@article {363, title = {Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare.}, journal = {JAMA}, volume = {296}, year = {2006}, month = {2006 Aug 2}, pages = {560-6}, 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.

}, keywords = {Adult, Aged, Anxiety, Chemical Warfare, Comorbidity, Cross-Sectional Studies, Depression, Female, Humans, Iran, Male, Mental Health, Middle Aged, Population Surveillance, Stress Disorders, Post-Traumatic, Survival}, issn = {1538-3598}, doi = {10.1001/jama.296.5.560}, author = {Hashemian, Farnoosh and Khoshnood, Kaveh and Desai, Mayur M and Falahati, Farahnaz and Kasl, Stanislav and Southwick, Steven} }