The proposed research entails the first large scale, general population study of the role of personal, environmental, and other risk factors in modifying the relationship between trauma, psychiatric symptoms, and functional status. The study will produce the first follow-up psychiatric data on a refugee population allowing examination of dose--effect relationships between trauma, psychiatric symptoms, and functional status, and the ability to engage in economic activity before and after repatriation. A model of the impact of trauma on populations over time will also be developed. The proposed research fills a major gap in understanding the impact of trauma on a person s ability to function and to participate in economic activity, by analyzing the duration and character of the dose-effect relationship. The design is a prospective cohort study in two time periods. Data on a Bosnian refugee cohort (n=536), collected in 1996, will be analyzed to establish baseline estimates of trauma, symptoms, functional status, and ability to participate in income-generating activities. Cohort members will be re-interviewed post repatriation, allowing prospective assessment of the psychiatric and functional outcomes of trauma. A standardized personal interview will be administered using the previously validated Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 to obtain retrospective reports of trauma, contemporaneous reports of trauma experienced during repatriation, and replicate measures of depression, PTSD, and functional outcomes. Concurrent measures of personal and environmental characteristics will also be obtained, along with measures of income-generating activity. These measurements will be used to assess change in the dose-effect relationship of trauma to mental and physical health outcomes, and to test hypotheses deriving from a conceptual model of the interaction between trauma and its psychiatric and functional outcomes over time. Quantitative analyses will employ graphical methods, descriptive statistics, and structural equation models.
| Mollica, Richard F; Caridad, Kathleen Rey; Massagli, Michael P (2007) Longitudinal study of posttraumatic stress disorder, depression, and changes in traumatic memories over time in Bosnian refugees. J Nerv Ment Dis 195:572-9 |
| Mollica, R F; Sarajlic, N; Chernoff, M et al. (2001) Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. JAMA 286:546-54 |
| Mollica, R F; McInnes, K; Sarajlic, N et al. (1999) Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA 282:433-9 |
