@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2019;11(1):23-27

Background
Disability is defined as the inability to perform all or part of the normal activities of individual or social life, which is due to a congenital or acquired defect in physical or mental health [1]. According to the age of person, it can affect his social, cultural and physical roles [2]. In this regard, spinal cord injury is one of the major problems associated with disability [3].
Previous Studies
... [4-6]. Paraplegia is associated with various complications, including physical, psychological and social problems, inadequacy in performing tasks as well as self-treatment, inability to perform tasks, and dependence on others [7]. Psychosocial problems are one of the most common outcomes of disability, which is widespread in the developing countries, especially Iran, and is steadily increasing [8]. ... [9-11]. According to studies, nearly one out of four soldiers who were involved in the war is suffering from severe psychological problems [12]. Mental health of veterans is affected by war and complications from chronic physical problems, as well as significant adverse effects in their families [13, 14]. ... [15]. According to statistics, about 25-30% of the soldiers who were involved in the Vietnam, Iraq and Afghanistan wars are suffering from psychiatric disorders [16]. Saadat et al. showed that among paraplegia subjects, those who are disabled have less access to social and human rights than veterans and they also face barriers, anger, and economic, social, psychological and social orientations in various societies [17].
Aim(s)
The aim of this study was to investigate the mental health in the paraplegic veterans and disabled subjects.
Research type
This research is a descriptive cross-sectional study.
Research society, place and time
This study was conducted on paraplegic veterans covered by the Martyrs and Veterans Foundation and paraplegic disabled subjects supported by the welfare organization of Mazandaran Province.
Sampling method and number
The samples were selected by stratified random sampling method. In fact, each stratum was disabled individuals and veterans homogenized by age and education. The inclusion included being male, married, aged over 35, at least 10 years of disability, the willingness to participate in research, the ability to communicate, understanding and answering questions, the no participation in psychological interventions over the past six months, and no use of medication for psychological problems. At first, 300 subjects (64 paraplegic veterans and 236 paraplegic disabled individuals) were selected based on inclusion criteria for participation in the study. Then, 135 individuals (29 veterans and 106 disabled individuals) were selected by proportional sampling method and all subjects participated in the study. Stratified random sampling was also used to compare the two groups.
Used devices&materials
Data was collected by a demographic questionnaire (assessing age and the educational level) and General Health Questionnaire (GHQ) [18-22]. The Mazandaran province geographically divided into three parts, central cities were selected from the center of the province, eastern cities from the east of the province, and from the west of the province the cities were randomly chosen. The information of veterans was collected by referring to the Rehabilitation Center of the Martyrs and Veterans Foundation as well as where they lived and data for disabled group was collected through a conference by the welfare organization and referring to their homes. This research was carried out following the approval and permission from the authorities of the studied groups. The samples were assured that about the confidentiality of data which were only collected the research, and also voluntary participation in this research was explained. Data was analyzed using SPSS 21 software. Descriptive statistics were used for research variables including measures of central tendency and dispersion in general health variables with its sub-tests in two sample groups. For inferential statistics, Kolmogorov-Smirnov test was first used and for normalized data, two groups were compared using the independent t-test for the studied variables. Data was analyzed with a significant level of 0.05 and a 95% confidence interval. Fischer's exact test was used to examine the homogeneity of the two groups in terms of demographic variables.
Findings by Text
The mean age of veterans and disabled persons was 49.72±5.34 and 47.36±5.92 years, respectively; in the disabled group, the minimum and maximum age was 36 and 59 years and in the veterans group they were was 39 and 63 years, respectively. In addition, two groups did not have a significant difference in mean age (p=0.054). In both groups, most subjects had below diploma education. Moreover, both groups were homogeneous in terms of education (p=0.61; Table 1). There was a significant difference between the mean scores of mental health of veterans and disabled subjects (p<0.0001, t=0.639) and the veterans group had more appropriate mental health (Table 2). Paraplegic veterans obtained higher scores in the physical symptoms, social function, anxiety symptoms, sleep disorders and depression subscales compared with disabled subjects and there were significant differences between both groups (p<0.05; Table 2).
Main comparison to the similar studies
More than half of the disabled and veterans had a lower level of mental health, so that veterans had better conditions than the disabled subjects, which is consistent with some other studies [21, 22]. Delavar et al. [22] studied physical mental health of physically disabled people compared with normal people on 60 Physical disabled and 60 normal subjects, showed that mental health of physically disabled subjects was significantly lower than that of normal people, and more than half of them had low mental health. In a research by Khani et al. [23], the mental health of amputated veterans in Mazandaran province was low and more than half of the patients had general signs of mental health disorder. Disability not only affects disabled people but also their attitudes can be affected, so it can result in psychological pressures, depression, loss of social rights, benefits and support, lifestyle changes, and discontinuity and social isolation [22, 23]. ... [24]. Silver et al. [25] reported that the most important preventive factor in returning to the community is using medical equipment, such as wheelchairs, suprapubic catheters in the bed, weakness and muscle contractions that restrict daily activities. According to Medola et al. [26], physical deprivation can lead to physical problems, defects and pain. Disabled people are also more affected than veterans, which can be due to economic issues and financial support. The economic level of the disabled people is lower than veterans; therefore, they use less advanced equipment and are more physically dependent [27]. The social function of the disabled group was lower than the veterans. According to the spinal cord injured persons views, healthy people do not have close contact with disabled people, which can lead to a reduction in their dynamics in the individual and social life [28]. ... [29].
Suggestions
More studies in this field and its different dimensions are suggested. In addition, more studies with larger sample size in Mazandaran province or in other provinces and across Iran are recommended to generalize the results.
Limitations
Due to the limited relevant studies, it was difficult to compare the results. The lack of access to more samples and the limitation of the statistical population limited to Mazandaran province were other limitations of this study, which makes it difficult to generalize results to other provinces.
Conclusions
The mental health of the paraplegic veterans and disabled subjects is unfavorable and veterans have higher level of mental health.
Acknowledgments
The authors are thankful to the Foundation of Martyrs and Veterans Affairs as well as the welfare organization of Mazandaran and all veterans and disabled persons who cooperated with completing the questionnaires.
Conflict of interest
None declared.
Ethical Permissions
This study was approved by the ethics committee of Islamic Azad University, Sari Branch.
Funding Sources
This study is based on a research supported by the vice chancellor of the Islamic Azad University of Sari.

TABLES and CHARTS

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