How does Housing First catalyze recovery?: Qualitative findings from a Canadian multi-site randomized controlled trial

Qualitative narrative interviews were conducted with 195 participants with histories of homelessness and mental illness at baseline and at an 18-month follow-up. Participants were randomly assigned at baseline to Housing First (HF; n = 119) or treatment as usual (TAU; n = 76) in five Canadian cities. Changes in consumers’ narratives over time were examined for 13 life domains (e.g., housing stability, typical day, social relationships). HF participants showed superior housing stability that led to three important transitions in their recovery journeys: (1) the transition from street to home (e.g., greater control over one’s environment, becoming unstuck), (2) the transition from home to community (e.g., pursuing relationships, participating in the community), and (3) the transition from the present to the future (e.g., developing autonomy and hope). In spite of the gains experienced by many HF participants and some TAU participants, there was a subgroup of HF participants and many more TAU participants who experienced considerable difficulty making positive transitions. This research affirms the importance of housing and support for people with mental illness who are homeless but extends previous research by elucidating how HF enables participants to navigate important transitions in their recovery journeys. Once housing stability is achieved, other services (e.g., supported employment, education, and socialization) are needed to accelerate the transitions that participants strive to make in their lives.     

Community Participation and Belonging Among Formerly Homeless Adults with Mental Illness After 12 months of Housing First in Vancouver,British Columbia: A Randomized Controlled Trial

This study examines community integration among homeless adults with mental illness 6 and 12 months after random assignment to Housing First (independent apartments or congregate residence) with support services or to treatment as usual (TAU). Residence in independent apartments was associated with increased ‘psychological integration’ for participants with less severe needs; however, no significant improvement in ‘physical integration’ was observed among any of the intervention groups. Analysis of individual items on the Psychological Integration subscale revealed that, compared to TAU, participants assigned to independent apartments were more likely to endorse statements related to the emotional components of community but not statements related to neighboring. Participants assigned to the congregate residence were more likely to endorse knowing their neighbors, but not interacting with neighbors or the emotional components of community. Findings are discussed in terms of housing program as well as broader contextual factors.     

Conduct disorder behaviors, childhood family instability, and childhood abuse as predictors of severity of adult homelessness among American veterans

Purpose

Despite US federal efforts to end and prevent homelessness among veterans, there has been limited examination of pre-military factors like childhood problems, associated with adult homelessness. This study examined childhood problems among homeless veterans and its relation to severity of homelessness and outcomes in supported housing.

Methods

Using data from 1,161 homeless veterans at 19 sites enrolled in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program, three types of childhood problems were examined: conduct disorder behaviors, family instability, and childhood abuse. Multiple regressions were conducted to examine the association between childhood problems and severity of homelessness before supported housing, and childhood problems and outcomes after supported housing.

Results

About one-third reported conduct disorder behaviors, over half reported family instability, and 40 % reported childhood abuse. Greater childhood problems were found in this sample compared to published samples of non-homeless veterans. Conduct disorder behaviors, family instability, and childhood abuse were each weakly associated with lifetime homeless episodes. One year after enrollment in the HUD-VASH program, past conduct disorder behaviors and family instability were not predictive of outcomes, except childhood abuse was related to less social support and lower quality of life.

Conclusions

These findings demonstrate not only the potential impact of childhood abuse on social relationships and quality of life in adulthood, but also the resilience of homeless veterans from adverse childhoods to be successfully housed in a supported housing program.     

Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings

Objective

To determine the standardized rates of mental disorder, health service use and barriers to care in a representatively diverse sample of homeless adults in three different sized urban centers in British Columbia, Canada.

Method

Five hundred homeless adults from Vancouver, Victoria and Prince George were recruited. The MINI-International Neuropsychiatric Interview PLUS was used to determine current and lifetime rates of mental disorder, mental disorder episodes and suicidality. Health service use and barriers to care were recorded.

