Skip to main content
×
×
Home

Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran–Iraq war

  • Khodabakhsh Ahmadi (a1), Mahmood Reshadatjoo (a2), GholamReza Karami (a1), Nariman Sepehrvand (a2), Pegah Ahmadi (a2) and Shahrzad Bazargan-Hejazi (a3)...
Abstract
Aims and method

Post-traumatic stress disorder (PTSD) has been reported in 90% of chemical warfare victims in previous studies. An individual's traumatic experience(s) may affect the lives of other family members as well. This cross-sectional case–control study compared the prevalence of PTSD symptoms in the husbands, the secondary PTSD symptoms in the wives and also aimed to identify if there was an association between the PTSD symptoms of the couples in the case group. Cases were 150 husband–wife couples where husbands were civilians exposed to chemical warfare; the controls were 156 husband–wife couples where there was no such exposure. Both cases and controls were recruited from Sardasht in Iran; this Kurdish city was attacked by four 250 kg sulphur mustard warheads in June 1987.

Results

Across three sets of cut-off points for the Mississippi Scale for Combat-Related PTSD symptomotology (<120 and ⩾121; <106 and ⩾107; and <65, 65–130 and > 130) wives in the case group demonstrated higher rates of PTSD symptoms than did those in the control group; the difference was statistically significant. Furthermore, husbands in the case group had a significantly higher overall mean score (123.0 (s.d. = 17.2)) than the husbands in the control group (112.3 (s.d. = 21.7); P<0.001, t = 4.80). There was no statistically significant association between the overall PTSD score of the husbands in the case group with that of their wives (P = 0.274, correlation coefficient 0.092).

