Long-term effects of sulfur mustard on civilians’ mental health 20 years after exposure (The Sardasht-Iran Cohort Study)

Rasoul Roshan,Ali Montazeri,Zeinab Ghazanfari,Parvin Rahnama,Mohammad Reza Soroush,Mahdiyeh Melyani,Mohammad Mehdi Naghizadeh,Azadeh Tavoli,Tooba Ghazanfari

doi:10.1186/1477-7525-11-69

Abstract

BackgroundSulfur mustard (SM) is an alkylating agent that induces short and long term toxicity on various organs. The aim of this study was to assess the long-term psychological symptoms among samples of exposed to sulfur mustard gas compared with unexposed civilians 20 years after exposure.MethodsThis historical cohort study was conducted on 495 civilians of Sardasht and Rabat in two age matched groups, including 367 sulfur mustard exposed participants from Sardasht and 128 unexposed subjects from Rabat. Psychological symptoms was assessed using the Symptom Check List-90 Revised (SCL-90-R) including measures of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism providing three global distress indices namely: Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Index (PSDI). Comparison was made between exposed and unexposed civilians.ResultsThere were significant differences in somatization (P = 0.002), obsessive-compulsive (P = 0.031), depression (P = 0.007), anxiety (P = 0.042), and hostility (P = 0.002), between the exposed and unexposed groups. In addition there were significant differences between two groups concerning the GSI (P = 0.045) and the PSDI (P < 0.001). The differences between two groups in other subscales were not significant.ConclusionsThe findings from this study showed that civilians who exposed to sulfur mustard gas were suffering from a number of psychological symptoms even 20 years after exposure. Providing mental health services and more resource allocation for this community are highly recommended.

Highlights

Sulfur mustard (SM) is an alkylating agent that induces short and long term toxicity on various organs
The exposed group was selected from the male individuals of Sardasht exposed to sulfur mustard 20 years ago based on the documents in the medical records verified by the Medical Committee of the Foundation of Martyr and Veterans Affair
There were no significant differences in terms of age, body mass index, marital status and employment status between the exposed and control groups (Table 1)

Summary

Introduction

Sulfur mustard (SM) is an alkylating agent that induces short and long term toxicity on various organs. Sulfur Mustard [bis-(2-chloroethyl) sulfide; mustard gas] is a vesicant chemical agent that can produce significant morbidity [1]. This agent was been used during the IraqIran war between 1980 and 1988. Mustard gas can be absorbed through skin, respiratory system, genital tract, and ocular surface [2] It affects many organs such as skin, eyes, lungs, gastrointestinal, endocrine and hematopoietic system [4]. Respiratory diseases are the major cause of long-term disability among these patients [2] It has been known as a DNA alkylating agent and classified as a known human carcinogen [5]

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