ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Rahnejat   A.M. (1)
Dabagi   P. (*)
Rabiei   M. (2)
Taghva   A. (3)
Valipoor   H. (1)
Donyavi   V. (3)
Ebrahimi   M.R. (3)






(*) Clinical Psychology Department, Medicine Faculty, AJA University of Medical Sciences, Tehran, Iran
(1) Clinical Psychology Department, Medicine Faculty, AJA University of Medical Sciences, Tehran, Iran
(2) Clinical Psychology Department, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
(3) Psychiatry Department , Medicine Faculty , AJA University of Medical Sciences, Tehran, Iran

Correspondence

Address: Shahid Etemadzade Street, West Fatemi Street, AJA University of Medical Sciences, Tehran, Iran
Phone: +98 (21) 22195164
Fax: +98 (21) 22197198
dabaghi_44@yahoo.com

Article History

Received:  June  29, 2016
Accepted:  November 21, 2016
ePublished:  March 10, 2017

BRIEF TEXT


The results of some studies show that almost 25% of people who are exposed to a traumatic event, eventually are diagnosed with PTSD [1-3].

… [4-26]. Donyavi et al. [27] in their descriptive and cross-sectional study on a number of Army Cadre Islamic Republic of Iran in Tehran, estimated the prevalence of this order 14.9%. …[28].

This study aimed to measure the prevalence of post-traumatic stress disorder in military veterans after 26 years of war.

The present study is descriptive and epidemiological one.

This cross-sectional study in 2015 was conducted among all the military forces of the Armed Forces of the Islamic Republic of Iran.

The sample size was estimated 383 using Cochran formula that due to the loss of 10% of respondent, a sample size was considered 400 people. The sample was elected based on cluster random sampling method from 21 units of one of the military units of the armed forces of the Islamic Republic of Iran. Inclusion criteria was being military employed or retired, having a record of presence in the warzone during the eight years of war, having at least high school education, having high motivation and willingness to participate in the research.

The following tools were used to collect data: 1. Post-Traumatic Stress Disorder Checklist-Military Version (PCL-M-5): This is a self-record scale for assessing post-traumatic stress disorder and screening these patients from normal individuals and other patients as a diagnostic tool. The advantage of this checklist is that is short and concise. Running time is approximately 10 minutes. This checklist has been prepared based on DSM-5 diagnostic criteria for the National Centre for Post-Traumatic Stress Disorder of America and include 20 articles that 5 of them are associated to the annoying and unwanted symptoms (Criterion B); 2 of which are related to the symptoms of avoidance (Criterion C); 7 of which are related to negative changes in cognition and mood (Criterion D), and 5 articles are related to the symptoms of arousal and reactivity (Criterion E). … [30]. In the present study, the reliability of Post-Traumatic Stress Disorder Symptoms Checklist (PCL-M-5) was determined using Cronbach`s alpha coefficient and Guttmann. The reliability coefficient of the overall score of PCL-5 based on Cronbach` alpha coefficient and Guttmann was 0.88 and 0.86 respectively, and they were 0.82 and 0.83 for re-experience (criterion B), 0.87 and 0.81 for negative change in cognition and mood (Criterion D), 0.87 and 0.70 for avoidance (criterion C) and 0.87 and 0.90 for arousal and reactivity (Criterion E). Cronbach`s alpha range was between 7.0 to 9.0 indicates that the PCL-5 used in the study had good reliability. 2. Clinician-Administered Post-Traumatic Stress Disorders Scale for DSM-5 (CAPS-5): This scale is a standard scale for assessing PTSD symptoms which has been prepared by the America National Association of PTSD based on DSM-5 diagnostic criteria. This scale has three frequency indicators of the depth and severity of the symptoms that by definition, the severity of the symptoms is the sum of the frequency and the depth is the effect of each symptom. The score of the two first indicators is determined in ascending zero to 4 and the score of severity of symptom is in the range of zero to 8 that least score of 4 (score of 3 for being sure) in the index of severity is essential for the sign of this symptom. … [30-32, 33]. This scale was received from the United States Veterans` Administration. Scoring is done based on the administrative instruction of the scale in form of the structure interview to assess both the presence or absence of signs and symptoms (frequency and repetition of signs in a week and a month), including symptoms with moderate severity or higher and minimum required symptoms in A, B, C, D, and E categories for diagnosis and symptoms of each of the disorders based on DSM-5. In this study the reliability of this scale was 0.89 among four raters. 3-Researcher-Made Demographic Questionnaire: This questionnaire contained questions used to collect data on age, education, degree, duration of presence in war, serving troop during the war, the number of traumatic events experienced during his time in war, beginning time of sign and symptoms after the stressful experience of war, percentage of disability and so on related to PTSD among military veterans. In order to analyze the collected data and determining the current prevalence of PTSD among the veterans, descriptive statistics, and for investigating the relation between demographic variables and prevalence and symptoms of PTSD, Pearson correlation and regression analysis were used.

