Article Type

Descriptive & Survey Study


Rostamizadeh   A. (1)
Abolfathi Momtaz   Y. (*1)
Foroughan   M. (1)

(1) Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran


Address: Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Koodakyar Street, Daneshjoo Boulevard, Velenjak Square, Tehran, Iran. Postal Code: 1985713834.
Phone: +98 (21) 71732256
Fax: +98 (21) 22180154

Article History

Received:  January  26, 2020
Accepted:  May 18, 2020
ePublished:  June 17, 2020


One of the most important problems caused by the war for people is post-traumatic stress disorder (PTSD), which is associated with unpredictable, destructive, and long-term consequences for the injured people, their family, and the community in which they live [1].

...[2]. Based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), PTSD includes a set of symptoms following a traumatic stressor and usually involves a perceived threat to life or physical integrity and severe fear, helplessness, or panic. [3] ...[4-16]. PTSD includes symptoms that interfere with trust, emotional closeness, interpersonal relationships, and problem-solving skills. These symptoms can make a problem in these people's families and affect their quality of life [17]. In the elderly, recurrence of this disorder is seen after years due to changes in lifestyle, death of relatives, close friends, and acquaintances, loss of abilities and physical strength and the presence of chronic and debilitating diseases, reduction of social networks, and loss of life plans, [18]. ...[19-22]. In addition to the psychological and physical problems associated with old age, the older people in war-torn areas have a long and bitter experience of war. Numerous studies on the consequences of war have been conducted on various military and civilian groups. None of them addressed the long-term effects of war-related psychological trauma on the elderly as a vulnerable group.

This study aimed to evaluate the rate of PTSD and its related factors in the elderly survivors of Ilam.

This is a retrospective cohort study.

This research was carried out in between the elderly in Ilam city in 2019-2020.

The sample size was estimated to be about 230 people using Cochran's formula. The sample was performed by the proportional multi-stage random sampling method. Considering that Ilam city has 18 health centers (11 health centers and seven health resorts), first Ilam city was divided into four geographical areas (north, south, east, west). This division was specified in the health center of Ilam city. According to this division, the northern, south, east, and west regions had 5, 3, 5, and 5 centers, respectively. In the next step, a health center was randomly selected from the north, south, east, and west regions. The SIB system was used to access the samples. Profiles of older people covered by each health center were extracted based on name and surname. This data was then entered into Excel, and several older people were selected by random sampling and according to the proportion of older people covered by each center. Inclusion criteria include not being military during the imposed war and currently being 60 years old or older who lived in Ilam during the Iraq-Iran war and now reside in Ilam, conscious consent to participate in this study, and the ability to communicate verbally. Exclusion criteria were unwillingness to continue participating in the study or the occurrence of an acute illness during the interview.

NSESSS-PTSD (National Stressful Events Survey Acute Stress Disorder Short Scale) was used to measure PTSD [23]. Rafiei et al. performed this tool on 600 survivors of the East Azerbaijan earthquake (Ahar, Harris, and Varzeqan), including the elderly, for measuring its validity and reliability. Cronbach's alpha was optimal for the Persian version of NSESSS-PTSD (α=0.88), which was consistent with the results of the original English version (α=0.91) and Turkish translation (α=0.87) and showed high reliability for measurement [24]. The questioner completed the questionnaire after obtaining permission by phone call and visiting the homes of the elderly. Questionnaire information contained a set of demographic characteristics (education, gender, age, marriage, marital status, and occupation), the NSESSS-PTSD tool, and a history of chronic illness by self-report. Descriptive statistics and independent T-test, ANOVA, and correlation test were used to assess PTSD-related factors by SPSS 23 software.

The mean age of the participants was 66.67±7.16. 54.2% of the participants were female. The highest and lowest frequency of participants in terms of the educational degree was related to illiterate people with 58.1% and theological education with 0.4%. The demographic information of the elderly during the war has been reported in Table 1. The rate of PTSD in the study population was 16.3%. The results of the inferential analysis showed that there was a significant relationship between marriage (p=0.05; t=1.96), employment (p=0.002), witnessing injury and killing (p=0.009; t=-2.64), and the age of the people at the time of the accident (p=0.05; r=-0.13) with PTSD. There was also a significant relationship between gender (P=0.006; t=2.77) and current education (p=0.029; F=3.60) with PTSD. Among 227 subjects, cardiovascular disease, hyperlipidemia, hypertension, diabetes, gastrointestinal disorders, musculoskeletal disorders, cancer, chronic respiratory diseases, vision problems, hearing problems and depression or anxiety problems were observed in 25.6%, 21.6%, 43.2%, 13.2%, 23.8%, 28.2%, 0.4%, 5.3%, 8.8%, 9.3% and 17.2% of the elderly, respectively. The results showed no significant relationship between cardiovascular disease, hypertension, vision problems, and chronic respiratory diseases with PTSD (p<0.05). There was a significant relationship between hyperlipidemia, diabetes, gastrointestinal disorders, musculoskeletal disorders, hearing problems, depression, and anxiety with PTSD (p<0.05; Table 2).