Results

Overall, 92.8 % of participants met criteria for a current mental disorder: 82.6 % for alcohol or drug dependence, 57.3 % anxiety disorder, 31.5 % mood disorder. Over half (53.4 %) met criteria for a concurrent disorder. Only 14.9 % had seen a psychiatrist and 12.7 % a mental health team in the year prior to the survey. Most common barriers included being poorly connected to the system of care and issues related to homelessness. Mental disorder rates across sites were high, however, differences were found that reflected the composition of the samples.

Conclusion

Improving the mental health state of the homeless will require significant capacity for mental health and concurrent disorder programming that is tailored to the community it intends to serve. Demographic features of the population may help in directing assessments of need.     

Suicidal behavior among homeless people in Japan

Purpose

The purpose of this study is to investigate the frequency and correlates of suicidal behavior among homeless people in Japan.

Methods

A face-to-face survey was conducted in two districts of Tokyo, Japan, with 423 subjects who resided on streets and riversides and in urban parks and stations (street homeless) or who were residents of shelters, cheap hotels, or welfare homes for homeless people (sheltered homeless).

Results

When questioned about suicidal ideation in the previous 2 weeks, 51 subjects (12.2 % of valid responses) had a recurring wish to die, 29 (6.9 %) had frequent thoughts of suicide, and 22 (5.3 %) had made suicide plans. In addition, 11 (2.9 %) subjects had attempted suicide in the previous 2 weeks and 74 (17.7 %) reported that they had ever attempted suicide. In univariate logistic regression analyses, street homelessness, lack of perceived emotional social support, poor subjective health perception, visual impairment, pain, insomnia, poor mental well-being, and current depression were significantly associated with recurrent thoughts of suicide in the previous 2 weeks. Among these, current depression had the greatest significance. In multivariate logistic regression analyses after controlling for depression, street homelessness and lack of perceived emotional social support were significantly associated with recurrent thoughts of suicide in the previous 2 weeks.

Conclusion

Comprehensive interventions including housing and social support as well as mental health services might be crucial as effective strategies for suicide prevention among homeless people.     

Prevalence of psychiatric disorders among homeless people in Athens area: a cross-sectional study

Purpose

Homelessness is a chronic social phenomenon in European and other Western cities. In the recent years, the number of homeless people in Greece, mainly in Athens, is also increasing.

Method

The aim of this study was to explore the prevalence of psychiatric disorders among a sample of 254 homeless people, using the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was drawn from the existing shelters, soup kitchens, and the streets.

Results

The sample was predominantly male (74 %) with mean age 51 years, being in their majority homeless for over 25 months, 27 % of them living in the streets. The vast majority of the sample was single or separated with an education level <12 years. Current prevalence of psychiatric disorders was 56.7 % with 20.8 % comorbidity. For psychotic and mood disorders, current prevalence rates were 13 and 16 %, respectively. One year prevalence of alcohol and drug dependence was found to be low. Logistic regression analysis revealed that being older with higher number of months living in the streets and exposed to high frequency of adverse social events, increase the likelihood to become a psychiatric case. Finally, the vast majority of the identified psychiatric cases were lacking any current psychiatric care.

Conclusions

The magnitude of the prevalence of psychiatric morbidity was more than three times higher than that of the general population in Athens. Implications for psychosocial care and the organization of a support network for the homeless people are discussed.     

Factors influencing patients’ recovery and the efficacy of a psychosocial post-discharge intervention: post hoc analysis of a randomized controlled trial

Purpose

The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme.

Methods

RCT using parallel group block randomisation, including 151 patients with ≤3 hospitalisations within the last 3 years, a GAF score ≤60, and aged 18–64 years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU).

Results

Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d = 0.44). In the TAU group, 15.6 % remained clinically impaired at 12-month follow-up as opposed to 48.1 % in the intervention group (p = 0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d = 0.46). Involuntary index admission (d = 0.42) and high educational degree (d = 0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU.

Conclusions

According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients’ social networks.

Funding

This study was supported by a private foundation.

Trial registration

ISRCTN58280620.

