anxiety disorders, panic disorder, obsessive-compulsive disorder, phobias, post-traumatic stress disorder

Iranian civilians exposed to high-intensity warfare and chemical weapons are experiencing significantly higher levels of psychological distress compared to those exposed to low-intensity warfare but not chemical weapons according to a report in the August 2 issue of the Journal of the American Medical Association (JAMA) devoted to the theme of violence and human rights.

The research was based on data collected in July 2004 on civilians in three towns bordering Iran and Iraq by researchers in the Department of Epidemiology and Public Health (EPH) at Yale School of Medicine, the Department of Psychiatry and the VA Connecticut Healthcare System.

The team, led by EPH research associate Farnoosh Hashemian, conducted a cross-sectional randomized study to measure civilian trauma during the Iran-Iraq war, which lasted from 1980 to 1988, caused one million casualties on both sides and 60,000 chemical warfare survivors in Iran. While much is known about the physical consequences of chemical warfare, the researchers sought to document the long-term effects of chemical attacks on mental health.

During two months in Iran, the team examined war-related mental health problems in three towns. One town was exposed to conventional low-intensity warfare, another was exposed to high-intensity warfare and the third, Sardasht, was exposed to both high-intensity warfare and chemical warfare. The team conducted 90-minute face-to-face interviews with residents and measured post-traumatic stress disorder (PTSD), anxiety and depression.

Those who were exposed to both high-intensity warfare and chemical weapons had significantly higher mental health disorders than did residents of the other two towns. Fifty-nine percent of Sardasht residents were found to have experienced PTSD in their lifetime. Thirty-three percent were currently suffering from PTSD, 65 percent reported major anxiety symptoms and 41 percent had severe depressive symptoms.

The study showed that depression, anxiety and PTSD are also prevalent among residents in the high-intensity warfare town. Thirty-one percent had lifetime PTSD, eight percent had current PTSD, 25 percent had major anxiety symptoms and 12 percent had severe depressive symptoms.

"Our results highlight the importance of examining long-term mental health problems in communities affected by war, particularly in those exposed to chemical weapons," said Hashemian, who was herself raised in Iran and witnessed the suffering caused by war and chemical warfare. "Survivors of chemical warfare need access to a variety of resources to recover from the trauma that happened 17 years ago. We hope this study raises awareness about the horrifying effects of the use of chemical weaponry and demonstrates the urgent need for a stronger international commitment to destruction of such weapons."

Hashemian said that at the time of the mustard gas attack, the residents assumed it was another conventional weapon bombardment. In a few hours, however, people experienced temporary blindness, shortness of breath, coughing, vomiting and severe blisters. Serious skin burns, eye damage and respiratory symptoms are the most common chronic health problems experienced by survivors of chemical warfare. "These physical wounds are being treated in those who survived, but now we have to focus our attention on treating the mental wounds," she said.

Hashemian F, Khoshnood K, Desai MM, Falahati F, Kasl S, Southwick S.
Anxiety, Depression, and Posttraumatic Stress in Iranian Survivors of Chemical Warfare
JAMA. 2006;296:560-566   [Abstract]