The impact of displacement on the expression of depressive disorder and social functioning among the war refugees.

Our research objective was to estimate the characteristics of major depressive disorder and social adaptation of women displaced during the war in Croatia in the early 1990s. We aimed to establish the relationship between major depressive disorder and displacement and study its impact on the outcome of depression in order to improve treatment and avoid possible complications. A group of 20 women, 35 to 55 years of age, displaced some time during the 199l.-1995. war in Croatia were compared to 27 women of the same age but with no experience of exile. All the patients suffered from major depressive disorder based upon DSM-IV diagnostic criteria. The Hamilton Rating Scale for Depression, the Zung Self Rating Depression Scale and the Social Adaptation Self-evaluation Scale were used. The objective intensity of depression of the displaced significantly decreased over time but not their personal experience of depression. All depressed patients manifested poor social adaptation. Many aspects of social functioning remained poor even after the improvement of depressive disorder. Displacement characteristics were: the length of time spent in exile, the place, and the circumstances of displacement regarding the members of the family accompanying the displaced women. These characteristics significantly influenced the expression of their major depressive disorder as well as social functioning. Displaced persons/refugees are at high risk of developing depressive disorder. Recognition of all risk factors and early diagnosis of depressive disorder followed by appropriate treatment could decrease the risk of chronic and complicated depression as well as the risk of poor social adaptation.