     

Is psychiatric residential facility discharge possible and predictable? A multivariate analytical approach applied to a prospective study in Italy

Background

A growing number of severely ill patients require long-term care in non-hospital residential facilities (RFs). Despite the magnitude of this development, longitudinal studies surveying fairly large resident samples and yielding important information on this population have been very few.

Aims

The aims of the study were (1) to describe the socio-demographic, clinical, and treatment-related characteristics of RF patients during an index period in 2010; (2) to identify predictors and characteristics associated with discharge at the 1-year follow-up; (3) to evaluate clinicians’ predictions about each patient’s likelihood of home discharge (HD).

Methods

A prospective observational cohort study was conducted involving all patients staying in 23 medium-long-term RFs of the St John of God Order with a primary psychiatric diagnosis. A comprehensive set of socio-demographic, clinical, and treatment-related information was gathered and standardized assessments (BPRS, HONOS, PSP, PHI, SLOF, RBANS) were administered to each participant. Logistic regression analyses were run to identify independent discharge predictors.

Results

The study involved 403 patients (66.7 % male), with a mean age of 49 years (SD = 10). The participants’ average illness duration was 23 years; median value for length of stay in the RF was 2.2 years. The most frequent diagnosis was schizophrenia (67.5 %). 104 (25.8 %) were discharged: 13.6 % to home, 8.2 % to other RFs, 2.2 % to supported housing, and 1.5 % to prison. Clinicians’ predictions about HD were generally erroneous.

Conclusions

Very few patients were discharged to independent accommodations after 1 year. The main variables associated with a higher HD likelihood were: illness duration of <15 years and effective social support during the previous year. Lower severity of psychopathology and higher working skill levels were also associated with a significantly greater HD likelihood.     

Housing First for People With Severe Mental Illness Who Are Homeless: A Review of the Research and Findings From the At Home–Chez soi Demonstration Project

Objective:

To provide a review of the extant research literature on Housing First (HF) for people with severe mental illness (SMI) who are homeless and to describe the findings of the recently completed At Home (AH)–Chez soi (CS) demonstration project. HF represents a paradigm shift in the delivery of community mental health services, whereby people with SMI who are homeless are supported through assertive community treatment or intensive case management to move into regular housing.

Method:

The AH–CS demonstration project entailed a randomized controlled trial conducted in 5 Canadian cities between 2009 and 2013. Mixed methods were used to examine the implementation of HF programs and participant outcomes, comparing 1158 people receiving HF to 990 people receiving standard care.

Results:

Initial research conducted in the United States shows HF to be a promising approach, yielding superior outcomes in helping people to rapidly exit homelessness and establish stable housing. Findings from the AH–CS demonstration project reveal that HF can be successfully adapted to different contexts and for different populations without losing its fidelity. People receiving HF achieved superior housing outcomes and showed more rapid improvements in community functioning and quality of life than those receiving treatment as usual.

Conclusions:

Knowledge translation efforts have been undertaken to disseminate the positive findings and lessons learned from the AH–CS project and to scale up the HF approach across Canada.     

Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Background

Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved.

Purpose

The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth.

Methods

This research performs a narrative synthesis of the results from included studies.

Results

Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified.

Conclusions

Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth.     

Patient-centered integrated healthcare improves quality of life in Parkinson’s disease patients: a randomized controlled trial

Introduction

Improving quality of life (QoL) is a key issue when dealing with Parkinson’s disease (PD). Integrative care shows potential to achieve improvements in QoL. Here, we analyzed whether a community-based, open-label, integrated approach improves QoL in PD patients.

Methods

PD patients were screened for eligibility and evaluated by a university-based PD specialist, a PD nurse, and a general neurologist at a local practice. Patients were randomly assigned to a control group (CG), receiving standard German neurological treatment including a baseline assessment and follow-up visit at 6 months, or an interventional group (IG) who received an individually tailored therapy plan and additional home visits. Patients and investigators were not blinded for either intervention. Primary outcome analysis compared the differential change of PDQ-39 from baseline to 6-month follow-up between CG and IG. Between-group changes in mood, motor/non-motor functioning, and cognition were secondary outcomes.

Results

300 patients were included and randomized equally to IG and CG. 132 IG and 125 CG patients had a valid PDQ-39 at follow-up and qualified for the modified ITT analysis. PDQ-39 improved more in IG compared to CG [2.2 points (95% CI ? 4.4 to 0.1); p = 0.044]. Likewise, change scores between IG and CG favored IG for UPDRS III (p < 0.001, mean change 3.3, 95% CI ? 4.9 to ? 1.7) and PD-NMS (p < 0.001, mean change 11.3, 95% CI ? 17.1 to ? 5.5).

Conclusions

Data show that an integrated approach, compared to regular PD care, improves QoL as well as motor and nonmotor PD symptoms over 6 months. Future studies need to address the cost–benefit ratio and whether positive effects can be maintained beyond intervention.

     

Cognitive function is associated with impaired heart rate variability in ageing adults: the Irish longitudinal study on ageing wave one results

Objective

To examine the independent association between heart rate variability (HRV) and cognitive performance, in a nationally representative population study of older adults.

Methods

Cross-sectional analysis of wave 1 data from the Irish longitudinal study on ageing (TILDA) was performed. A subset of 4,763 participants who underwent ECG recording during resting and paced breathing periods were used for the analysis. HRV indices were divided into quintiles for comparison of values and cognitive performance was defined using the Montreal cognitive assessment (MOCA) score. Multivariate linear regression was used to model the association between cognition and different quintiles of each HRV index, after adjustment for covariates.

Results

The mean age was 61.7 ± 8.3 years and 2,618 (55 %) were female. Lower quintiles of SDNN (P = 0.01-paced), LF (P = 0.001-paced), and LF:HF ratio (P = 0.049-paced) were significantly associated with lower MOCA scores (during both recording periods), independent of confounders. Sub-domains of MOCA responsible for the relationship were predominantly memory recall and language.

Interpretation

Reduced HRV is significantly associated with lower cognitive performance at a population level in people aged 50 and older. This further strengthens the relationship between autonomic dysfunction and cognitive disorders.     

Associations with quality of life and the effect of psychopathology in a community study

Purpose

Quality of life (QoL) is considerably impaired in mental illness and especially in depression. In this study, we aimed to determine the demographic, personality-related and psychopathological associations with QoL. In addition, we studied how the associations with QoL differ depending on the burden of psychopathology.

Methods

We used a longitudinal observational cohort study, enriched for high levels of psychopathology, to examine data for QoL when the subjects were 34–35. We conducted a hierarchical linear regression analysis to determine how sex, personality, sociodemographics, somatic symptoms and psychopathology affect QoL.

Results

Once all the variables were included in the model, total psychopathology is strongly negatively associated with QoL, while mastery and income were shown to have positive associations with QoL. Sex, personality and somatic symptoms had no significant associations with QoL once the other variables had been introduced into the regression. Due to the outstanding association with psychopathology, we tested whether the relationship had any interaction with the other predictors, but none reached statistical significance.

Conclusions

The most important association with QoL is psychopathology, regardless of sex, personality, coping resources, sociodemographics or the extent somatic symptoms. The relationship holds across the other variables included and the results are, thus, widely applicable.     

Sleep and suicide: an analysis of a cohort of 394,000 Taiwanese adults

Background

Sleep problems may lead to, or be symptomatic of, depression and other mental illnesses yet few studies have investigated their association with suicide risk.

Design

Prospective cohort study.

Setting

Taiwan.

Participants

393,983 men and women aged 20 or above participating in the MJ health check-up programme.

Results

There were 335 suicides over a mean of 7.4 years follow-up. There was a reverse J-shaped association between sleep duration and suicide risk. When compared with those sleeping 6–8 h per night the adjusted hazard ratios (95 % confidence intervals) for suicide associated with 0–4, 4–6 and >8 h sleep were 3.5 (2.0–6.1), 1.5 (1.1–1.9) and 1.5 (1.1–2.0), respectively. People requiring sleeping pills to get to sleep (1.2 % participants) were at over 11-fold increased risk; difficulty falling asleep (11.5 % participants), frequent dreaming (16.7 %) and being easily awoken (30.6 %) were associated with a 2.0-, 1.6- and 1.3-fold increased risk of suicide, respectively.

