| Summary: | a) The research carried out: eight different samples of citizens of Bosnia and Herzegovina were assessed in 1998 and 1999, two to four years after the end of the 1992-5 war, covering a wide range of variables including traumatic and stressful experiences and various measures of psychosocial adaptation including PTSD. b) Main results and conclusion: the results were published in nine papers which are described in this Context Statement, and which are also included as Appendices. Taken together, the specific (and sometimes tragic) features of the conflict in B&H, and some strengths of the research design, enabled the papers to make a significant contribution to three key psychological themes. The first theme was PTSD concept and measurement. The psychometric performance of measures of PTSD in B&H were found to be similar to other published results, suggesting that the construct is as valid for the B&H population as for the comparison populations on which the instrument was developed. The case is also made for dropping Criterion A from the DSM PTSD diagnosis altogether, on the grounds of overwhelming practical and conceptual problems with assessing it using populations with multiple stressors. The second theme was epidemiology and aetiology of PTSD and other symptom groups. Quite apart from PTSD, the war had a very significant impact on general mental health across the population. Current PTSD prevalences in the non-treatment samples ranged from 11% amongst returned refugees to 36% amongst internally displaced persons (IDPs) in camps, which are in line with the literature. Beyond PTSD, impact was concentrated in particularly high levels of somatisation, paranoid ideation, and aggression. PTSD prevalences amongst returned refugees are clearly lower than those of their peers who stayed in host countries, and much lower than all known reports in refugee samples abroad. Analysis of persons in treatment suggests that those who seek treatment for PTSD (as opposed to other medical problems) do have high levels of PTSD symptoms specifically, but not necessarily because they experienced a larger number of traumatic events. The third theme looked beyond psychopathology. Findings suggest that the concept of post-traumatic growth can be validly extended to this population, but levels were considerably lower than reported in most other studies on other kinds of traumatic event. Finally PTSD and the PTSD diagnosis are discussed in a broader social context and it is concluded that while the war had many different kinds of consequences beyond the purely clinical, this should not divert attention from the fact that individual, clinically-relevant suffering was prevalent in the population at levels warranting urgent attention from public health care.
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