Contrary to popular opinion, posttraumatic stress disorder and depression in war survivors appear to develop independently of a perceived lack of redress for trauma, according to a study conducted in three former Yugoslav republics.
Impunity for those responsible for trauma is widely believed to aggravate psychological problems in survivors of war.
But a cross-sectional survey of more than 1,300 war survivors in four areas of the former Yugoslavia suggests that a general fear-induced helplessness—rather than emotional responses to impunity specifically—is the most important mediating factor in PTSD and depression, said Metin Basoglu, M.D., of the Institute of Psychiatry at King's College in London, and associates (JAMA 2005;294:580–90).
Survivors had stronger emotional responses to impunity than did individuals who did not directly experience the trauma of war (the controls)—in addition to higher rates of PTSD and depression—but they also had greater fear and loss of control over life. It was these latter factors that played the biggest role, they said.
The findings might have “important implications for reconciliation efforts in postwar countries and effective interventions for traumatized war survivors,” the investigators said.