Mental health status following severe sulfur mustard exposure: a long‐term study of Iranian war survivors

Khateri, Shahriar; Soroush, Mohammadreza; Mokhber, Naghmeh; Sedighimoghaddam, Mohammadreza; Modirian, Ehsan; Mousavi, Batool; Mousavi, Seyed Javad; Hosseini, Maryam

doi:10.1111/appy.12252

Cited by 9 publications

(13 citation statements)

References 19 publications

(30 reference statements)

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“…The participants reported severe concerns regarding their general health, QOL and access to health care, which is consistent with previous studies. [16, 17, 22] All participants experienced deterioration in physical and mental health and wellbeing, and attributed their health problems to the CWA exposure, saying that the SM had become a “part of their body” and had damaged, and was continuing to damage, their organs.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the experience of CWAs and fear of renewed exposure to CWAs implies chronic poor health status and post-traumatic stress disorder (PTSD). [16, 22, 23] A recent study reports that SM effects on the respiratory system in particular are closely associated with psychiatric disorders. [22] A study on Iranian male war veterans revealed that SM victims with ophthalmological complications had lower health-related quality of life (HRQOL) compared to a control group.…”

Section: Introductionmentioning

confidence: 99%

“…[16, 22, 23] A recent study reports that SM effects on the respiratory system in particular are closely associated with psychiatric disorders. [22] A study on Iranian male war veterans revealed that SM victims with ophthalmological complications had lower health-related quality of life (HRQOL) compared to a control group. [24] Yet, knowledge regarding health and quality of life (QOL) in civilian survivors of CWAs, such as SM, is very limited.…”

Section: Introductionmentioning

confidence: 99%

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Health perspectives among Halabja’s civilian survivors of sulfur mustard exposure with respiratory symptoms—A qualitative study

et al. 2019

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Background In 1988, Halabja came under heavy chemical warfare attack using chemicals such as sulfur mustard (SM). Thousands of survivors of SM exposure in the city today live with multiple health complaints, such as severe, long-lasting respiratory symptoms; but their perceptions of health have never been adequately researched. We aimed to explore current major health concern topics in civilian survivors with long-term respiratory symptoms. Method Sixteen subjects (f:m10:6, mean age 45.5 years (range 34–67)) were interviewed. Study participants were recruited in 2016 via a purposive sampling strategy among civilian survivors of chemical warfare in the city of Halabja in Kurdistan-Iraq. A qualitative research design was applied including semi-structured, face-to-face interviews. Data was analyzed using systematic text condensation. Results The analysis yielded fourteen themes related to: (1) General health: all participants described a deterioration in physical and psychological health, following the SM exposure, foremost involving respiratory symptoms, fatigue, sleeping disorders, ocular problems, depressive symptoms, and anxiety; (2) Quality of life: most notably, they reported a limited family life, limited social relations, lack of work ability, and concern about their financial situation. Moreover, many lived in constant fear of a renewed attack; (3) access to health care services: all participants reported that they had no, or only poor, access to health care services and limited access to specialist care, and all reported lack of financial resources to obtain treatment. Conclusions The post-exposure somatic and psychosocial effects such as respiratory symptoms of CWA are plausible contributor to poor general health and quality of life among survivors. We conclude that multidisciplinary interventions are needed to tackle the biopsychosocial complications in survivors of SM exposure to minimize further health damage in the future, as well as to promote their health-related quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health perspectives among Halabja’s civilian survivors of sulfur mustard exposure with respiratory symptoms—A qualitative study

et al. 2019

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“…These findings are consistent with the literature, reporting impairment in social abilities and a higher exposure to traumatic events as predictors of PTSD. (Ribeiro et al, ; Jakob, Lamp, Rauch, Smith, & Buchholz, ; Palgi, ; Idemudia et al, ; Gelkopf, Berger, Bleich, & Silver, ) Also, the exposure to toxic substances appears to be an important predictor of mental health disease, and especially of PTSD, (Khateri et al, ) due to the immediate physical harm and to the fear of long term medical disease (Pechura & Rall, ). Considering the WHODAS 2.0, higher scores in “understanding and communication,” suggesting the presence of impairment in social abilities, were predictors of higher scores in the PC‐PTSD and in the PCL‐5.…”