Clinical implications

Husbands who were exposed to the chemical agents reported higher PTSD symptoms and there were higher rates of PTSD symptoms among the wives of individuals who were exposed to chemical warfare. Study results suggest the need for coordinated treatments, policy efforts and interventions to improve the wellbeing of chemical warfare victims and their caregiver wives.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran–Iraq war
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran–Iraq war
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran–Iraq war
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Khodabakhsh Ahmadi (k.ahmadi@bmsu.ac.ir)
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Ghazanfari, T, Faghihzadeh, S, Aragizadeh, H, Soroush, MR, Yaraee, R, Mohammad Hassan, Z, et al. Sardasht-Iran cohort study of chemical warfare victims: design and methods. Arch Iran Med 2009; 12: 514.
2 Washington Post. Poison gas attack kills Kurds. Washington Post 1988; 24 March.
3 Sidell, FR, Urbanetti, JS, Smith, WJ, Vesicants, HC. Medical Aspects of Chemical and Biological Warfare. Textbook of Military Medicine Series. Part 1. Warfare, Weaponry, and the Casualty. Borden Institute, Walter Reed Army Medical Center, 1997.
4 Centres for Disease Control and Prevention. Facts About Sulfur Mustard. CDC, 2006 (http://www.bt.cdc.gov/agent/sulfurmustard/basics/facts.asp).
5 Fassihi, F. In Iran, grim reminders of Saddam's arsenal. The Star Ledger 2002; 27 October.
6 Security Council. Report of Specialists Appointed by the Secretary General to Investigate Allegations by the Islamic Republic of Iran concerning the use of Chemical Weapons. United Nations, 1986.
7 Tavallaie, SA, Assari, S, Najafi, M, Habibi, M, Ghanei, M. Study of sleep disorders among chemical warfare victims [in Persian]. J Mil Med 2004; 6: 241–8.
8 Khateri, S, Ghanei, M, Keshavarz, S, Soroush, M, Haines, D. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med 2003; 45: 1136–43.
9 Hasani, M. Pathology of Chemical Weapons. Chemical warfare victims' Broadcasting Center, 2005.
10 Hashemian, F, Khoshnood, K, Desai, MM, Falahati, F, Kasl, S, Southwick, S. Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare. JAMA 2006; 296: 560–6.
11 Zarchi, K, Akbar, A, Naieni, KH. Long-term pulmonary complications in combatants exposed to mustard gas: a historical cohort study. Int J Epidemiol 2004; 33: 579–81.
12 Ford, JD, Schnurr, PP, Friedman, MJ, Green, BL, Adams, G, Jex, S. Posttraumatic stress disorder symptoms, physical health, and health care utilization 50 years after repeated exposure to a toxic gas. J Trauma Stress 2004; 17: 185–94.
13 Schnurr, PP, Friedman, MJ, Green, BL. Post-traumatic stress disorder among World War II mustard gas test participants. Mil Med 1996; 161: 131–6.
14 Schnurr, PP, Ford, JD, Friedman, MJ, Green, BL, Dain, BJ. PTSD in WWII mustard gas test participants. A preliminary report. Ann N Y Acad Sci 1997; 821: 425–9.
15 Jankowski, MK, Schnurr, PP, Adams, GA, Green, BL, Ford, JD, Friedman, MJ. A mediational model of PTSD in World War II veterans exposed to mustard gas. J Trauma Stress 2004; 17: 303–10.
16 Romano, JA, King, JM. Psychological casualties resulting from chemical and biological weapons. Mil Med 2001; 166: 21–2.
17 Mohammadi, MR, Noori, AR. Common psychologic disorders among chemical warfare victims. In Proceedings of the Conference on Neuropsychologic Complications of War, 1993: 147–50. Bonyad Publishing Company, 1993.
18 Haghdadi, G, Parchami, M. Comparisonal survey of disabled people (Janbazan) with severe psychologic symptoms among two groups exposed or nonexposed to chemical agents. In Proceedings of the Conference on Neuropsychologic Complications of War, 1993: 508–31. Bonyad Publishing Company, 1993.
19 Vafaei, B, Seidy, A. Study of the prevalence and intensity of depression in 100 devotees with chemical and non-chemical war injuries (30–70%) of imposed war in Tabriz. J Mil Med 2003; 2: 105–10.
20 Devilly, GJ. The psychological effects of a lifestyle management course on war veterans and their spouses. J Clin Psychol 2002; 58: 1119–34.
21 Radfar, S, Haghani, H, Tavalaei, A, Modirian, E, Falahati, M. Evaluation of mental health state in veterans family (15–18 Y/O adolescents). J Mil Med 2005; 3: 203–9.
22 McCann, IL, Pearlman, LA. Constructivist self-development theory: a theoretical framework for assessing and treating traumatized college students. J Am Coll Health 1992; 40: 189–96.
23 Motta, RW. Secondary trauma. Int J Emerg Ment Health 2008; 10: 291–8.
24 Marriage, S, Marriage, K. Too many sad stories: clinician stress and coping. Can Child Adolesc Psychiatr Rev 2005; 14: 114–7.
25 Stevens, MM, Olson, AL, Gaffney, CA, Tosteson, TD, Mott, LA, Starr, P. A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion. Pediatrics 2002; 109: 490–7.
26 Goldblatt, H. Caring for abused women: impact on nurses' professional and personal life experiences. J Adv Nurs 2009; 65: 1645–54.
27 Kleespies, PM, Dettmer, EL. The stress of patient emergencies for the clinician: incidence, impact, and means of coping. J Clin Psychol 2000; 56: 1353–69.
28 Pross, C. Burnout, vicarious traumatization and its prevention. Torture 2006; 16: 19.
29 Farrar, AR. Vicarious traumatization of the mental health professional. APAGS Newsletter 2002; Winter.
30 Bilal, MS, Rana, MH, Rahim, S, Ali, S. Psychological trauma in a relief worker – a case report from earthquake-struck areas of north Pakistan. Prehosp Disaster Med 2007; 22: 458–61.
31 Geller, JA, Madsen, LH, Ohrenstein, L. Secondary trauma: a team approach. Clin Soc Work J 2004; 32: 415–30.
32 Fullerton, CS, Ursano, RJ. Posttraumatic responses in spouse/significant others of disaster workers. In Posttraumatic Stress Disorder: Acute and Long-term Responses to Trauma and Disaster (eds Fullerton, CS & Ursano, RJ): 5976. American Psychiatric Press,, 1997.
