Croatian War Veterans Research Articles

CHRONIC MEDICAL CONDITIONS IN CROATIAN WAR VETERANS COMPARED TO THE GENERAL POPULATION: 25 YEARS AFTER THE WAR.

Many published reports have documented an increased prevalence of chronic medical conditions among veterans, but there were only a few studies that compared these increases with the general population. The aim of this study was to determine differences in chronic medical conditions between Croatian war veterans and the general population. This study included two groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from the general population. Medical history, physical examination, laboratory tests and specific diagnostic procedures were taken during systematic physical examination in both groups. The prevalence of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis, smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary heart disease (4.3% vs. 1%), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%), and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases among Croatian war veterans and emphasized the need of better control of their medical conditions.

Normative Data for Blood Pressure in Croatian War Veterans: A Population-Based Study.

Purpose: The current study aimed to investigate the normative data for blood pressure. Materials and Methods: From 2017 to 2020, 2032 men and women classified as ‘war veterans’ were recruited (mean age ± standard deviation (SD): 60.97 ± 7.98 years; mean stature: 172.50 ± 9.10 cm; mean body mass: 90.25 ± 36.45 kg; mean body-mass index: 29.66 ± 5.59 kg/m2; 29.9% women). Their systolic and diastolic blood pressures were measured three times. The procedure was carried out according to the American Heart Organization. The sex-specific and age-specific normative data for the 5th, 25th, 50th (median), 75th, and 90th percentiles for systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (measured as SBP-DBP) and mid-BP (the average of SBP and DBP) were presented. Results: The men had higher SBP (p < 0.001), DBP (p < 0.001), pulse pressure (p < 0.001) and mid-BP (p < 0.001) compared to the women. The age-specific differences showed that older individuals had higher values of SBP (p < 0.001), pulse pressure (p < 0.001), and mid-BP (p < 0.001), while no significant differences for DBP (p = 0.496) were observed. Conclusions: This is the first study providing sex-specific and age-specific normative data for blood pressure in war veterans.

Metabolomics in posttraumatic stress disorder: Untargeted metabolomic analysis of plasma samples from Croatian war veterans

Posttraumatic stress disorder (PTSD) is a severe, multifactorial and debilitating neuropsychiatric disorder, which can develop in a subset of individuals as a result of the exposure to severe stress or trauma. Such traumatic experiences have a major impact on molecular, biochemical and cellular systems, causing psychological and somatic alterations that affect the whole organism. Although the etiology of PTSD is still unclear, it seems to involve complex interaction between various biological genetic and environmental factors. Metabolomics, as one of the rapidly developing “omics” techniques, might be a useful tool for determining altered metabolic pathways and stress-related metabolites as new potential biomarkers of PTSD. The aim of our study was to identify metabolites whose altered levels allow us to differentiate between patients with PTSD and healthy control individuals. The study included two cohorts. The first, exploratory, group included 50 Croatian veterans with PTSD and 50 healthy control subjects, whereas a validation group consisted of 52 veterans with PTSD and 52 control subjects. The metabolomic analysis of plasma samples was conducted using liquid chromatography coupled with mass spectrometry (LC-MS), as well as gas chromatography coupled with mass spectrometry (GC-MS). The LC-MS analysis determined significantly different levels of two glycerophospholipids, PE(18:1/0:0) and PC(18:1/0:0), between control subjects and PTSD patients in both cohorts. The altered metabolites might play a role in multiple cellular processes, including inflammation, mitochondrial dysfunction, membrane breakdown, oxidative stress and neurotoxicity, which could be associated with PTSD pathogenesis.

