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Sylvia Nassar-Mcmillan, Phd; Richard Lambert, Phd; Adnan Hammad, Phd

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Sylvia Nassar-Mcmillan, Phd; Richard Lambert, Phd; Adnan Hammad, Phd C. MEDICAL COMPLAINTS OF IRAQI AMERICAN PEOPLE BEFORE AND AFTER THE 1991 GULF WAR Hikmet Jamil, MD, PhD; Sylvia Nassar-McMillan, PhD; Richard Lambert, PhD; Adnan Hammad, PhD Ethn Dis. 2007;17[Suppl 3]:S3-77–S3-78 INTRODUCTION residents in the metropolitan Detroit area. The participants were selected Key Words: Iraq,GulfWar,Immigrant Health Thousands of Iraqis immigrated to randomly from a list of 5,490 residents. the United States before the 1991 Gulf The random sample consisted of 350 War for a variety of reasons that were participants because of limited funding. predominately economic. Post-1991 Analysis of participants’ residences Gulf War immigration among this showed that they represent various cities group represents a new wave of immi- that differ on demographic character- gration from Iraq.1 Most post-Gulf War istics, such as socioeconomic status. Also Iraqi immigrants, many of them refu- the analysis showed that the participants gees, suffered a sequence of serious came from 55 zip code areas within 24 traumas in Iraq, either before, during cities in the metropolitan Detroit area. or after the Gulf War. These individuals Participants were verbally asked to fill appear to suffer from a host of physical out a series of questionnaires adminis- and mental health maladies, some tered in their native language. If the similar to those affecting other groups participant was unable to read, the such as US Gulf War veterans.2,3 questions were given verbally in an To date, there is no published interview format. The questionnaires scientific research about the 1991 Gulf were designed to obtain information War explaining the etiological agents regarding the subject’s medical condi- possibly responsible for such com- tions (diseases or symptoms) at the time plaints.4 Studies of Iraqi Americans are of the survey and whether that condi- very scarce, although a few recently tion was present before or after the 1991 published studies conducted with the Gulf War. Demographic information Iraqi veteran refugee population indi- was also obtained. cated high levels of medical and mental The study was conducted during disorders.2,5,6,7 However, Iraqis who 2004 and 2005. Group A consisted of immigrated after the 1991 Gulf War 206 participants who immigrated to represent a population with the highest America after 1991, and Group B potential exposure to toxic materials consisted of 144 participants who during this war. It is imperative to immigrated to America before 1991. examine closely their physical and The interview questionnaire was based mental disorders. Therefore, the objec- on an instrument from the Iowa Persian tive of the study was to compare the Gulf War Study Group, 1997.8 prevalence of medical conditions be- tween Iraqis who immigrated after the 1991 Gulf War (Group A) and Iraqis RESULTS who immigrated before the 1991 Gulf War (Group B). From the Department of Family Med- Group A had fewer male partici- icine at Wayne State University (HJ), pants (51.5%) than Group B (62.5%). Detroit, Michigan; Department of Counsel- More participants were below the age of or Education, University of North Carolina METHODS 40 years in Group A (38.5%) than in (SNM), Charlotte, NC; Department of Group B (18.6%). There were more Educational Leadership, University of North Carolina (RL), Charlotte, NC; and ACCESS Ethical clearance was obtained from married participants in Group A Community Health and Research Center Wayne State University. The study is (85.9%) than in Group B (71.5%). (AH), Dearborn, Michigan. a cross-sectional study among Iraqi More participants had less than high Ethnicity & Disease, Volume 17, Summer 2007 S3-77 MENTAL HEALTH - Jamil et al school education in Group A (44.7%) the study indicate that the prevalence of REFERENCES than in Group B (32.6%). Most of the 13 out of 29 medical conditions (dis- 1. Nassar-McMillan SC. Counseling Arab Amer- participants were Iraqi Americans of eases and symptoms) were significantly icans. In: Vacc NA, DeVaney SB, Brendel JM, eds. Counseling Multicultural and Diverse Arabic-speaking descent (Group A: higher (range between P,.05 and Populations.4th ed. New York: Brunner- 70.4%, Group B: 72.9%), while the P,.001) among Iraqis who immigrated Routledge, 2003;117–139. remainder were Iraqi Americans of to the United States after the 1991 Gulf 2. Jamil H, Nassar-McMillan SC, Lambert R. Chaldean descent (Group A: 29.6%; War (Group A) in comparison to Iraqis Aftermath of the Gulf War: mental health Group B: 27.1%). The occupational who immigrated to the United States issues among Iraqi Gulf War veteran refugees in the United States. JofMentHealth category with the highest percentage before the 1991 Gulf War (Group B). Counseling. 