98% of the respondent aged 45 to 55 years old. Also, 98.2% of them were married. The most frequency of the participants based on the educational level was diploma (39.0%) and the lowest one was related to associate degree (12.0%), respectively. 32.8% of the participants had between one and three years of presence in war and 10.3% had the experience of cavity. 43.1% of them were among common class of military that the most frequency category was military service (61.8%) and the least frequency was related to the category of health service and treatment (3.2%). 53.6% of the samples were retired and 39.0% were employed at the time of study. 80.0% of them had work experience of 25 years and more that the work place of 63.6% of them was the ground force. 78.5% had a history of injuries during the war that they type of injury in 47.2% of these people were both physical and blast wave injuries. The mean age of the participants in time of presence in war was 22.7 ± 6.2. 31.0% of the veterans had some percentage of injury. 41.3% had shown the psychological symptoms and signs immediately after the exposure to trauma that the most traumatic events experienced in the participants respectively included: blast wave (57.1%), intense bombardment (33.1%), martyred comrades (32.5%), one`s injury (32.2%), seeing the bodies of comrades martyr (30.4%), being surrounded by enemy (28.4%), seeing the bodies of the enemies (27.8%), injury of comrades (25.8%), killing enemy troops (24.6%), and captivity (22.2%) respectively. 82(24.0%) of 341 fighters participating in the study, had the PTSD diagnosis symptoms and the most prevalent signs of PTSD in them was arousal and reactivity in the first place, and then negative changes in cognition and mood (Table 1). On the relationship between demographic variables and PTSD, there was a negative and significant relation between the level of education (p<0.01, r=0.191) and the age of presence in the war (p<0.05, r=0.046) on one hand and the score of PCL-5 on the other hand which means that the more is the education level and lower age of presence in the war, the score of PCL-5 was more. Also, there was a positive and significant relation between the duration of war presence (p<0.05, r=0.347) and the score of PCl-5 i.e. along with increasing the duration of presence in war and with more injury and severity of injury, the possibility of the PTSD was increased. Other demographic variables did not have any significant relation with the risk of PTSD. Also, 13% of variance in PTSD, was explained by demographic factors (p<0.01), 10% of which is related to the variable of education level (p=0.04, β=- 0.10) and 3% of it was related to the variable of injury and severity of injury (p=0.0001, β=0.3).

Simultaneous analysis of variance showed that 13% of variance related to PTSD is explained by demographic variables of injury, severity of injury, duration of presence in war, the age of presence in war and level of education that this finding is almost consistent with the results of similar studies among veterans [8, 18, 20-22, 24-26, and 34-41].

It is suggested that in future researches, this research be repeated with larger sample size of warriors to ensure the generalizability of the findings of this study, the prevalence of psychiatric disorders comorbid with PTSD be investigated and the prevalence of this order in the total armed forced participating in war be estimated.

The most important limitation of this study is the lack of generalizability of the current study to the other military forces. Also, given that this disorder is accompanied with psychiatric and physical disorders such as depression, panic attacks, drug and alcohol abuse and other psychiatric problems, chronic pain, problems in marital relation, and social problems, one of the other important limitation of this study was lack of assessment of mental disorders comorbid with PTSD. Another limitation was associated with dissatisfaction with the service and negative attitude. Therefore, some participants did not have complete participation in implementing of the study and did not fill the questionnaire completely.

After 26 years of war, a large number of military veterans still have PTSD disorders and the most common symptoms of them are arousal and reactivity.

The authors of this study appreciate all the warriors who participated in this study.

Non-declared

This study was confirmed in the ethical committee of the university associated to the authors.

This study is a part of a research work that has been conducted by financial support of Iran Army Military University of Medical Sciences between 2015 and 2016.

TABLES and CHARTS

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