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Post-Traumatic Stress Disorder and Depression Among Survivals of Chemical Attack in Halabja


  • Razaw Nury Hama Faraj Clinical Psychology Department, Faculty of Science and Health, Koya University


The main aim of this study was to find out the prevalence rates of post-traumatic stress disorder (PTSD) and depression, likewise to find out significant gender differences in the level of this mental disorder among survivals of the chemical attack in Halabja. PTSD and depression among 109 (45 were males and 64 were females) survivors of the chemical attack were assessed by the Kurdish version scales of post-traumatic stress disorder checklist for DSM-5, and depression section of the Hopkins symptoms checklist-15. And the non-random snowball sampling technique was used to select the sample. Besides, face to face and structured interviews were used to collect data. The results of this study showed that the prevalence rate of PTSD was 46.78%, and there was a significant gender difference in the level of PTSD among survivals in Halabja. The prevalence rate of depression was 45.87%, and there was no significant gender difference in the level of depression among participants in this study.


PTSD, depression, survivals of chemical attack, Halabja


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K. Address, S. Adams, and G. Centre, “Halabja , Chemical Weapons and the Genocide against the Kurds?: Implications for Iraq and the World Today,” no. March, 2018.


K. Aziz, J. Alhajbaker, S. Ali, and Y. Gardi, “Documentation of Kurdish Genocide and Common Diseases Occurred among Victims after Genocide: Retrospective Study,” pp. 34–42, 2018.

B. English, “Over 170 Children Still Missing Since Halabja Chemical Attack,” kurdistan, 2019. [Online]. Available:

B. Friedrich, D. Hoffmann, J. Renn, F. Schmaltz, and M. Wolf, One Hundred Years of Chemical Warfare?: Research , Deployment ,. Gewerbestrasse 11, 6330 Cham, Switzerland: Springer Nature, 2017.

K. Davenport, “Chemical Weapons?: Frequently Asked Questions Fact Sheets & Briefs,” no. June, pp. 1–7, 2018.

L. Etemad, M. Moshiri, and M. Balali-Mood, “Delayed complications and long- term management of sulfur mustard poisoning: A narrative review of recent advances by iranian researchers part II: Clinical management and therapy,” Iran. J. Med. Sci., vol. 43, no. 3, pp. 235–247, 2018.

J. D. Ford, P. P. Schnurr, M. J. Friedman, B. L. Green, G. Adams, and S. Jex, “Posttraumatic Stress Disorder Symptoms, Physical Health, and Health Care Utilization 50 Years After Repeated Exposure to a Toxic Gas,” J. Trauma. Stress, vol. 17, no. 3, pp. 185–194, 2004.

S. Khateri et al., “Mental health status following severe sulfur mustard exposure: a long-term study of Iranian war survivors,” Asia-Pacific Psychiatry, vol. 9, no. 2, 2017.

H. M. Team, M. Team, F. Quarter, H. Taze, S. Piryady, and O. Hours, “Program for Survivors of Chemical Attacks Jiyan Foundation for Human Rights,” vol. 00, no. March, 2010.

F. Hashemian, K. Khoshnood, M. M. Desai, F. Falahati, S. Kasl, and S. Southwick, “Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare,” J. Am. Med. Assoc., vol. 296, no. 5, pp. 560–566, 2006.

R. Roshan et al., “Long-term effects of sulfur mustard on civilians’ mental health 20 years after exposure (The Sardasht-Iran Cohort Study),” Health Qual. Life Outcomes, vol. 11, no. 1, pp. 1–7, 2013.

A. P. Association, Diagnostic and statistical manual of mental disorder Fifth Edition, vol. 1542. 2015.

J. Iribarren, P. Prolo, N. Neagos, and F. Chiappelli, “Post-traumatic stress disorder: Evidence-based research for the third millennium,” Evidence-based Complement. Altern. Med., vol. 2, no. 4, pp. 503–512, 2005.

P. N. Santiago et al., “A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations: Intentional and Non-Intentional Traumatic Events,” PLoS One, vol. 8, no. 4, pp. 1–5, 2013.

American Psychiatric Association, Specific Learning Disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 2013.

N. Elektricheska and N. Ead, “Jiyan foundation Annual Report 2011,” pp. 1–124, 2011.

T. Pedersen, “Chemical Weapon Victims Can Suffer Lifelong Mental , Physical Health Problems,” pp. 5–7, 2019.

S. Asnakew, S. Shumet, W. Ginbare, G. Legas, and K. Haile, “Prevalence of post-traumatic stress disorder and associated factors among Koshe landslide survivors, Addis Ababa, Ethiopia: A community-based, cross-sectional study,” BMJ Open, vol. 9, no. 6, pp. 1–8, 2019.

T. Housen et al., “Prevalence of anxiety, depression and post-traumatic stress disorder in the Kashmir Valley,” BMJ Glob. Heal., vol. 2, no. 4, 2017.

T. H. Hoppen and N. Morina, “The prevalence of PTSD and major depression in the global population of adult war survivors?: a meta-analytically informed estimate in absolute numbers,” Eur. J. Psychotraumatol., vol. 1, no. 10, 2019.

