| Popis: |
PTSP je poremećaj čiji je nastanak uvjetovan složenom interakcijom bioloških, psiholoških te socijalnih faktora koji određuju reakciju pojedinca. Dosadašnja istraživanja izdvojila su razne faktore rizika koji pogoduju nastanku ovog poremećaja. Na temelju dosadašnjih spoznaja pretpostavljeno je da u podlozi internaliziranog, odnosno eksternaliziranog tipa PTSP-a koji se razvio nakon proživljene ratne traume, stoje raniji genetski i okolinski rizični faktori. Cilj istraživanja bio je provjeriti prikladnost internaliziranog-eksternaliziranog modela za objašnjenje kliničke slike poremećaja, predisponirajućih rizičnih faktora i zdravstvenih ishoda u uzorku hrvatskih branitelja. Pretpostavljeno je da će veterani s internaliziranim tipom PTSP-a imati više komorbidnih dijagnoza iz skupine depresivnih i anksioznih poremećaja, kao i da će vjerojatnije oboljeti od bolesti dišnog i probavnog sustava, zatim endokrinih bolesti, bolesti prehrane i bolesti metabolizma, te zloćudnih novotvorina. S druge strane, da će veterani s eksternaliziranim tipom PTSP-a imati u komorbiditetu više mentalnih poremećaja i poremećaja ponašanja uzrokovanih upotrebom psihoaktivnih tvari, više bolesti cirkulacijskog sustava kao i bolesti nastalih kao posljedica zlouporabe psihoaktivnih tvari. Ukupno 433 sudionika koji su liječeni pod dijagnozom posttraumatskog stresnog poremećaja i/ili trajnih promjena ličnosti proizašlih iz PTSP-a ispunilo je TSI i MMPI-201 upitnike na temelju kojih je provjerena mogućnost prepoznavanja internaliziranog i eksternaliziranog tipa PTSP-a, a kliničkim intervjuom dobiveni su podaci o sociodemografskim i psihosocijalnim varijablama te tjelesnim bolestima. Rezultati su pokazali da se mogu razlikovati dvije skupine. Skupina sudionika s manje izraženim simptomima PTSP-a također se razlikovala i na MMPI-201 upitniku od skupine s jače izraženim simptomima PTSP-a. Intenzivniji PTSP povezan je s kliničkim ljestvicama MMPI-201 upitnika koje odgovaraju eksternaliziranim simptomima, kao što su agresija, actingout, neprijateljstvo i nepovjerenje, dok je manje intenzivni PTSP bio povezan s anksioznodepresivnim simptomima. Nisu potvrđeni rizični predisponirajući faktori. Potvrđene su razlike u obrazovanju pri čemu su sudionici s tipom 1 PTSP-a češće imali (ne)završenu osnovnu školu u odnosu na tip 2; radnom statusu gdje su sudionici s tipom 1 PTSP češće bili nezaposleni. Pokušaje suicida ili promišljanja o suicidu češće su navodili sudionici s tipom 1 PTSP-a, no među onima koji su pokušali suicid, nema razlika između tipova PTSP-a. Potvrđene su razlike u dvije skupine tjelesnih bolesti. Kod skupine koja pripada tipu 2 bile su češće bolesti živčanog sustava, dok su kod skupine koja pripada tipu 1 češće dijagnosticirane bolesti dišnoga sustava u odnosu na tip 2 PTSP-a. U ostalim skupinama tjelesnih bolesti prema MKB-10 nije bilo razlika. U Hrvatskoj do sada nije provjeravan dvodimenzionalni internalizirani-eksternalizirani model PTSP-a, kao niti pitanje jesu li ta dva podtipa PTSP-a povezana s različitim zdravstvenim ishodima. Iako u ovom istraživanju nisu dobiveni očekivani nalazi o predisponirajućim rizičnim faktorima i posttraumatskim faktorima za internalizirani i eksternalizirani PTSP, potvrđeno je da je i u hrvatskim uvjetima moguće razlikovati dva tipa PTSP-a što je klinički informativno za identificiranje rizičnih ponašanja i predviđanje poremećaja u ponašanju i osobito je korisno za planiranje liječenja, sprečavanje i smanjenje zdravstvenih rizika hrvatskih veterana. PTSD is a disorder whose occurrence is conditioned by the complex interaction of biological, psychological, and social factors that determine an individual's response. Previous research has identified various risk factors that favour the occurrence of this disorder A two-dimensional internalizing/externalizing model could provide a useful frame work from which to examine the co-occurring psychiatric symptoms associated with PTSD. Based on current knowledge, it has been assumed that the underlying internalized or externalized type of PTSD that developed after experiencing war trauma is genetic and environmental risk factors. The aim of this study is to determine the usefulness of a two-dimensional internalizing-externalizing PTSD model for understanding symptoms and health outcomes in the sample of Croatian war veterans. It was assumed that veterans with an internalized type of PTSD will have more comorbid diagnoses from the group of depressive and anxiety disorders, as well as being more likely to suffer from diseases of the respiratory and digestive systems, then endocrine diseases, diseases of nutrition and metabolism, and malignant neoplasms. On the other hand, veterans with externalizing type of PTSD will have more mental and behavioural disorders caused by the use of psychoactive substances in co morbidity, as well as more circulatory system diseases as well as diseases resulting from the abuse of psychoactive substances. A total of 433 participants who were treated under the diagnosis of post-traumatic stress disorder and/or permanent personality changes resulting from PTSD filled out the TSI and MMPI-201 questionnaires, based on which the possibility of recognizing the internalized and externalized type of PTSD was checked, and the clinical interview obtained data on sociodemographic and psychosocial variables and physical diseases. The results showed that two groups can be distinguished. The group of participants with less pronounced PTSD symptoms also differed on the MMPI-201 questionnaire from the group with more pronounced PTSD symptoms. More intense PTSD was associated with clinical scales of the MMPI-201 questionnaire corresponding to externalizing symptoms, such as aggression, acting-out, hostility and mistrust, while less intense PTSD was associated with anxietydepressive symptoms. Risk predisposing factors have not been confirmed. Differences in education were confirmed, whereby participants with type 1 PTSD more often had (not) finished primary school compared to type 2; work status, where participants with type 1 PTSD were more likely to be unemployed. Suicide attempts or thoughts about suicide were more often reported by participants with type 1 PTSD, but among those who attempted suicide, there were no differences between PTSD types. Differences in two groups of physical diseases were confirmed. In the group belonging to type 2, diseases of the nervous system were more common, while in the group belonging to type 1, diseases of the respiratory system were diagnosed more often compared to type 2 PTSD. There were no differences in other groups of physical diseases according to ICD-10. In Croatia, the two-dimensional internalized-externalized model of PTSD has not been tested so far, nor has the question whether these two subtypes of PTSD are associated with different health outcomes. Although the expected findings on predisposing risk factors and posttraumatic factors for internalized and externalized PTSD were not obtained in this research, it was confirmed that even in Croatian conditions it is possible to distinguish two types of PTSD, which is clinically informative for identifying risky behaviours and predicting behavioural disorders, and especially is useful for treatment planning, prevention and reduction of health risks of Croatian veterans. |