Mobilizacijska struktura veteranskog pokreta u Hrvatskoj

Cilj rada je istražiti dinamiku udruživanja hrvatskih ratnih veterana te ustanoviti ključna obilježja koja doprinose članstvu u veteranskim organizacijama. Analiziraju se podaci veteranskih organizacija iz Registra udruga RH za razdoblje od 1991. do 2014. godine te podaci o socio-demografskim karakteristikama, veteranskom identitetu i političkim preferencijama članova veteranskih organizacija prikupljeni anketnim istraživanjem 2015. godine. Rezultati pokazuju da je članstvo veteranskih organizacija određeno ratnim iskustvom, socio-demografskim te političkim obilježjima. Veteranske organizacije su dominantno mjesnog karaktera, a ključne interne razlike u udruživanju određene su posljedicama rata i načinom ulaska u rat. Zabilježene su značajne razlike između članova i ne-članova veteranskih organizacija u smislu da su članovi u većoj mjeri orijentirani prema desnom političkom spektru, što pokazuje da u određenim prilikama veteranske organizacije mogu značajno usmjeravati kolektivno djelovanje ratnih veterana u političkoj areni. U radu se raspravljaju uvidi o asocijacijskoj gustoći veterana, razlike između članova i ne-članova veteranskih organizacija te obrasci i ciklusi veteranskog udruživanja.

Reflection on the (Un)Power of Men in the Context of Post-war Everyday Life of Croatian War Veterans with Mental Disorders from World War I

U radu se raspravlja o resocijalizaciji hrvatskih branitelja s psihičkim smetnjama iz Prvog svjetskog rata. Analiza se temelji na istraživanju psihijatrijskih povijesti bolesti vojnika koji su se liječili u dvije hrvatske psihijatrijske bolnice od 1919. do 1924. godine. Proces njihove socijalne reintegracije u zajednicu nakon povratka s ratišta razmatra se u odnosu na njihovu nemogućnost ispunjavanja normativnih očekivanja vezanih za rodnu uloge muškaraca. Namjera je bila istražiti je li ta okolnost dijelom pridonijela razvoju osjećaja nemoći kod veterana te posljedično uzrokovala njihova asocijalna ponašanja zbog kojih su bili socijalno isključivani iz svoje matične zajednice.

Temperament, Character, and Subjective Well-Being in Croatian War Veterans Suffering From Posttraumatic Stress Disorder.

Subjective well-being is decreased in war-affected populations. However, no previous research has investigated the role of temperament and character dimensions in life satisfaction among war veterans with posttraumatic stress disorder (PTSD). This study enrolled 148 Croatian male war veterans being treated for combat-related PTSD. The participants completed the Beck Depression Inventory-Second Edition, Satisfaction with Life Scale, and Temperament and Character Inventory-Revised. Two multivariate regression analyses with life satisfaction as a dependent variable and temperament and character dimensions, respectively, as predictor variables, were performed. Temperament dimensions harm avoidance and novelty seeking as well as character dimensions self-directedness and cooperativeness were unique predictors of life satisfaction, while controlling for the influence of depressive symptoms, education level, and employment status. Given the influence of personality dimensions on life satisfaction, the routine assessment of these dimensions might help to establish the individually tailored treatment among war veterans with PTSD.

VETERAN CENTERS AS EXAMPLE OF COMPREHENSIVE CARE FOR CROATIAN HOMELAND WAR VETERANS

In countries with a long military tradition such as the United States or Israel, veteran centers are the backbone of the care system for veterans and their family members. For many y ears in Croatia, there has been a discussion about the need to establish veteran centers, but for now, only the Croatian War Veterans Home in Lipik has been established, which is considered a pilot project, or a predecessor of veteran centers. The Republic of Croatia spends a considerable amount of money to meet the Croatian Homeland War veterans’ expectations and resolve their problems , but reactions of our Homeland War veterans have triggered a perception that the offered solutions provide no final results. The Croatian Ministry of War Veterans recognized the need for a systematic approach to address the Homeland War veterans’ problems. In 2019, the Ministry will start the process of building five veteran centers in Daruvar, Petrinja, Osijek, Sibenik, and Sinj with the help of EU funds. In this paper, we have tried to analyze the socio-economic and health care issues that directly affect the position of Homeland War veterans in the society and the levels of their satisfaction. The conclusion is that veteran centers, with professional leadership, adequate structure and organization, could solve the most acute problems of the Homeland War veterans’ population.

