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

Ibrahim Mohammed^1*Hataw Ahmed Sharif²Bushra Hasin³Jan Kizilhan⁴Hemn Nariman⁵Salah Ahmed⁶Azad Qader³Segi Papiol⁷Monika Rubekeil⁷Thomas G Schulze^10,7,8,9Urs Heilbronner⁷Martin HAUTZINGER²

• ¹University of Tübingen, Tübingen, Germany
• ²Eberhard Karls Universitat Tubingen, Tübingen, Germany
• ³University of Sulaimani, Sulaymaniyah, Iraq
• ⁴Duale Hochschule Baden Wurttemberg, Stuttgart, Germany
• ⁵Qaiwan International University, Sulaymaniyah, Iraq
• ⁶Jiyan Foundation for Human Rights, Erbil, Iraq
• ⁷LMU Klinikum Institut fur Psychiatrische Phanomik und Genomik, Munich, Germany
• ⁸SUNY Upstate Medical University Hospital, Syracuse, United States
• ⁹Johns Hopkins Medicine Department of Psychiatry and Behavioral Sciences, Baltimore, United States
• ¹⁰SUNY Downstate Health Sciences University Department of Psychiatry & Behavioral Sciences, New York, United States

Background: 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 This is a provisional file, not the final typeset article psychological and physical health of survivors. Objectives: 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. Methods: A total of 534 participants were recruited (300 females and 234 males). Data collection was completed in seven 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. Results: 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 .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. Conclusion: 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.