Conclusions

Less than 6 h sleep duration, sleep disturbances and reported use of sleep medicines are markers of suicide risk. Sleep problems should be assessed when evaluating suicide risk.     

Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial

Background

Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence.

Purpose

We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes.

Methods

Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms.

Results

Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms.

Conclusions

We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.     

Kognitive Leistungsfähigkeit nach Operation und stentgeschützter Angioplastie einer Karotisstenose

Background

This prospective, controlled, randomised study evaluates differences concerning cognitive functions between carotid endarterectomy (CEA) and stent-protected angioplasty (CAS) as a treatment for symptomatic carotid stenosis. Both techniques include risks whose effect on neuropsychological abilities remains yet unknown.

Methods

Twenty-seven patients suffering from high-grade symptomatic carotid stenosis underwent neuropsychological testing before, 1 month, and 6 months after treatment. After the first testing patients were randomly assigned for CEA (n=10) or CAS (n=17) as treatment. The patients’ cognitive functions were compared to those of 13 healthy controls.

Results

Whether patients underwent CEA or CAS made no difference in the neuropsychological outcome 4 weeks and 6 months after treatment. Patients always performed worse than the healthy controls.

Conclusion

Both techniques seem to have no different effect on cognitive functions.     

Effect of hormone replacement therapy on cardiac autonomic modulation

Objective

To investigate the effects of hormone replacement therapy (HRT) on heart rate variability (HRV) in healthy postmenopausal women.

Methods

Two groups were evaluated: group 1 (G1): 20 women not undergoing HRT (60 ± 5.89 years), group 2 (G2): 20 women undergoing HRT (59 ± 5.70 years). The HRTs involved were either conjugated equine estrogen with or without medroxyprogesterone, synthetic estrogen hormone, estradiol associated with norethisterone acetate or isoflavonoids. Electrocardiogram was recorded in the supine position for 10 min. Spectral analysis included low and high frequencies in absolute (LF and HF) and normalized units (LFnu and HFnu), which are predominantly cardiac sympathetic modulation (CSM) and cardiac vagal modulation (CVM) indicators, respectively. The LF/HF ratio was also calculated. Symbolic analysis involved the following indexes: 0V % (CSM indicator), 1V % (CSM and CVM indicators), 2LV % (predominantly CVM indicator) and 2UV % (CVM indicator). Shannon and conditional entropies were also calculated.

Results

Spectral analysis demonstrated that HRT affected HRV. LF, LFnu and LF/HF ratio were higher (showing increased CSM), while HFnu was lower (representing decreased CVM) in G2 than in G1. Correlations between complexity indices and HFnu were significant and positive only in G1.

Interpretation

Women undergoing HRT presented higher CSM and lower CVM than those who were not. Moreover, the expected positive relationship between CVM and complexity of HRV was found only in control group, thus indicating that CVM in women under therapy drop below a minimal value necessary to the association to become apparent, suggesting an unfavorable cardiac autonomic modulation in spite of HRT.     

Sympathetic withdrawal is associated with hypotension after hepatic reperfusion

Objective

Post-reperfusion syndrome (PRS), severe hypotension after graft reperfusion during liver transplantation, is an adverse clinical event associated with poorer patient outcomes. The purpose of this study was to determine whether alterations in autonomic control in liver transplant recipients prior to graft reperfusion are associated with the subsequent development of PRS.

Methods

Heart rate variability (HRV), systolic arterial blood pressure (SBP) variability, and baroreflex sensitivity of 218 liver transplant recipients were evaluated using 5 min of ECG and arterial blood pressure signals 10 min before graft reperfusion along with other clinical parameters. Logistic regression analyses were performed to assess predictors of PRS occurrence.

