Anger and hatred in war survivors with chronic pain and mental comorbidity in Kosovo: The interactive effects on employment outcome, quality of sleep and suicide ideation

Background/Method: The management of long-term debilitating health conditions after trauma remains a challenge in the post-war setting. In order to define independent and interactive effects of pain and multiple comorbid conditions, a dataset of 63 male and 62 female victims of torture and massive violence identified in Kosovo was analyzed in May 2011. We focused on the results of Patient Health Questionnaire-Brief, McGill Pain Questionnaire and Margolis Pain Diagram.

Results: 90% of participants were doing unpaid work and 50% took medications against depression and anxiety. Mental problems and negative emotions, in particular anger, were associated with greater pain score and with having more pain locations. The participants with recent anger, aggressiveness and hatred reported more headaches. Chest and abdomen pains were more common in participants reporting recent crying. Risk of changing job or stopping job or schooling due to depression or injury increased significantly for those with higher sensory dimensional pain score and with pain in neck, shoulder or upper limbs. Prevalence of sleep disorders and suicide ideation was 80% and 70%, respectively; their main predictors were major depression and greater pain. The effects of anger and phobia of military and police on sleep disorders were significant. Feelings of hatred and crying were associated with increased risk of suicide ideation.

Conclusions: The findings provide an overview of pain characteristics in multiple comorbid conditions and confirm the hypothesized effects on employment outcome, sleep disorders and suicide ideation. We suggest including the anger-hatred management in the intervention for treatment-refractory depression and pain.