@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2014;6(5):207-214

Background
… [1-4] The amount and intensity of flashbacks, which occur directly after the traumatic experiencecan predict post-traumatic stress disorder (PTSD) [5]. Only 8% of persons with the trauma show the whole symptoms of PTSD [6, 7]. The disorder affects different activities including individual, recreational, economic, marital, and social activities [8]. Physical and mental diseases might badly affect the families, both of economical and psychological aspects. The patient’s family members experience tension due to the patient’s life [9]. … [10] PTSD can become a chronic form. In case of chronic PTSD, the family members become disappointed at recovery of the injured person [11]. Care for the patient with chronic disease by the family-members leads to reduction of their quality of life [12].
Previous Studies
Emotional relationships, marital agreeableness, and sexual relationships have been introduced as the concerns of the family members about the patient with PTSD. In their families, physical violence against wives and children is common; and the wives bear additional pressure due to both the husbands’ problems and keeping themselves and children away from the husbands’ harmful behaviors [13]. The families of the patients with chronic diseases are in emotionally more difficult, more unstable, and often more exhausting situation. The numbers of emotional indices such as tension and stress in the families and patients, as well as anxiety and depression are few [14]. The families of veterans with PTSD more suffer from psychological problems [15]. … [16, 17] The wives of the patients with PTSD have shown similar psychopathological symptoms to the patients [18]. Living with a person with PTSD can lead to symptoms similar to PTSD, which is called “secondary trauma” [19]. The family members of the patients’ with PTSD have been significantly affected by the tension due to living with the patients [20].In the families, the caregivers, who are often the patient’s wives, suffer additional tension and stress due to caring the patients [21]. … [22, 23]
Aim(s)
The aim of this study was to assess the effect of having a post-traumatic stress disorder (PTSD) husband on the quality of life, depression, stress, anxiety, and structure of the family.
Research type
This is a cross-sectional comparative study.
Research society, place and time
Families, referred to Jannat Hospital, Shiraz, Iran, were studied in 2011-12.
Sampling method and number
To increase external credibility, while considering statistical loss, 100 families having PTSD husband (PTSD group) and 100 normal families (control group) were selected using achievable sampling method [24].Considering the inclusion conditions for persons and based on the medical records and psychiatric diagnosis according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), families, having a PTSD veteran, were matched with normal families in having children and no family-member with a specific mental illness or chronic disease, which were investigated by the researcher via interviews. Finally, the results from 100 families were analyzed in each group. … [25]
Used devices&materials
Data were collected using quality of life questionnaire (WHOQOL-BREF), depression, anxiety, and stress questionnaire (DASS-21), and family agreeableness and cohesion evaluation scale (FACES-III). They were completed by husbands, wives, and more than 18-years old children. The quality of life questionnaire has 28 questions, provided by WHO. It investigates the concept of health. It has 24 questions, investigating physical health (7 questions), mental health (6 questions), social communication health (3 questions), and environmental health (8 questions) domains. Two first questions are not related to the mentioned domains and they show general health status. The questionnaire has 26 questions with 2 other questions added based on Iranian normalization. (It has 28 questions, totally). Scores of the domains are between zero and 100, with higher scores showing better situations. Reliability of the questionnaire has been reported 0.82. Reliabilities of physical, mental, social communication, and environmental health domains have been obtained 0.77, 0.77, 0.75, and 0.84, respectively. Validity of the questionnaire has been proved by score differences of healthy people and patients in the different domains. Using Cronbach’s Alpha, overall reliability was computed 0.69 and reliabilities of physical, mental, social communication, and environmental health sub-scales were computed 0.71, 0.68, 0.63, and 0.72, respectively. Family agreeableness and cohesion evaluation scale (FACES-III) assesses family activity. It measures two main dimensions, which are “cohesion” (10 questions) and “agreeableness” (10 questions). Based on likert’s 5-point scale, the responses are from “never” (1 score) to “almost always” (5 scores). Reliabilities of the re-test for cohesion and agreeableness dimensions have been reported 0.83 and 0.80, respectively. Construct validity of cohesion and agreeableness dimensions has been shown close to zero, which means that the dimensions are fully independent. Evaluation scales of family agreeableness and cohesion have been obtained 0.75 and 0.74 through Cronbach’s Alpha, respectively [26]. The values of Cronbachs’ alpha were obtained 0.78 and 0.66 for cohesion and agreeableness, respectively. Depression, anxiety, and stress questionnaire has 