Review

Post-traumatic Stress
This work is licensed
under a Creative
Commons Attribution-
NonCommercial 3.0
Unported License.

Disorder
H Javidi1, M Yadollahie2
Abstract
1
Islamic Azad Univer- Unexpected extreme sudden traumatic stressor may cause post-traumatic stress disorder
sity, Marvdasht Branch, (PTSD). Important traumatic events include war, violent personal assault (e.g., sexual as-
Department of Psychol-
ogy, Marvdasht, Iran sault, and physical attack), being taken hostage or kidnapped, confinement as a prisoner of

D
2
NIOC Health Organiza- war, torture, terrorist attack, severe car accidents, and natural disasters. In childhood age
tion, Medical Education sexual abuse or witnessing serious injuries or unexpected death of a beloved one are among
and Research Center,
Shiraz, Iran important traumatic events.

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PTSD can be categorized into two types of acute and chronic PTSD: if symptoms persist for
less than three months, it is termed “acute PTSD,” otherwise, it is called “chronic PTSD.”
60.7% of men and 51.2% of women would experience at least one potentially traumatic
event in their lifetime. The lifetime prevalence of PTSD is significantly higher in women than
men. Lifetime prevalence of PTSD varies from 0.3% in China to 6.1% in New Zealand. The
prevalence of PTSD in crime victims are between 19% and 75%; rates as high as 80% have
of
been reported following rape. The prevalence of PTSD among direct victims of disasters was
reported to be 30%–40%; the rate in rescue workers was 10%–20%. The prevalence of
PTSD among police, fire, and emergency service workers ranged from 6%–32%. An over-
all prevalence rate of 4% for the general population, the rate in rescue/recovery occupa-
tions ranged from 5% to 32%, with the highest rate reported in search and rescue person-
nel (25%), firefighters (21%), and workers with no prior training for facing disaster. War is
ive

one of the most intense stressors known to man. Armed forces have a higher prevalence of
depression, anxiety disorders, alcohol abuse and PTSD. High-risk children who have been
abused or experienced natural disasters may have an even higher prevalence of PTSD than
adults.
Female gender, previous psychiatric problem, intensity and nature of exposure to the trau-
ch

matic event, and lack of social support are known risk factors for work-related PTSD. Working
with severely ill patients, journalists and their families, and audiences who witness serious
trauma and war at higher risk of PTSD.
The intensity of trauma, pre-trauma demographic variables, neuroticism and temperament
Ar

traits are the best predictors of the severity of PTSD symptoms. About 84% of those suffer-
ing from PTSD may have comorbid conditions including alcohol or drug abuse; feeling shame,
despair and hopeless; physical symptoms; employment problems; divorce; and violence
which make life harder. PTSD may contribute to the development of many other disorders
such as anxiety disorders, major depressive disorder, substance abuse/dependency disor-
ders, alcohol abuse/dependence, conduct disorder, and mania. It causes serious problems,
thus its early diagnosis and appropriate treatment are of paramount importance.

Keywords: Stress disorders, post-traumatic; Occupations; Depression; Anxiety; Diagnos-

tic and statistical manual of mental disorders

Introduction cluded tachycardia, anxiety, breathless-

ness, and hyper-arousal. These symptoms

I
Correspondence to
Hojjatollah Javidi, PhD,
PO Box: 71436-94871,
n 1871, Dr. Jacob Mendez Da Costa, which were first referred to as “soldier's
Shiraz, Iran described certain symptoms in a heart syndrome,” later named after him,
Tel: +98-711-227-6081
E-mail: javidih@hot- group of soldiers. The symptoms in- “Da Costa syndrome.” During World War
mail.com
Received: Aug 9, 2011 Cite this article as: Javidi H, Yadollahie M. Post-traumatic stress disorder. The International Journal of Occupa-
Accepted: Nov 21, 2011 tional and Environmental Medicine 2012;3:2-9.

