Anxiety, Depression, and Posttraumatic Stress in Iranian Survivors of Chemical Warfare | Depressive Disorders | JAMA | JAMA Network
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1.
Taheri Shemirani S. The war of the cities. In: Rajaee F, ed. The Iran-Iraq War: The Politics of Aggression. Gainesville: University Press of Florida; 1993
2.
 News chronology: November 1994 through February 1995.  Chemical Weapons Convention Bulletin: Quarterly Journal of the Harvard Sussex Program on CBW Armament and Arms. 1995;28:20Google Scholar
3.
 Holt World History: The Human Journey.  Pupil’s Edition Full Volume. http://go.hrw.com/hrw.nd/gohrw_rls1/pKeywordResults?keyword=st9%20iran%201988. Accessibility verified July 11, 2006
4.
Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries.  Lancet. 2005;365:1309-131415823380Google ScholarCrossref
5.
Cardozo BL, Bilukha OO, Crawford CA.  et al.  Mental health, social functioning, and disability in postwar Afghanistan.  JAMA. 2004;292:575-58415292083Google ScholarCrossref
6.
de Jong JT, Komproe IH, Van Ommeren M.  et al.  Lifetime events and posttraumatic stress disorder in 4 postconflict settings.  JAMA. 2001;286:555-56211476657Google ScholarCrossref
7.
Ohtani T, Iwanami A, Kasai K.  et al.  Post-traumatic stress disorder symptoms in victims of Tokyo subway attack.  Psychiatry Clin Neurosci. 2004;58:624-62915601387Google ScholarCrossref
8.
Schnurr PP, Friedman MJ, Green BL. Posttraumatic stress disorder among World War II mustard gas test participants.  Mil Med. 1996;161:131-1368637639Google Scholar
9.
Schnurr PP, Ford JD, Friedman MJ, Green BL, Dain BJ, Sengupta A. Predictors and outcomes of posttraumatic stress disorder in World War II veterans exposed to mustard gas.  J Consult Clin Psychol. 2000;68:258-26810780126Google ScholarCrossref
10.
Khateri S, Ghanei M, Keshavarz S, Soroush M, Haines D. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent.  J Occup Environ Med. 2003;45:1136-114314610394Google ScholarCrossref
11.
Ghanei M, Aslani J, Khateri S, Hamadanizadeh K. Public health status of the civil population of Sardasht 15 years following large-scale wartime exposure to sulfur mustard.  J Burns Surg Wound Care. 2003;2:1-9http://www.journalofburnsandwounds.com/volume02/volume02_article07.pdf. Accessed June 30, 2006Google Scholar
12.
Beck AT, Beck RW. Screening depressed patients in family practice.  Postgrad Med. 1972;52:81-854635613Google Scholar
13.
Hamilton A. Diagnosis and rating of anxiety.  Br J Psychiatry. 1969;3:(special publication)  76-79Google Scholar
14.
Blake DD, Weathers FW, Nagy LM.  et al.  The development of a Clinician-Administered PTSD Scale.  J Trauma Stress. 1995;8:75-907712061Google ScholarCrossref
15.
Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory–Second Edition: BDI-II-PERSIAN.  Depress Anxiety. 2005;21:185-19216075452Google ScholarCrossref
16.
Malekzai AS, Niazi JM, Paige SR.  et al.  Modification of CAPS-1 for diagnosis of PTSD in Afghan refugees.  J Trauma Stress. 1996;9:891-8988902755Google ScholarCrossref
17.
Kavyani H, Mossavi AS, Mohit A. Psychological Scales and Interviews (Farsi). Tehran, Iran: Sana Publications; 2001:179-205
18.
Schnurr PP, Friedman MJ, Rosenberg SD. Premilitary MMPI scores as predictors of combat-related PTSD symptoms.  Am J Psychiatry. 1993;150:479-4838434666Google Scholar
19.
Strokes ME, Davis CS, Koch GG. Categorical Data Analysis Using the SAS System. 2nd ed. Cary, NC: SAS Institute Inc; 2000
20.
Scott SC, Goldberg MS, Mayo NE. Statistical assessment of ordinal outcomes in comparative studies.  J Clin Epidemiol. 1997;50:45-559048689Google ScholarCrossref
21.
Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak.  Psychiatry. 2002;65:207-23912405079Google Scholar
22.
Scholte WF, Olff M, Ventevogel P.  et al.  Mental health symptoms following war and repression in eastern Afghanistan.  JAMA. 2004;292:585-59315292084Google ScholarCrossref
23.
Kulka RA, Schlenger WE, Fairbank JA.  et al.  Trauma and the Vietnam War Generation. New York, NY: Brunner/Mazel; 1990
24.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey.  Arch Gen Psychiatry. 1995;52:1048-10607492257Google ScholarCrossref
25.
Deering CG, Glover SG, Ready D, Eddleman HC, Alarcon RD. Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma.  Compr Psychiatry. 1996;37:336-3468879908Google ScholarCrossref
26.
Davidson JR, Kudler HS, Saunders WB, Smith RD. Symptom and comorbidity patterns in World War II and Vietnam veterans with posttraumatic stress disorder.  Compr Psychiatry. 1990;31:162-1702311383Google ScholarCrossref
27.
Green BL, Lindy JD, Grace MC. Posttraumatic stress disorder.  J Nerv Ment Dis. 1985;173:406-4114009157Google ScholarCrossref
28.
McCall GJ, Resick PA. A pilot study of PTSD symptoms among Kalahari Bushmen.  J Trauma Stress. 2003;16:445-45014584628Google ScholarCrossref
29.
Kessler RC. Posttraumatic stress disorder.  J Clin Psychiatry. 2000;61:(suppl 5)  4-1210761674Google Scholar
Original Contribution
August 2, 2006

