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Original Articles
Introduction
Studies have documented high prevalence rates of post-traumatic stress disorder (PTSD) in war-affected communities, sometimes many years after the war (de Jong et al. 2001; Fazel et al. 2005; Priebe et al. 2009), yet little is known about the course of such disorders and the factors associated with persistence versus improvement over time. Longitudinal studies of PTSD, following events other than war, suggest an often persistent course, with most affected people recovering within the first 4-6 years post-trauma, after which time the condition is more likely to be unremitting (Breslau et al. 1998; Kessler et al. 1995; Perkonigg et al. 2005).
Longitudinal research concerning war-related PTSD has been mostly conducted on war veterans and refugees in Western countries. Some studies on UK war veterans deployed in Iraq and Afghanistan found low prevalence rates of probable PTSD (4%) that remained stable at 6-year follow-up (Hotopf et al. 2006; Fear et al. 2010). A prospective study of more than 50 000 US veterans deployed in the same regions found that more than 40% of those with probable PTSD at baseline had persistent self-reported PTSD symptoms 3 years later (Smith et al. 2008). Research on army personnel conducted over longer periods of time has reported remission rates of 55% after 14 years (Koenen et al. 2003), 69% after 20 years (Solomon & Mikulincer, 2006) and 93% after 32 years (Shlosberg & Strous, 2005).
Studies on refugee samples have considered time frames of up to 3 years after resettlement, used a variety of measures to assess symptoms and diagnosis, and provided inconsistent findings. Some of studies have reported a gradual decrease in PTSD symptoms over time (Hauff & Vaglum, 1994; Drozdek, 1997; Weine et al. 1998; Mollica et al. 2001). For example, 77% of Bosnian refugees with PTSD living in a refugee camp in Croatia and 56% of Vietnamese refugees in Norway no longer had the disorder 3 years later. Other studies indicated that PTSD symptoms may persist or even increase, at least during the initial period after the war and resettlement (Lie, 2002; Roth et al. 2006). In Bosnian refugees living in Sweden, the symptom levels increased significantly over 3-year follow-up period, whereas among Kosovans in the same...