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[Characteristics of depression in Otocac ten years after the war].

BACKGROUND
Depression is an important public health problem today. In the primary care setting, a high percentage of patients with depression present exclusively with physical symptoms; depression can often go undiagnosed in these patients. Another challenge for primary care doctors is the treatment of patients with depression and somatic comorbidity. When faced with demands to treat multiple chronic diseases, physicians may give depression less priority. The consequences of exposure to war stress on mental health have been constantly explored. Posttraumatic stress disorder and depression have been identified as the most common psychopathological consequences of exposure to war stressors. The 1991-1995 war in Croatia left deep psychosocial scars and affected self-perceived health, physical ability and mental health of the entire Croatian population stricken by war. Otocac is one of the areas that were more severely affected by war.


OBJECTIVES
The aim of the study was to evaluate the prevalence and characteristics of depression in general practice patients in Otocac, Croatia, ten years after the war in Croatia.


METHODS
In March 2005, 300 patients aged 18 and older were systematically selected from the patient list of a general practitioner in Otocac, Croatia. These patients were assessed for depression and classified as having a mild, moderate, severe or severe depressive episode with psychotic elements, according to the criteria of the ICD-10 classification of Mental and Behavioral Disorders, Croatian edition. Data were also collected on psychosomatic complaints, chronic diseases, sociodemographic characteristics, participation in war actions, refugee status, comorbid psychiatric diseases in patients and their family members. Differences in the characteristics of depressive and non-depressive patients were tested by chi2-test and Fisher's test. The level of significance was set at p < 0.05. The collected data were analyzed using the SPSS statistical software package, version 12.0.0.


RESULTS
A total of 147 (49.0%) patients (65 male and 82 female) met ICD-10 criteria for depressive episode. Distribution of severity of depression showed the majority of depressive patients to meet the criteria for moderate (38.8%) and severe (39.5%) depressive episode. There was a statistically significant difference in the presence of all psychosomatic complaints between depressive and nondepressive patients. Unemployed patients were more often depressed (p = 0.002), and so were divorced and widowed patients (p < 0.001). There was no statistically significant sex difference in the frequency of depressive symptoms. Depression showed no correlation with the patient refugee status, but there was significant correlation with the presence of psychiatric diseases in a patient family member (p = 0.0001). Correlation between depression and the patient chronic somatic diseases was statistically significant for hypertension, cardiac diseases and malignant diseases.


CONCLUSION
The results of our study indicated a high prevalence of depression in the group of general practice patients in Otocac, Croatia, ten years after the war in Croatia. Severe and moderate depressive episodes predominated, without sex difference in the frequency of depressive symptoms. Long-term psychological consequences of exposure to war stress as well as other characteristics of the post-war period in the area affected by war may in part explain these findings.