero on the Direct War Ex-

perience Scale

Discussion

On average the respondents reported 24 othe 15 possible war-related distress symptomsAbout 13 exceeded the threshold o seven ormore symptoms while almost hal o the re-spondents did not report any war-related dis-tress symptoms Although war-related distressis known to diminish as a unction o time(29) there are still a substantial number o

people in Bosnia and Herzegovina who sufferrom various degrees o war-related distress

Our first hypothesis that war experienc-es have an effect on war-related distress eveneight years afer the end o the war was clearlysupported by our study Tis finding is consis-tent with other studies (13-15)

Our second hypothesis that direct war experiences have a stronger effect on war-relateddistress than indirect war experiences was also

supported In act indirect war-experiencesshowed no effect on war-related distress at allTis is consistent with a study in Croatia (26)Also a cross-sectional survey on 1358 war sur-

vivors who had experienced at least one war-related stressor (combat torture internal dis-

placement reugee experience siege andoraerial bombardment) showed findings consis-tent with ours (25) Te study included our



Croat Med J 20084975-86

84

sites in the ormer Yugoslavia Belgrade in Ser-bia Rijeka in Croatia Sarajevo in Bosnia andHerzegovina and Banja Luka in the Republic

o Srpska Bosnia and Herzegovina Controlgroups at two study sites with no direct expo-sure to war-related distress (Banja Luka andRijeka) were matched with survivors on sexage and education Tey ound that survivorshad higher rates o war-related distress com-

pared with the controls Fear o threat to sae-ty and loss o control over lie appeared to bethe most important mediating actors in war-related distress

According to our third hypothesis social

support would buffer war-related distress Alarge review indicates that social support romriends amily members community andspiritual leaders provides protection againstadverse psychological outcomes in civil wars(29) In the Croatian study social support

was reported to affect war-related distress al-though not all orms o social support turnedout to be beneficial or mental health (26)People with close personal relationships were

no better off than others On the other handrequent participation in social activities wasbeneficial or reducing distress showing thestrength o weak ties (42)

Our study showed a weak support or thefirst indicator married persons scored slight-ly lower than unmarried on the War-relatedDistress Scale For the second indicator o so-cial support the results were contradictory toour expectations household size was positive-ly and significantly related to war-related dis-

tress Both these findings are consistent withthe Croatian study Teir interpretation o thelatter finding is that large households insteado being a source o support may be a burdenin the economic sense or just by overcrowd-ing the dwelling Further more the larger thehousehold the greater the chances that per-sons close to you have been hurt in the warOther aspects o social support such as partic-

ipation in social activities were not includedin our study

Comparing studies on war experiences and

war-related distress is problematic due to di-erences in sample designs main variablestime since the traumatic events and different

war circumstances Different methods o datacollection such as use o interviews instead oquestionnaires may also make the compari-son problematic For instance higher rates oPSD among war veterans have been ound istructured clinical interviews rather than sel-report measures were utilized (43) Since ourstudy is based on a survey and not on clinical

interviews we cannot exclude the possibilitythat the respondents have underreported their

war-related distress experiences and thus con-tributed to an underestimation o war-relateddistress

Another inevitable methodological short-coming o our study is the cross-sectional de-sign with retrospective inormation on war ex-

periences rom about eight years afer the warRecall and subjectivity bias increase with the

lapse o time between the event and the timeo measurementFurthermore our study shares the weakness

o most o the studies by not covering impor-tant control variables about the respondentsrsquoearlier history such as childhood experiencesand mental health Earlier research has how-ever shown that actors related to traumat-ic events and environmental conditions aferthe events (level o social support presence olie stressors) emerged as stronger predictors o

PSD development than did pre-trauma ac-tors (44) Tere may also be unobserved post-

war actors that may have influenced the re-sponses on the war-related distress

Te main strength o our study is theunique representative sample o more than3000 respondents in Bosnia and Herzegovina

which allows statistical generalizations to the population In this sense our study is superior




85

to the studies based on small samples or samples rom particular areas which cannot makesuch generalizations

According to our findings more than ahal o the people in Bosnia and Herzegovinastill suffer rom various degrees o war-relateddistress and quite a ew reported many symp-toms (7 or more 13 10 or more 6) Sucha high number o symptoms may indicate the

presence o PSD which requires psycholog-icalpsychiatric treatment and ollow-up ormany years to come

Our study shows that there is still a needor psychological medical and social ollow-up

services or the war victims and their amiliesIt is worth noticing however that almost a halo the respondents did not report any war-re-lated distress symptoms which shows the resil-ience o the population Tus uture researchshould investigate why some victims seem toovercome war-related distress whereas in oth-ers the symptoms persist over many years

Acknowledgments

Te South-East European Social Survey Project was

ounded by Te Research Council o Norway within theSouth-Eastern Europe Programme grant No 144826S30 We also grateully acknowledge Proessor SabrinaP Ramet or valuable comments

References

1 Nilsen KA Death toll in Bosnian war was 102000 Availablerom httpwwwfreerepubliccomfocusf-news1291965 posts Accessed November 6 2007

2 Research and Documentation Center Sarajevo he status odatabase by the centers April 2004 - January 2007 Availablerom httpwwwidcorgbaaboutusOverview_of_jobs_ according_to_20centershtm Accessed November 6 2007

3 Simons M Court declares Bosnia killings were genocideNew York imes 2007 Feb 27 Available rom httpwwwnytimescom20070227worldeurope27haguehtml_r=1amppartner=rssnytampemc=rssamporef=slogin AccessedNovember 6 2007

4 Wikipedia Srebrenica massacre Available rom httpen wikipediaorgwikiSrebrenica_massacre Accessed Novem-ber 6 2007

5 World Bank Bosnia and Herzegovina Post-conlictreconstruction and the transition to a market economy AnOED evaluation o World Bank support Washington (DC)he World Bank 2004

6 Nelson BS Post-war trauma and reconciliation in Bosnia-Herzegovina observations experiences and recommen-

dations or marriage and amily therapy Am J Fam her200331305-16 doi10108001926180390201990

7 Ramet SP he three Yugoslavias state-building andlegitimation 1918-2005 Washington (DC) Woodrow Wilson Center Press 2006

8 American Psychiatric Association Diagnostic and statisticalmanual o mental disorders 4th ed Washington DC 1994

9 Marinic I Supek F Kovacic Z Rukavina L Jendricko Kozaric-Kovacic D Posttraumatic stress disorder diagnosticdata analysis by data mining methodology Croat Med J200748185-97 Medline17436383

10 Sambunjak D Posttraumatic stress disorder and CroatianMedical Journal still not the time or a wrap-up Croat Med J 200748130-2

11 Momartin S Silove D Manicavasagar V Steel Z Dimensionso trauma associated with posttraumatic stress disorder(PSD) caseness severity and unctional impairment astudy o Bosnian reugees resettled in Australia Soc Sci Med200357775-81 Medline12850105 doi101016S0277-9536(02)00452-5

12 Owens GP Baker DG Kasckow J Ciesla JA Mohamed SReview o assessment and treatment o PSD among elderlyAmerican armed orces veterans Int J Geriatr Psychiatry2005201118-30 Medline16315160 doi101002gps 1408

13 Klaric M Klaric B Stevanovic A Grkovic J Jonovska SPsychological consequences o war trauma and postwar socialstressors in women in Bosnia and Herzegovina Croat Med J200748167-76 Medline17436381

14 Hasanovic M Sinanovic O Pavlovic S Acculturation and psychological problems o adolescents rom Bosnia andHerzegovina during exile and repatriation Croat Med J200546105-15 Medline15726684

15 Kozaric-Kovacic D Kocijan-Hercigonja D JambrosicA Psychiatric help to psychotraumatized persons during

and ater war in Croatia Croat Med J 200243221-8 Medline11885051

16 de Jong J Komproe IH Van Ommeren M El Masri M ArayaM Khaled N et al Lietime events and posttraumatic stressdisorder in 4 postconlict settings JAMA 2001286555-62 Medline11476657 doi101001jama2865555

17 Green BL Goodman LA Krupnick JL Corcoran CBPetty RM Stockton P et al Outcomes o single versusmultiple trauma exposure in a screening sample J raumaStress 200013271-86 Medline10838675 doi101023A1007758711939

18 Holliield M Warner D Lian N Krakow B Jenkins JH Kesler J et al Measuring trauma and health statusin reugees a critical review JAMA 2002288611-21 Medline12150673 doi101001jama2885611

19 Lopes Cardozo B Vergara A Agani F Gotway CA Mentalhealth social unctioning and attitudes o Kosovar Albaniansollowing the war in Kosovo JAMA 2000284569-77 Medline10918702 doi101001jama2845569

20 Durakovic-Belko E Kulenovic A Dapic R Determinantso posttraumatic adjustment in adolescents rom Sarajevo who experienced war J Clin Psychol 20035927-40 Medline12508329 doi101002jclp10115

21 Breslau N Kessler RC Chilcoat HD Schultz LR Davis GCAndreski P rauma and posttraumatic stress disorder inthe community the 1996 Detroit Area Survey o raumaArch Gen Psychiatry 199855626-32 Medline9672053 doi101001archpsyc557626



Croat Med J 20084975-86

86

22 Mollica RF McInnes K Pham Smith Fawzi MC MurphyE Lin L he dose-eect relationships between torture and psychiatric symptoms in Vietnamese ex-political detaineesand a comparison group J Nerv Ment Dis 1998186543-53 Medline9741560 doi10109700005053-199809000-

00005

23 Silove D Steel Z McGorry P Mohan P rauma exposure postmigration stressors and symptoms o anxiety depressionand post-traumatic stress in amil asylum-seekerscomparison with reugees and immigrants Acta PsychiatrScand 199897175-81 Medline9543304 doi101111 j1600-04471998tb09984x

24 Hau E Vaglum P Chronic posttraumatic stress disorderin Vietnamese reugees A prospective community studyo prevalence course psychopathology and stressors J Nerv Ment Dis 199418285-90 Medline8308537 doi10109700005053-199402000-00004

25 Basoglu M Livanou M Crnobaric C Franciskovic SuljicE Duric D et al Psychiatric and cognitive eects o war inormer Yugoslavia association o lack o redress or traumaand posttraumatic stress reactions JAMA 2005294580-90 Medline16077052 doi101001jama2945580

26 Kunovich RM Hodson R Civil war social integration andmental health in Croatia J Health Soc Behav 199940323-43 Medline10643159 doi1023072676329

27 Shalev AY uval-Mashiach R Hadar H Posttraumaticstress disorder as a result o mass trauma J Clin Psychiatry200465 Suppl 14-10 Medline14728091

28 House JS Landis KR Umberson D Social relationshipsand health Science 1988241540-5 Medline3399889 doi101126science3399889

29 Norris FH Friedman MJ Watson PJ Byrne CM DiazE Kaniasty K 60000 disaster victims speak Part I Anempirical review o the empirical literature 1981-2001

Psychiatry 200265207-39 Medline12405079

30 Klaric M Franciskovic Social support and psychologicalconsequences in emales exposed to war trauma Eur Psychiatry200722S272 doi101016jeurpsy200701915

31 Cohen S Wills A Stress social support and the bueringhypothesis Psychol Bull 198598310-57 Medline3901065 doi1010370033-2909982310

32 Breslau N Davis GC Andreski P Peterson EL Schultz LRSex dierences in posttraumatic stress disorder Arch GenPsychiatry 1997541044-8 Medline9366662

33 Breslau N Davis GC Andreski P Peterson E raumatic

events and posttraumatic stress disorder in an urban population o young adults Arch Gen Psychiatry199148216-22 Medline1996917

34 Powell S Rosner R Butollo W edeschi RG Calhoun LGPosttraumatic growth ater war a study with ormer reugeesand displaced people in Sarajevo J Clin Psychol 20035971-83 Medline12508332 doi101002jclp10117

35 Silove D he psychosocial eects o torture mass humanrights violations and reugee trauma toward an integratedconceptual ramework J Nerv Ment Dis 1999187200-7 Medline10221552 doi10109700005053-199904000-00002

36 Ross CE Wu CL he links between education and healthAm Sociol Rev 199560719-45 doi1023072096319

37 CIA he world actbook Available rom httpswwwciago983158librarypublicationsthe-world-factbookgeos bkhtmlPeople2007 Accessed November 6 2007

38 United Nations Population Division World population prospects 2006 revision population database Availablerom httpesaunorgunpp Accessed November 6 2007

39 Sijtsma K Molenaar IW Introduction to nonparametricitem response theory 5 ed housand Oaks (CA) SAGEPublications 2002

40 Molenaar IW Sijtsma K MSP5 or Windows Groningeniec ProGAMMA 2000

41 Erikson R Goldthorpe JH he constant lux A study oclass mobility in industrial societies Oxord ClarendonPress 1992

42 Granovetter MS Strength o weak ties Am J Sociol1973781360-80 doi101086225469

43 Averill PM Beck JG Posttraumatic stress disorder inolder adults a conceptual review J Anxiety Disord 200014133-56 Medline10864382 doi101016S0887-6185 (99)00045-6

44 Brewin CR Andrews B Valentine JD Meta-analysis orisk actors or posttraumatic stress disorder in trauma-exposed adults J Consult Clin Psychol 200068748-66 Medline11068961 doi1010370022-006X685748



Croat Med J 20084975-86

76

8000 Bosniac men and boys were killed bySerbian orces Tis massacre was later de-scribed as genocide by the International

Criminal ribunal or Yugoslavia (ICY)in Te Hague (34) More than two million

people were driven away rom their homesin the process o ethnic cleansing Accordingto the World Bank estimates about 60 oall houses in Bosnia and Herzegovina hal othe schools and a third o the hospitals weredamaged or destroyed (5) War o such an in-tensity can leave no inhabitants untouchedthough some were harmed ar more than oth-ers (67)

Such traumatic ofen lie-threateningevents have been reported to be the main ac-tor predicting posttraumatic stress disorder(PSD) (8-11) Research has also shown thatthe effects o war experiences may be pres-ent many years afer the exposure to traumat-ic events (12-15) We will use the concept o

war-related distress since our instrument mea-sures war-related symptoms

Our main explanatory variables are based

on reported war experiences In additionthere are many actors that may affect war-re-lated distress such as social support as well ascontrol variables including sex age educationsocio-economic status and ethnicity

A number o studies showed that multipleexposures to traumatic events or cumulativetraumas were associated with higher levels o

psychological problems (16-21)Studies among Cambodian and Bosnian

reugees have shown that the exposure to a

variety o adverse events was associated withan increasing risk o PSD (1122) Similarfindings were obtained among asylum seekers(23) and reugees rom diverse cultural back-grounds (24)

Some studies have shown that experienc-ing direct war violence is a stronger predictoro war-related distress than indirect war expe-riences (2526) Another study ound howev-

er high rates o war-related distress despite di-erent degrees o direct exposure (27) We willargue that the distinction between direct and

indirect war experiences influences the seri-ousness o the war distress Our questionnaireincluded questions on events the respondentsexperienced directly ie witnessed personal-ly or that happened to their amily or in theircommunity as well as questions on events therespondents experienced indirectly ie about

which they were told but did not personally witness

Lack o social support may have a negativeimpact on physical and psychological health

while availability o social support may havea positive impact (28-31) So ar only a ewstudies have examined the relationship be-tween social support and mental health in so-cial systems which have experienced serioustraumatic events (26) Although there are sev-eral components o social support (28) we o-cused on social support rom close amily rela-tions which is why we examined respondentsrsquomarital status and number o household mem-

bersEarlier research has identified a range orisk actors or developing posttraumatic stresssymptoms such as emale sex (20263233)age (3435) socioeconomic status (2636)level o education (263335) and urban resi-dence (26) o estimate the effects o war ex-

periences on war-related distress we controlledor several socio-demographic variables In ad-dition we also controlled or belonging to di-erent ethnic groups (Bosniacs Croats and

Serbs) and ethnic heterogeneous neighbor-hoods Te aim o this study was to exam-ine whether war experiences have an effect on

war-related distress even eight years afer theend o the Bosnian war whether direct warexperiences have a stronger effect on war-relat-ed distress than indirect war experiences and

whether social support such as marital statusand household size buffers war-related distress




77


Study sample


















C roat 831 (25)

Serb 1022 (31)

other 156 (5)

Sex male 1515 (46)

female 1798 (54)

Age group (years) 18-29 1066 (32)

30-49 1242 (38)

50-86 997 (30)


married 1807 (55)

divorced 106 (3)

w idowed 303 (9)


2-3 1372 (42)

4 or more 1573 (48)


p rimary 656 (20)


secondary 1180 (36)

tertiary 595 (18)

Social classsect

service 572 (18)




no class 1025 (33)


up to 500 1147 (35)

501 to 1500 1274 (38)








Croat Med J 20084975-86

78
























79


















dagger





451 (14) 2708 (82) 154 (5) 057


541 (16) 2612 (79) 160 (5) 050




275 (8) 2905 (88) 133 (4) 059







288 (9) 2851 (86) 174 (5) 060

Scalability H 055

Reliability ρ 092




Croat Med J 20084975-86

80












dagger













Scalability H 049

Reliability ρ 086












Scalability H 056

Reliability ρ 088






81




pected (r = 057)

