# A study on long-term trauma-related mental health outcomes among Kurdish survivors of chemical attacks

## TL;DR

This study examines long-term mental health effects in Kurdish survivors of chemical attacks, finding high rates of PTSD and related symptoms linked to trauma exposure, gender, and education.

## Contribution

The study provides novel insights into the long-term mental health outcomes of chemical attack survivors in the Kurdistan region, emphasizing sociodemographic and trauma-related predictors.

## Key findings

- 78.8% of participants met PTSD criteria, with 46.3% showing comorbid symptoms across multiple domains.
- Gender, trauma exposure, education, and clinical factors significantly predicted symptom severity (p < 0.001).
- Women exhibited higher symptom severity than men after adjusting for covariates.

## Abstract

The Kurdistan region experienced a series of devastating events, such as the 1988 chemical attacks and the 2014 Yazidi genocide, which have had substantial impacts on the psychological and physical health of survivors.

This study evaluates the long-term mental health of individuals who were exposed to chemical gas, with a focus on the prevalence and severity of psychological symptoms and their associations with sociodemographic, clinical, and trauma-related factors.

A total of 534 participants were recruited (300 women and 234 men). Data collection was completed in 7 months, from March to September 2023. All participants completed validated psychological assessments, including the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-15 (PHQ-15), and Hopkins Symptom Checklist-25 (HSCL-25). Multivariate General Linear Modeling (GLM) was performed, adjusting for trauma exposure to simultaneously assess the effects of demographic and clinical variables on multiple symptom domains.

Most of the participants exhibited clinically significant symptoms, with 78.8% meeting the post-traumatic stress disorder (PTSD) threshold and 46.3% exhibiting comorbid symptoms across multiple domains. The GLM demonstrated that gender, trauma exposure, education level, and clinical factors were significantly associated with symptom severity across PTSD, somatic, and anxiety/depression symptoms (p < 0.001). The model explained up to 47% of variance in symptom outcomes. After adjusting for covariates, women showed higher symptom severity than men. Greater trauma exposure and lower education independently predicted increased symptoms.

These findings highlight serious psychological and somatic effects among survivors and underscore the urgent need for targeted mental health interventions for those affected by chemical attacks, with particular attention to individuals with lower levels of education and socioeconomic status, while incorporating gender-sensitive approaches to address differential vulnerabilities.