Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran–Iraq war

Aims and method

Post-traumatic stress disorder (PTSD) has been reported in 90% of chemical warfare victims in previous studies. An individual's traumatic experience(s) may affect the lives of other family members as well. This cross-sectional case–control study compared the prevalence of PTSD symptoms in the husbands, the secondary PTSD symptoms in the wives and also aimed to identify if there was an association between the PTSD symptoms of the couples in the case group. Cases were 150 husband–wife couples where husbands were civilians exposed to chemical warfare; the controls were 156 husband–wife couples where there was no such exposure. Both cases and controls were recruited from Sardasht in Iran; this Kurdish city was attacked by four 250 kg sulphur mustard warheads in June 1987.

Results

Across three sets of cut-off points for the Mississippi Scale for Combat-Related PTSD symptomotology (<120 and ⩾121; <106 and ⩾107; and <65, 65–130 and > 130) wives in the case group demonstrated higher rates of PTSD symptoms than did those in the control group; the difference was statistically significant. Furthermore, husbands in the case group had a significantly higher overall mean score (123.0 (s.d. = 17.2)) than the husbands in the control group (112.3 (s.d. = 21.7); P<0.001, t = 4.80). There was no statistically significant association between the overall PTSD score of the husbands in the case group with that of their wives (P = 0.274, correlation coefficient 0.092).

Clinical implications

Husbands who were exposed to the chemical agents reported higher PTSD symptoms and there were higher rates of PTSD symptoms among the wives of individuals who were exposed to chemical warfare. Study results suggest the need for coordinated treatments, policy efforts and interventions to improve the wellbeing of chemical warfare victims and their caregiver wives.

Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study

Background

Sulfur mustard (SM) has been used as a chemical warfare agent since the early twentieth century. Despite the large number of studies that have investigated SM induced ocular injuries, few of those studies have also focused on the psychological health status of victims. This study has evaluated the most prominent influences on the psychological health status of patients with severe SM induced ocular injuries.

Methods

This descriptive study was conducted on 149 Iranian war veterans with severe SM induced eye injuries. The psychological health status of all patients was assessed using the Iranian standardized Symptom Check List 90-Revised (SCL90-R) questionnaire. The results of patients' Global Severity Index (GSI) were compared with the optimal cut-off point of 0.4 that has previously been calculated for GSI in Iranian community. The Mann-Whitney U test, T tests and effect sizes (using Cohen's d) were employed as statistical methods. Data were analyzed using SPSS software.

Results

The mean age of patients was 44.86 (SD = 8.7) and mean duration of disease was 21.58 (SD = 1.20) years. Rate of exposure was once in 99 (66.4%) cases. The mean GSI (1.46) of the study group was higher compared to standardized cut off point (0.4) of the Iranian community. The results of this study showed that the mean of total GSI score was higher in participants with lower educational levels (effect size = 0.507), unemployment (effect size = 0.464) and having more than 3 children (effect size = 0.62). Among the participants, 87 (58.4%) cases had a positive psychological history for hospitalization or receiving outpatient cares previously and 62 (41.6%) cases had a negative psychological history. In addition, the mean of GSI in participants with negative psychological history was lower than those with positive psychological history (Mean Change Difference = -0.621 with SD = 0.120). There was a significant difference between positive and negative psychological history with respect to GSI (P < 0.001).

Conclusion

The study showed that severe ophthalmologic complications in chemical survivors are accompanied with destructive effects on psychological health status. Appropriate management may improve psychological health status in these patients.

Subjective age, PTSD and physical health among war veterans

OBJECTIVES

To examine the contribution of posttraumatic stress disorder (PTSD) and physical health to subjective age among war veterans.

METHOD

The sample included 502 veterans of the first Lebanon War who were assessed 20 years after the war by a series of self-report questionnaires. Data analyses included descriptive statistics, hierarchical and logistic regressions.

RESULTS

Veterans with PTSD reported older subjective age than veterans without PTSD. Furthermore, both PTSD and general physical health contributed to subjective age, above and beyond chronological age and negative life events. Among the physical health problems, memory problems and weight gain were found to contribute to older age identity. In addition, the relation between general physical health and subjective age was stronger among veterans without PTSD than among veterans with PTSD.

DISCUSSION

Possible explanations, clinical implications for integrative therapy for elderly PTSD victims, and recommendations for future research are presented.

Posttraumatic stress disorder and health-related quality of life among a sample of treatment- and pension-seeking deployed Canadian Forces peacekeeping veterans

OBJECTIVES

To examine the health-related quality of life (HRQOL) in deployed Canadian Forces peacekeeping veterans, addressing associations with posttraumatic stress disorder (PTSD), and depression severity.

METHODS

Participants (n = 125) were consecutive male veterans who were referred for a psychiatric assessment. Instruments administered included the Clinician-Administered PTSD Scale, Hamilton Depression Scale, Short-Form-36 Health Survey, and sociodemographic characteristics.

RESULTS

Mental HRQOL was significantly lower for peacekeepers with, than without, PTSD. Using univariate analyses, PTSD and depression severity were each significantly negatively related to mental HRQOL. In sequential regression analyses controlling for age, we found that PTSD and depression severity significantly predicted both mental and physical HRQOL.

CONCLUSIONS

Veterans with PTSD have significant impairments in mental and physical HRQOL. This information is useful for clinicians and Veterans Affairs administrators working with the newer generation of veterans, as it stresses the importance of including measures of quality of life in the psychiatric evaluation of veterans to better address their rehabilitation needs.

Health and well being of substance use disorder patients with and without posttraumatic stress disorder

While studies link posttraumatic stress disorder (PTSD) to substance use disorders (SUDs), little is known about the health and functional status of patients with such comorbidity. This study examined the health and well being of SUD patients with and without PTSD. Participants were assessed using structured clinical interviews and self-administered questionnaires assessing chronic physical symptoms, and functional status and well being. PTSD was significantly associated with more cardiovascular, neurological, and total chronic physical symptoms. In addition, PTSD was significantly related to poorer functional status and well being, particularly in the mental health realm of functioning. The association between PTSD and mental health component of functional health and well-being remained significant after controlling for chronic physical symptoms and other comorbid psychopathology.

Posttraumatic stress disorder and health status among female and male medical patients

Posttraumatic stress disorder (PTSD) is associated with objective health problems in specific populations, such as Vietnam veterans. Less is known about PTSD and health among medical samples, especially PTSD patients with different etiologic traumas. This study examined PTSD and health in medical patients within the Department of Veterans Affairs healthcare system. A total of 134 patients completed an interview and questionnaires. Data on physician-diagnosed illnesses were gathered from medical records. PTSD diagnosis and symptoms were associated with a higher likelihood of circulatory and musculoskeletal disorders. In addition, PTSD symptoms were associated with more medical conditions. PTSD symptoms and diagnoses were also associated with poorer health related quality of life. Most of these findings remained significant after controlling for comorbid depressive, generalized anxiety disorder, and panic attack symptoms. Overall, gender did not moderate the relationship between PTSD and poorer health.

In vitro neurotoxic and DNA-damaging properties of nitrogen mustard

Sulfur mustard and nitrogen mustard (HN2) are reported to produce neurobehavioral and neuropathological changes in animals and humans, but the mechanisms are unknown. We examined the cytotoxic properties of HN2 in cultures of dividing and post-mitotic neurons and astrocytes, which comprise the majority of cells in the central nervous system. Cultures of rat cerebellar astrocytes, post-mitotic granule cell neurons or dividing and terminally differentiated human SY5Y neuroblastoma cell cultures were treated with various concentrations of HN2 for 24 h. After treatment, culture medium was removed, the cell monolayer was incubated for 30 min with calcein-AM (green, live cells) and propidium iodide (red, dead cells) in control medium, the fluorochrome-containing medium was removed and replaced with control medium and cell density and viability were examined by fluorescence and light microscopy. Extensive cell loss (>90%) was observed in rat neuronal and SY5Y neuroblastoma cell cultures treated with 10 microM HN2, whereas cell loss was similar to controls in comparably treated astrocyte cultures. The DNA from HN2-treated cultures of rat neurons and SY5Y neuroblastoma cells was examined by high-performance liquid chromatography with electrochemical detection for the major HN2 DNA adduct N-(2-hydroxyethyl)-N[2-(7-guaninyl)ethyl]methylamine (GMOH). GMOH was detected in rat neuronal (85 fmol microg(-1) DNA) and SY5Y neuroblastoma cell cultures (46 fmol microg(-1) DNA) treated with 10 microM HN2 for 24 h, but was not detected in comparably treated astrocyte cell cultures. These findings are consistent with HN2 preferentially targeting neurons in vivo, possibly through a mechanism involving DNA damage.