Results

Seventy-seven patients (35 %) developed PRS while 141 did not. There were significant differences in SBP (110 ± 16 vs. 119 ± 16 mmHg, P < 0.001) and the ratio of low frequency power to high frequency power (LF/HF) of HRV (1.0 ± 1.4 vs. 2.1 ± 3.7, P = 0.003) between the PRS group and No-PRS group. In multivariate logistic regression analysis, predictors were LF/HF (odds ratio 0.817, P = 0.028) and SBP (odds ratio 0.966, P < 0.001).

Interpretation

Low LF/HF and SBP measured before hepatic graft reperfusion were significantly correlated with subsequent PRS occurrence, suggesting that sympathovagal imbalance and depressed SBP may be key factors predisposing to reperfusion-related severe hypotension in liver transplant recipients.     

Dose-Response Effects of Aerobic Exercise on Quality of Life in Postmenopausal Women: Results from the Breast Cancer and Exercise Trial in Alberta (BETA)

Background

Exercise generally improves quality of life (QoL) and psychosocial functioning in adult populations but few randomized trials have examined dose-response effects.

Purpose

The purpose of the present study was to report the QoL and psychosocial outcomes from the Breast Cancer and Exercise Trial in Alberta (BETA).

Methods

Healthy but inactive postmenopausal women at risk for breast cancer were randomized to a year-long aerobic exercise intervention consisting of either 150 min/week (moderate volume group, n = 200) or 300 min/week (high volume group, n = 200). QoL was assessed at baseline and 1 year using the short form-36 health survey. Sleep quality, depression, anxiety, stress, self-esteem, and happiness were also assessed. Participant preference for group assignment (i.e., exercise volume) was assessed at baseline and tested as a moderator.

Results

There were no statistically significant dose-response effects of aerobic exercise on any QoL, sleep quality, or psychosocial outcome. Participant preference for group assignment did not moderate any QoL, sleep quality, or psychosocial responses. Marital status was a significant moderator (p for interaction = 0.01) and obesity showed a trend towards being a moderator (p for interaction = 0.08) of the dose-response effects of aerobic exercise on global sleep quality such that unmarried and obese women improved sleep quality with the higher volume of aerobic exercise.

Conclusions

A higher volume of aerobic exercise, approximately double the minimum public health guideline, did not provide additional QoL or psychosocial benefits compared to the minimum public health guideline in inactive postmenopausal women, even for women who preferred the higher volume of exercise at baseline.

Trial Registration

Trial Registration clinicaltrials.gov identifier: NCT1435005.

     

Verläufe von Traumafolgen bei ehemaligen politisch Inhaftierten der DDR

Background

In a sample of ex-political prisoners in the GDR examined in the middle of the 1990s, a follow-up examination carried out 15 years later investigated alterations in the diagnosis and symptom prevalence of post-traumatic stress syndrome PTSS) as well as other psychiatric disorders. The diagnosis course given by the clinicians was compared with the retrospective subjective estimations by participants.

Methods

A total of 93 ex-political prisoners participated in the follow-up study (85 %) with an average age of 64 years. Diagnoses and symptoms were collated using structured clinical interviews and questionnaires. The retrospective subjective estimation of progression of the participants was calculated using a PTSS symptom index based on four symptom groups (intrusions, avoidance, numbing and hyperarousal).

Results

At the time of follow-up PTSS was present in 33 % of participants (in 1997 it was 29 %). In 1994 this was present in only approximately 50 % of cases and in the other 50 % it concerned newly incident or remission cases. The next most common diagnoses were major depression episodes (26 %), panic (with or without agoraphobia 24 %) and somatoform disorders (19 %). In the PTSS symptom profile intrusions, flashbacks and alienation feelings decreased with time but in contrast irritability and shock reactions increased. The subjective self-estimation of the course of PTSS symptoms by the participants often gave a resilient (never PTSS) or delayed and rarely a remission course pattern in comparison to the diagnosing clinicians.

Conclusions

The results indicate a trauma-related long-term morbidity which is, however less stable than previously assumed.