Other variables













Results








Croat Med J 20084975-86

82











Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)


Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)


Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

















83















perience Scale

Discussion










Croat Med J 20084975-86

84



























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005




























77


Study sample


















C roat 831 (25)

Serb 1022 (31)

other 156 (5)

Sex male 1515 (46)

female 1798 (54)

Age group (years) 18-29 1066 (32)

30-49 1242 (38)

50-86 997 (30)


married 1807 (55)

divorced 106 (3)

w idowed 303 (9)


2-3 1372 (42)

4 or more 1573 (48)


p rimary 656 (20)


secondary 1180 (36)

tertiary 595 (18)

Social classsect

service 572 (18)




no class 1025 (33)


up to 500 1147 (35)

501 to 1500 1274 (38)








Croat Med J 20084975-86

78
























79


















dagger





451 (14) 2708 (82) 154 (5) 057


541 (16) 2612 (79) 160 (5) 050




275 (8) 2905 (88) 133 (4) 059







288 (9) 2851 (86) 174 (5) 060

Scalability H 055

Reliability ρ 092




Croat Med J 20084975-86

80












dagger













Scalability H 049

Reliability ρ 086












Scalability H 056

Reliability ρ 088






81




pected (r = 057)

Other variables













Results








Croat Med J 20084975-86

82











Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)


Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)


Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

















83















perience Scale

Discussion










Croat Med J 20084975-86

84



























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005



























Croat Med J 20084975-86

78
























79


















dagger





451 (14) 2708 (82) 154 (5) 057


541 (16) 2612 (79) 160 (5) 050




275 (8) 2905 (88) 133 (4) 059







288 (9) 2851 (86) 174 (5) 060

Scalability H 055

Reliability ρ 092




Croat Med J 20084975-86

80












dagger













Scalability H 049

Reliability ρ 086












Scalability H 056

Reliability ρ 088






81




pected (r = 057)

Other variables













Results








Croat Med J 20084975-86

82











Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)


Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)


Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

















83















perience Scale

Discussion










Croat Med J 20084975-86

84



























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005




























79


















dagger





451 (14) 2708 (82) 154 (5) 057


541 (16) 2612 (79) 160 (5) 050




275 (8) 2905 (88) 133 (4) 059







288 (9) 2851 (86) 174 (5) 060

Scalability H 055

Reliability ρ 092




Croat Med J 20084975-86

80












dagger













Scalability H 049

Reliability ρ 086












Scalability H 056

Reliability ρ 088






81




pected (r = 057)

Other variables













Results








Croat Med J 20084975-86

82











Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)


Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)


Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

















83















perience Scale

Discussion










Croat Med J 20084975-86

84



























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005



























Croat Med J 20084975-86

80












dagger













Scalability H 049

Reliability ρ 086












Scalability H 056

Reliability ρ 088






81




pected (r = 057)

Other variables













Results








Croat Med J 20084975-86

82











Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)


Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)


Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

















83















perience Scale

Discussion










Croat Med J 20084975-86

84



























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005




























81




pected (r = 057)

Other variables













Results








Croat Med J 20084975-86

82











Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)


Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)


Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

















83















perience Scale

Discussion










Croat Med J 20084975-86

84



























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005



























Croat Med J 20084975-86

82











Femaledagger 0599 0135 0000 1472 (1115-1943)

Age in yea rs 0043 0027 0114 1039 (0983-1097)

Age squared 0000 0000 0591 1000 (0999-1000)


Croat -0737 0177 0000 0520 (0349-0774)

Serb -0259 0160 0106 0831 (0612-1128)

other -0073 0338 0828 1573 (0847-2921)


Town city gt10000sect 0211 0148 0155 1104 (0822-1482)

















83















perience Scale

Discussion










Croat Med J 20084975-86

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Acknowledgments



References


























Croat Med J 20084975-86

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00005




























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perience Scale

Discussion










Croat Med J 20084975-86

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85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005



























Croat Med J 20084975-86

84



























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005




























85






Acknowledgments



References


























Croat Med J 20084975-86

86


00005



























Croat Med J 20084975-86

86


00005

























War Experience and War Related Distress in Bosnia

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Transcript of War Experience and War Related Distress in Bosnia