Workplan

The workplan has been divided into two parts, part A and part B.

Part A

This is a cross-sectional mainly exploratory study. It will yield results on the barriers to treatment and coping strategies by comparing non-treatment seekers with patients in specialised treatment centres where possible – i.e. Belgrade and Zagreb, and comparing non-treatment seekers in Germany and the UK (Dresden and London) with those who stayed in Croatia and Serbia (Belgrade and Zagreb).

Despite the exploratory nature, there are several specific hypotheses:

• Non-treatment seekers have – on average - a lower level of posttraumatic stress then patients in treatment centres, but scores in the two groups overlap.
• When the overall degree of posttraumatic stress is controlled for, non-treatment seekers have more symptoms of withdrawal and avoidance than patients in treatment centres.
• Non-treatment seekers report more successful coping strategies and a higher degree of social support. The level of posttraumatic stress in non-treatment seekers is associated with the report of less successful coping strategies and of less social support.
• Considering local circumstances, approx. n=150 non-treatment seekers will be recruited in each of four centers, i.e. in Croatia, Germany, Serbia, and the UK.

The interview will assess posttraumatic stress symptoms, stressful life events, quality of life, general psychopathology, costs of health care, previous psychiatric history and physical health by using structured questionnaires. Coping strategies and barriers to treatment will be assessed by semi-structured qualitative interview.

Part B

Treatment seekers are recruited in specialized treatment centers in Bosnia-Herzegovina, Croatia, and Serbia. In addition to the comparison between characteristics of patients and non-treatment seekers (see Part A), this part of the study addresses the following questions

• What outcomes in changes of symptoms, treatment satisfaction, social functioning and quality of life are to be expected for different sub-groups of patients in specialised treatment centres?
• What baseline characteristics and treatment components are consistently associated with a more favourable outcome across treatment centres?
• What are the treatment and support costs for patients suffering from posttraumatic stress and how are costs linked to outcome?

Part B is a longitudinal mainly exploratory study. It assesses treatment processes and outcomes of patients in specialized treatment centers in Belgrade, Rijeka, Sarajevo and Zagreb. Patients are interviewed at baseline (i.e. pre-treatment), and then after 3 and after 12 months.

In addition to the hypothesis mentioned in part A, we predict that:

• Patients reporting a lower level of social support, less successful coping strategies and wishes for compensation at baseline have a poorer outcome.
• Investigation link between treatment elements and outcome is exploratory.

All patients referred to treatment in the specialised treatment centres are assessed eligibility for the study. Altogether, 375 newly admitted patients at the four treatment centres would be recruited and assessed at baseline.