Politička participacija i stranačke preferencije ratnih veterana u Hrvatskoj

The paper examines distinctiveness of war veterans compared to general population in Croatia according to three important political phenomena: political participation, party preferences and ideological self-identification. Analysis of sociological survey conducted in 2015 shows that there is no difference in the level of political participation measured by voting turnout in 2011 and 2015 parliamentary and 2015 presidential level between Croatian war veterans and the rest of the public. On the other side, war veterans differ from the rest of the electorate, with other variables held constant, in terms of party preferences and ideological self-identification. Compared to non-veterans, war veterans are more inclined to vote for the right and center-right parties and position themselves to the right side of the political spectrum. The paper discusses these differences, as well as its roots and consequences.

The relationship among psychopathology, religiosity, and nicotine dependence in Croatian war veterans with posttraumatic stress disorder

AimTo examine relationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, suicidality, nicotine dependence, and religiosity in Croatian veterans.MethodsThis cross-sectional study used Combat Exposure Scale (CES) to quantify the stressor severity, PTSD Checklist 5 (PCL) to quantify PTSD severity, Duke University Religion Index to quantify religiosity, Montgomery Asberg (MADRS) and Hamilton Depression (HAM-D) rating scales to measure depression/suicidality, and Fagerstrom Test for Nicotine Dependence to assess nicotine dependence. Zero-order correlations, cluster analysis, multivariate regression, and mediation models were used for data analysis.ResultsOf 69 patients included, 71% met “high religiosity” criteria and 29% had moderate/high nicotine dependence. PTSD was severe (median PCL 71), depression was mild/moderate (median MADRS 19, HAM-D 14), while suicidality was mild. A subset of patients was identified with more severe PTSD/depression/suicidality and nicotine dependence (all P < 0.001). Two “chains” of direct and indirect independent associations were detected. Higher CES was associated with higher level of re-experiencing and, through re-experiencing, with higher negativity and hyperarousal. It also showed “downstream” division into two arms, one including a direct and indirect association with higher depression and lower probability of high religiosity, and the other including associations with higher suicidality and lower probability of high nicotine dependence.ConclusionsPsychopathology, religiosity, and nicotine dependence are intertwined in a complex way not detectable by simple direct associations. Heavy smoking might be a marker of severe PTSD psychopathology, while spirituality might be targeted in attempts of its alleviation.Oxford Centre for Evidence-based Medicine level of evidence: 3

Narrating victimhood: gender, religion and the making of place in post-war Croatia

Mythologies and narratives of victimization pervade contemporary Croatia, set against the backdrop of militarized notions of masculinity and the political mobilization of religion and nationhood. Based on extensive ethnographic fieldwork in rural Dalmatia in the Croatian-Bosnian border region, this book provides a unique account of the politics of ambiguous Europeanness from the perspective of those living at Europe's margins. Examining phenomena such as Marian apparitions, a historic knights tournament, the symbolic re-signification of a massacre site, and the desolate social situation of Croatian war veterans, Narrating Victimhood traces the complex mechanisms of political radicalization in a post-war scenario. This book provides a new perspective for understanding the ongoing processes of transformation in Southeastern Europe and the Balkans.

Myofascial Pain in War Veterans with Post-Traumatic Stress Disorder

AbstractObjectives: This study is aimed to investigate occurrence of myofascial pain syndrome in a group of Croatian war veterans suffering from post-traumatic stress disorder [PTSD] and to compare them with a healthy normal control [HNC] group, and to describe the most frequent locations of trigger points in the head and neck region.Methods: A total of 202 male subjects participated in the examination. They were divided into a group of war veterans suffering from a PTSD and an HNC group. The first group consisted of 101 war veterans with PTSD [mean age = 47.22 years, range = 33–73 years]; the HNC group consisted of 101 subjects [mean age = 46.72 years, range = 34–61 years] who did not participate in the War of Independence.Results: The PTSD group revealed a higher prevalence of headaches [p < 0.001], cervical spine problems [p < 0.001], jaw clicking and popping [p = 0.032], teeth grinding or clenching during the day [p < 0.001], teeth grinding or clenching while sleeping [p < 0.001], jaw ache in the morn...

Eicosapentaenoic acid in serum lipids could be inversely correlated with severity of clinical symptomatology in Croatian war veterans with posttraumatic stress disorder.

