Open Access Research article

War-related psychological sequelae among emergency department patients in the former Republic of Yugoslavia

Brett D Nelson12, William G Fernandez34*, Sandro Galea5, Sarah Sisco5, Kerry Dierberg12, Gordana Subaric Gorgieva6, Arijit K Nandi5, Jennifer Ahern5, Mihajlo Mitrović7, Michael VanRooyen12 and David Vlahov5

Author Affiliations

1 Center for International Emergency, Disaster and Refugee Studies, Johns Hopkins University School of Medicine, Baltimore, MD, USA

2 Department of Emergency Medicine, Johns Hopkins University School of Medicine, Johns Hopkins University, 615 N. Wolfe Street, Room E-8007, Baltimore, MD, 21205, USA

3 Division of Emergency Medicine, New York Presbyterian Hospital, Columbia University, New York, NY, USA

4 Department of Emergency Medicine, Boston Medical Center, Boston, MA 02118, USA

5 Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1215 5th Avenue, Room 556, NY, NY 10029

6 Emergency Care Center, Laplje Selo District Hospital, Laplje Selo, Province of Kosovo

7 Emergency Center, Clinical Center of Serbia, Belgrade University, Pasterova 2, 11000 Belgrade, Serbia

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BMC Medicine 2004, 2:22  doi:10.1186/1741-7015-2-22

Published: 1 June 2004



Residents of the Republic of Serbia faced civil war and a NATO-led bombing campaign in 1999. We sought to assess the burden of metal health dysfunction among emergency department (ED) patients presenting for care three years post-war in Serbia.


This study was conducted during July and August 2002 at two sites: a university hospital ED in Belgrade, Serbia and an ED in a remote district hospital serving a Serbian enclave in Laplje Selo, Kosovo. Investigators collected data on a systematic sample of non-acute patients presenting to the ED. All respondents completed a structured questionnaire assessing demographics and symptoms of post-traumatic stress disorder (PTSD) (using the Harvard Trauma Questionnaire), and major depression (using the Center for Epidemiologic Studies Depression Scale).


A total of 562 respondents participated (310 in Belgrade, 252 in Laplje Selo); the response rate was 83.8%, 43% were female, and mean age was 37.6 years (SD = 13.4). Overall, 73 (13.0%) participants had symptoms consistent with PTSD, and 272 (49.2%) had symptoms consistent with depression. Sixty-six respondents had both disorders (11.9%). In separate multivariable logistic regression models, predictors of PTSD were refugee status and residence in Laplje Selo, and predictors of depression were older age, current unemployment, and lower social support.


Three years post-war, symptoms of PTSD and major depression in Serbia remained a significant public health concern, particularly among refugees, those suffering subsequent economic instability, and persons living in rural, remote areas.