33 Figley, CR. Strangers at home: comment on Dirkzwager, Bramsen, Adèr, and van der Ploeg (2005). J Fam Psychol 2005; 19: 227–9.
34 Figley, CR. Burnout in Families: The Systematic Cost of Caring. CRC Press, Taylor & Francis Group, 1998.
35 Bell, H. Strengths and secondary trauma in family violence work. Soc Work 2003; 48: 513–22.
36 Koić, E, Francišković, T, Mužinić-Masle, L, ðorÐević, V, Vondraček, S. Chronic pain and secondary traumatization in wives of Croatian war veterans treated for post traumatic stress Disorder. Acta Clinica Croatica 2002; 41: 295306.
37 Dekel, R, Solomon, Z, Bleich, A. Emotional distress and marital adjustment of caregivers: contribution of level of impairment and appraised burden. Anxiety Stress Coping 2005; 18: 7182.
38 Solomon, Z, Levi, G, Waysman, M, Fried, B, Mikulincer, M, Florian, V, et al. Secondary traumatization among wives of soldiers with combat stress reaction [in Hebrew]. Harefuah 1993; 124: 750–6, 796.
39 Renshaw, KD, Rodrigues, CS, Jones, DH. Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: relationships with spouses' perceptions of veterans' experiences and symptoms. J Fam Psychol 2008; 22: 586–94.
40 Dekel, R. Posttraumatic distress and growth among wives of prisoners of war: the contribution of husbands' posttraumatic stress disorder and wives' own attachments. Am J Orthopsychiatry 2007; 77: 419–26.
41 Dekel, R, Solomon, Z. Secondary traumatization among wives of Israeli POWs: the role of POWs' distress. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 2733.
42 Westerink, J, Giarratano, L. The impact of posttraumatic stress disorder on partners and children of Australian Vietnam veterans. Aust N Z J Psychiatry 1999; 33: 841–7.
43 Calhoun, PS, Beckham, JC, Bosworth, HB. Caregiver burden and psychological distress in partners of veterans with chronic posttraumatic stress disorder. J Trauma Stress 2002; 15: 205–12.
44 Hendrix, CC, Erdmann, MA, Briggs, K. Impact of Vietnam veterans arousal and avoidance on spouses' perceptions of family life. Am J Fam Ther 1998; 26: 115–28.
45 Jordan, BK, Marmar, CR, Fairbank, J, Schlenger, WE, Kulka, RA, Hough, RL, et al. Problems in families of male Vietnam veterans with posttraumatic stress disorder. J Consult Clin Psychol 1992; 60: 916–26.
46 Bramsen, I, Reuling, IE, van der Ploeg, HM. Indirect traumatization of spouses of Dutch war victims [in Dutch]. Ned Tijdschr Geneeskd 2000; 144: 2210–4.
47 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (Text Revision) (DSM–IV–TR). APA, 1994.
48 Keane, TM, Caddell, JM, Taylor, KL. Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: three studies in reliability and validity. J Consult Clin Psychol 1988; 56: 8590.
49 Norris, FH, Perilla, JL. The revised civilian mississippi scale for PTSD: reliability, validity, and cross-language stability. J Trauma Stress 1996; 9: 285–98.
50 McFall, ME, Smith, DE, Roszell, DK, Tarver, DJ, Malas, KL. Convergent validity of measures of PTSD in Vietnam combat veterans. Am J Psychiatry 1990; 147: 645–8.
51 Goodarzi, MA. Evaluating validity and reliability of Mississippi Post Traumatic Stress disorder Scale. J Psychol 2003; 7: 153–78.
52 Lyons, JA, Caddell, JM, Pittman, RL, Rawls, R, Perrin, S. The potential for faking on the Mississippi Scale for Combat-Related PTSD. J Trauma Stress 1994; 7: 441–5.
53 Shalev, AY, Freedman, S, Peri, T, Brandes, D, Sahar, T. Predicting PTSD in trauma survivors: prospective evaluation of self-report and clinician-administered instruments. Br J Psychiatry 1997; 170: 558–64.
54 Yaffe, K, Vittinghoff, E, Lindquist, K, Barnes, D, Covinsky, KE, Neylan, T, et al. Posttraumatic stress disorder and risk of dementia among US veterans. Arch Gen Psychiatry 2010; 67: 608–13.
55 Zatzick, DF, Marmar, CR, Weiss, DS, Browner, WS, Metzler, TJ, Golding, JM, et al. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry 1997; 154: 1690–5.
56 Ouimette, P, Coolhart, D, Sugarman, D, Funderburk, JS, Zelman, RH, Dornau, C. A pilot study of posttraumatic stress and associated functioning of army National Guard following exposure to Iraq warzone trauma. Traumatol 2008; 14: 51–6.
57 Sayer, NA, Noorbaloochi, S, Frazier, P, Carlson, K, Gravely, A, Murdoch, M. Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatr Serv 2010; 61: 589–97.
58 Dirkzwager, AJE, van der Velden, PG, Grievink, L, Yzermans, CJ. Disaster-related posttraumatic stress disorder and physical health. Psychosom Med 2007; 69: 435–40.
59 Francisković, T, Stevanović, A, Jelusić, I, Roganović, B, Klarić, M, Grković, J. Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croat Med J 2007; 48: 177–84.
60 Al-Turkait, FA, Ohaer, JU. Post-traumatic stress disorder among wives of Kuwaiti veterans of the first Gulf War. J Anxiety Disord 2008; 22: 1831.
61 Gure, TR, Kabeto, MU, Blaum, CS, Langa, KM. Degree of disability and patterns of caregiving among older Americans with congestive heart failure. J Gen Intern Med 2008; 23: 70–6.
62 Evans, RL, Bishop, DS, Ousley, RT. Providing care to persons with physical disability. Effect on family caregivers. Am J Phys Med Rehabil 1992; 71: 140–4.
63 Davis, LC, Sander, AM, Struchen, MA, Sherer, M, Nakase-Richardson, R, Malec, J. Medical and psychosocial predictors of caregiver distress and perceived burden following traumatic brain injury. J Head Trauma Rehabil 2009; 24: 145–54.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 1 *
Loading metrics...

Abstract views

Total abstract views: 134 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 22nd July 2018. This data will be updated every 24 hours.

Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran–Iraq war

  • Khodabakhsh Ahmadi (a1), Mahmood Reshadatjoo (a2), GholamReza Karami (a1), Nariman Sepehrvand (a2), Pegah Ahmadi (a2) and Shahrzad Bazargan-Hejazi (a3)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *