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ASSOCIATION BETWEEN PREMORBID BEHAVIOUR and PTSD IN
WAR VETERANS IN CROATIA
Mirjana Grubišić-Ilić, Tina Peraica, Davor Rak, Anita Alegić Karin, Andrea Jambrošić-Sakoman,
Dragica Kozarić-Kovačić
Department of Psychiatry, The Referral Centre of the Ministry of Health and Social Welfare for Stress-related Disorders,
Regional Center for Psychotrauma, University Hospital Dubrava, Zagreb, Croatia
Introduction: Studies of biological
characteristics, personality traits
or elements in behaviour in the premorbid phase of psychiatric disorders are
important as relevant facts or predictors in early diagnostic procedure both in
clinical and in forensic practice, as well as in effective prevention and
treatment for the individuals who are at risk of developing the so-called major
psychiatric disorders, such as schizophrenia or depression as well as the
trauma-related disorders (1, 2, 3).
In the group of war veterans with sociopathological elements in behaviour in the pre-war period the diagnoses of
personality disorder and of personality disorder with comorbidity were diagnosed more often than in the other
group; 15.2% in the first group and 5.6% in the second group (p=0.002), which was statistically significant.
Figure 1. Number of sociopathology behavior in war veterans
Aim: The aim of this study was to investigate the connection between
some sociopathological characteristics in premorbid behaviour as possible
risk factors in the development of PTSD.
350
303
300
No. of veterans
Materials & Methods: The study included 415 compensationseeking war veterans who experienced combat and war stress in the period
from 1991 – 1995. They were examined by the psychiatric expert to confirm
the diagnosis of PTSD and related disorders for compensation- related
purposes, as required by the Law on Rights of War Veterans and Their Family
Members adopted in 2001. The expert examination included a structured
diagnostic procedure and an analysis of military service data. Their behaviour
in the premorbid phase was also assessed and was categorised as follows:
1) socially adequate, and 2) socially inadequate, that is, sociopathological,
which was further categorised as follows: behaviour issues in school,
problems during military service, misdemeanour charges, and criminal
offence. In the first group there were 303 (73.2%) veterans who did not report
any kind of sociopathological behaviour in the premorbid phase and in the
second group there were 112 (26.98%) veterans who reported having some
characteristics of sociopathological behaviour in the premorbid phase. The
mean age in the first group was 42.71 +/- 7.58 years, and their combat
activity was 28.87 +/- 20.29 months. The mean age in the second group of
veterans was 43.44 +/- 8.08 years. The mean duration of their combat activity
was 28.93 +/- 20.05 months. There were no significant difference between
these two groups according to age and combat activity.
According to some socio-demographic characteristics there was statistical
differences between these two groups of veterans related to education; there
were 30 (9.9%) veterans who finished secondary school in the first group
(p=0.046) and 72 (64.3%) veterans who finished school for skilled labour in
the second group (p=0.032). There were no statistically differences according
to employment status, marital status and parenting between these two
groups.
150
100
16
14
problems during behaviour issues
military services
in school
38(33.9)
11(9.8)
40(35.7)
17(15.2)
1(.9)
2(1.8)
2(2.7)
101(33.3)
34(11.2)
106(35.0)
17(5.6)
11(3.6)
6(2.0)
28(9.2)
Spearman r'ho
.006
-.020
.007
.155
-.073
-.006
-.111
misdemeanour
charges
felonies
without
sociopathology
Type of sociopathology behaviour
112 veterans reported having some sociopathological elements in behaviour in the prewar period. Behaviour
issues in the school were reported by 16 (14.3%) veterans, problem during military service by 14 (12.5%) of them,
40 (35.7%) were misdemeanour offenders and 42 (37.5%) were criminal offenders.