2 www.theijoem.com Vol 3 Number 1;www.SID.ir

January, 2012
 review

H. Javidi, M. Yadollahie

I, employment of newly advanced weap- no control over what is happening. Anyone

ons in the combat were so rapid that it who has experienced a life-threatening
sounded as if they came from a super- condition can felt scared, confused, or an-
natural source; the soldiers were very gry. After a traumatic event, many people
bitter to think they were surrounded by may develop some acute symptoms like
invisible enemies. Some of the soldiers severe anxiety, dissociative symptoms,
presented with symptoms like staring dissociative amnesia, poor concentration,
eyes, severe tremors, blue cold extremi- sleep disturbance, and derealization.7
ties, unexplained deafness or blindness, However, the symptoms may not only
and paralysis. The condition was then resolve but also get worse in some of the

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called “shell shock.”1,2 Similar symptoms victims, and the condition progresses to
were reported in World War II veterans PTSD. It is still not clear why some people
and survivors of atomic bombings against develop PTSD while others do not. There

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Hiroshima and Nagasaki. The condition are many known factors that would deter-
then was termed “combat neurosis or mine the likelihood a person may develop
operational fatigue.”3 In the 1900s, psy- PTSD. Both the duration and intensity of
choanalysts, particularly those in the US the trauma are among important risk fac-
coined the term “traumatic neurosis” to tors. The distance from and the extent of
of
describe the condition.4 Constellation reaction to the event, feeling about how
of these symptoms is now termed “post- well the condition is under control, loss of
traumatic stress disorder” (PTSD). or hurt to a beloved or close one, and the
level of help and support the victims re-
ive

Definition of PTSD ceive in the aftermath of the event are all

variables affecting the likelihood one may
According to the Diagnostic and Statisti- develop PTSD.
cal Manual of Mental Disorders (DSM), PTSD symptoms may disrupt normal
PTSD is an anxiety disorder. In the Inter- life, making it hard to continue with daily
ch

national Classification of Diseases, Inju- activities.7 The symptoms are seriously

ries, and Causes of Death (ICD-10, 1992), dependent upon the causative traumatic
it is classified as a neurotic stress-related event. For example, wildfires would sig-
and somatoform disorder. nificantly cause more symptoms of so-
Ar

PTSD may develop if a person encoun- matization, anxiety (especially phobic

ters an unexpected extreme traumatic anxiety), depression, hostility, and para-
stressor. Important traumatic events noia while veterans returning back from
which usually cause PTSD include war, vi- the wars in Iraq and Afghanistan, had
olent personal assault (e.g., sexual assault, more problems with sleep disruption,
and physical attack), being taken hostage and sleep-disordered breathing.8 Patients
or kidnapped, confinement as a prisoner with comorbid PTSD complained more
of war, torture, terrorist attack, or severe frequently of distressing auditory halluci-
car accidents. In children, sexual abuse or nations.9
witnessing serious injuries or unexpected Based on its duration, PTSD can be
death of a beloved one may cause PTSD.5 categorized into two types of acute and
The disorder can also occur after natural chronic PTSD: if symptoms persist for
disasters like wildfire, tornado, hurricane, less than three months, it is termed
flood, and earthquake.6 During such hor- “acute PTSD,” otherwise, it is called
rible events, everyone thinks that their “chronic PTSD.” There is also a “delayed-
own life is in great danger and they have onset PTSD,” which refers to a condition

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review

Post-traumatic Stress Disorder

PTSD could be made in those who would

not have been diagnosed with the condi-
TAKE-HOME MESSAGE
tion earlier.
● PTSD is an anxiety disorder.
Epidemiology
● Exposure to unexpected extreme
traumatic stressor may cause PTSD. Exposure to traumatic events during one's
lifetime is almost inevitable. It has been
● War, violent personal assault (e.g., reported that 60.7% of men and 51.2%
sexual assault, and physical attack), of women would experience at least one

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being taken hostage or kidnapped, potentially-traumatic event in their life-
confinement as a prisoner of war, time.10,11
torture, terrorist attack, or severe car Although PTSD can appear at any age,

