Posredna traumatizacija u supruga ratnih veterana oboljelih od posttraumatskoga stresnog poremećaja : doktorska disertacija

Pozadina: Posttraumatski stresni poremećaj (PTSP) uzrokovan ratnim traumatskim iskustvima ima učinke na sva područja života veterana. To se posebno odražava na partnerske relacije i kvalitetu braka kao i psihičko zdravlje njihovih supruga uzrokujući psihičke smetnje. Cilj: Utvrditi kvalitetu partnerskih relacija parova oboljelih od PTSP-a, te da li supruge oboljelih veterana imaju simptome sekundarnog traumatskog stresa, simptome izgaranja i druge nespecifične psihičke simptome i kolika je u tome uloga socio-demografskih faktora, razine osobne traumatizacije i razine traumatizacije njihovih partnera . Ispitanici i metoda: Ispitnu skupinu činilo je 154 veterana koji se zbog PTSP-a uzrokovanog ratnom psihotraumatizacijom liječe u KB Mostar, i njihovih supruga/partnerica. Kontrolnu skupinu činilo je 77 ratnih veterana koji nemaju PTSP, i njihovih supruga. Ispitanici kontrolne skupine kontaktirani su preko veteranskih udruga po snow balling metodi. U istraživanju je korišten Opći demografski upitnik, Harvard trauma upitnik-verzija za BiH, SCL-90 upitnik, MINI, Upitnik posredne traumatizacije (PCL), upitnik kvalitete života (MANSA), Spanier-ova skala partnerske prilagodbe, Upitnik pregorijevanja u partnerskim odnosima, Upitnik tereta skrbnika i Upitnik trajne promjene osobnosti. Rezultati: Kvaliteta partnerskih relacija supruga veterana oboljelih od PTSP-a manja je u odnosu na supruge veterana bez PTSP-a. U situacijama kada i supruga ima PTSP kvaliteta braka je još niža u odnosu na onu kada samo veteran ima PTSP. Supruge veterana oboljelih od PTSP-a postižu statistički značajno više rezultate i na svim varijablama upitnika posredne traumatizacije (broj i intenzitet posttraumatskih simptoma i ukupni rezultat) i značajno više ih zadovoljava kriterije za dijagnozu sekundarnog traumatskog stresnog poremećaja (STSP) (75.2%:19.5%) u odnosu na supruge veterana bez PTSP-a (χ²=62.38; ss=1; p < 0.001). Također, ove ispitanice postižu značajno više rezultate i na svim subskalama upitnika tereta skrbnika, upitniku pregorijevanja u partnerskim odnosima i trajne promjene ličnosti, a veći im je i opći psihološki distres. Uz visoku sekundarnu traumatizaciju, supruge veterana oboljelih od PTSP-a u usporedbi sa suprugama veterana koji nemaju PTSP značajno češće imaju i neki od pratećih anksioznih i afektivnih psihički poremećaja, ili oba i visokog su i suicidalnog rizika. Psihički simptomi kod žena čiji su muževi oboljeli od PTSP-a najbolje se mogu predvidjeti na osnovi njihove traumatizacije, a manjim dijelom na osnovi socio-demografskih pokazatelja i razine traumatizacije partnera. Zaključak: PTSP veterana je povezan sa kvalitetom partnerskih relacija te posrednom traumatizacijom, subjektivnim i objektivnim doživljajem tereta skrbnika, pregorijevanjem u partnerskim odnosima i općim psihološkim distresom njihovih supruga.Background: Posttraumatic stress disorder (PTSD) caused by war trauma experience has effects on every aspect veterans’ lives. It particularly reflects partnership relations and marital quality as well as psychic health of their wives causing disturbances. Aim: To establish the quality of partnership relations of couples suffering from PTSD, as well as to see whether spouses of diseased veterans have symptoms of Secondary Traumatic Stress Disorder, burnout symptoms and other nonspecific mental symptoms; and to what extent is that affected by the socio-demographic factors, level of personal traumatization and level of personal traumatization of their partners. Participants and method: Experimental group consisted of 154 veterans who were being treated at the Clinical Hospital Mostar for PTSD caused by war psychotrauma, and their wives/partners. Control group consisted of 77 war veterans without PTSD, and their wives. Participants in the control group were contacted through veterans’ associations by snowballing method. The following instruments were used in the research: General Demographic Questionnaire, Harvard trauma questionnaire – Bosnia and Herzegovina version, SCL-90 questionnaire, MINI, PCL Questionnaire, Quality of Life Questionnaire (MANSA), Spanier’s Dyadic Adjustment Scale, Partnership Burnout Questionnaire, Caretaker Burden Questionnaire and Permanent personality change questionnaire. Results: The quality of partnership relation of the PTSD veterans’ wives is lesser than wives of veterans without PTSD. In situations when wife also suffers from PTSD the marriage quality is even lesser than in situation where only the veteran has PTSD. PTSD veterans’ wives also have statistically higher scores on all variables of PCL Questionnaire (number and intensity of posttraumatic symptoms and total score). Also, significantly more of them meets the criteria for diagnosis of Secondary Traumatic Stress Disorder (STSD) (75.2%:19.5%) in comparison with the wives of veterans without PTSD (χ²=62.38; ss=1; p < 0.001). These participants reach significantly higher results also on all subscales of Caretaker Burden Questionnaire, Partnership Burnout Questionnaire and Permanent personality change questionnaire, and their general psychological distress is higher. Along with high secondary traumatization, the wives of PTSD veterans, in comparison to wives of veterans without PTSD, significantly more often have one of accompanying anxious and affective mental disorders, or both, and are highly suicidal. Mental symptoms in women whose spouses have PTSD are best predicted on the basis of their traumatization, and in small part on the basis of socio-demographic indicators and level of partners’ traumatization. Conclusion: Veterans’ PTSD is connected with the quality of partners’ relations and secondary traumatization, subjective and objective perception of the caretaker burden, burnout in partnership relations and general psychological distress of their wives