To explore the association between plasma fatty acids composition and the severity of clinical symptoms in Croatian war veterans with posttraumatic stress disorder (PTSD). This cross-sectional study included 62 men diagnosed with PTSD caused by combat activities during the War in Croatia 1991-1995. Clinician-Administered PTSD Scale (CAPS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D-17) were used. Plasma fatty acids composition was determined by gas chromatography. Data about life-style habits were collected by a structured interview. To evaluate the association between plasma fatty acid levels and PTSD severity scales, multivariate general linear models (GLM) were applied while controlling for different confounders. Significant negative correlations were found between plasma eicosapentaenoic acid (EPA, 20:5n-3) level and the scores on psychological scales (τ = -0.326, P<0.001 for CAPS; τ-0.304, P =0 .001 for HAM-A; and τ = -0.345, P<0.001 for HAM-D-17). GLM confirmed that PTSD severity was affected by EPA (Wilks'Λ = 0.763-0.805, P = 0.006-0.018, ηp 0.195-0.237), arachidonic acid (AA)/EPA (Wilks'Λ = 0.699-0.757, P = 0.004, ηp 0.243-0.301), and dairy products consumption (Wilks'Λ = 0.760-0.791, P = 0.045-0.088, ηp 0.128-0.111). No other fatty acid or dietary/lifestyle variable was significant ( P = 0.362-0.633). The study suggests that lower EPA levels are associated with the severity of clinical symptoms in PTSD.

The Prevalence and Psychosocial Correlates of Suicide Attempts Among Inpatient Adolescent Offspring of Croatian PTSD Male War Veterans

Despite evidence that children of male war veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk for behavior problems, very little is currently known about suicidal behaviors in this population of youth. This study aimed to examine the prevalence and psychosocial correlates of suicide attempts among psychiatrically hospitalized adolescent offspring of Croatian male PTSD veterans. Participants were psychiatric inpatients, ages 12-18 years. Self-report questionnaires assessed demographics, suicide attempts, psychopathology, parenting style, and family functioning. The prevalence of suicide attempts was 61.5% (65.2% for girls and 58.0% for boys). Internalizing symptoms, family dysfunction, lower levels of maternal and paternal care, and paternal overcontrol were significantly associated with suicide attempts. Our findings suggest that suicide attempts are common among inpatient adolescent offspring of male PTSD veterans and that interventions targeting both adolescent psychopathology and family relationships are needed for adolescents who have attempted suicide.

Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans

The presence of posttraumatic stress disorder (PTSD) in male war veterans has been linked with family dysfunction andpsychopathology in their children [1, 2]. This study aimed to evaluate self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans and determine the degree that parent-child bonding and family functioning contributed to adolescent behavior problems. Internalizing and externalizing behavior problems, parent-child bonding and family functioning were assessed in a sample of clinically referred Croatian PTSD veterans adolescent offspring (N=122) and non-PTSD veteran adolescent offspring (N=122) matched for age, sex, educational level, family income, parental employment status, ethnicity, and residential area. Youth Self-Report, Parental Bonding Instrument, Family Assessment Device were used. Adolescent offspring of PTSD veterans reported having significantly more internalizing and externalizing problems than non-PTSD veteran offspring, and also more difficulties in their family functioning, lower levels of maternal and paternal care, and more impaired mother-child and father-child bonding than control subjects. Internalizing symptoms were associated with family dysfunction, while externalizing symptoms were associated with paternal overcontrol/overprotection, and low maternal and paternal care. In conclusion, the increase in internalizing and externalizing symptoms as well as family and parental dysfunction among clinically referred adolescent offspring of PTSD veterans compared to their non-PTSD veteran counterparts indicates a need for early detection and interventions targeting both adolescent psychopathology and family relationships.