21 items, consisted of 3 self-report sub-scales to evaluate negative emotional moods in depression, anxiety, and stress. Its scores were from “never” (zero scores) to “very much” (3 scores), based on Likert’s scale. Its reliability has been confirmed for all the three sub-scales as depression (0.91), anxiety (0.84), and stress (0.90) using Cronbach’s Alpha [27]. Reliabilities of depression, anxiety, and stress were obtained 0.75, 0.69, and 0.63, respectively. The mean value of the scores in the family (including wives and more than 18-years old children) was considered as the family status. To obtain total score of the families, the required tools were collected and divided by the family number, separately. This led to the mean score for each family in the scales. Therefore, each family was considered as a separate whole, which had an average of the measurement tools. Data were analyzed using SPSS 18 software and Independent-T test (to compare the investigated indices between two groups).
Findings by Text
In PTSD group, mean ages of husbands, wives, and children were 46.7±10.6, 41.5±9.6, and 22.1±4.9, respectively. In control group, mean ages of husbands, wives, and children were 45.1±12.4, 39.8±11.0, and 19.9±6.1, respectively. Husbands in PTSD group showed significantly less physical, mental, and environmental health than the husbands in control group. Husbands of PTSD group showed significantly more depression and stress than husbands of control group. Husbands in the PTSD group showed lower cohesion and agreeableness than husbands in control group. There was no significant difference between mean family scores of PTSD and control groups in mental health domain. The family of PTSD group showed significantly more depression and anxiety than the family of control group. The family of PTSD group showed weaker performance in cohesion and agreeableness than the family of control group (Table 1).
Main comparison to the similar studies
The families of the veterans with PTSD showed weaker performance and conditions in structural and emotional domains (and generally in the quality of life) than the normal families. The families of the veterans with PTSD showed lower quality in physical, mental, and environmental health domains than the normal families. These are consistent with the studies on the chronic diseases [28-30]. There was a significant difference in cohesion and agreeableness between the families of the veterans with PTSD in the current situations and the families without a patient with PTSD. These are consistent with the other studies [31, 32]. Many years after wars, soldiers have experienced stress, which is the major cause of violence in the home and the immediate and hostile behavior toward wife and children [33]. There were problems in cohesion and agreeableness in the families of the patients. The results are consistent. There are inter-personal violence, marital dissatisfaction, and difficulties in adaptation in the families with patients [34], which are consistent with the present results. … [35-37] The differences in cohesion and agreeableness between the families with patients with PTSD and the families without such patients indicated that there was a deeper separation between the current and the ideal situations in the patients’ families than the other families. Normal families treat the current situation not very separate from the ideal situation.The less the separation, the better the family status is. The results are consistent with the previous results [23, 28, 29, 38, 39], while in the families with patients, dissatisfaction with the current situation leads to deeper separation between the situation and the ideal one.The families of the veterans with PTSD showed higher depression level than families without such patients. The families of patients with chronic mental diseases encounter problems due to the diseases,significantly [21]. Persons, experiencing mental stress and crisis, show symptoms of avoidance, depression, and interpersonal problems [40]. The wives of soldiers with PTSD, being in lower mental health according to self-report questionnaires, bear more stress than the wives of other soldiers [23]. … [41]
Suggestions
To universalize the investigation of the families of the patients with PTSD, McMaster full interview tool should be used, since the tool is as interviews with the family members. In addition, the role and fatigue of the person, as one of the most important and effective family person, must be included as the mediator variables.
Limitations
Difficult and almost impossible groups matching in many variables in the sampling method and low or no association of wives, children, patient, and some of the employees of Martyr Foundation and the hospital due to veterans’ conditions and their sensitivity were of the limitations of this study.
Conclusions
Families, having husband with PTSD, have poor conditions in the structural and emotional domains and generally in quality of life, than the families without husband with PTSD
Acknowledgments
The researchers feel grateful to Aja University of Medical Sciences, all the managers of Jannat Hospital (Shiraz, Iran), and the veterans’ family.
Conflict of interest
Non-declared
Ethical Permissions
All the procedures were approved by Martyrs and Veterans Foundation (Fars Province, Iran).
Funding Sources
The study was funded by Research Deputy of Aja University of Medical Sciences.

TABLES and CHARTS

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