SI
accidents, in children, sexual abuse it is more common in young adults, be-
or witnessing serious injuries or un-
cause they are more likely to be exposed
expected death of a beloved one
may cause PTSD.
to precipitating situations. Children can
also develop PTSD. Men and women dif-
fer in the types of traumas to which they
of
● The symptoms are seriously depen-
dent upon the causative traumatic are exposed and their liability to develop
event. PTSD.12 The lifetime prevalence of PTSD
is significantly higher in women than
● PTSD can appear at any age. It is men,13 so that women are twice as likely
ive

more common in young adults, be- to develop PTSD as men are.14

cause they are more likely to be The prevalence of PTSD varies enor-
exposed to precipitating situations. mously among different populations.
Women are twice as likely to develop Lifetime prevalence of PTSD varies from
PTSD as men are.
0.3% in China to 6.1% in New Zealand.15
ch

● Work-related PTSD are common in

In general US population, the prevalence
health and social services, deployers of PTSD is around 6.8%.16 Reported rates
in combat-specific occupations, jour- among crime victims are between 19%
nalists, police, fire, and emergency and 75%, and rates as high as 80% have
Ar

service workers. been reported following rape.

Those residing Gaza Strip face serious
● Trauma intensity, pre-trauma demo- problems resulting in loss of income, lim-
graphic variables, and temperament ited access to health care facilities, and de-
traits are responsible for develop- creased quantity and quality of food. One
ment of PTSD. study conducted by the Gaza Community
Mental Health Program (GCMHP) in
where the disease onset occurs at least six 1996 showed that the prevalence of PTSD
months after the traumatic event. was 30% among ex-political prisoners in
In 2000, for the importance of PTSD, Gaza.17
in the fourth edition of DSM (DSM-IV- Although comparable international
TR), the American Psychiatric Association data are limited, we know that large pro-
(APA) has revised the diagnostic criteria portions of populations in many countries
of PTSD.7 The threshold for the diagnosis round the globe are exposed to terrorism,
of PTSD was set to a lower level so that forced relocation, and violence, which
according to the new criteria, diagnosis of suggests that the overall prevalence of

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January, 2012
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H. Javidi, M. Yadollahie

exposure to traumatic events worldwide Studies have examined the prevalence

may be high.18 of PTSD among high-risk children who
PTSD does not only affect victims of have been abused or experienced natural
disasters but also influences rescue work- disasters. It was shown that these chil-
ers; the prevalence of PTSD among di- dren may have an even higher prevalence
rect victims of disasters was reported to of PTSD than adults.15 Loss of a parent
be 30%–40%; the rate in rescue workers in childhood is another severe trauma.
was 10%–20%.19-21 In one study, the prev- It possesses a stronger association with
alence of PTSD among police, fire, and psychiatric sequelae compared to sudden
emergency service workers ranged from natural parental death.37

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6%–32%.22 A recent study has shown that
the highest risk of developing PTSD was Work-Related PTSD
reported in construction/engineering

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workers, sanitation workers, and unaffili- Several disasters like explosions, may oc-
ated volunteers.23 Another study revealed cur in workplace. These disasters may
that, compared to an overall prevalence result in physical and mental heath co-
rate of 4% for the general population,16 morbidity, depression, PTSD and panic
the rate in rescue/recovery occupations disorder.38 Several factors are known risk
of
ranged from 5% to 32%,24-28 with the high- factors for work-related PTSD. Those in-
est rate reported in search and rescue per- clude female gender, previous psychiatric
sonnel (25%),26 firefighters (21%),29 and problem, degree and nature of exposure
workers with no prior training for facing to the traumatic event, and lack of social
ive

disaster.27,30,31 One study showed that the support.39-41 For personal aspects mostly
prevalence rate of PTSD was significantly attributed to emotional and relational
higher in those people who performed factors, at work, women are more subject
tasks not common for their occupation.23 to harassment compared to men. Women
Survivors who had been in impend- aged between 34 and 45 years showed a
ch

ing danger of dying during the disaster high prevalence (65%) of “mobbing syn-
and lost their colleagues and friends were drome” or other work-related stress disor-
more susceptible to develop PTSD com- ders.42 The most affected fields are health
pared to the general population. Septem- and social services (15.7%), followed by
Ar

