@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2016;8(1):25-32

Background
... [1]. In veterans` families, women are extremely under pressure due to husband`s disease or disability and this issue affects the health, welfare and educational conditions of the mothers, members with serious duties, more than others [2].
Previous Studies
... [3-4]. Some medical interventions including education, support, psychotherapy and good care may have a significant impact in reducing caregivers` mental pressure so that the plots for increasing the quality of care will be laid, and caregivers` physical and mental health can be promoted [5]. ... [6-21]. The results obtained from studying 80 women married to disabled spouses have indicated that cognitive-behavioral group training of life skills has improved their mental health [22] ... [23-26].
Aim(s)
The aim of this study was to investigate the effectiveness of life skills` training on mental health of the partners of veterans suffering from temper disorder.
Research type
This study is quasi-experimental with a design of pretest-posttest and the control group.
Research society, place and time
This study was carried out in 2013 among all the wives of veterans suffering from mood disorders who had referred to Sadr Psychiatric Hospital in Tehran.
Sampling method and number
The convenience sampling was done among the veterans' wives whose husbands had diagnosis of mood disorders. According to Cohen table, the sample size in the error level of 0.05, the size effect of 0.50 and the test potency of 0.90 was estimated as 19 for each of the experimental and control groups [27]; In other words, the number of people in the sample group was 38 totally which this number increased to 50 considering the possibility of loss. At first, by referring to available files in the clinic of Sadr Psychiatric Hospital, the names of veterans were obtained who had got mood disorders` diagnosis in 2012 by the psychiatrist. These patients had received mood disorders` diagnosis including the bipolar disorder type I and type II by psychiatrists using the Structured Clinical Interview for clinical disorders and diagnosis of mental disorders, and were treated by psychiatric medicine. Among 880 veterans with mood disorders, 50 spouses of them were invited to participate in a briefing session. The criteria for entering the study were regarded as willingness and informed consent to attend meetings, diagnosis of veteran`s mood disorders and residence in Tehran, and exclusion criteria included another psychological disease and records of attendance in continuous educational psychotherapy classes or counseling, and related fields to group meetings simultaneously (to determine the effectiveness of such education).
Used devices&materials
Researcher-made questionnaire of demographic information and General Health Questionnaire (GHQ-28) were used to collect data. Demographic information included information related to age, education, number of children, employment status and so on. General Health Questionnaire (GHQ-28) was first prepared in 1979 by Goldberg and Hiller, and has 28 questions. The questionnaire comprises four scales of physical symptoms, anxiety, deficiency in social functioning and depression. Each of these scales has 7 questions which is scored based on Likert scale ranging from zero (more than ever) to 3 (very worse than ever). A score of 23 or higher indicates the lack of mental health and scores lower than 23 shows the mental health [6]. Goldberg has reported the reliability and validity of the questionnaire as 0.89 and 0.83, respectively [28]. In Iran, Yaqoubi et al. have also reported the questionnaire`s reliability using test-retest and the validity of its subscales as 0.88 and 0.55, respectively; each question of this questionnaire is scored on a four-item Likert scale. The total reliability of this questionnaire has been reported 0.95 and the internal reliability of this questionnaire`s components for physical health, anxiety, deficiency in social functioning and depression has been calculated 0.73, 0.77, 0.58 and 0.86, respectively, through Cronbach's alpha [29]. Moreover, Palahang has reported the validity of this questionnaire as 0.91 and has estimated the amounts of Cronbach's alpha coefficient for physical symptoms, anxiety, deficiency in social functioning and depression each 0.84, 0.78, 0.81, 0.79, respectively [30]. After selecting the participants and assigning them randomly in experimental and control groups, the general health questionnaire was first answered in both groups. The experimental group was trained for the cognition of mood disorders in 2 sessions, each lasting 2 hours, and after that, life skills like increasing self-awareness, effective communication, coping with stress and rage control were taught in 8 sessions, each lasting 2 hours and held once a week. Educational program was totally accomplished in 10 sessions of 120 minutes and consisted of three parts; theoretical education, group discussion about the material, and practices on the subject at the end of each session so that all participants could experimentally practice the