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

Rasoul Roshan12, Parvin Rahnama3, Zeinab Ghazanfari45, Ali Montazeri6, Mohammad Reza Soroush7, Mohammad Mehdi Naghizadeh8, Mahdiyeh Melyani9, Azadeh Tavoli9 and Tooba Ghazanfari110*

Author Affiliations

1 Immunoregulation Research Center, Shahed University, Tehran, Iran

2 Department of Psychology, Shahed University, Tehran, Iran

3 Department of Midwifery, Shahed University, Tehran, Iran

4 Psycho-Social Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran

5 Department of Public Health, Ilam University of Medical Sciences, Ilam, Iran

6 Mental Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

7 Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran

8 Department of Biostatistics, Fasa University of Medical Sciences, Fasa, Fars Province, Iran

9 Department of Psychology, Faculty of Humanity Studies, Tarbiat Modares University, Tehran, Iran

10 Department of Immunology, Shahed University, Tehran, Iran

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Health and Quality of Life Outcomes 2013, 11:69  doi:10.1186/1477-7525-11-69

Published: 24 April 2013



Sulfur 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.


This 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.


There 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.


The 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.