Section: Discussionmentioning

confidence: 99%

Post‐traumatic stress disorder and subthreshold post‐traumatic stress disorder in recent male asylum seekers: An expected but overlooked “European” epidemic

et al. 2019

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The literature shows an increased risk for post-traumatic stress disorder (PTSD) among illegal migrants. We aimed to estimate the prevalence of PTSD, subthreshold PTSD, the degree of disability, and differences in sociodemographic and anamnestic characteristics associated with these clinical conditions in a sample of newly arrived migrants.Two hundred male asylum seekers from West sub-Saharan Africa were evaluated for traumatic life events, PTSD symptoms, and disability through the Life Events Checklist for DSM-5 (LEC-5), the Primary Care PTSD Screen, the PTSD Checklist for DSM-5, and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).The current prevalence of PTSD and subthreshold PTSD was 9.5% and 12.0%, respectively. PTSD and subthreshold PTSD subgroups presented higher WHODAS 2.0 scores and LEC-5 events, an over-representation of individuals with childhood adversities and an excess of premigration psychiatric contacts unrelated to PTSD spectrum disorders and peri-migration offences. Witnessing a traumatic event and disability in understanding and communication predicted both the presence of PTSD symptoms and PTSD status.PTSD spectrum disorders should be considered among the clinical emergencies associated with asylum seeker condition, and targeted interventions also involving the host citizens should be predisposed. K E Y W O R D Smental health, post-traumatic stress, racial, ethnic, and cultural factors in health

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“…It also likely plays a role in the findings described in recent Iranian reports that have documented the persistent long-term and chronic effects of H exposure during the Iran-Iraq war that include ocular, dermatological, respiratory, gastrointestinal, haematological, neurological, neuromuscular, immunological and endocrine disruptions ( Fig. 3 ) [ [25] , [26] , [27] , [28] , [29] , [30] ].…”

Section: Introductionmentioning

confidence: 99%

N-Acetylcysteine as a treatment for sulphur mustard poisoning

Sawyer

2020

Free Radical Biology and Medicine

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In the long and intensive search for effective treatments to counteract the toxicity of the chemical warfare (CW) agent sulphur mustard (H; bis(2-chloroethyl) sulphide), the most auspicious and consistent results have been obtained with the drug N-acetylcysteine (NAC), particularly with respect to its therapeutic use against the effects of inhaled H. It is a synthetic cysteine derivative that has been used in a wide variety of clinical applications for decades and a wealth of information exists on its safety and protective properties against a broad range of toxicants and disease states. Its primary mechanism of action is as a pro-drug for the synthesis of the antioxidant glutathione (GSH), particularly in those circumstances where oxidative stress has exhausted intracellular GSH stores. It impacts a number of pathways either directly or through its GSH-related antioxidant and anti-inflammatory properties, which make it a prime candidate as a potential treatment for the wide range of deleterious cellular effects that H is acknowledged to cause in exposed individuals. This report reviews the available literature on the protection afforded by NAC against the toxicity of H in a variety of model systems, including its efficacy in treating the long-term chronic lung effects of H that have been demonstrated in Iranian veterans exposed during the Iran-Iraq War (1980-1988). Although there is overwhelming evidence supporting this drug as a potential medical countermeasure against this CW agent, there is a requirement for carefully controlled clinical trials to determine the safety, efficacy and optimal NAC dosage regimens for the treatment of inhaled H.

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Mental health status following severe sulfur mustard exposure: a long‐term study of Iranian war survivors

Abstract: The psychiatric morbidity in the chemically injured populations was remarkable and significantly different between the populations. The prevalence of mental illness in these groups highlights the need for the appropriate provision of mental health services.

Cited by 9 publications

References 19 publications

Health perspectives among Halabja’s civilian survivors of sulfur mustard exposure with respiratory symptoms—A qualitative study

Health perspectives among Halabja’s civilian survivors of sulfur mustard exposure with respiratory symptoms—A qualitative study

Post‐traumatic stress disorder and subthreshold post‐traumatic stress disorder in recent male asylum seekers: An expected but overlooked “European” epidemic

N-Acetylcysteine as a treatment for sulphur mustard poisoning

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