educational topics outside the learning situation. After two and a half months and at the end of the sessions, the General Health Questionnaire was again administered to both experimental and control groups. The educational content of life skills included understanding oneself and his/her abilities, recognizing the personal and family values, setting purposes, realizing goals and aspirations, getting familiar with the concept of social pressure, knowing how to communicate well with others, non-verbal communication, recognizing violence and the ways to control it, learning the concept of anxiety and identifying it from useful tensions, and using the techniques of reducing anxiety such as muscular relaxation which were adopted from the guideline of life skills` training (Taremian et al.) [31]. Reviewing previous sessions, the philosophy of providing the specified training in each session, reviewing the assignments, deciding on the next session, summarizing, and finally receiving feedback were all fulfilled at each session (Table 1). The data was analyzed through covariance analysis test.
Findings by Text
The mean age of the experimental group (veterans' wives who received life skills` training) and the control group (veterans` wives who did not receive life skills` training) was 44.00 ± 2.38 and 47.00 ±2.65 years, respectively (Table 2). The mean scores of life skills of both groups showed a significant difference in post-test stage with the pre-test effect control, in general health and the subscales of physical symptoms, anxiety symptoms, and deficiency in social functioning, but no significant difference was observed in the subscale of depression symptoms. Therefore, life skills’ training was able to boost the mean scores of the participants in the experimental group in dependent variable (except the depression symptoms). In addition, performing the intervention resulted in 59% of difference in the variance of general health`s post-test scores, 10% of difference in the variance of physical symptoms` post-test scores, 29% of difference in the variance of anxiety symptoms` post-test grades, and 30% of differences in the variance in post-test scores of deficiency in social functioning in both groups (Table 3).
Main comparison to the similar studies
The results of this research are in line with the findings of studies by Parand et al. [2], Bahreynian and Borhani [18], Zargar et al. [19], Karami Nia et al. [20], Wales and Barsqua [21], and Faramarzi et al. [22]. The findings of a study by Catalano et al. demonstrated that these trainings are accompanied with increasing the spontaneity, social competence and empathy, and will improve the psychological health [32] ... [33-39]. There are ample studies on the reasons behind the low level of mental health among veterans' wives which confirm too much stress and marital discord in these families and the stresses are also heightened affected by their symptoms [23-25].
Suggestions
It is suggested to use larger and more comprehensive samples in future studies in order to generalize the results more certainly and to administer follow-up tests within longer intervals for examining the persistence of treatment effects.
Limitations
This study has been conducted on the wives of veterans suffering from mood disorders who are under medical treatment. Thus, the findings should be carefully generalized to other disorders. Moreover, given that the sample is composed of women, there are difficulties in generalizing the results to men. Besides, impossibility of identifying and controlling the effective activities on the experimental group outside the experimental situations, individual and family counseling interventions, behavioral-cognitive therapies, medical treatments, hospitalization and social work for veterans, wives and children, and holding planned educational classes for veterans` children simultaneously with workshops for spouses are all to be mentioned which these intervening variables may affect spouses` mental health. In the end, it was not possible to follow up the experimental group at different time intervals.
Conclusions
Training the life skills is an efficient and effective strategy for improving the general health, physical symptoms, anxiety symptoms and deficiency in social functioning in the wives of veterans who are suffering from mood disorder.
Acknowledgments
Many thanks are addressed to all the wives of veterans with mood disorders who have assisted us by participating in this study as well as the Head of Sadr Psychiatric Hospital and their colleagues, Tehran Peace Museum and Cultural Research Bureau of Martyr and Veterans` Affairs Foundation for Research and Cultural Communication Deputy.
Conflict of interest
There has been no conflict of interests.
Ethical Permissions
This project was approved after initial assessments and writing the proposal in the scientific committee of the Cultural Research Bureau of Martyr and Veterans` Affairs Foundation for Research Deputy.
Funding Sources
This study was funded by the authors and supported by Tehran Peace Museum.

TABLES and CHARTS

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