Subjective quality of life in war-affected populations
1 Unit for Social and Community Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Cherry Tree Way, London E13 8SP, United Kingdom
2 Unit for Social and Community Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
3 Unit for Social and Community Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
4 Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
5 School of Medicine, University of Rijeka, Rijeka, Croatia
6 Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
7 School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
8 Belgrade University School of Medicine, Belgrade, Serbia
9 Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
10 Faculty of Philosophy, University of Skopje, Skopje, FYR Macedonia
11 Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
12 Unit for Social and Community Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
BMC Public Health 2013, 13:624 doi:10.1186/1471-2458-13-624Published: 2 July 2013
Exposure to traumatic war events may lead to a reduction in quality of life for many years. Research suggests that these impairments may be associated with posttraumatic stress symptoms; however, wars also have a profound impact on social conditions. Systematic studies utilising subjective quality of life (SQOL) measures are particularly rare and research in post-conflict settings is scarce. Whether social factors independently affect SQOL after war in addition to symptoms has not been explored in large scale studies.
War-affected community samples were recruited through a random-walk technique in five Balkan countries and through registers and networking in three Western European countries. The interviews were carried out on average 8 years after the war in the Balkans. SQOL was assessed on Manchester Short Assessment of Quality of Life - MANSA. We explored the impact of war events, posttraumatic stress symptoms and post-war environment on SQOL.
We interviewed 3313 Balkan residents and 854 refugees in Western Europe. The MANSA mean score was 4.8 (SD = 0.9) for the Balkan sample and 4.7 (SD = 0.9) for refugees. In both samples participants were explicitly dissatisfied with their employment and financial situation. Posttraumatic stress symptoms had a strong negative impact on SQOL. Traumatic war events were directly linked with lower SQOL in Balkan residents. The post-war environment influenced SQOL in both groups: unemployment was associated with lower SQOL and recent contacts with friends with higher SQOL. Experiencing more migration-related stressors was linked to poorer SQOL in refugees.
Both posttraumatic stress symptoms and aspects of the post-war environment independently influence SQOL in war-affected populations. Aid programmes to improve wellbeing following the traumatic war events should include both treatment of posttraumatic symptoms and social interventions.