Stress of war causes mental health problems for Iraqis; few seek treatment

From The New York Times:

BAGHDAD — Only when the guns fall silent does the extent of damage wrought by conflict become visible.

So in Iraq, as security improves, only now are the full effects of the violence on the Iraqi people emerging.

Two studies being released this weekend, one on mental health and the other on the status of women, paint a sobering portrait of the enormous difficulties that lie ahead as the country tries to recover from years of war and state-sponsored terrorism under Saddam Hussein and the more recent sectarian and ethnic strife that followed the American invasion.

In the mental health study, released Saturday, the Iraqi government and the World
Health Organization surveyed 4,332 Iraqis over 18 years old nationwide and found that 17 percent suffered from mental disorders of some kind, with depression, phobias, post-traumatic stress disorder and anxiety among the most common.

The sense of desperation was so severe that among those who had mental health issues, nearly 70 percent said they had contemplated suicide. Nonetheless, the psychiatrists and psychologists who carried out the survey in 2006 to 2007 said that they were surprised that the percentages were not even higher given the levels of violence and trauma, and they hypothesized that Iraqis had developed defenses to protect themselves.

“Iraqi society has suffered for nearly 50 years from difficult circumstances, but gradually people seem to have become accustomed to enduring hard experiences,” said Abdul al-Monaf al-Jadiry, a psychiatrist at Amman University in Jordan who supervised the study.

The study found that women were particularly vulnerable to mental illness. Among men, 14 percent suffered from mental health problems while 19 percent of women did. A higher proportion of women than men were found to suffer from severe depression, phobias and anxiety.

Just 2 percent of Iraqis suffering from mental health troubles had sought treatment, which is hard to come by here. Social stigma attached to mental illness as well as a scarcity of psychiatrists and psychologists have meant that there is little treatment available.

Often those who are severely mentally ill are kept at home and untreated, out of sight of neighbors and others, for fear that malicious rumors would circulate about the whole family. A minority of Iraqis confine their ill relatives in one of just a few psychiatric hospitals.

More common ills like depression usually go untreated. A number of Iraqis self-medicate. Pharmacy customers commonly ask for Valium or sleeping medicines.

The higher levels of stress and mental illness among women, common in many postconflict societies, may be even higher in Iraq because of the long period of war, according to a study to be released Sunday by the nonprofit research group Oxfam
and Amal, an Iraqi nonprofit group that concentrates on issues of concern to women.

Despite the recent increase in stability in Iraq, many women have seen their circumstances worsen over the past two years, according to the study, which surveyed 1,700 women in five provinces and was completed last May.

More than three decades of war have made widows of an estimated 740,000 women and left many others fatherless or without brothers to look after them, said Olga Ghazaryan, Oxfam’s regional director for the Middle East.

The survey found that more than three-quarters of all widows were not receiving pensions, and a third of the women surveyed had three hours or less electricity per day. Quality health care is harder to obtain than it was in 2006 and 2007, they said.

“These widows take care not only of their children but often of their extended family so they are bearing a heavy burden,” Ms. Ghazaryan said. The responsibility of finding food for the family and obtaining electricity and water puts great stress on women.

Beyond that, she said, “many of these women have lost loved ones and seen what happened to them, they have seen family members killed in front of them and that’s a tremendous burden.”