Table 2. Non-parametric correlation within the groups of war veterans with pre-war sociopathology behaviour (N = 112)
Behaviour issues
in school
No. (%) of patients at assessment
With sociopathology
Without sociopathology
behaviour (n = 112)
behaviour (n = 303)
42
40
0
Table 1. Non-parametric correlation between the groups of war veterans with p re-war sociopathology and without pre-war
sociopathology with the present diagnosis
PTSD[1]
Partial PTSD[2]
Anxiety – depressive disorders[3]
Personality disorders[4]
Psychotic disorders[5]
Alcoholism [6]
Other[7]
200
50
Results:
Diagnosis
250
p
.909
.685
.890
.002
.140
.899
.024
Legend: [1] Posttraumatic stress disorder and posttraumatic stress disorder with comorbid diagnosis; [2] Partial posttraumatic stress disorder and partial posttraumatic stress disorder with comorbid diagnosis; [3]
Anxiety depressive disorders with or without comorbid diagnosis, depressive disorder with or without comorbid diagnosis, somatoform disorder with or without comorbid diagnosis, adjustment disorder with or without
comorbid diagnosis; [4] Primary personality disorder with or without comorbid diagnosis; [5] Psychotic disorders with or without comorbid diagnosis; [6] Alcoholism with or without comorbid diagnosis; [7] Other
diagnosis.
Diagnosis
PTSD[1]
Partial PTSD[2]
Anxiety–depressive disorders[3]
Personality disorders[4]
Psychotic disorders[5]
Alcoholism[6]
Other[7]
6(42.9)
2(14.3)
2(14.3)
1(7.1)
1(7.1)
0(0)
2(14.3)
No. (%) of patients at assessment
Problems during
Misdemeanour
military services
charges
7(43.8)
0(0)
6(37.5)
0(0)
0(0)
1(6.3)
2(12.5)
13(32.5)
5(12.5)
15(37.5)
6(15.0)
0(0)
0(0)
1(2.5)
Felonies
Spearman r'ho
p
12(28.6)
4(9.5)
27(40.5)
5(11.9)
0(0)
1(2.4)
3(7.1)
-.118
.043
.092
.100
-.102
-.029
-.071
.214
.652
.335
.294
.283
.764
.635
[1] Posttraumatic stress disorder and posttraumatic stress disorder with comorbid diagnosis; [2] Partial posttraumatic stress disorder and partial posttraumatic stress disorder with comorbid diagnosis; [3] Anxiety depressive disorders with or
without comorbid diagnosis, depressive disorder with or without comorbid diagnosis, somatoform disorder with or without comorbid diagnosis, adjustment disorder with or without comorbid diagnosis;[4] Primary personality disorder with or
without comorbid diagnosis;[5] Psychotic disorders with or without comorbid diagnosis;[6] Alcoholism with or without comorbid diagnosis;[7] Other diagnosis.
There were no statistical differences related to diagnostical categories between subgroups related to various
forms of sociopathological behaviour within the second group.
Conclusion: War veterans who reported having some characteristics of sociopathological behaviour
In the group of war veterans (112) who reported sociopathological behaviour in
the premorbid phase 38 (33.9%) of them were diagnosed with PTSD without
and PTSD with comorbid diagnoses and in the group who did not report
sociopathological behaviour (303), 101 (33.3%) veterans were diagnosed with
PTSD without and PTSD with comorbid diagnoses. There were no statistically
significant differences between these two groups related to the diagnostic
categories mentioned here (p=0.909). Eleven (9.8%) veterans were diagnosed
with partial PTSD without and partial PTSD with comorbid diagnoses in the
group with sociopathological behaviour in the premorbid phase, and 34
(11.2%) veterans were diagnosed with the same diagnoses in the group of
veterans without sociopathological behaviour. There were no statistically
significant differences between these two groups related to diagnostic
categories (p= 0.685).
and
war veterans who did not report such kind of behaviour characteristics in the premorbid period do not differ
between themselves in relation to diagnoses PTSD without and PTSD with comorbid diagnoses and partial PTSD
without and partial PTSD with comorbid diagnoses.
References:
1. Bramsen I., Dirkzwager A J.E., van der Ploeg H E. Predeployment Personality Traits and Exposure to Trauma as Predictors of Posttraumatic Stress
Symptoms: A Prospective Study of Former Peacekeepers. Am J Psychiatry 2000;157:1115-9.
2. Jang KL., Stein MB., Taylor S., Asmundson GJ., Livesley WJ. Exposure to traumatic events and experiences: aetiological relationships with personality
function. Psychiatry Res 2003 Aug 30;120(1):61-9.
3. Heinrich M., Wagner D., Schoch W., Soravia LM., Hellhammer DH., Ehlert U. Predicting Posttraumatic Stress Symptoms From Pretraumatic Risk factors: A 2Year Prospective Follow-Up Study in Firefigheters. Am J Psychiat 2005;162:2276-86.