title: Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Shahed University, Tehran, Iran.
authors.forename: Gholamhosein
authors.initials: G
authors.lastname: Ghaedi
authors.forename: Hassan
authors.initials: H
authors.lastname: Ghasemi
authors.forename: Batool
authors.initials: B
authors.lastname: Mousavi
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Soroush
authors.forename: Parvin
authors.initials: P
authors.lastname: Rahnama
authors.forename: Farhad
authors.initials: F
authors.lastname: Jafari
authors.forename: Siamak
authors.initials: S
authors.lastname: Afshin-Majd
authors.forename: Maryam
authors.initials: M
authors.lastname: Sadeghi Naeeni
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Naghizadeh
mesh_terms: D000328:Adult; D000368:Aged; D002057:Burns, Chemical / Q000209:etiology* / Q000523:psychology*; D002618:Chemical Warfare; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005126:Eye Burns / Q000139:chemically induced* / Q000523:psychology*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007492:Iran; D008603:Mental Health; D008875:Middle Aged; D009151:Mustard Gas / Q000009:adverse effects*; D011594:Psychometrics; D012720:Severity of Illness Index; D012923:Social Class; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014728:Veterans / Q000523:psychology
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas