Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran-Iraq war
Aims and method: Post-traumatic stress disorder (PTSD) has been reported in 90% of chemical warfare victims in previous studies. An individual's traumatic experience(s) may affect the lives of other family members as well. This crosssectional case-control study compared the prevalence of PTSD symptoms in the husbands, the secondary PTSD symptoms in the wives and also aimed to identify if there was an association between the PTSD symptoms of the couples in the case group. Cases were 150 husband-wife couples where husbands were civilians exposed to chemical warfare; the controls were 156 husband-wife couples where there was no such exposure. Both cases and controls were recruited from Sardasht in Iran; this Kurdish city was attacked by four 250 kg sulphur mustard warheads in June 1987. Results: Across three sets of cut-off points for the Mississippi Scale for Combat-Related PTSD symptomotology (<120 and ?121; <106 and ?107; and <65, 65-130 and 4130) wives in the case group demonstrated higher rates of PTSD symptoms than did those in the control group; the difference was statistically significant. Furthermore, husbands in the case group had a significantly higher overall mean score (123.0 (s.d. = 17.2)) than the husbands in the control group (112.3 (s.d. = 21.7); P<0.001, t = 4.80). There was no statistically significant association between the overall PTSD score of the husbands in the case group with that of their wives (P = 0.274, correlation coefficient 0.092). Clinical implications: Husbands who were exposed to the chemical agents reported higher PTSD symptoms and there were higher rates of PTSD symptoms among the wives of individuals who were exposed to chemical warfare. Study results suggest the need for coordinated treatments, policy efforts and interventions to improve the well-being of chemical warfare victims and their caregiver wives. © 2011 The Royal College of Psychiatrists.