Cognitive status of Croatian combat veterans and their compensation-seeking

Aim: To explore the differences in MMPI-2 scales and cognitive function scales (WAIS-III) in combat veterans submitted to expert examination for compensation-related purposes, compensation-seeking (CS) and war veterans who were under regular medical examination, non-compensation-seeking (NCS) veterans in Croatia. Methods: The study included 64 CS Croatian war veterans and 48 NCS war veterans. Both patient groups were assessed and diagnosed by a psychiatrist. Data were collected by Mini International Neuropsychiatric Interview (M.I.N.I) and Clinically Administered PTSD Scale. Psychological data on cognitive functions were collected by Wechsler Intelligence Scale- Revised (WAIS-III-R) and Minnesota Multi Personality Inventory-2 (MMPI-2). Results: Significant differences in CS and NCS groups on executive scales (digit-span and arithmetic), memory scales (numeric and visual), visual processing scales (visual completion), and control scales of MMPI-2 (F, Fb, K and L). There were no significant differences between compensation-seeking and non-compensation-seeking PTSD patients in verbal, non-verbal and global intelligence (VIQ, NIQ and IQ). Significantly lower results are shown on memory scales and higher results on control MMPI-2 scales for CS PTSD (with and without comorbid diagnoses) in comparison to NCS with PTSD or PTSD with comorbid diagnoses. Conclusion: Cognitive functions and over-reporting symptoms of PTSD are correlated especially in working memory, executive functions (digit-span, numeric memory and arithmetic) and visual completion and visual memory. Compensation-seeking could be an important artefact in neuropsychological measures and also offer additional help in the diagnosis of PTSD and cognitive impairment.

2723 – Risk and protective factors for suicidality among croatian war veterans with posttraumatic stress disorder

There are limited data about suicidality among Croatian war veterans. The present study is aimed to assess correlation between suicidality and possible risk and protective factors in PTSD patients. Method The sample consisted of 123 war veterans who completed Suicide Behaviors Questionnaire (SBQ-R), Reasons for Living Inventory (RFL-48), General Health Questionnaire - subscale for suicidal behavior (GHQ), Hopkins Symptom Checklist Depression Scale (HSCL-25) and Harvard Trauma Questionnaire (HTQ). Results indicated that suicidality is correlated with higher PTSD and depression scores, and negatively correlated with reported reasons for living. We discuss our results in terms of their use and applicability in everyday work with patients who are in suicidal risk.

Disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans with posttraumatic stress disorder: case-control study

AimTo determine the presence of disorder of extreme stress not otherwise specified (DESNOS) in Croatian war veterans who suffer from combat-related posttraumatic stress disorder (PTSD).MethodsThe research included 247 veterans of the 1991-1995 war in Croatia who suffered from PTSD and were psychiatrically examined at four clinical centers in Croatia during a month in 2008. It was based on the following self-assessment instruments: The Harvard Trauma Questionnaire (HTQ): Croatian Version, the Structured Interview for Disorder of Extreme Stress (SIDES-SR), and the Mini International Neuropsychiatric Interview (MINI)ResultsBased on the SIDES-SR results, we formed two groups of participants: the group with PTSD (N = 140) and the group with both PTSD and DESNOS (N = 107). Forty three percent of participants met the criteria for DESNOS. There was a significant difference in the intensity of posttraumatic symptoms between the group with both PTSD and DESNOS and the group with PTSD only (U = 3733.5, P = 0.001). Respondents who suffered from both PTSD and DESNOS also reported a significantly larger number of comorbid mental disorders (U = 1123.5, P = 0.049) and twice more frequently reported comorbid depression with melancholic features (OR = 2.109, P = 0.043), social phobia (OR = 2.137, P = 0.036), or panic disorder (OR = 2.208, P = 0.015).ConclusionOur results demonstrate that PTSD and DESNOS can occur in comorbidity, which is in contrast with the ICD-10 criteria. A greater intensity of symptoms and a more frequent comorbidity with other psychiatric disorders, especially depression, panic disorder, and social phobia require additional therapy interventions in the treatment processes.

Repeated Assessments of Endocrine- and Immune-Related Changes in Posttraumatic Stress Disorder

Objective: It is assumed that stress-related changes in the endocrine and immune systems are key mediators involved in the development of diseases associated with posttraumatic stress disorder (PTSD). Evidence suggests that those changes might be related to the duration of PTSD. The aim of our study was to investigate the differences in selected endocrine- and immune-related variables between PTSD patients and control subjects, and whether these differences persist over time. Methods: We assessed 39 Croatian war veterans with PTSD and 25 healthy volunteers (civilians without traumatic experience), all men, at two time points separated by 5.6 years (median; interquartile range: 5.4–6.3). Cortisol and prolactin levels were measured by radioimmunoassays while interleukin-6 and tumor necrosis factor-α were determined by enzyme-linked immunosorbent assays. Immune function was assessed by in vitro natural killer cell cytotoxicity (NKCC). Lymphocyte counts, immunophenotype and intracellular glucocorticoid receptor expression in various lymphocyte subsets were determined by three-color flow cytometry. Results: At the first assessment, moderate to large effect size estimates of differences between patients and controls were observed for most of the measured variables. Only prolactin levels and lymphocyte counts remained significantly elevated in PTSD patients at the second assessment with low to moderate effect size estimates of differences between patients and controls in other variables. Conclusion: Observed endocrine- and immune-related changes in PTSD over time may depend on the duration of the allostatic load posed by the disorder and its impact on interactions between the endocrine and immune systems involved in stress response.

Treatment of chronic hepatitis C in Croatian war veterans: experiences from Croatian reference center for viral hepatitis

AimTo examine the risk factors, comorbidity, severity of liver disease, treatment course, and outcome in Croatian war veterans with chronic hepatitis C, especially those suffering from posttraumatic stress disorder (PTSD).MethodsWe collected medical records of 170 adult men diagnosed with chronic hepatitis C who started treatment with a combination of pegylated interferon-alpha and ribavirin between January 2003 and June 2009 at the Croatian Reference Centre for Viral Hepatitis.ResultsParticipants’ mean age was 43 ± 9 years. Among 170 participants, there were 37 war veterans (22%). The main risk factor in veteran patients were operative procedures with transfusions (46% vs 5% in non-veterans; P < 0.001) and in non-veteran patients intravenous drug use (42.1% vs 13%; P < 0.001). The average duration of infection was longer in war veterans (14.5 ± 3.4 vs 12.2 ± 7.2 years; P = 0.020). The percentage of PTSD comorbidity in the whole group was 11% (18/170) and in the war veterans group 49% (18/37). The prevalence of sustained virological response in patients with PTSD was 50% and in patients without PTSD 56%. Treatment reduction in patients with PTSD (33%) was higher than in patients without PTSD (12%;P = 0.030).ConclusionCroatian war veterans are a group with high risk of chronic hepatitis C infection because many of them were wounded during the Croatian War 1991-1995. Considerations about PTSD as a contraindication for interferon treatment are unjustified. If treated, patients with PTSD have an equal chance of achieving sustained virological response as patients without PTSD.

Combat Posttraumatic Stress Disorder and Chronic Pain

chronic post-traumatic stress disorder (PTSD) is commonly accompanied by depression and anxiety as comorbidity. The psychological states, such as depression and anxiety, can increase pain symptoms. A number of recent research results have shown that chronic post-traumatic stress disorder and chronic pain frequently co-occur and similar mechanisms have been identified that sustain both conditions. Method: the data were collected from medical records of 184 Croatian war veterans diagnosed with chronic PTSD and chronic pain as co-morbid condition. On the basis of medical records, interviews and different types of self-assessment questionnaires the inter-relationship between chronic pain and chronic PTSD was analysed. PTSD was assessed by CAPS (Clinical Administered Posttraumatic Scale) and M-PTSD (Mississippi Scale for combat PTSD), whereas pain was measured by Melzack-McGill Pain Questionnaire—short form (MPQ-SF) and Visual Analogue Scale (VAS). Results: the combat veterans with PTSD reported in descending order the following: pain in the head, back pain, widespread pain and limb pain. The patients with chronic PTSD had significantly higher total pain scores as well as affective and sensory pain components when compared to the patients without PTSD. Anxiety and depression were also highly correlated with pain. The relation between pain severity and depression was mediated by the severity of PTSD. Conclusion: our findings are directed towards the need for multidisciplinary approach in the treatment of patients with chronic PTSD and co-morbid chronic pain, which will optimize treatment and result in more cost-effective care.