The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #60511

William G Fernandez, MD, MPH¹, Sandro Galea, MD, MPH², Brett D. Nelson, MS3³, Sarah Sisco, MPH, MSSW², Kerry Dierberg, MS2³, Gordana Subaric Gorgieva, MD, PhD⁴, Mihajlo Mitrovic, MD⁵, Michael Van Rooyan, MD, MPH³, and David Vlahov, PhD². (1) Division of Emergency Medicine, New York Presbyterian Hospital, Columbia University, 600 West 168th Street, PH 137, New York City, NY 10032, 212.305.2995, billmanfernandez@hotmail.com, (2) Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, (3) Center for International Emergency, Disaster and Refugee Studies, Johns Hopkins University/School of Medicine, Johns Hopkins University, Department of Emergency Medicine, 1227 William Street, Baltimore, MD 21230, (4) Emergency Care Center, Laplje Selo Distric Hospital, Laplje Selo Distric Hospital, Laplje Selo, Yugoslavia, (5) Emergency Center, Belgrade University, Clinical Center of Serbia, Belgrade University, Belgrade, Yugoslavia

INTRODUCTION: Residents of the Republic of Serbia faced civil war and a NATO-led bombing campaign in 1999. We sought to assess the burden of mental health problems among persons presenting to an emergency department (ED) setting in post-war Serbia. METHODS: This study was conducted between July and August 2002 at an ED in Belgrade, Serbia and an ED in a remote, district hospital serving a Serbian enclave in Laplje Selo, Kosovo. Investigators collected data on a systematic sample of non-acute patients presenting to the ED. All respondents completed a structured questionnaire including demographics, the Harvard Trauma Questionnaire and the Center for Epidemiologic Studies Depression Scale. RESULTS: 562 respondents participated (310 in Belgrade, 252 in Laplje Selo). 43% were female. Response rate was 83.8%. Mean age was 37.6 years (SD=13.4). 335 (59.61%) reported post-traumatic stress symptoms (PTSS) consistent with DSM-IV criteria; 272 (48.4%) respondents had symptoms consistent with depression; 195 (34.7%) met criteria for both. In separate multivariable logistic regression models, predictors of PTSD were: having moved multiple times in the past 5-years (OR=1.5), living in a remote location (OR=1.7), and low income (OR=1.8). Predictors of depression were: older age (OR=1.3); female gender (OR=1.5); having been a refugee (OR=2.0); lower education (OR=1.84); being currently unemployed (OR=1.55); and low social support (OR=1.51). CONCLUSIONS: Three years post-war, mental health problems in Serbia, particularly among persons who were displaced from their homes, those that became refugees, those suffering subsequent economic instability, and persons living in rural, remote areas, remain a significant public health concern.

Learning Objectives:

• To describe the mental health status of civilian in post-war Serbia
• To identify the determinants of mental health dysfunction among persons presenting for care in an acute care setting
• To alert policy-makers of the consequences of war on mental health in Serbia

Keywords: Mental Health, Emergency Department/Room

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.