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Study: Hardened Iraqis are mentally resilient

A mental health survey found that Iraqis have suffered from a surprisingly low rate of severe mental disorders, which officials said indicated resilience in the face of decades of war and hardship.
A man searches for his son after a double car bomb attack in Baghdad, Iraq, on Feb. 12, 2007.Khalid Mohammed / AP
/ Source: The Associated Press

About 30 percent have been exposed to shootings or bombings. Others have witnessed killings or mutilated bodies. Nearly 10 percent had a family member kidnapped or had been abducted, captured or imprisoned themselves.

The trauma experienced by respondents of Iraq's first nationwide mental health survey, which was released Saturday, was a grim litany of the violence that pushed the country to the brink of civil war.

The study, conducted by the World Health Organization and the Iraqi government, found that Iraqis have suffered from a surprisingly low rate of severe mental disorders such as PTSD, which officials said indicated resilience in the face of decades of war and hardship.

The findings showed that nearly 17 percent of a random sample of 4,332 Iraqis over the age of 18 surveyed had suffered from a mental disorder in their lifetime, ranging from post-traumatic stress disorder to depression.

Women showed a higher rate of severe depression and phobias, such as a fear of leaving the house, than men.

Few seek treatment
Of the total, however, less than 10 percent had sought treatment, highlighting the need for improved psychiatric care in a country where the overall health care system has been devastated by fighting and sanctions.

Mental disorders are also considered a stigma in Iraq.

"This ability of the Iraqi people to overcome difficulties gives great hope for a better future," Iraqi Health Minister Saleh al-Hasnawi said at a conference to release the report. "But we have to fight the discrimination the mentally ill patient faces."

Much has been documented about the mental effect of war on the U.S.-led forces in Iraq, but the study sought to cast attention on the plight of Iraqis.

"Among those who have mental illnesses in Iraq, they're pretty serious," said Ronald Kessler, a health care policy professor at Harvard Medical School who was involved in the study. "The percent who are suicidally depressed is high."

Nearly 70 percent of those who suffered from a mental disorder also said they had considered suicide.

'Inured to the stress'
The authors said the overall figure suggested that Iraqis have adapted to trauma as a way of life after nearly six years of brutal conflict and previous suffering under Saddam Hussein.

"They eventually get inured to the stress. It just becomes a part of life," Kessler said.

The study also noted that the social stigma of having a medical disorder in Iraq could have prevented some respondents from replying honestly.

The Health Ministry announced ambitious plans to open psychiatric units in regular hospitals as well as building new facilities devoted to mental health.

Iraq's mental health system, along with other institutions, has been depleted of professionals after many fled the country to escape the violence.

The 102-page report included recent data showing that there are 437 psychiatric and social workers nationwide in a country of nearly 30 million people.

The survey was carried out from August 2006 to March 2007, during a time of fierce sectarian fighting between the majority Shiites and disaffected Sunnis, as well as battles involving U.S.-led forces.

Out of the initial sample of 10,080 households, 370 were not visited due to security considerations. The overall response rate was about 95 percent.

Few PTSD cases
Researchers said they were particularly surprised by the relatively low number of cases of PTSD — just over 3.5 percent of respondents. But some expressed concern that it appeared to be increasingly common among young people, indicating the recent sectarian bloodshed and insecurity has exacted a heavy psychiatric toll.

PTSD — which has been one of the main afflictions facing U.S. troops returning home from Iraq — was reported by 3.7 percent of male respondents ages 18 to 34 and by 5.89 percent of those over 65. The figures were 2.1 percent and 6.08 percent, respectively, for women.

But a paper based on the study and published simultaneously in the journal World Psychiatry said the lifetime risk of mental disorders increased over the generations of Iraqis included in the survey, with the largest jump for PTSD, or post traumatic stress disorder.

"The most important finding here is the increasing prevalence of mental disorders, particularly PTSD, across the generations," said Mario Maj, the president of the World Psychiatric Association. "This may be a function of the intergenerational increase in sectarian violence."

He also said it was important to bring the problem to the public's attention.

"Society should know that mental problems are important. They should know that they can be addressed," Maj said.