2004;26(4):295–308. of people in Group A was profes- In particular, the medical conditions 3. Jamil H, Nassar-McMillan SC, Salman WA, sional work (24.4%) when they were related to mental disorders were signif- Tahar M. Iraqi Gulf War veteran refugees: in Iraq, but this percentage declined icantly more prevalent in Group A PTSD and physical symptoms. J of Soc Work in Health Care. In press. to 9.3% when they came to the United (P,.001). The greater prevalence of 4. Knoke JD, Smith TC, Gray GC, Kaiser States. The percentage of unskilled the medical conditions among Group A KS, Hawksworth AW. Factor analysis of self- 5 workers in Group A was 5.4% when was consistent with previous research. reported symptoms: does it identify a Gulf they were in Iraq and 22.4% when Also the results were consistent with War syndrome? Am J Epidemiol. 2000;152(4): individuals immigrated to the United a number of small surveys, which were 379–388. 5. Jamil H, Hakim-Larson J, Farrag M, Kafaji T, States. Group B showed more or less conducted in Iraq comparing health Duqum I, Jamil L. A retrospective study of the reverse trend in these two occupa- data from before and after the Gulf Arab American mental health clients: trauma 9,10 tions. War. and the Iraqi refugees. Am J of Orthopsychiatry. Among the 29 medical conditions 2002;72:355–361. (symptoms and illnesses) that could be 6. Takeda J. Psychological and economic adap- tation of Iraqi adult male refugees: Implica- reported, only one (thyroid problem) CONCLUSIONS tions for social work practice. J of Soc Serv Res. was more prevalent in Group B and one 2000;26:1–21. (eczema) was equal in both groups. 7. Via T, Callahan S, Barry K, Jackson C, Gerber N There were significant differences in Among the 29 medical conditions more D. Middle East meets Midwest: the new health more than half of the medical prevalent in Group A, 13 were statisti- care challenge. J of Multicultural Nurs & conditions (including mental disor- Health. 1997;3:35–39. cally more prevalent (eg, sleep apnea, ders) between the Iraqis who immi- 8. Iowa Persian Gulf Study Group. Self-reported memory loss, chronic headache, fa- grated before and after the 1991 illness and health status among Gulf War tigue). The medical conditions related veterans. J of Am Med Assoc.1997;277: Gulf War. to mental disorders (PTSD, panic 238–245. N More clinical and epidemiological disorder, anxiety and depression) were 9. El-Shihabi WM. Preliminary study on changes research among Iraqis who partici- of pattern of complaints of Iraqi patients after statistically more prevalent among par- pated in the 1991 Gulf War is the 1991 war. Paper presented at: The ticipants in Group A as compared to International Scientific Symposium on Post needed. Group B. War Environmental Problems in Iraq. Iraqi Society for Environment Protection and Improvement; December 10–12, 1994. Bagh- dad, Iraq. DISCUSSION ACKNOWLEDGMENTS 10. Al-Taha SAH. A survey of genetic clinic This research could not have been un- patients for chromosomal genetic syndromes Significant differences were found dertaken without the support of Pfizer and congenital malformations as detected by for most demographic variables between Corporation. The research team would like clinical and chromosomal studies: 1989–90 vs to thank all of the outreach health advocates 1992–93. The International Scientific Sym- Iraqis who immigrated after the 1991 who worked hard to collect the data. We posium on Post War Environmental Problems Gulf War (Group A) and those who would also like to thank all who participated in Iraq. Iraqi Society for Environment Pro- immigrated before the 1991 Gulf War in this research. This research does not tection and Improvement; December 10–12, (Group B) (P,.05). Also the results of influence Pfizer’s vision. 1994. Baghdad, Iraq. S3-78 Ethnicity & Disease, Volume 17, Summer 2007.
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