@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2018;10(4):221-226

Background
The stresses caused by the eight-year Iran-Iraq war have caused many psychological disorders in veterans. According to the national and international studies, veterans are more involved than the normal people with disorders such as anxiety, obsession, and depression, and the symptoms of post-traumatic stress disorder (PTSD) such as depression and anger are associated with their risk of suicide [1-3].
Previous Studies
... [4-22]. Defense mechanisms are psychologically considered in the conceptualization of psychiatric disorders and their treatment and mental disorders are associated with certain immature defense mechanisms [23]. ... [24, 25]. Individuals with mature defense mechanisms can greatly deal with psychological stresses, solving conflicts, and controlling anger. Such potent and mature functions can indicate the Ego's power to cope with stresses and adaptive emotional adjustment. However, immature defense mechanisms have been associated with many negative health factors, such as personality disorders and depression [22, 23, 26]. ... [27, 28]. It has been shown that there is a significant relationship between the level of compatibility with military services and the family environment of the soldiers by using mature mechanisms [29]. Individuals with neurotic defense mechanisms have a lower level of compatibility compared with those with mature defense mechanisms, and those who often use immature defense mechanisms have difficulty in adjusting, expressing and understanding emotional experiences and controlling anger [20, 30, 31]. It has been demonstrated that veterans with mental health more use problem-focused coping strategy, and those who have mental health disorders more use maladaptive coping strategies [32, 33], and those with PTSD and the disabled veterans more use maladaptive coping strategies [33, 34].
Aim(s)
The aim of this study was to compare the mature, immature, and neurotic defense mechanisms in the veterans and normal people.
Research type
The present study is a causal-comparative retrospective research.
Research society, place and time
This study was done on the veterans supported by the Tehran Foundation of Martyrs and Veterans Affairs, as well as normal people over 25 years old living in Tehran, in 2016.
Sampling method and number
Using convenience sampling method, 40 veterans and 40 normal people were selected. The veterans were selected from the Sarallah Rehabilitation Hospital, Sadr Psychiatric Hospital, and Niyayesh Psychiatric Hospital and the normal people were selected from the spouses of female students from the Tehran Cognitive-Behavioral Center. Due to the empirically standard sample size for causal-comparative studies (15 subjects in each group) [35], 40 subjects were assigned to each group, given the possible withdraw in participants. The questionnaires were completed accurately by the participants. Inclusion criteria included the informed consent to participate in the research, veterans with at least 20% level of injury, the male gender, and lack of psychiatric disorders according to their documents. The exclusion criteria included non-willingness to continue the study.
Used devices&materials
The Defense Styles Questionnaire (DSQ) was used as the research tool. It was developed by Andrews et al. in 1993. DSQ comprises of 40 items in a 9-point Likert format: (1: totally agree to 9 totally disagree). It assesses 20 defense mechanisms and three defense styles in three categories, including mature, immature, and neurotic. The reliability of DSQ was reported 0.46 to 0.86 through the re-test method and its internal consistency for mature, neurotic, immature styles was reported 0.68, 0.58, and 0.80 respectively [31]. The acceptable correlation between NEO PI.R inventory and defense styles questionnaire can indicate the acceptable validity of this scale. The high Cronbach's alpha of DSQ in the studied groups (0.81 to 0.87) and the high correlation in two times uses, showed the desirable reliability of this questionnaire [36]. In Iran, using Cronbach's alpha and split half method, the reliability of DSQ was calculated 0.84 and 0.82 for the total score of the questionnaire, 80.8 and 0.80 for immature defense style, 0.55 and 0.63 for mature defense style, and 0.55 and 0.60 for neurotic defensive style, respectively, which indicate a relatively favorable reliability for this questionnaire [23]. The mature defense mechanisms include sublimation, humor, anticipation, and suppression. Neurotic defense mechanisms include undoing, false altruism, idealization, and regression. Immature defense mechanisms include projection, passive aggression, transition to operation, isolation, making unworthy, autistic thinking, denial, displacement, segregation, twofoldness, reasoning, and somatization. In this research, using Cronbach's alpha, the internal consistency