ASSOCIATION BETWEEN PREMORBID BEHAVIOUR and PTSD IN WAR VETERANS IN CROATIA

1. ASSOCIATION BETWEEN PREMORBID BEHAVIOUR and PTSD IN WAR VETERANS IN CROATIA Mirjana Grubišić-Ilić, Tina Peraica, Davor Rak, Anita Alegić Karin, Andrea Jambrošić-Sakoman, Dragica Kozarić-Kovačić Department of Psychiatry, The Referral Centre of the Ministry of Health and Social Welfare for Stress-related Disorders, Regional Center for Psychotrauma, University Hospital Dubrava, Zagreb, Croatia Introduction:Studies of biological characteristics, personality traits or elements in behaviour in the premorbid phase of psychiatric disorders are important as relevant facts or predictors in early diagnostic procedure both in clinical and in forensic practice, as well as in effective prevention and treatment for the individuals who are at risk of developing the so-called major psychiatric disorders, such as schizophrenia or depression as well as the trauma-related disorders (1, 2, 3). In the group of war veterans with sociopathological elements in behaviour in the pre-warperiod the diagnoses of personality disorder and of personality disorder with comorbidity were diagnosed more often than in the other group; 15.2% in the first group and 5.6% in the second group (p=0.002), which was statistically significant. Aim:The aim of this study was to investigate the connection between some sociopathological characteristics in premorbid behaviour as possible risk factors in the development of PTSD. Materials & Methods: The study included 415 compensation-seeking war veterans who experienced combat and war stress in the period from 1991 – 1995. They were examined by the psychiatric expert to confirm the diagnosis of PTSD and related disorders for compensation- related purposes, as required by the Law on Rights of War Veterans and Their Family Members adopted in 2001. The expert examination included a structured diagnostic procedure and an analysis of military service data. Their behaviour in the premorbid phase was also assessed and was categorised as follows: 1) socially adequate, and 2) socially inadequate, that is, sociopathological, which was further categorised as follows: behaviour issues in school, problems during military service, misdemeanour charges, and criminal offence. In the first group there were 303 (73.2%) veterans who did not report any kind of sociopathological behaviour in the premorbid phase and in the second group there were 112 (26.98%) veterans who reported having some characteristics of sociopathological behaviour in the premorbid phase. The mean age in the first group was 42.71 +/- 7.58 years, and their combat activity was 28.87+/- 20.29 months. The mean age in the second group of veterans was 43.44+/- 8.08 years. The mean duration of their combat activity was 28.93+/- 20.05 months. There were no significant difference between these two groups according to age and combat activity. According to some socio-demographic characteristics there was statistical differences between these two groups of veterans related to education; there were 30 (9.9%) veterans who finished secondary school in the first group (p=0.046) and 72 (64.3%) veterans who finished school for skilled labour in the second group (p=0.032). There were no statistically differences according to employment status, marital status and parenting between these two groups. Table 2. Non-parametric correlation within the groups of war veterans with pre-war sociopathology behaviour (N = 112) No. (%) of patients at assessment Behaviour issues Problems during Misdemeanour Felonies Spearman r'ho p in school military services charges Diagnosis PTSD[1]6(42.9) 7(43.8) 13(32.5) 12(28.6) -.118 .214 Partial PTSD[2]2(14.3) 0(0) 5(12.5) 4(9.5) .043 .652 Anxiety–depressive disorders[3]2(14.3) 6(37.5) 15(37.5) 27(40.5) .092 .335 Personality disorders[4]1(7.1) 0(0) 6(15.0) 5(11.9) .100 .294 Psychotic disorders[5]1(7.1) 0(0) 0(0) 0(0) -.102 .283 Alcoholism[6]0(0) 1(6.3) 0(0) 1(2.4) -.029 .764 Other[7]2(14.3) 2(12.5) 1(2.5) 3(7.1) -.071 .635 Results: [1] Posttraumatic stress disorder and posttraumatic stress disorder with comorbid diagnosis; [2] Partial posttraumatic stress disorder and partial posttraumatic stress disorder with comorbid diagnosis; [3] Anxiety depressive disorders with or without comorbid diagnosis, depressive disorder with or without comorbid diagnosis, somatoform disorder with or without comorbid diagnosis, adjustment disorder with or without comorbid diagnosis;[4] Primary personality disorder with or without comorbid diagnosis;[5] Psychotic disorders with or without comorbid diagnosis;[6] Alcoholism with or without comorbid diagnosis;[7] Other diagnosis. There were no statistical differences related to diagnostical categories between subgroups related to various forms of sociopathological behaviour within the second group. Conclusion:War veterans who reported having some characteristics of sociopathological behaviour and war veterans who did not report such kind of behaviour characteristics in the premorbid period do not differ between themselves in relation to diagnoses PTSD without and PTSD with comorbid diagnoses and partial PTSD without and partial PTSD with comorbid diagnoses. In the group of war veterans (112) who reported sociopathological behaviour in the premorbid phase 38 (33.9%) of them were diagnosed with PTSD without and PTSD with comorbid diagnoses and in the group who did not report sociopathological behaviour (303), 101 (33.3%) veterans were diagnosed with PTSD without and PTSD with comorbid diagnoses. There were no statistically significant differences between these two groups related to the diagnostic categories mentioned here (p=0.909). Eleven (9.8%) veterans were diagnosed with partial PTSD without and partial PTSD with comorbid diagnoses in the group with sociopathological behaviour in the premorbid phase, and 34 (11.2%) veterans were diagnosed with the same diagnoses in the group of veterans without sociopathological behaviour. There were no statistically significant differences between these two groups related to diagnostic categories (p= 0.685). References: 1. Bramsen I., Dirkzwager A J.E., van der Ploeg H E. Predeployment Personality Traits and Exposure to Trauma as Predictors of Posttraumatic Stress Symptoms: A Prospective Study of Former Peacekeepers. Am J Psychiatry 2000;157:1115-9. 2. Jang KL., Stein MB., Taylor S., Asmundson GJ., Livesley WJ. Exposure to traumatic events and experiences: aetiological relationships with personality function. Psychiatry Res 2003 Aug 30;120(1):61-9. 3. Heinrich M., Wagner D., Schoch W., Soravia LM., Hellhammer DH., Ehlert U. Predicting Posttraumatic Stress Symptoms From Pretraumatic Risk factors: A 2-Year Prospective Follow-Up Study in Firefigheters. Am J Psychiat 2005;162:2276-86.