T. B. Kashdan, N. Morina, and S. Priebe, “Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress and quality of life,” J. Anxiety Disord., vol. 23, no. 2, pp. 185–196, 2009.

N. Morina, K. Stam, T. V. Pollet, and S. Priebe, “Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies,” J. Affect. Disord., vol. 239, no. July, pp. 328–338, 2018.

and V. Thabet, Tawahina , Sarraj, “Death Anxiety, PTSD, Trauma, Grief, And Mental Health Of Palestinians Victims Of War On Gaza,” Heal. Care Curr. Rev., vol. 1, no. 2, pp. 1–8, 2013.

A. Justice, P. D, and C. A. Brandt, “Among Connecticut War Veterans of Iraq and Afghanistan,” Heal. (San Fr., vol. 19, no. 2, 2010.

H. Safi-Aghdam, M. Shafie, A. Khoshdel, E. Moazen-Zadeh, F. Avakh, and A. Rahmani, “Long-Term Effects of Chemical Warfare on Post-traumatic Stress Disorder, Depression, and Chronic Medical Conditions in Veterans Hamideh,” Community Ment. Health J., vol. 55, no. 3, pp. 493–496, 2019.

B. Vafaee and A. Seidy, “Prevalence of depression among physically-disabled veterans in northwestern Iran,” Iran. J. Med. Sci., vol. 29, no. 1, pp. 43–44, 2004.

K. Ahmadi, M. Reshadatjoo, G. R. Karami, N. Sepehrvand, and P. Ahmadi, “Vicarious PTSD in Sardasht chemical warfare victims’ offspring,” Procedia - Soc. Behav. Sci., vol. 5, no. September, pp. 170–173, 2010.

A. Ekzayez, M. D. Flecknoe, L. Lillywhite, P. Patel, A. Papamichail, and H. Elbahtimy, “Chemical Weapons and public health: assessing impact and responses,” J. Public Health (Bangkok)., pp. 1–9, 2019.

A. Ahmad, M. A. Sofi, V. Sundelin-Wahlsten, and A. L. Von Knorring, “Posttraumatic stress disorder in children after the military operation ‘Anfal’ in Iraqi Kurdistan,” Eur. Child Adolesc. Psychiatry, vol. 9, no. 4, pp. 235–243, 2000.

A. Alwaely, H. Al-qaralocy, K. Al-Asadi, M. Chaichan, and H. Kazem, “The environmental aftermath resulted from chemical bombardment of Halabja Territory for the period 1988-2014,” Int. J. Sci. Eng. Res., vol. 6, no. 9, pp. 40–44, 2015.

P. Bolton, L. Michalopoulos, A. M. A. Ahmed, L. K. Murray, and J. Bass, “The mental health and psychosocial problems of survivors of torture and genocide in Kurdistan, Northern Iraq: a brief qualitative study.,” Torture, vol. 23, no. 1, pp. 1–14, 2013.

J. Dworkin, M. Prescott, R. Jamal, S. A. Hardawan, A. Abdullah, and S. Galea, “The long-term psychosocial impact of a surprise chemical weapons attack on civilians in halabja, Iraqi kurdistan,” J. Nerv. Ment. Dis., vol. 196, no. 10, pp. 772–775, 2008.

F. M-Hasan, “P01-164 - A quantitative analysis about the prevalence of PTSD after the chemical attack in halabja,” Eur. Psychiatry, vol. 26, p. 164, 2011.

F. Moradi, M. Söderberg, F. Moradi, B. Daka, A. C. Olin, and M. Lärstad, “Health perspectives among Halabja’s civilian survivors of sulfur mustard exposure with respiratory symptoms—A qualitative study,” PLoS One, vol. 14, no. 6, pp. 1–16, 2019.

and J. L. D. Christy A.Blevins, Frank W. Weathers, Margaret T. Davis, Tracy K. Witte, “Prevalence and Psychological Correlates of Complicated,” J. Trauma. Stress, vol. 20, no. 3, pp. 251–262, 2015.

J. H. Wortmann et al., “Psychometric analysis of the PTSD checklist-5 (PCL-5) among treatment-seeking military service members,” Psychol. Assess., vol. 28, no. 11, pp. 1392–1403, 2016.

H. Ibrahim, V. Ertl, C. Catani, A. A. Ismail, and F. Neuner, “The validity of Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) as screening instrument with Kurdish and Arab displaced populations living in the Kurdistan region of Iraq,” BMC Psychiatry, vol. 18, no. 1, pp. 1–8, 2018.

M. B. Parloff, H. C. Kelman, and J. D. Frank, “Comfort, effectiveness, and self-awareness as criteria of improvement in psychotherapy.,” Am. J. Psychiatry, vol. 111, no. 5, pp. 343–352, 1954.

P. Tinghög and J. Carstensen, “Cross-cultural equivalence of HSCL-25 and WHO (ten) wellbeing index: Findings from a population-based survey of immigrants and non-immigrants in Sweden,” Community Ment. Health J., vol. 46, no. 1, pp. 65–76, 2010.

