This study examined the relative contribution of 2 exile-related variables--social isolation and daily activity level--and war experiences of violence and loss, to levels of PTSD and depressive symptomatology in 2 groups of Bosnian refugees, 1 clinical group (N = 59) and the other a nonclinical community (N = 40) group. As hypothesized, exposure to war-related violence was highly predictive of PTSD symptoms in both groups; in addition, social isolation was significantly related to PTSD symptomatology in the community group. In contrast, depressive symptomatology was accounted for primarily by the exile-related stressors. For the clinical group, depressive symptoms were also accounted for by experiences of war-related loss. The implications of these findings for mental health interventions with refugees are considered.

The objective of this study was to profile trauma related psychiatric symptoms in a group of refugees not seeking mental health services and to consider the services implications. The study involved research assessments of two groups of Bosnian refugees: those who have not presented for mental health services and those who have. A total of 28 of 41 nonpresenters (70%) met symptom criteria for posttraumatic stress disorder (PTSD) diagnosis. All service presenters (N = 29) met symptom criteria for PTSD diagnosis. The group that did not present for services reported substantial but lower trauma exposure, PTSD symptom severity, and depression symptom severity. They had significant differences on all subscales of the MOS SF-36, indicating better health status. We concluded that those who do not seek services have substantial symptom levels, but their self-concept appears to be less oriented toward illness and help seeking. Innovative access, engagement, and preventive interventions are needed to address those who have symptoms but do not readily seek help for trauma mental health services.

Three new antidepressants were used in treating posttraumatic stress disorder (PTSD) and symptoms of depression in Bosnian refugees. Thirty-two Bosnian refugees seeking treatment at a mental health clinic participated in a case series study. All received open trials of Sertraline (n = 15), Paroxetine (n = 12), or Venlafaxine (n = 5), with standard clinical doses. Overall, Sertraline and Paroxetine produced statistically significant improvement at 6 weeks in PTSD symptom severity in depression, and in Global Assessment of Functioning. Venlafaxine produced improvement in PTSD symptom severity and in Global Assessment of Functioning, did not yield improvement in symptoms of major depressive disorder; and had a high rate of side effects. Notwithstanding improvement of symptoms, all 32 refugees remained PTSD positive at the diagnostic level at the 6-week follow-up.

Multiple studies have examined the age of onset of major depression, indicating it is most frequent in adolescence and young adulthood. In this context, the offspring of depressed parents have a 2 to 4 time increased risk for depression compared with children of non-depressed parents.Treatment for depression in adolescents can be divided into psychosocial, psychopharmacologic, somatic and combined psychosocial-psychopharmacologic, psychosocial-psychosomatic and psychopharmacologic-psychosomatic.Depression in the children and adolescent population has been an area of research for over 20 years. Among novel therapeutic strategies, transcranial magnetic stimulation (TMS) has demonstrated the most favorable side effect profile. Until this time there are no published suicide attempts associated with this treatment and it may offer an option that is not associated with stigma of electroconvulsive therapy (ECT) or medications. Further research may provide more access to this therapy and hope to children, adolescents with depression and their families.