Mental Health, Social Functioning, and Attitudes of Kosovar Albanians Following the War in Kosovo

Abstract

CONTEXT: The 1998-1999 war in Kosovo had a direct impact on large numbers of civilians. The mental health consequences of the conflict are not known. OBJECTIVES: To establish the prevalence of psychiatric morbidity associated with the war in Kosovo, to assess social functioning, and to identify vulnerable populations among ethnic Albanians in Kosovo. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional cluster sample survey conducted from August to October 1999 among 1358 Kosovar Albanians aged 15 years or older in 558 randomly selected households across Kosovo. MAIN OUTCOME MEASURES: Nonspecific psychiatric morbidity, posttraumatic stress disorder (PTSD) symptoms, and social functioning using the General Health Questionnaire 28 (GHQ-28), Harvard Trauma Questionnaire, and the Medical Outcomes Study Short-Form 20 (MOS-20), respectively; feelings of hatred and a desire for revenge among persons surveyed as addressed by additional questions. RESULTS: Of the respondents, 17.1% (95% confidence interval [CI], 13.2%-21.0%) reported symptoms that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PTSD; total mean score on the GHQ-28 was 11.1 (95% CI, 9.9-12.4). Respondents reported a high prevalence of traumatic events. There was a significant linear decrease in mental health status and social functioning with increasing amount of traumatic events (P</=.02 for all 3 survey tools). Populations at increased risk for psychiatric morbidity as measured by GHQ-28 scores were those aged 65 years or older (P =.006), those with previous psychiatric illnesses or chronic health conditions (P<.001 for both), and those who had been internally displaced (P =.009). Populations at risk for poorer social functioning were living in rural areas (P =.001), were unemployed (P =.046) or had a chronic illness (P =.01). Respondents scored highest on the physical functioning and role functioning subscales of the MOS-20 and lowest on the mental health and social functioning subscales. Eighty-nine percent of men and 90% of women reported having strong feelings of hatred toward Serbs. Fifty-one percent of men and 43% of women reported strong feelings of revenge; 44% of men and 33% of women stated that they would act on these feelings. CONCLUSIONS: Mental health problems and impaired social functioning related to the recent war are important issues that need to be addressed to return the Kosovo region to a stable and productive environment. JAMA. 2000;284:569-577