M. Dargère, “What is the translation of the Hopkins Symptom Checklist in 25 items into Croatian? A Delphi consensus procedure for forward-backward translation,” 2014.

H. Ibrahim, V. Ertl, C. Catani, A. A. Ismail, and F. Neuner, “Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide,” BMC Med., vol. 16, no. 1, pp. 1–11, 2018.

H. N. Mahmood, H. Ibrahim, K. Goessmann, A. A. Ismail, and F. Neuner, “Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq,” pp. 1–11, 2019.

H. C. Covey, L. M. Grubb, R. J. Franzese, and S. Menard, “Adolescent Exposure to Violence and Adult Anxiety, Depression, and PTSD,” Crim. Justice Rev., p. 073401681772129, 2017.

A. Eytan, M. Gex-Fabry, L. Toscani, L. Deroo, L. Loutan, and P. A. Bovier, “Determinants of postconflict symptoms in Albanian Kosovars,” J. Nerv. Ment. Dis., vol. 192, no. 10, pp. 664–671, 2004.

N. Morina, K. Stam, T. V. Pollet, and S. Priebe, “Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies,” Journal of Affective Disorders, vol. 239, no. July. pp. 328–338, 2018.

H. Sepahvand, M. M. Hashtjini, M. Salesi, H. Sahraei, and G. P. Jahromi, “Prevalence of post-traumatic stress disorder (PTSD) in Iranian population following disasters and wars: A systematic review and meta-analysis,” Iranian Journal of Psychiatry and Behavioral Sciences, vol. 13, no. 1. pp. 1–12, 2019.

EU, “The Kurdish Genocide: Achieving Justice through EU Recognition,” 2012.

A. Maheux and M. Price, “The indirect effect of social support on post-trauma psychopathology via self-compassion,” Pers. Individ. Dif., vol. 88, pp. 102–107, 2016.

M. Pilania et al., “Prevalence of depression among the elderly (60 years and above) population in India, 1997-2016: A systematic review and meta-analysis,” BMC Public Health, vol. 19, no. 1, pp. 1–18, 2019.

A. Z. Loh, J. S. Tan, M. W. Zhang, and R. C. Ho, “The Global Prevalence of Anxiety and Depressive Symptoms Among Caregivers of Stroke Survivors,” J. Am. Med. Dir. Assoc., vol. 18, no. 2, pp. 111–116, 2017.

M. M. Alsubaie, H. J. Stain, L. A. D. Webster, and R. Wadman, “The role of sources of social support on depression and quality of life for university students,” Int. J. Adolesc. Youth, vol. 24, no. 4, pp. 484–496, 2019.

A. A. Mahdanian, “Journal of Psychiatry and Behavioral Health Forecast Religion and Depression?: A Review of the Literature,” vol. 1, no. March, pp. 1–4, 2018.

C. R. Ronneberg, E. A. Miller, E. Dugan, and F. Porell, “The protective effects of religiosity on depression: A 2-year prospective study,” Gerontologist, vol. 56, no. 3, pp. 421–431, 2016.

D. N. Ditlevsen and A. Elklit, “The combined effect of gender and age on post traumatic stress disorder: Do men and women show differences in the lifespan distribution of the disorder?,” Ann. Gen. Psychiatry, vol. 9, pp. 1–12, 2010.

D. N. Ditlevsen and A. Elklit, “Gender, trauma type, and PTSD prevalence: a re-analysis of 18 nordic convenience samples,” Ann. Gen. Psychiatry, vol. 11, pp. 1–6, 2012.

T. Heetkamp and I. De Terte, “PTSD and resilience in adolescents after New Zealand earthquakes,” NZ. J. Psychol., vol. 44, no. 1, pp. 31–38, 2015.

M. S. Birkeland, I. Blix, Ø. Solberg, and T. Heir, “Gender differences in posttraumatic stress symptoms after a terrorist attack: A network approach,” Front. Psychol., vol. 8, no. DEC, pp. 1–11, 2017.

H. Ibrahim and C. Q. Hassan, “Post-traumatic stress disorder symptoms resulting from torture and other traumatic events among Syrian Kurdish refugees in Kurdistan Region, Iraq,” Front. Psychol., vol. 8, no. FEB, pp. 1–8, 2017.

G. Shiferaw, L. Bacha, and D. Tsegaye, “Prevalence of Depression and Its Associated Factors among Orphan Children in Orphanages in Ilu Abba Bor Zone, South West Ethiopia,” Psychiatry J., vol. 2018, pp. 1–7, 2018.

M. Afifi, “Depression in adolescents: Gender differences in Oman and Egypt,” East. Mediterr. Heal. J., vol. 12, no. 1–2, pp. 61–71, 2006.

& S. Ghanbari, Jafari, Bagheri, Neamtolahi, “Study of the Effect of Using Purposeful Activity (Gardening) on Depression of Female Resident in Golestan Dormitory of Ahvaz Jundishapur University of Medical Sciences,” J. Rehabil. Sci. Res., vol. 2, no. March, pp. 8–11, 2015.