253216 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

Wednesday, November 2, 2011

Shr-Jie Wang, MPH, PhD , Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark
Jens Modvig, MD, PhD , Research department, Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark
Feride Rushiti, MD , Kosova Rehabilitation Centre for Torture Victims, Pristina, Kosovo
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.

Learning Areas:
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Our objective is to define the pain characteristics and analyze the independent and interactive effect of chronic pain, comorbid mental problems and emotional disturbance on victims of torture and massive violence. First, we described the difference in pain characteristics (sensory and affective dimension of pain and pain rating index (PRI) of Mcgill Pain Questionnaire (MPQ) in victims with PTSD, major depression and anxiety disorder, emotional disturbance and different numbers of bodily injuries. Second, we further assessed the association of particular pain locations and the total number of pain locations with mental problems and emotional disturbance. Third, we analyzed the interactive effect of pain and multiple comorbid conditions on the following outcomes of interests: 1) having changed or stopped jobs or stopped schooling, 2) sleep disorders and 3) suicide ideation. Another objective of the study was to demonstrate that the standardized pain and general health assessment tools can be applied in the routine health screening in the post-war Kosovo.

Keywords: Co-morbid, Public Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I received my MPH from Yale University School of Public Health and PhD in Clinical and Intervention Epidemiology from Swiss Tropical and Public Health Institute, Basel University. I have been working with war-affected population and marginalised population in Africa, Middle-east and south-east Asia with NGOs and UN agencies since 1998.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.