Anxiety, Depression, and Posttraumatic Stress in Iranian Survivors of Chemical Warfare

Author Affiliations
 

Author Affiliations: Department of Epidemiology and Public Health, (Ms Hashemian and Drs Khoshnood, Desai, and Kasl) and Department of Psychiatry (Drs Desai and Southwick), Yale University School of Medicine, New Haven, Conn; Northeast Program Evaluation Center and Mental Illness Research, Education, and Clinical Center (Dr Desai) and National Center for PTSD (Dr Southwick), VA Connecticut Healthcare System, West Haven, Conn; and Chemical Warfare Victims Unit, Organization of Veterans Affairs, Tehran, Iran (Dr Falahati).

JAMA. 2006;296(5):560-566. doi:10.1001/jama.296.5.560
Abstract

Context In the 1980-1988 Iran-Iraq War, extensive use of chemical weapons resulted in high rates of morbidity and mortality. While much is known about the physical consequences of chemical warfare, there is a paucity of information about the long-term effects of chemical attacks on mental health.

Objective To assess the long-term psychological impact of chemical warfare on a civilian population.

Design, Setting, and Participants Cross-sectional randomized survey conducted in July 2004 of 153 civilians in 3 towns exposed to warfare in northwestern Iran: Oshnaviyeh (low-intensity conventional warfare), Rabat (high-intensity conventional warfare), and Sardasht (both high-intensity conventional warfare and chemical weapons).

Main Outcome Measures Full or partial posttraumatic stress disorder (PTSD) diagnosis, anxiety symptoms, and depressive symptoms were assessed using Farsi versions of the Clinician-Administered PTSD Scale, Hamilton Scale for Anxiety, and Beck Depression Inventory, respectively.

Results Overall participation rate was 93%. Respondents had a mean age of 45 years and were all of Kurdish ethnicity. Among individuals exposed to both high-intensity warfare and chemical weapons, prevalence rates for lifetime PTSD, current PTSD, major anxiety symptoms, and severe depressive symptoms were 59%, 33%, 65%, and 41%, respectively. Among the low-intensity warfare group, the corresponding rates were 8%, 2%, 18%, and 6%, respectively, while intermediate rates were found among those exposed to high-intensity warfare but not to chemical weapons (31%, 8%, 26%, and 12%, respectively). Compared with individuals exposed to low-intensity warfare, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (odds ratio [OR], 18.6; 95% confidence interval [CI], 5.8-59.4), current PTSD (OR, 27.4; 95% CI, 3.4-218.2), increased anxiety symptoms (OR, 14.6; 95% CI, 6.0-35.6), and increased depressive symptoms (OR, 7.2; 95% CI, 3.3-15.9). Exposure to high-intensity warfare but not to chemical weapons was also significantly associated with lifetime PTSD (OR, 5.4; 95% CI, 1.7-17.6), compared with those in the low-intensity warfare group. Further, compared with individuals exposed to high-intensity warfare alone, those exposed to both high-intensity warfare and chemical weapons were at higher risk for lifetime PTSD (OR, 3.4; 95% CI, 1.5-7.4), current PTSD (OR, 6.2; 95% CI, 2.0-20.1), increased anxiety symptoms (OR, 5.6; 95% CI, 2.5-12.6), and increased depressive symptoms (OR, 3.7; 95% CI, 1.8-7.2).

Conclusion Exposure to chemical warfare is an extreme traumatic event that has long-lasting adverse consequences on mental health.

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