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Barbara Lopes Cardozo, MD, MPH; Alfredo Vergara, PhD; Ferid Agani, MD; Carol A. Gotway, PhD

JAMA. 2000;284:569-577.

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.

Author Affiliations: National Center for Environmental Health, International Emergency and Refugee Health Branch (Dr Lopes Cardozo), National Center for Infectious Diseases, Division of Quarantine (Dr Vergara), and National Center for Environmental Health, Environmental Hazards and Health Effects (Dr Gotway), Centers for Disease Control and Prevention, Atlanta, Ga; and Institute for Mental Health and Recovery, Pristina, Kosovo (Dr Agani).

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