in the normal people and veterans were 0.70 and 0.77 for the mature defense mechanisms, 0.47 and 0.65 for neurotic defense mechanisms, and 0.60 and 0.75 for immature defense mechanisms, respectively. Data was analyzed using SPSS 22. Kolmogorov-Smirnov test was used to examine the normal distribution of the scores of defense mechanisms in the normal people and veterans, Leven test to evaluate the homogeneity of error variances in each dimension of defense mechanisms in two groups, independent T-test to examine the homogeneity of ages, Box's M to investigate the variance-covariance matrix of dependent variables for the scores of the studied groups, Bartlett's Curtis test to investigate the correlation between dependent variables, Multivariate covariance analysis to examine the differences in using defense mechanisms in two groups, and Bonferroni's post hoc test to assess the difference between each defense mechanism (mature, immature, and neurotic) between the two groups.
Findings by Text
The age range of veterans was between 45 and 65 years and the age range of normal people was between 25 and 72 years. The average age of men in the veteran group was 52.25±4.75 years and 42.28±10.97 years in the normal people (Table 1). There was a significant difference in mean age scores between two groups (t=9.975, p<0.01), which indicates that the age of the participants was not homogeneous. Accordingly, the age was controlled as the covariate variable.There was no variances homogeneity in the immature defense mechanism (p=0.036), but it can be said that it was not so beyond what was expected and it was expected not to discredit the results of the analysis, due to the same sample size of the groups. There was a significant difference between normal people and veterans in using various defense mechanisms through controlling the effect of age (F=8.420, p<0.01). There was a significant difference between the mean scores of the mature and immature defense mechanisms in the normal people and veteran groups, so that veterans were more likely to use immature defense mechanisms than normal people, and were less likely to use mature defense mechanisms. The mean scores of neurotic defense mechanisms were not significantly different between two groups (Table 2).
Main comparison to the similar studies
According to the findings, veterans were more likely to use immature defense mechanisms than normal people, and were less likely to use mature defense mechanisms, whereas there was no significant difference in using neurotic defense mechanisms among the groups. The results of this study were consistent with the results of studies by Nezami [27], Ehtesham Zadeh et al. [23], Dortaj [37], Bahrami et al. [34], Cadigan et al. [38], and Aqdasi & Eydi [39]. ... [40-43]. According to the findings of this research, normal people use mature defense mechanisms in dealing with problems, by which they may be more satisfied with optimized balance between opposing motives. The mature defense mechanism, as the dominant mechanism in normal people (such as suppression and sublimation), can facilitate their exposure to psychological changes and stressful environmental stimuli and result in consistent adaptation. Well-being, positive function, and psychosocial compatibility are recognized as the outcomes of mature defense mechanisms [22, 31, 43]. The results showed that there was no significant difference between veterans and normal people to use immature and neurotic defense mechanisms. Although it was not expected, Besharat indicated that normal people also use neurotic defense mechanisms in some occasions; however it may not be the dominant mechanism of the normal people [31].
Suggestions
It is suggested that future studies should be done on different types of defense mechanisms, including mature, immature, and neurotic with regard to the level and type of injury of the veterans.
Limitations
The lack of the same level of injury in veterans can be considered as one of the limitations of this study. In addition, in this study, the homogeneity of the occupation status in the two groups was not possible. Furthermore, the random selection of sample groups was not possible, so that caution should be taken to generalize the findings.
Conclusions
Veterans use more mature and immature defense mechanisms than normal people, but they do not differ in the use of neurotic defense mechanisms.
Acknowledgments
The authors are grateful to those who have made this research possible, as well as the veterans who participated in this study.
Conflict of interest
None declared.
Ethical Permissions
Participating in this study did not have any passible disadvantage to the participants and their consent to participate was obtained and their information remained confidential, a well.
Funding Sources
There was no financial support from a person or organization.

TABLES and CHARTS

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