Top

Health and Quality of Life Outcomes

Published in:

Open Access 01-12-2022 | Mood Disorders | Research

The impact of sulfur mustard on quality of life and mental health in Kurdish survivors in Sweden, thirty years after exposure

Authors: Faraidoun Moradi, Fazil Moradi, Ying Li, Anna-Carin Olin, Bledar Daka

Published in: Health and Quality of Life Outcomes | Issue 1/2022

Abstract

Background

The Iraqi state used chemical warfare agents (CWAs) like sulfur mustard (SM) in al-Anfal genocide in the present-day Kurdistan Region of Iraq. In addition to somatic injuries, exposure to CWAs causes biopsychosocial complications. We investigated the long-term impact of SM exposure on quality of life (QoL) and depression severity in Kurdish survivors resettled in Sweden.

Methods

This is a case-control study, where subjects exposed to SM (n = 18, mean age 51.3 years, 50% women) and sex- and age-matched nonexposed subjects (n = 30, mean age 48.7 years, 47% women) of Kurdish residents in Sweden. Data were collected through in-person interviews based on the RAND 36-item Short Form Health Survey to assess QoL and the Montgomery-Åsberg Depression Rating Scale-self assessment (MADRS-S) to investigate the presence and the gravity of depressive symptoms.

Results

The SM-exposed group had a significantly lower QoL than the nonexposed group (p < 0.001). Also, the overall mean MADRS-S scores among the SM-exposed group, corresponding to moderate depression, were higher than the scores of the nonexposed (22 points (p) vs. 9 p, p < .001). Overall, the participants within the exposed group reported worse mental than physical well-being 36p and 32p, respectively. Within the SM-exposed group, there was no gendered-related difference neither in terms of depression severity nor for QoL, but the groups were small.

Conclusion

Individuals exposed to SM had worse QoL and a higher level of depressive severity compared with nonexposed individuals three decades after exposure, indicating the importance of increased clinician knowledge, guidelines, and an approach to assess and respond to the exposed groups’ biopsychosocial needs. These findings indicate that those exposed to SM might need early identification of mental illnesses and more support to promote QoL.

Eisenkraft A, Gilburd D, Kassirer M, et al. What can we learn on medical preparedness from the use of chemical agents against civilians in Syria? AM J Emerg Med. 2014;32(2):186. https://doi.org/10.1016/j.ajem.2013.11.005.CrossRef

Jones E, Palmer I, Wessely S. Enduring beliefs about effects of gassing in war: qualitative study. BMJ. 2007;335(7633):1313–5. https://doi.org/10.1136/bmj.39420.533461.25.CrossRef

Hashemian F, Khoshnood K, Desai MM, et al. Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare. JAMA. 2006;296(5):560–6. https://doi.org/10.1001/jama.296.5.560.CrossRef

Woodall J. Tokyo subway gas attack. Lancet. 1997;350(9073):296. https://doi.org/10.1016/s0140-6736(05)62271-4.CrossRef

Balte PP, Clark KA, Mohr LC, et al. The immediate pulmonary disease pattern following exposure to high concentrations of chlorine gas. Pulm Med. 2013;2013:325869. https://doi.org/10.1155/2013/325869.CrossRef

Amnesty International. Clouds of injustice: bhopal disaster 20 years on. https://www.amnesty.org/en/documents/ASA20/015/2004/en/.

Moradi F, Buchenhorst R, Six-Hohenbalken M. Memory and genocide: on what remains and the possibility of representation. New York: Routledge;2017.CrossRef

Dworkin J, Prescott M, Jamal R, et al. The long-term psychosocial impact of a surprise chemical weapons attack on civilians in Halabja, Iraqi Kurdistan. J Nerv Ment Dis. 2008;196(10):772–5. https://doi.org/10.1097/NMD.0b013e3181878b69.CrossRef

Moradi F, Soderberg M, Moradi F, et al. Health perspectives among Halabja’s civilian survivors of sulfur mustard exposure with respiratory symptoms—a qualitative study. PLoS ONE. 2019;14(6):e0218648. https://doi.org/10.1371/journal.pone.0218648.CrossRef

10.

Rowell M, Kehe K, Balszuweit F, Thiermann H. The chronic effects of sulfur mustard exposure. Toxicology. 2009;263(1):9–11. https://doi.org/10.1016/j.tox.2009.05.015.CrossRef

11.

Khateri S, Soroush M, Mokhber N, Sedighimoghaddam M, Modirian E, Mousavi B, et al. Mental health status following severe sulfur mustard exposure: a long-term study of Iranian war survivors. Asia-Pac Psychiatry Off J Pac Rim Coll Psychiatr. 2017. https://doi.org/10.1111/appy.12252.CrossRef

12.

Satkin M, Ghanei M, Ebadi A, Allahverdi S, Elikaei M. The quality of life of mustard gas victims: a systematic review. Tanaffos. 2017;16(2):115–26.

13.

Moradi F, Moradi F, Söderberg M, et al. Gendered lived experiences of marriage and family following exposure to chemical warfare agents: content analysis of qualitative interviews with survivors in Halabja, Kurdistan-Iraq. BMJ Open. 2020;10(10):e034277. https://doi.org/10.1136/bmjopen-2019-034277.CrossRef

14.

Ebadi A, Moradian T, Mollahadi M, et al. Quality of life in Iranian chemical warfare veteran’s. Iran Red Crescent Med J. 2014;16(5):e5323. https://doi.org/10.5812/ircmj.5323.CrossRef

15.

Mousavi B, Khateri S, Soroush M, Amini R, Masumi M, Montazeri A. Comparing quality of life between survivors of chemical warfare exposure and conventional weapons: results of a National Study from Iran. J Med CBR Def. 2011;8.

16.

Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.CrossRef

17.

Montgomery SA, Åsberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134(4):382–9. https://doi.org/10.1192/bjp.134.4.382.CrossRef

18.

Orwelius L, Nilsson M, Nilsson E, et al. The Swedish RAND-36 Health Survey—reliability and responsiveness assessed in patient populations using Svensson’s method for paired ordinal data. J Patient Rep Outcomes. 2017;2(1):4. https://doi.org/10.1186/s41687-018-0030-0.CrossRef

19.

Ware JE, Kosinski M, Keller SD. SF-36 physical and mental health summary scales: a user’s manual. Boston: The Health Institute, New England Medical Center;1994.

20.

Svanborg P, Ekselius L. Self-assessment of DSM-IV criteria for major depression in psychiatric out- and inpatients. Nord J Psychiatry. 2003;57(4):291–6. https://doi.org/10.1080/08039480307281.CrossRef

21.

Ware J, Snoww K, Kosinski MA, et al. SF-36health survey: manual and interpretation guide. Johnston: Quality Metric Inc.;1993.

22.

UNIDIR. Missing Links: Understanding sex- and gender-related impacts of chemical and biological weapons. https://unidir.org/publication/missing-links-understanding-sex-and-gender-related-impacts-chemical-and-biological; 2019

23.

Robroek SJ, Schuring M, Croezen S, et al. Poor health, unhealthy behaviors, and unfavorable work characteristics influence pathways of exit from paid employment among older workers in Europe: a four year follow-up study. Scand J Work Environ Health. 2013;39(2):125–33. https://doi.org/10.5271/sjweh.3319.CrossRef

24.

van Zon SKR, Reijneveld SA, Mendes de Leon CF, et al. Correction to: the impact of low education and poor health on unemployment varies by work life stage. Int J Public Health. 2019;64(5):809–12. https://doi.org/10.1007/s00038-018-1123-5.CrossRef

25.

Bennet L, Lindstrom M. Self-rated health and social capital in Iraqi immigrants to Sweden: the MEDIM population-based study. Scand J Work Environ Health. 2018;46(2):194–203. https://doi.org/10.1177/1403494817730997.CrossRef

26.

Gilardoni M, Léonço D, Caffin F, Gros-Désormeaux F, Eldin C, Béal D, et al. Evidence for the systemic diffusion of (2-chloroethyl)-ethyl-sulfide, a sulfur mustard analog, and its deleterious effects in brain. Toxicology. 2021;462:152950. https://doi.org/10.1016/j.tox.2021.152950.CrossRef

27.

Vythilingam M, Luckenbaugh DA, Lam T, Morgan CA 3rd, Lipschitz D, Charney DS, et al. Smaller head of the hippocampus in Gulf War-related posttraumatic stress disorder. Psychiatry Res. 2005;139(2):89–99. https://doi.org/10.1016/j.pscychresns.2005.04.003.CrossRef

28.

Mousavi SS, Vahedi E, Shohrati M, et al. Nocturnal serum melatonin levels in sulfur mustard exposed patients with sleep disorders. J R Army Med Corps. 2017;163(6):411–5. https://doi.org/10.1136/jramc-2016-000677.CrossRef

29.

Haley RW, Tuite JJ. Epidemiologic evidence of health effects from long-distance transit of chemical weapons fallout from bombing early in the 1991 Persian Gulf War. Neuroepidemiology. 2013;40(3):178–89. https://doi.org/10.1159/000345124.CrossRef

30.

Hjern A. Migration and public health: Health in Sweden. The National Public Health Report 2012. Chapter 13. Scand J Public Health. 2012;40(9):255–67. https://doi.org/10.1177/1403494812459610.CrossRef

31.

Rindner L, Nordeman L, Strömme G, et al. Prognostic factors for future mental, physical and urogenital health and work ability in women, 45–55 years: a six-year prospective longitudinal cohort study. BMC Womens Health. 2020;20(1):171. https://doi.org/10.1186/s12905-020-01015-4.CrossRef

32.

Hassankhani H, Taleghani F, Mills J, et al. The challenges experienced by Iranian war veterans living with chemical warfare poisoning: a descriptive, exploratory study. Scand J Caring Sci. 2010;24(2):290–8. https://doi.org/10.1111/j.1471-6712.2009.00719.x.CrossRef

33.

Mousavi B, Soroush MR, Montazeri A. Quality of life in chemical warfare survivors with ophthalmologic injuries: the first results from Iran chemical warfare victims health assessment study. Health Qual Life Outcomes. 2009;7:2. https://doi.org/10.1186/1477.CrossRef

Title: The impact of sulfur mustard on quality of life and mental health in Kurdish survivors in Sweden, thirty years after exposure
Authors: Faraidoun Moradi
Fazil Moradi
Ying Li
Anna-Carin Olin
Bledar Daka
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Published in: Health and Quality of Life Outcomes / Issue 1/2022
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/s12955-022-02081-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of sulfur mustard on quality of life and mental health in Kurdish survivors in Sweden, thirty years after exposure

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Correlates of health-related quality of life in primary caregivers of perinatally HIV infected and HIV exposed uninfected adolescents at the Kenyan Coast

Self-care time and rating of health state in persons with diabetes: results from the population-based KORA survey in Germany

Adaptation and validation of the HIV Knowledge Questionnaire-18 for the general population of Indonesia

Predictors of problems reported on the EQ-5D-3L dimensions among people with impaired vision in northern Portugal

Mental and psychosocial health and health related quality of life before and after cardiac rehabilitation: a prospective cohort study with comparison to specific population norms

Valuing EQ-5D-Y: the current state of play