title: Long-term effects of sulfur mustard on civilians' mental health 20 years after exposure (The Sardasht-Iran Cohort Study).
abstract: BACKGROUND
  Sulfur mustard (SM) is an alkylating agent that induces short and long term toxicity on various organs. The aim of this study was to assess the long-term psychological symptoms among samples of exposed to sulfur mustard gas compared with unexposed civilians 20 years after exposure.
  
  
  METHODS
  This historical cohort study was conducted on 495 civilians of Sardasht and Rabat in two age matched groups, including 367 sulfur mustard exposed participants from Sardasht and 128 unexposed subjects from Rabat. Psychological symptoms was assessed using the Symptom Check List-90 Revised (SCL-90-R) including measures of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism providing three global distress indices namely: Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Index (PSDI). Comparison was made between exposed and unexposed civilians.
  
  
  RESULTS
  There were significant differences in somatization (P = 0.002), obsessive-compulsive (P = 0.031), depression (P = 0.007), anxiety (P = 0.042), and hostility (P = 0.002), between the exposed and unexposed groups. In addition there were significant differences between two groups concerning the GSI (P = 0.045) and the PSDI (P < 0.001). The differences between two groups in other subscales were not significant.
  
  
  CONCLUSIONS
  The findings from this study showed that civilians who exposed to sulfur mustard gas were suffering from a number of psychological symptoms even 20 years after exposure. Providing mental health services and more resource allocation for this community are highly recommended.
authors.affiliation: Immunoregulation Research Center, Shahed University, Tehran, Iran.
authors.forename: Rasoul
authors.initials: R
authors.lastname: Roshan
authors.forename: Parvin
authors.initials: P
authors.lastname: Rahnama
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Ghazanfari
authors.forename: Ali
authors.initials: A
authors.lastname: Montazeri
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Soroush
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Naghizadeh
authors.forename: Mahdiyeh
authors.initials: M
authors.lastname: Melyani
authors.forename: Azadeh
authors.initials: A
authors.lastname: Tavoli
authors.forename: Tooba
authors.initials: T
authors.lastname: Ghazanfari
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D057189:Checklist; D002619:Chemical Warfare Agents / Q000009:adverse effects*; D015331:Cohort Studies; D035061:Control Groups; D004066:Digestive System Diseases; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D009151:Mustard Gas / Q000009:adverse effects*; D011788:Quality of Life; D012959:Socioeconomic Factors; D013001:Somatoform Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas