ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Sedighi Moghadam   M.R. (1)
Afshar   H. (2)
Khateri   Sh. (1)
Soroush   M. (1)
Mousavi   B. (*)
Mousavi   S.J. (1)
Modirian   E. (3)
Hosseini   M. (1)






(*) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
(1) Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
(2) “Psychosomatics Research Center” and “Psychiatry Department, Medicine Faculty”, Isfahan university of Medical Sciences, Isfahan, Iran
(3) Emergency Department, Medical Faculty, Qazvin University of Medical Sciences, Qazvin, Iran

Correspondence

Address: Janbazan Medical and Engineering Research Center (JMERC), No. 17, Farokh Street, Moghadas Ardabili Street, Yaman Street, Shahid Chamran Highway, Tehran, Iran
Phone: +982122416699
Fax: +982122416699
mousavi.b@gmail.com

Article History

Received:  February  3, 2015
Accepted:  April 19, 2015
ePublished:  November 21, 2015

BRIEF TEXT


… [1-9] Mental health and, especially, post-traumatic stress disorder (PTSD) in the veterans have been studied long ago [10, 11]. About 50 years after the end of WWII, the veterans have been studied and there have been significant differences between experimental and control groups in depression, anxiety, insomnia, paranoid, and schizophrenia [11].

Iranian veterans exposed to mustard sulfur need regular visits by the psychiatrists [12]. There are higher PTSD levels in the veterans exposed to mustard sulfur than veterans with no chemical injury [13], bad sleep quality [14], and psychosis, panic, and hypochondriasis [15]. … [16-21]

The aim of this study was to investigate mental health status in the veterans severely exposed to mustard sulfur.

This is a cross-sectional study.

Iranian veterans with severe chemical injuries exposed to mustard sulfur were studied in Isfahan, Iran, for 10 days in 2015.

292 persons were studied.

Demographic information including age, gender, marital status, number of children, level of education, job status, and number of exposure to chemical materials was asked from the subjects. At the next stage, through a semi-structured clinical interview based on DSM-IV, three psychiatrics investigated face characteristics, including general face, mood, emotion, speech, understanding, type of illusion, thinking, content of thought, navigation, short-term memory, long-term memory, insight, and reliability, for 20 minutes. Then, any type of psychiatric disorders was investigated in the victims with severe pulmonary chemical injuries according to multi-axis DSM-IV system including 5 axes [21]. Axis 1 is used to diagnose any psychiatric disorder except personal disorders and retardation. Axis 2 assesses any personal disorder and retardation. Axis 3 assesses other general health problems. Axis 4 assesses other environmental problems affecting predicting, diagnosing, and treating the psychiatric disorders in axes 1 and 2. In Axis 5, the psychiatrist judges the persons’ efficiency level. There is a 100-score scale (GAF) [22]. The disease having been diagnosed and DSM-IV form having been completed, a suitable treatment program was administrated for each patient. Data was analyzed by SPSS 22 software. Pearson correlation coefficient and chi-square tests were used to investigate any correlation between the demographic variables and the results of DSM-IV questionnaire such as the psychiatric disorders. … [23]

Mean age of the participants was 46.9±7.8 years (Table 1). More than three quarters of the veterans were with abnormal mood (Diagram 1). 12 persons (4.1%) had formerly referred to psychiatric centers and one of them (0.3%) had been hospitalized. 213 veterans (72.9%) were with psychiatric disorders and 36 persons (12.3%) were with anxiety and depression simultaneously. Therefore, 201 cases (68.8%) were diagnosed as new patients. Anxiety disorder was the most prevalent disorder in the Axis 1. In addition, more than 90% of the anxiety disorders were PTSD (Table 2). Based on the investigations on the Axis 2, there was only one person (0.3%) with mental retardation and 3 persons (1.0%) were with personality disorder. Based on the investigations on the Axis 3, 49 persons (16.8%) were with other physical diseases effective on mind health. The most prevalent disease was blood pressure with 13-person frequency (4.5%). And following, there were cardio-vascular disease and diabetes each one with 5-person frequency (1.7%), hearing disorder, fragments inside other organs, vision disorder, and spinal cord injury each one with 3-person frequency (1.0%), migraine headaches and myopathy each one with 2-person frequency (0.7%), kidney stones, pelvic injury, benign prostatic hyperplasia, epilepsy, Parkinson, and chondromalacia each one with 1-person frequency (0.3%), and other general health problems with 4-person frequency (1.4%).Based on the Axis 4, 26 persons (8.9%) were suffered by different family conflicts including no proper relationship with the child, separation from the spouse, death of the spouse, and emigration of the relatives. In addition, 24 persons (8.2%) suffered economic problems and 1 person (0.3%) suffered bad job situation. Based on GAF analysis, more than 90% of the veterans received less than 60 scores (Table 3). The disease having been diagnosed by psychiatrists, suitable treatment plan was presented to each patient. 12 patients (4.1%), formerly referred to psychiatrists, needed no new medication intervention and former treatments were advised to them to continue. From 201 newly diagnosed patients, simultaneous psychotherapy and pharmacotherapy, start of pharmacotherapy, and psychotherapy were administrated for 36 (12.3%), 139 (47.6%), and 19 (6.5%) patients, respectively. Hospitalization was administrated for 7 patients (2.4%). There were fully significant and direct correlations between Axis 4 and number of children (p=0.007), level of education (p=0.027), and the veterans’ job status (p<0.001). There was a significant and direct correlation between Axis 5 (the veterans’ efficiency level) and the veterans’ job status (p<0.001). There was a significant correlation between the disorders of Axis 1 and level of education (p=0.001) and marital status (p<0.001). There was no correlation between other axes and age (p>0.05). There was a fully significant correlation between axes 1 and 5 (p<0.001). There was no significant correlation between one or two psychiatric disorder and demographic characteristics including age, marital status, job, and level of education (p>0.05). Based on a comparison between four groups, including “no psychiatric disorder”, “anxiety disorder”, “depression disorder”, and “two simultaneous disorders”, there was no difference between demographic variables, including age, level of education, job status, marital status, and number of children, as well as axes 3 and 4 (p>0.05). Nevertheless, there was a fully significant difference in Axis 5 (p<0.001). The severer the psychiatric disorder, the lower the efficiency level was.

More than a half of the veterans with severe pulmonary chemical injuries suffered anxiety disorders and specially, PTSD. Anxiety frequency in the veterans with chemically injuries is between 18 and 65% [24]. … [25] The prevalence of PTSD is between 38 and 56% [24, 26]. The frequency of anxiety and depression in the non-military persons exposed to mustard sulfur and control group is fully significant [1]. The frequency of anxiety disorder in the non-military persons exposed to the low levels of mustard sulfur is 3 times more than the control group [27]. The prevalence of anxiety in COPD patients is 31% [28]. More than half of the patients show moderate-to-severe levels of anxiety, and PTSD frequency is about 40% in them [29]. About half of the participants were with different depression levels. There is depression prevalence in non-military veterans, non-chemically injured veterans, and chemically injured veterans [1, 27, 30, 31]. There is more than 90% depression frequency in the victims of the chemical wars [27]. There is 65% mean depression frequency in the Iranian citizens exposed to mustard sulfur [31], which shows a higher prevalence than the findings of the present study. There is 6 to 46% severe depression prevalence in the chemically injured veterans [24]. The severe depression level is 10% in the chemically injured veterans, and about 90% of the depression cases are mild to slight depression cases [27]. A comparison between depression prevalence in the chemically injured veterans (92%), non-chemically injured veterans (57%), and control group (36%) show that the depression prevalence in the chemically injured veterans is considerably higher than other groups [30], which is higher than the present results. The frequency of major depressive disorder (MDD) in COPD patients is about 3 times more than the normal society [32]. There was a higher major depression compared to other studies and it was 5 to 7 times more than other studies [27, 32]. … [33] Employment of the chemically injured veterans alone cannot positively affect their mental health, and dissatisfaction in the job status lead to the psychological disorders [34]. The higher the level of the psychiatric disorders, the lower the ability to perform daily activities is [35]. The result is consistent with the present results. … [36, 37]

The effects of gender on the mind health, as well as the mind health of the family members of the veterans with severe pulmonary injuries caused by sulfur mustard, should be investigated.

Lack of ability to assess the effects of gender on the mind health was one of the limitations for the present study.

There is a higher prevalence level of the psychiatric disorders, including depression, anxiety, and PTSD, in the veterans with severe pulmonary chemical injuries caused by sulfur mustard than other veterans, and it is 3 to 5 times more than the Iranian normal population.

Isfahan Martyrs and Veterans Foundation and Janbazan Medical and Engineering Research Center (JMERC) are appreciated.

Non-declared

The veterans participated voluntarily. There were no financial expenses or life risks for the veterans. Treatment plan was proposed to participants who needed treatment sessions. The participants were permitted to exit from the study at any stage they were not willing to continue their participation.

The study was founded by JMERC.

TABLES and CHARTS

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