@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2020;12(3):165-172

Background
The 8-year Iraq-Iran war has resulted in various psychological disorders, including post-traumatic stress disorder (PTSD), in addition to economic damage and organ damage, which still affect society [1].
Previous Studies
A war veteran with PTSD back from the war has war-related thoughts about war, avoids those around him, and responds to others anxiously [2]. ... [3-13]. Family problems are on the rise in families of patients with PTSD; thus, it seems that spouses are more likely to experience psychological problems. Therefore, spouses need to use different educational methods to create adjustment and reduce tension in marital relationships [14]. Training the cognitive-behavioral techniques by controlling the effect of depression, anxiety, and stress was effective in reducing PTSD symptoms in spouses of PTSD veterans [15]. Also, training the techniques of two cognitive-behavioral and schema therapies in modulating the symptoms of secondary trauma of the spouses of veterans with PTSD was an effective strategy and their effectiveness was not different [16].
Aim(s)
The aim of this study was to compare the effect of two spiritual-religious and hope interventions in reducing stress, anxiety, and depression in the spouses of veterans with PTSD.
Research type
The present research was is a quasi-experimental study.
Research society, place and time
This study was performed using a pre-test post-test design with control and follow-up groups on the spouses of veterans referring to Sadr Psychiatric Hospital in Tehran from 2003 to 2016.
Sampling method and number
Using the purposeful sampling method, some of the spouses of PTSD veterans completed the Secondary Traumatic Stress Scale (STSS-17) questionnaire. Their responses were evaluated by hospital psychologists according to the chart of the comparison of PTSD and STSD symptoms using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) [2], and 51 cases were eligible to enter the study and were randomly divided into two experimental groups and one control group (17 people in each group). The sample size was calculated based on the minimum number of each group in experimental research (n=15), and considering Cochran's formula, in which d value was considered at the error level of 5%, the effect size of 50%, and test power of 65%. The wives of veterans with PTSD who wished to participate in the study, had at least a fifth grade level of education, obtained the required score (above the cut-off point 38) on the STSS, and were living in Tehran, were included in the study. Those who were unwilling to participate in the study, cases who were absent for more than two training sessions, cases who used drugs, those with a mental disorder that prevented treatment, and cases who were separated or divorced were excluded from the study.
Used devices&materials
The data were collected using the following questionnaires: 1- Secondary Traumatic Stress Scale (STSS-17): This scale has acceptable validity and the reliability of Cronbach's alpha for the whole scale is reported to be 98% [17]…. [18]. 2- Depression, Anxiety, and Stress Scale (DASS-21): Criterion validity of the DASS-21 Scale has been reported as satisfactory; The reliability of this tool was obtained 97% using Cronbach's alpha method for the whole scale [19]. The criterion validity of this tool explained 46.66% of the variance, which shows that all correlations are significant at the level of 0.001. Its reliability was reported by Cronbach's alpha for the three subscales of depression, anxiety, and stress as 0.77, 0.79, and 0.78, respectively [20]. The groups answered the demographic form questions and completed the DASS-21 in the pre-test stage. The experimental group 1 received the combined training of some spiritual-existential interventions based on the Victor Frankl approach [21, 22], religious-spiritual intervention based on the model of Richards and Bergin [23], and religious teachings, including six dimensions for 8 sessions in 3 even days of the week. The experimental group 2 underwent hope therapy training based on the theories of Snyder [24, 25] and Worthington [26] in 8 sessions 3 days a week. One week after the end of the training sessions, the post-test was performed for both experimental and control groups. Three months after the end of the training, participants were followed up to continue the training effect. The control group did not receive any training in this period. Data were evaluated using descriptive and inferential statistics. In the descriptive part, the mean and distribution of scores were calculated and in the inferential part, the combined multivariate analysis of variance (MANOVA) using SPSS 20 software was used to compare the differences of the mean scores of the three groups.
Findings by Text
The mean age of the participants in the first experimental group (spiritual-religious) was 46.16±6.52 years, in the second experimental group (hope therapy) was 48.18±4.40 years, and in the control group was 46.18±6.58 years. With the exception of the scores of depression in the first group in the pre-test stage and anxiety in the second group in the pre-test stage, the distribution of scores in the groups in all three stages was normal. The results of Wilkes lambda test showed that the value of F=1.676 (92, 6) was not significant (p<0.05); therefore, depression, anxiety, and stress in the pre-test stage were not significantly different between the three groups, and the hypothesis of independence of the pre-test variable from the group variable was established. Also, the results of Mauchly's test showed that unlike anxiety (x2(2)=3.806; p>0.05), the spherical assumption for depression (x2(2)=16.381; p<0.01) and stress (x2(2)=7.363; p<0.05) was not established; therefore, the degree of freedom related to depression and stress was modified using the Greenhouse-Geisser estimation method leading to the sufficient correlation between the dependent variables (p<0.001). According to the results of the DASS-21 scale, in the pre-test stage, the wives of veterans with PTSD obtained high scores from the subscales of stress, anxiety, and depression. After the interventions, the mean scores of depression, anxiety, and stress in the experimental groups decreased in the post-test and 3-month follow-up compared with the pre-test stage. However, the mean scores of the control group did not change in the post-test and follow-up stages (Table 1). The interaction effect of the spiritual-religious intervention and hope therapy was not significant (p<0.05), but the interaction effect of spiritual-religious intervention and control group as well as hope therapy and control group was significant at the level of 1% (p<0.01); thus, there was no significant difference in the effectiveness of two spiritual-religious interventions and hope therapy in reducing depression, anxiety and stress of spouses of veterans with PTSD (p<0.05).
Main comparison to the similar studies
The aim of this study was to compare the effects of the spiritual-religious intervention and hope therapy in reducing stress, anxiety, and depression in the wives of PTSD veterans. Spiritual-religious treatment reduced depression in the wives of PTSD veterans. This finding is consistent with the findings of McConnell & Pargament [27], Moritz et al. [28], Harris et al. [29], and Amirarajmandi et al. [30]. ... [31-33]. Hope therapy led to a reduction in depression in the wives of PTSD veterans. This finding is consistent with that of Snyder [34], Mehmet & Michael [35], Chiones et al. [36], and Manouchehri et al. [37]. The spiritual-religious treatment reduced the anxiety of the wives of PTSD veterans. This finding is consistent with that of Ajar et al. [38], Ellison et al. [39], and Yaghoubi et al. [40]. ... [41, 42]. Hope therapy reduced the anxiety of the wives of PTSD veterans. This finding is consistent with that of German et al. [43], Michel [44], Rajandarm et al. [45], and Lowell et al. [46]. ... [47-50]. The spiritual-religious treatment reduced the stress of the spouses of PTSD veterans. This finding is consistent with that reported by Pargament et al. [51], Richards and Patz [31], and Beigi et al. [52]. .... [53-55]. Hope therapy reduced the stress of the wives of PTSD veterans. This finding is consistent with the research of Snyder & Lopez [56] and Rostown et al. [57]. ... [58].
Suggestions
It is suggested that psychiatrists and psychologists use the results of the present study in therapeutic interventions to help improve the symptoms of veterans' spouses.
Limitations
None.
Conclusions
Both spiritual-religious intervention and hope therapy as interactive interventions are effective in reducing stress, anxiety, and depression in the wives of PTSD veterans with the same effectiveness.
Acknowledgments
We would like to thank the wives of the veterans with PTSD who helped us by participating in this study, as well as the support and guidance of the esteemed director of Sadr Psychiatric Hospital in Tehran and their colleagues in the research process.
Conflict of interest
None declared.
Ethical Permissions
None.
Funding Sources
This article was not supported and is taken from a Master's thesis in clinical psychology (Manizheh Taghavi), Islamic Azad University, Roodehen Branch.

TABLES and CHARTS

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