The results of the present study showed PTSD in the elderly survivors of bombardment. Glasmer et al. estimated the PTSD rate to be 3.4 to 7.2% [18]. In other studies, this value was between 0.9 and 13% [26], and in the study of Nowsord et al. [27], 13.3% was mentioned. The present study results showed a significant relationship between lifestyle and PTSD, which was inconsistent with the results of the study of Shin et al. [28] and was in accordance with the study of Mohammadabadi et al. [21]. …[29]. There was no significant relationship between injuries (veterans) and PTSD, which was consistent with the study of Ahmadi et al. [30] and was inconsistent with the study of Rahnajat et al. [3], and Kamalmanesh et al. [4]. There was a significant relationship between a person's current education and PTSD. This means that the rate of PTSD was higher in the elderly with higher education than in the elderly with less education, which was consistent with the study of Shin et al. [28] but was inconsistent with the results of Javidi & Yadali [5], Ahmadi et al. [12], and Rahnjat et al. [3] studies. According to the results of this study, the rate of PTSD in women was higher than in men, which is consistent with the studies of Kessler et al. [31], Halligan et al. [32], Zadok & Kaplan [33], Khou et al. but it was inconsistent with the study of strategies and colleagues. The results of this study showed that age could inversely predict this disorder. Another result of the study was the relationship between marital status at the time of the accident. The current PTSD rate, which was consistent with the studies of Cook et al. [37], Shin et al. [28], Abbasi et al. [7] but was inconsistent with the study of Narimani et al. [35] There was a significant relationship between the status of witnessing the injury or death of someone at the time of the accident and the rate of PTSD in the elderly, which was consistent with the studies of Morina et al. [34], and Khou et al. [16]. There was a relationship between diabetes and PTSD, which the studies of Vaxarino et al. [38] and Saeedi [39] confirm this result. A significant relationship was found between hyperlipidemia and PTSD, which was consistent with the studies of Solter et al. [40], Maya et al. [41], Sadeghi et al. [42] but was inconsistent with the study of Fakhari et al. [43]. There was a significant relationship between musculoskeletal disorders and PTSD. This finding was consistent with the studies of Buskemi et al. [44], Samani & Ghallea Jahi [45], Mulla Agha Babaei et al. [46]. There was a significant relationship between hearing disorders and PTSD, which is consistent with the studies of Fagelson et al. [47], and Firoozeh & Khalidin [48]. There was a significant relationship between depression and anxiety with PTSD. This means that people with depression and anxiety have a higher rate of PTSD, which is consistent with the studies of Kashedan et al. [49], Morina et al. [34], and Khodadadi et al. [50].

It is recommended that older women, unmarried women, people who have witnessed injuries and deaths, and people with chronic illnesses be screened for more services. In future studies, this study should be repeated in a larger sample size than the elderly to ensure the findings' generalizability further. On the other hand, the interaction of this disorder with the lack of proper development of the province in economic, welfare, social, health, and medical aspects can increase the residents' harmfulness, which requires serious attention from officials.

One of the limitations of this study was the study of PTSD in the elderly of Ilam city (civilian survivors) after 31 years after the war. Therefore, the possibility of encountering other traumatic events in addition to war and bombing during this period may be present, and the person may not remember it. Also, the validity and reliability of the NSESSS-PTSD instrument were performed on earthquake survivors (Ahar, Harris, and Varzeqan), which differs from the study population in terms of culture and language.

16.3% of the elderly survivors of the Ilam city's bombardment have post-traumatic stress disorder (PTSD).

The cooperation and assistance of the officials and the elderly participating in this research are appreciated.

There is no conflict of interest.

This study has been approved by the ethics code IR.USWR.REC.1398.103 in Tehran University of Social Welfare and Rehabilitation Sciences.

No cases have been reported by the authors.


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