The challenges experienced by Iranian war veterans living with chemical warfare poisoning: a descriptive, exploratory study

The impact of sulfur mustard on quality of life and mental health in Kurdish survivors in Sweden, thirty years after exposure

BACKGROUND

The Iraqi state used chemical warfare agents (CWAs) like sulfur mustard (SM) in al-Anfal genocide in the present-day Kurdistan Region of Iraq. In addition to somatic injuries, exposure to CWAs causes biopsychosocial complications. We investigated the long-term impact of SM exposure on quality of life (QoL) and depression severity in Kurdish survivors resettled in Sweden.

METHODS

This is a case-control study, where subjects exposed to SM (n = 18, mean age 51.3 years, 50% women) and sex- and age-matched nonexposed subjects (n = 30, mean age 48.7 years, 47% women) of Kurdish residents in Sweden. Data were collected through in-person interviews based on the RAND 36-item Short Form Health Survey to assess QoL and the Montgomery-Åsberg Depression Rating Scale-self assessment (MADRS-S) to investigate the presence and the gravity of depressive symptoms.

RESULTS

The SM-exposed group had a significantly lower QoL than the nonexposed group (p < 0.001). Also, the overall mean MADRS-S scores among the SM-exposed group, corresponding to moderate depression, were higher than the scores of the nonexposed (22 points (p) vs. 9 p, p < .001). Overall, the participants within the exposed group reported worse mental than physical well-being 36p and 32p, respectively. Within the SM-exposed group, there was no gendered-related difference neither in terms of depression severity nor for QoL, but the groups were small.

CONCLUSION

Individuals exposed to SM had worse QoL and a higher level of depressive severity compared with nonexposed individuals three decades after exposure, indicating the importance of increased clinician knowledge, guidelines, and an approach to assess and respond to the exposed groups' biopsychosocial needs. These findings indicate that those exposed to SM might need early identification of mental illnesses and more support to promote QoL.

Gendered lived experiences of marriage and family following exposure to chemical warfare agents: content analysis of qualitative interviews with survivors in Halabja, Kurdistan-Iraq

OBJECTIVE

To study gendered experiences of the long-term effects of a chemical warfare agent (CWA; sulfur mustard).

DESIGN

Qualitative face-to-face semi-structured in-depth interview study using content analysis approach with thematic analysis and anthropological inquiries.

SETTING

The city of Halabja in the Kurdistan Region of Iraq.

PARTICIPANTS

Survivors of CWA (n=16, female:male 10:6, mean age 45.5 years (range 34 to 67)) with lung damage diagnosis and with a range of sociodemographic variables.

RESULTS

Latent content was expressed as: To get or not to get married? Two categories-social abandonment and uncertain marriage-emerged as expressions of the manifest content. The majority of the participants showed uncertainty as a central concern that affects all decision-making in their private and social life. Uncertainty over marriage and family were huge, corresponding to their fear of giving birth to children with congenital birth defects. Exposure to CWAs was conceptualised in terms of stigmatised illnesses, and consequently resulted in loneliness and social isolation, leading to negative impacts on other aspects of professional and social life. The results demonstrated a gendered pattern: CWA-exposed women were more affected psychosocially than CWA-exposed men. More CWA-exposed women were unemployed, divorced or single, or lived under vulnerable circumstances compared with men.

CONCLUSION

Survivors of CWA exposure have developed a sense of gendered uncertainty around getting married and building a family. Sulfur mustard-exposed women, in particular, long to be desired in the community as they face social exclusion. Survivors should be provided evidence-based consultancy to optimise their decision-making around marriage and other social and family challenges.

A study of stigma among Iranian family caregivers of patients with multiple sclerosis: A descriptive explorative qualitative study

AIM

This study was done to investigate the experiences of family caregivers of people with multiple sclerosis (MS) about stigmatization in Iranian health care context.

BACKGROUND

Stigmatization has been observed obviously among patients with MS but few studies have been conducted on stigma among the family caregivers of these patients.

METHODS

This qualitative study with thematic analysis was done to explore this issue. Fourteen family caregivers of patients with MS were selected by purposive sampling. The data were collected through in-depth and unstructured interviews.

RESULTS

Four main subthemes emerged from the analysis of the transcripts: "feeling shame", "fear of being ridiculed by others", "ignored by family" and "concealing disease to be secure against the perceptions of disease".

CONCLUSIONS

Healthcare professionals should be encouraged to inform caregivers about social engagement strategies and to train them on the management of stigma as an important factor for the reduction of their social problems.

Impact of Psychological Problems and Marital Adjustment of Iranian Veterans on Their Children's Quality of Life and Happiness

Background:

The Iran-Iraq war during the 1980-1988 has left many consequences on veterans and their families that persist long after the war ended.

Objectives:

The aim of this study was to evaluate the impact of psychological problems and marital adjustment of Iranian veterans on their children's quality of life and happiness 24 years after the war ended.

Patients and Methods:

The sample was all children of veterans in Isfahan city that registered by Veterans and Martyrs Affair Foundation (VMAF). One hundred sixty-three veterans were selected by systematic randomized sampling and the symptom checklist-90-revised (SCL-90-R) and dyadic adjustment scale (DAS) were administered for them. Their wives filled out the DAS and their children answered to World Health Organization Quality of Life-Brief version (WHOQOL-BREF) and Oxford Happiness Inventory (OHI). The data from questionnaires completed by 149 families were analyzed using the multiple regressions analysis.

Results:

Global Severity Index (GSI) scores of veterans and veteran's age were inversely correlated with the scores of children's quality of life, while marital adjustment of parents and number of rooms in house were positively correlated. Mother's age was inversely correlated with the scores of children's happiness, while marital adjustment of the parents, the number of rooms in their house and the number of children were positively correlated.

Conclusions:

In veterans' family, psychological health of the veterans and marital adjustment of the parents have a significant relationship with their children's quality of life and happiness.

Experience of Iranian persons receiving hemodialysis: a descriptive, exploratory study

Patients living with end-stage renal disease experience different levels of physical and psychological disability that can impact on the type and level of social interaction in which they engage with others. The researchers concurrently collected and thematically analyzed the interview data that were generated from 21 participants who were undergoing hemodialysis in Iran. Four major themes were constructed from the analysis of the transcripts: living with fatigue; changes in self-image; patients' dependency on the device, place, and time of hemodialysis; and hiding the disease. The results from this study showed that the patients who were living with hemodialysis in Iran experienced altered social interactions with others. The culture of Iran resulted in the participants trying to hide their disease from others, which led to social avoidance, thus reducing the participants' social interactions with others. It is recommended that nurses include a comprehensive assessment of the social interactions of persons who are receiving hemodialysis in their overall nursing assessment and that this is reviewed on a regular basis.