ber 11, 2001 terrorist attacks in New York public administration, hotels, restaurants
City is an example.32-35 and transport. In all considered areas of
War is one of the most intense stress- work, women suffer greater discrimina-
ors known to man. The main war-related tion (3.1%) than men (0.8%).
mental health disorders reported in those Among deployers in combat-specific
experienced traumatic events in Iraq and occupations (e.g., infantry, armor, artil-
Afghanistan were PTSD, anxiety, and lery), larger percentages were diagnosed
depression. Armed forces have a higher with PTSD and anxiety-related disorders
prevalence of depression, anxiety disor- after the second and third than the first
ders, alcohol abuse and PTSD. Fifteen deployments; for all other conditions,
years after the end of Vietnam war, 15% larger percentages were affected after the
of male veterans still suffered from PTSD first than any repeat deployments.43
and almost one-third of them would suf- Working with severely or terminally
fer from PTSD in their lifetime.30 The ill patients may arouse feelings of grief,
prevalence rate of PTSD in Gulf War vet- anger, and hopelessness which in some
erans was 12.1%.36 cases, may eventually lead to PTSD.7,44

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Post-traumatic Stress Disorder

Journalists who report on trauma, with the development of PTSD.51,52

war and so on are more likely to develop
PTSD.45 This is not limited to the “front Comorbidity of PTSD
line” reporters but also is true for all who
are involved in news gathering, their fam- About 84% of those suffering from PTSD
ilies, and audiences. may have comorbid conditions including
alcohol or drug abuse; feeling shame, de-
Risk Factors spair and hopeless; physical symptoms;
employment problems; divorce; and vio-
Early research studies on traumatic stress lence which make life harder. PTSD may

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revealed that trauma intensity—and not contribute to the development of many
personality traits of exposed person—was other disorders such as anxiety disorders,
responsible for development of PTSD. e.g., panic disorder (9.5%) and social

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The intensity of trauma, pre-trauma de- phobia (28%), major depressive disorder
mographic variables, and temperament (48%), substance abuse/dependency dis-
traits are the best predictors of the sever- orders (31%), alcohol abuse/dependence
ity of PTSD symptoms.46,47 (40%), conduct disorder (29%), and ma-
The mean PTSD score after burn in- nia (9%).10
of
creased with hospitalization period, male
gender, younger age, and higher total Conclusion
body surface area burned.48
Neuroticism is a personality trait de- On account of many traumatic situa-
ive

fined by the tendency to react to events tions humans faced with, Albert Camus
with greater than average negative affect. called the 20th century “the century of
In a sample of 7076 adults, neuroticism fear.” These situations—e.g., threats of
predicted the onset of both anxiety disor- war, technological disasters, and city vi-
ders and depression.49,50 It is possible that olence—are still at work in 21st century.
ch

high level of neuroticism, is also predic- The body of knowledge on psychologi-

tive for PTSD severity because persons cal impact of extreme stress, in particu-
with high neuroticism are more likely to lar traumatic events, on human health
choose less effective coping strategies.50 is rapidly growing. We witness the grow-
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Studies from the cognitive perspec- ing interest in social significance of these
tive indicate that people who are able to events.53 Considering the growing num-
maintain sense of control during the trau- ber of stressors, we should pay more at-
ma are less likely to develop PTSD. After tention to PTSD and its early treatment,
exposure to trauma, people who rely on as it would be associated with long-term
dissociative coping strategies seem more sequelae (particularly in women and chil-
likely to develop PTSD compared to peo- dren) if left untreated.
ple who rely on other strategies.
After the devastating earthquake in Conflicts of Interest: None
Bam, the prevalence of PTSD in survived declared.
students was 36.3% in those older than 15
years and 51.6% in students younger than
References
15. The presence of body injury, living far
from parents, female gender, lower edu- 1. Coleman P. Flashback: Posttraumatic Stress
cation, unemployment, and loss of fam- Disorder, Suicide, and the Lessons of War. Boston:
ily members had significant correlations Beacon Press, 2006.

