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Mental Health and Nutritional Status Among the Adult Serbian Minority in Kosovo
Peter Salama, MBBS, MPH;
Paul Spiegel, MD, MPH;
Marci Van Dyke, MPH;
Laura Phelps, MSc;
Caroline Wilkinson, MSc
JAMA. 2000;284:578-584.
Context Since the beginning of the North Atlantic Treaty Organization intervention in Kosovo in June 1999, few objective data have been available on relevant health indicators for the Serbian ethnic minority in Kosovo.
Objective To determine the prevalence of undernutrition among Serbian adults aged 60 years or older and psychiatric morbidity among the adult Serbian population in Kosovo.
Design, Setting, and Participants A systematic random sample survey of 212 households was conducted between September 27 and October 2, 1999, in Pristina, the capital city, and in 10 towns in the rural municipality of Gnjilane in Kosovo. Of the 212 households surveyed, 204 adults aged 15 years or older completed the General Health Questionnaire-28 (GHQ-28) and anthropometric measurements were taken for 98 adults aged 60 years or older and for a comparison group of 51 adults aged 18 to 59 years.
Main Outcome Measures Body mass index of less than 18.5 kg/m2 in older adults; nonspecific psychiatric morbidity among adults; and self-reported use of health care services, access to food rations, and primary sources of prewar and postwar income.
Results Undernutrition was found in 11.2% (95% confidence interval [CI], 5.7%-19.2%) of Serbian adults aged 60 years or older compared with 2.0% (95% CI, 0.1%-11.8%) of Serbian adults aged 18 to 59 years. The mean (SE) total score for the GHQ-28 was 13.0 (0.52). In a comparison of the GHQ-28 scores of the Serbian adults with the Kosovar Albanian adults (data from a recent survey), the mean (SE) score adjusted for age and sex was 12.8 (0.52) vs 11.1 (0.58); P = .03, respectively. The GHQ-28 scores were also higher for the Serbians in the subcategories of social dysfunction (2.8 [0.17] vs 2.2 [0.13]; P = .008) and severe depression (1.9 [0.15] vs 0.9 [0.09]; P<.001), respectively. Serbian women and persons living alone or in small family units were more prone to psychiatric morbidity. Of the 141 respondents reporting the need for health care services, 83 (57.6%) reported not obtaining such services; 204 of 212 (96.2%) households were on a food distribution list. The majority of prewar income came from government jobs compared with farming and humanitarian aid for postwar income.
Conclusions The undernutrition of older Serbian adults in Kosovo should be monitored. The high prevalence of symptoms of social dysfunction and severe depression suggest the need for implementation of mental health programs in the Serbian community.
Author Affiliations: Epidemic Intelligence Service, Epidemiology Program Office (Dr Salama) and International Emergency and Refugee Health Branch, National Center for Environmental Health (Drs Spiegel and Salama), Centers for Disease Control and Prevention, Atlanta, Ga; International Rescue Committee (Ms Van Dyke) and Action Against Hunger (Mss Phelps and Wilkinson), Pristina, Kosovo.
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