Posttraumatic stress disorder among Croatian veterans: A causal model

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Abstract
The present study investigates the etiological roles of premilitary risk factors, military entry conditions, war zone experiences, dissociative reactions to war zone experiences and homecoming reception in the development of chronic posttraumatic stress disorder (PTSD) among Croatian veterans. A total of 150 Croatian war veterans with the diagnosis of chronic combat-related PTSD, who sought treatment at Psychiatric Clinic, Osijek, Croatia, in the period 1993–1998, and who provided complete data, were selected as the sample for the present study from the treatment-seeking group of the ex-soldier population. Structural equation modeling is used to develop an etiological model concerning the relationships of premilitary risk factors, military entry conditions, war zone experiences, dissociative reactions, and homecoming reception with current symptoms of PTSD. An etiological model with satisfactory fit and parsimony was developed. In terms of the magnitude of variables' total contributions to the development of PTSD, war zone experiences are the most influential contributor which is followed by dissociative reactions, homecoming reception, military entry conditions and premilitary risk factors. Statistical significant direct effects to the development of PTSD were found for dissociative reactions and low family postwar support. The etiology of combat-related PTSD among Croatian veterans remains largely unexplained. Partial explanations are omission of other etiological factors, retrospective nature of the data and small study sample. The results are the source of questions for further research.