6 www.theijoem.com Vol 3 Number 1;www.SID.ir

January, 2012
 review

H. Javidi, M. Yadollahie

2. Hitchcock FC. Stand To: A Diary of the Trenches. 15. Gabbay V, Oatis MD, Silva RR, HIRSCH GS. Post-
Heathfield, England, The Naval & Military Press, traumatic stress disorders in children and ado-
Ltd, 2001. lescents: HandbookSilva. US New York, NY, WW
Norton & Co, 2004.
3. El-Sarraj E, Diab T, Thabet AA. Post-traumatic
stress disorder. In: Laeth Sari Nasir LS, Abdul-Haq 16. Kessler RC, Chiu WT, Demler O, et al. Prevalence,
AK, eds. Caing for arab patients: A Biopsychosocial severity, and comorbidity of 12-month DSM-IV
Approach, Radcliffe Publishing, 2008: 185-97. disorders in the National Comorbidity Survey Rep-
lication. Arch Gen Psychiatry 2005;62:617-27.
4. Buther JN, Mineka S, Hooley J. Abnormal Psychol-
ogy 13th ed, Pearson/Allyn and Bacon, 2007. 17. el Sarraj E, Punamaki RL, Salmi S, Summerfield
D. Experiences of torture and ill-treatment and
5. L. Russell. Post-Traumatic Stress Disorder (PTSD).
posttraumatic stress disorder symptoms among

D
2011. Available from http://www.mental-health-
Palestinian political prisoners. J Trauma Stress
today.com/ptsd/dsm.htm (Accessed November
1996;9:595-606.
21, 2011).
18. Kessler RC. Posttraumatic stress disorder: the

SI
6. Papanikolaou V, Adamis D, Mellon RC, Prodromi-
burden to the individual and to society. J Clin Psy-
tis G. Psychological distress following wildfires
chiatry 2000;61(Suppl 5):4-12; discussion 3-4.
disaster in a rural part of Greece: a case-control
population-based study. Int J Emerg Ment Health 19. Schlenger WE, Caddell JM, Ebert L, et al. Psycho-
2011; 13:11-26. logical reactions to terrorist attacks: findings from
the National Study of Americans' Reactions to
7. American Psychiatric Association. Diagnostic and
of
September 11. JAMA 2002;288:581-8.
Statistical Manual of Mental Disorders. 4th ed.
Washington DC, American Psychiatric Association, 20. Turner SW, Thompson J, Rosser RM. The Kings
2000. Cross fire: psychological reactions. J Trauma Stress
1995;8:419-27.
8. Capaldi VF 2nd, Guerrero ML, Killgore WD. Sleep
ive

disruptions among returning combat veterans 21. Havenaar JM, Rumyantzeva GM, van den Brink
from Iraq and Afghanistan. Mil Med;176:879-88. W, et al. Long-term mental health effects of the
Chernobyl disaster: an epidemiologic survey
9. Steel C, Haddock G, Tarrier N, et al. Auditory hallu-
in two former Soviet regions. Am J Psychiatry
cinations and posttraumatic stress disorder within
1997;154:1605-7.
schizophrenia and substance abuse. J Nerv Ment
Dis;199:709-11. 22. McFarlane AC, Williamson P, Barton CA. The im-
ch

pact of traumatic stressors in civilian occupational

10. Kessler RC, Sonnega A, Bromet E, et al. Posttrau-
settings. J Public Health Policy 2009;30:311-27.
matic stress disorder in the National Comorbidity
Survey. Arch Gen Psychiatry 1995;52:1048-60. 23. Perrin MA, DiGrande L, Wheeler K, et al. Dif-
ferences in PTSD prevalence and associated
11. Breslau N, Kessler RC, Chilcoat HD, et al. Trauma
Ar

