@2025 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2016;8(3):149-156

Background
Movement disabilities are the most prevalent in disabilities. Amputation is one of the most common motor disabilities [1].
Previous Studies
… [2-13]. The results of studies on veterans and people with amputation in Iran shows the high prevalence of depression, anxiety, anger, resentment, fear, helplessness, hopelessness, and loss of life satisfaction among the veterans [8, 14]. … [15-18].
Aim(s)
The aim of this study was to determine the status and dimensions of veterans ‘mental health in Mazandaran province.
Research type
This study is a descriptive and cross-sectional.
Research society, place and time
This study was conducted among the amputee veterans with the support of the Foundation of Martyrs and Veterans Affairs in Mazandaran province in 2013.
Sampling method and number
Of the 575 registered amputee veterans in Mazandaran province [19], with respect to access and satisfaction of respondents, 275 persons were selected of which 256 of them, fully completed the research questionnaires by a trained clinical psychologist and a general practitioner (during filling the questionnaire, a clinical psychology interview was conducted by a clinical psychologist that included demographic questions) and the rest were excluded from the study (due to factors such as incomplete filling of the questionnaires, not returning the questionnaires, lack of minimum literacy for filling the questionnaire, and unwillingness to participate in the research). Additional questions were also asked from the patients by the general practitioner.
Used devices&materials
The assessment tools were: the researcher-made demographic questionnaire for evaluating demographic characteristics such as age, sex, education level, occupation, and veteran`s specifications, marital status before and after the injury and emotional status of veterans, as well as Symptom Checklist-90-Revised Questionnaire (SCL-90-R), which assesses the severity of symptoms and common complaints. For each question in SCL-90-R questionnaire, there are five options of “none” (zero score) to “extremely” (score 4) that the respondent specifies with regard to the extent to which he/she has experienced such a problem during the past week. This questionnaire has 9 dimensions and 3 index. Nine dimensions of this questionnaire are: physical complaints, obsession-compulsion, sensitivity in mutual relationships, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychosis. Three total indices indicate the discomfort and depth of severity of mental health in the individual. These indicators are :1) Global Severity Index (GSI) that the score of this indicator is the mean scores of all questions in the test and can fluctuate in the range between zero to 4, 2)Positive Symptoms Total (PST) that is the number of symptoms or questions that the participant reports in positive manner and can fluctuate in a range between zero and 90, and 3) Positive Symptom Distress Index (PSDI) that is the mean of symptoms and questions that the subject reports in positive form and can fluctuate between zero and 4. The reliability of this questionnaire has been reported between 0.77 and 0.90 in other countries from 0.80 for the physical complaints to 0.90 for paranoid ideation [20, 21]. Participants having the total index of illness more than 0.7 are considered as possible mental patients; persons with total index of illness between 0.4 to 0.7 are considered as suspected mental patients and those who have the total index less than 0.4 are considered as probably healthy one [21]. Moreover. Based on the findings of previous studies, those whose score is above the mean of population, were considered as potential patient and those shoes score was less than the mean of population were considered as potential healthy ones [22]. Statistical analysis was performed using SPSS 16.0 software. To calculate absolute and relative frequency of the variables as well as central parameters, spread and standard deviation, descriptive statistics, and for statistical analysis, Chi-square, independent t-test and ANOVA were used.
Findings by Text
Of the 575 veterans with amputations, 256(44.52%) with the mean age of 46.44±2.60 years and age range of 20 to 70 years filled the questionnaire completely. Of the male veterans, 243 (94.9%) were married and 202 (78.8%) had the education level of diploma or less and 160 (62.5%) had the injury higher than 50%. Amputation of the veterans was in different levels (Table 1). Of the all veterans, 136 (53.1%) complained of back pain in the past five years and 164 (64.1%) complained of joints pain in the past year. Also, 150 (41%) of the veterans reported the pain as the most common clinical adverse in the remaining organ (Table 2). 177 (69.1%) of the participants had the GSI more than 0.7 and therefore considered as a possible psychiatric patient, 42(16.4%) had the GSI between 0.4 to 0.7 and considered as suspected for mental health and finally 37 (14.5%) had GSI less than 0.4 and were considered as probably healthy ones. Also, The mean overall index score of 140 (54.7%) of the patients was less than mean index score of illness in the population and therefore were considered as potential patients. However, the overall index score of the other 116 (45.3%) patients, was higher than the mean overall score of population that were considered as the probably healthy ones (Table 3). The relationship between demographic variables such as marital status after being injured with the mental health variable suggested that the social support has the most positive impact on mental health of amputee veterans. In fact, people who had less support from family and community, had less mental health so that there was a significant relationship between social support with all nine dimensions and PSDI index (p<0.05). Economic status of amputee veterans was among other effective factors. Veterans who were dissatisfied with their economic situation and had more economic problems had less mental health. This variable had significant relationship with the PSDI index and nine dimensions except paranoid ideation (p<0.05). Occupation after the injury had significant relation with the nine dimensions except the dimension of paranoid ideation and three indices of GSI, PST and PSDI (p<0.05). Percentage of injury had no effect on the mental health of this group of people. The level of education, also, had the minimum impact on the mental health and only the dimension of aggression was effective. In other words, to the extent that education level was lower, these people, also, had higher aggression.
Main comparison to the similar studies
… [23-25] More social support, more self-esteem, less self-blame, less threatening and better adoption are seen in veterans who receive social support and they have better mental health [26-28].
Suggestions
It is suggested that in future studies, veterans with different severity of illness be studied.
Limitations
The limitations of this study were the lack of access to veterans of all ages and comparing other social, psychological, and emotional condition of them.
Conclusions
Most of the amputee veterans in Mazandaran Province have the physical problems and symptoms of war and after war and this issue has reduced their mental health. More than half of studied people had the General severity index which indicates the low quality of life in these veterans.
Acknowledgments
The authors of this article give their special thanks to all honorable officials of the Foundation of Martyrs and Veterans Affairs specially Dr. Hamid Ali Samimi, the president of this foundation, Dr. Seyed Abbas mirsadeghi deputy of health, and Dr. Gholam Reza Taghavi, Deputy of Research and Cultural Relations for their continues financial and spiritual support of applied research and knowledge production. The authors, also, gives special thanks to Dr. Hamid Reza Taghavi specializing in rehabilitation and physical medicine and Sayyed Nasrallah Nasrollah, former head of Research Department of Foundation of Martyrs and Veterans Affairs for their help and cooperation in this project.
Conflict of interest
Non-declared
Ethical Permissions
This research is morally approved by the Medical Department of Mazandaran University of Medical Sciences and the written consent was taken from all participants.
Funding Sources
This study has been funded by Research and Cultural Deputy of Foundation of Martyrs and Veterans Affairs.

TABLES and CHARTS

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