Evaluation of secondary post-traumatic stress disorder symptoms in the spouses of chemical warfare victims 20 years after the Iran-Iraq war

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 (5120 and 5121; 5106 and 5107; and 565, 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); P50.001, 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 wellbeing
of chemical warfare victims and their caregiver wives.
Declaration of interest None.