A controlled study of the experience of traumatised women in relation with their marital, parenta... more A controlled study of the experience of traumatised women in relation with their marital, parental and sexual life in Kosovo
In this article, we present, as participants and observers, an analysis of the social and politic... more In this article, we present, as participants and observers, an analysis of the social and political impact of the 2015 art installation “Mendoj Për Ty” [Thinking of You], dedicated to survivors of wartime sexual violence in Kosovo. We argue that art possesses an extraordinary power to unveil the “public secret” of wartime rape, as well as produce a “reparative” reading of the past, creating solidarity for, and recognition of, survivors, which simultaneously empowers them and their advocates. We also confirm the crucial role of women’s networks and subjectivity to the inclusion of women’s perspectives for effective transitional justice.
Mental health symptoms differ among women with forcible rape (FR) compared to drug- or alcohol-fa... more Mental health symptoms differ among women with forcible rape (FR) compared to drug- or alcohol-facilitated/incapacitated rape (DAFR/IR) histories, but differences in suicidal ideation are unknown. The differences in suicidal ideation based on FR and DAFR/IR history were examined in national samples of college (n = 2,000) and household-residing (n = 3,001) women. For both college women and household-residing women, FR and DAFR/IR were associated with recent suicidal ideation. Differences emerged when examined indirectly through recent posttraumatic stress disorder, drug abuse, and alcohol abuse. Therefore, it is important to examine both FR and DAFR/IR when assessing suicidal ideation.
Purpose The purpose of this paper is to explore the association between the quality of prison lif... more Purpose The purpose of this paper is to explore the association between the quality of prison life and mental health among prisoners and the occurrence of violence. Design/methodology/approach In total, 203 prisoners from Dubrava Correctional Center in Kosovo participated. Data on background characteristics of the prisoners, quality of prison life, mental health symptoms and exposure to physical, psychological and sexual violence were collected through interviewer-administered questionnaires. Data were analyzed using general linear models (GLM) and manual backwards model search with step-wise exclusion. Findings The GLM analysis showed a significant negative association between anxiety symptom load (−1.4), physical violence (−1.5) and psychological violence (−1.9), and quality of prison life. Furthermore, it appeared that prisoners rating of quality of life (QoL) increased with time among prisoners not exposed to violence, while this was not seen among prisoners exposed to violence....
Background: To develop an evidence-based rehabilitation programme, we investigated injury and pai... more Background: To develop an evidence-based rehabilitation programme, we investigated injury and pain complaints in relation to collective exposure to violence and human rights violations the population in Mitrovic district of Kosovo. Methods: The population-based study consists of two elements: household survey and functional assessment at a mobile clinic (presented in the part II). A cross-sectional two-stage cluster sampling was used. The survey was conducted in September-October 2008. We surveyed 1,115 households with a population of 6,845. Results: Around 7% of the population had been tortured and 20% had mental or physical pain complaints. Pain complaints increased with age over 35 years old. An association was found between the proportion of family members with pain complaints and a decline in the household income because of the injury of a family member. A family's affiliation with the Kosovo Liberation Army and participation in a protest prior to 1999 were related to being...
Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during... more Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during pregnancy and offspring DNA methylation and cortisol levels. Materials & methods: Blood genome-wide DNA methylation and cortisol was measured in the youngest child of 117 women who experienced sexual violence/torture during the Kosovo war. Results: Seventy-two percent of women had PTSD symptoms during pregnancy. Their children had higher cortisol levels and differential methylation at candidate genes ( NR3C1, HTR3A and BNDF) . No methylation differences reached epigenome-wide corrected significance levels. Conclusion: Identifying the biological processes whereby the negative effects of trauma are passed across generations and defining groups at high risk is a key step to breaking the intergenerational transmission of the effects of mental disorders.
Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for ... more Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012-14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo. A single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score. Over 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45-137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance. The impact of bio-psycho-social intervention is likely sensitive to the context of post-war economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability. Clinicaltrials.gov (NCT01696578).
Staff well-being including stress awareness and stress management skills is usually not a priorit... more Staff well-being including stress awareness and stress management skills is usually not a priority in (mental) health policies. In Kosovo, the level of stress amongst primary health care (PHC) professionals is high because health professionals are part of the population seriously affected by conflict. The need to support staff and look after their well-being was recognised by the Director of the Centre for Development of Family Medicine, Head of Primary Care. In response, the Antares Foundation and the Kosovo Rehabilitation Centre for Torture Victims (KRCT), in close cooperation with the Centers for Disease Control and Prevention, implemented an integrated psycho-social capacity building programme for PHC professionals. This case-study describes how staff well-being was integrated into the PHC system in Kosovo. This was accomplished through raising awareness on staff well-being and stress management as well as strengthening knowledge of and skills in stress management. Eighteen national PHC staff were trained and more than a thousand family doctors and nurses attended stress management workshops. A steering committee consisting of key stakeholders was responsible for overseeing the execution of the programme. This steering committee successfully advocated for integration of staff well-being and stress management in the revised mental health strategy 2014-2020. The curriculum developed for the training was integrated in the professional staff development programme for family doctors and nurses. The effectiveness of the programme was assessed through an evaluation (including a survey among PHC professionals trained under the programme). Evaluation findings showed that offering structured support, entailing the opportunity to discuss work related problems and providing tools to deal with stress related to work or personal life, helps staff to continue their professional tasks under challenging conditions. Evaluation findings suggest that results can be sustained through an integrated approach and involvement of key stakeholders. The case study may be of interest to policy makers involved in health reform processes and for managers implementing changes in complicated post conflict contexts. For both groups, acknowledgment of staff well-being could be a key ingredient in the motivation of staff and the quality of services.
A controlled study of the experience of traumatised women in relation with their marital, parenta... more A controlled study of the experience of traumatised women in relation with their marital, parental and sexual life in Kosovo
In this article, we present, as participants and observers, an analysis of the social and politic... more In this article, we present, as participants and observers, an analysis of the social and political impact of the 2015 art installation “Mendoj Për Ty” [Thinking of You], dedicated to survivors of wartime sexual violence in Kosovo. We argue that art possesses an extraordinary power to unveil the “public secret” of wartime rape, as well as produce a “reparative” reading of the past, creating solidarity for, and recognition of, survivors, which simultaneously empowers them and their advocates. We also confirm the crucial role of women’s networks and subjectivity to the inclusion of women’s perspectives for effective transitional justice.
Mental health symptoms differ among women with forcible rape (FR) compared to drug- or alcohol-fa... more Mental health symptoms differ among women with forcible rape (FR) compared to drug- or alcohol-facilitated/incapacitated rape (DAFR/IR) histories, but differences in suicidal ideation are unknown. The differences in suicidal ideation based on FR and DAFR/IR history were examined in national samples of college (n = 2,000) and household-residing (n = 3,001) women. For both college women and household-residing women, FR and DAFR/IR were associated with recent suicidal ideation. Differences emerged when examined indirectly through recent posttraumatic stress disorder, drug abuse, and alcohol abuse. Therefore, it is important to examine both FR and DAFR/IR when assessing suicidal ideation.
Purpose The purpose of this paper is to explore the association between the quality of prison lif... more Purpose The purpose of this paper is to explore the association between the quality of prison life and mental health among prisoners and the occurrence of violence. Design/methodology/approach In total, 203 prisoners from Dubrava Correctional Center in Kosovo participated. Data on background characteristics of the prisoners, quality of prison life, mental health symptoms and exposure to physical, psychological and sexual violence were collected through interviewer-administered questionnaires. Data were analyzed using general linear models (GLM) and manual backwards model search with step-wise exclusion. Findings The GLM analysis showed a significant negative association between anxiety symptom load (−1.4), physical violence (−1.5) and psychological violence (−1.9), and quality of prison life. Furthermore, it appeared that prisoners rating of quality of life (QoL) increased with time among prisoners not exposed to violence, while this was not seen among prisoners exposed to violence....
Background: To develop an evidence-based rehabilitation programme, we investigated injury and pai... more Background: To develop an evidence-based rehabilitation programme, we investigated injury and pain complaints in relation to collective exposure to violence and human rights violations the population in Mitrovic district of Kosovo. Methods: The population-based study consists of two elements: household survey and functional assessment at a mobile clinic (presented in the part II). A cross-sectional two-stage cluster sampling was used. The survey was conducted in September-October 2008. We surveyed 1,115 households with a population of 6,845. Results: Around 7% of the population had been tortured and 20% had mental or physical pain complaints. Pain complaints increased with age over 35 years old. An association was found between the proportion of family members with pain complaints and a decline in the household income because of the injury of a family member. A family's affiliation with the Kosovo Liberation Army and participation in a protest prior to 1999 were related to being...
Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during... more Aim: To investigate the association between maternal post-traumatic stress disorder (PTSD) during pregnancy and offspring DNA methylation and cortisol levels. Materials & methods: Blood genome-wide DNA methylation and cortisol was measured in the youngest child of 117 women who experienced sexual violence/torture during the Kosovo war. Results: Seventy-two percent of women had PTSD symptoms during pregnancy. Their children had higher cortisol levels and differential methylation at candidate genes ( NR3C1, HTR3A and BNDF) . No methylation differences reached epigenome-wide corrected significance levels. Conclusion: Identifying the biological processes whereby the negative effects of trauma are passed across generations and defining groups at high risk is a key step to breaking the intergenerational transmission of the effects of mental disorders.
Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for ... more Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012-14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo. A single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score. Over 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45-137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance. The impact of bio-psycho-social intervention is likely sensitive to the context of post-war economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability. Clinicaltrials.gov (NCT01696578).
Staff well-being including stress awareness and stress management skills is usually not a priorit... more Staff well-being including stress awareness and stress management skills is usually not a priority in (mental) health policies. In Kosovo, the level of stress amongst primary health care (PHC) professionals is high because health professionals are part of the population seriously affected by conflict. The need to support staff and look after their well-being was recognised by the Director of the Centre for Development of Family Medicine, Head of Primary Care. In response, the Antares Foundation and the Kosovo Rehabilitation Centre for Torture Victims (KRCT), in close cooperation with the Centers for Disease Control and Prevention, implemented an integrated psycho-social capacity building programme for PHC professionals. This case-study describes how staff well-being was integrated into the PHC system in Kosovo. This was accomplished through raising awareness on staff well-being and stress management as well as strengthening knowledge of and skills in stress management. Eighteen national PHC staff were trained and more than a thousand family doctors and nurses attended stress management workshops. A steering committee consisting of key stakeholders was responsible for overseeing the execution of the programme. This steering committee successfully advocated for integration of staff well-being and stress management in the revised mental health strategy 2014-2020. The curriculum developed for the training was integrated in the professional staff development programme for family doctors and nurses. The effectiveness of the programme was assessed through an evaluation (including a survey among PHC professionals trained under the programme). Evaluation findings showed that offering structured support, entailing the opportunity to discuss work related problems and providing tools to deal with stress related to work or personal life, helps staff to continue their professional tasks under challenging conditions. Evaluation findings suggest that results can be sustained through an integrated approach and involvement of key stakeholders. The case study may be of interest to policy makers involved in health reform processes and for managers implementing changes in complicated post conflict contexts. For both groups, acknowledgment of staff well-being could be a key ingredient in the motivation of staff and the quality of services.
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