risk factors among World Trade Center disaster

and posttraumatic stress disorder in the commu-
rescue and recovery workers. Am J Psychiatry
nity: the 1996 Detroit Area Survey of Trauma. Arch
2007;164:1385-94.
Gen Psychiatry 1998;55:626-32.
24. Fullerton CS, Ursano RJ, Wang L. Acute stress dis-
12. Punamaki RL, Komproe IH, Qouta S, et al. The role
order, posttraumatic stress disorder, and depres-
of peritraumatic dissociation and gender in the
sion in disaster or rescue workers. Am J Psychiatry
association between trauma and mental health in
2004;161:1370-6.
a Palestinian community sample. Am J Psychiatry
2005;162:545-51. 25. Epstein RS, Fullerton CS, Ursano RJ. Posttraumatic
stress disorder following an air disaster: a pro-
13. Tolin DF, Foa EB. Sex differences in trauma and
spective study. Am J Psychiatry 1998;155:934-8.
posttraumatic stress disorder: a quantitative
review of 25 years of research. Psychol Bull 26. Ozen S, Sir A. Frequency of PTSD in a group of
2006;132:959-92. search and rescue workers two months after
2003 Bingol (Turkey) earthquake. J Nerv Ment Dis
14. Breslau N, Chilcoat HD, Kessler RC, Davis GC.
2004;192:573-5.
Previous exposure to trauma and PTSD effects of
subsequent trauma: results from the Detroit Area 27. Guo YJ, Chen CH, Lu ML, et al. Posttraumatic stress
Survey of Trauma. Am J Psychiatry 1999;156:902- disorder among professional and non-professional
7. rescuers involved in an earthquake in Taiwan.

www.theijoem.com Vol 3 Number 1; January, 2012 www.SID.ir7

review

Post-traumatic Stress Disorder

Psychiatry Res 2004;127:35-41. of risk factors for posttraumatic stress disorder

in trauma-exposed adults. J Consult Clin Psychol
28. North CS, Tivis L, McMillen JC, et al. Psychiatric
2000;68:748-66.
disorders in rescue workers after the Oklahoma
City bombing. Am J Psychiatry 2002;159:857-9. 41. Galea S, Nandi A, Vlahov D. The epidemiology
of post-traumatic stress disorder after disasters.
29. Chang CM, Lee LC, Connor KM, et al. Posttrau-
Epidemiol Rev 2005;27:78-91.
matic distress and coping strategies among rescue
workers after an earthquake. J Nerv Ment Dis 42. Tonini S, Lanfranco A, Dellabianca A, et al. Work-
2003;191:391-8. related stress and bullying: gender differences
and forensic medicine issues in the diagnostic
30. Kulka RA, Schlenger WE, Fairbank JA, et al.
procedure. J Occup Med Toxicol;6:29.
Trauma and the Vietnam War generation: report

D
of findings from the National Vietnam Veterans 43. Associations between repeated deployments
Readjustment Study. New York, NY, Brunner/Ma- to Iraq (OIF/OND) and Afghanistan (OEF) and
zel, 1990. post-deployment illnesses and injuries, active
component, U.S. Armed Forces, 2003-2010. Part

SI
31. Dyregrov A, Kristoffersen JI, Gjestad R. Voluntary
II. Mental disorders, by gender, age group, military
and professional disaster-workers: similarities
occupation, and “dwell times” prior to repeat
and differences in reactions. J Trauma Stress
(second through fifth) deployments. MSMR;18:2-
1996;9:541-55.
11.
32. Hull AM, Alexander DA, Klein S. Survivors of
44. Rashotte J, Fothergill-Bourbonnais F, Chamberlain
the Piper Alpha oil platform disaster: long-term
of
M. Pediatric intensive care nurses and their grief
follow-up study. Br J Psychiatry 2002;181:433-8.
experiences: a phenomenological study. Heart
33. Green BL, Lindy JD, Grace MC, Leonard AC. Chron- Lung 1997;26:372-86.
ic posttraumatic stress disorder and diagnostic
45. Pyevich CM, Newman E, Daleiden E. The relation-
comorbidity in a disaster sample. J Nerv Ment Dis
ship among cognitive schemas, job-related trau-
ive

1992;180:760-6.
matic exposure, and posttraumatic stress disorder
34. Galea S, Vlahov D, Resnick H, et al. Trends of prob- in journalists. J Trauma Stress 2003;16:325-8.
able post-traumatic stress disorder in New York
46. Strelau J, Zawadzki B. Trauma and Temperament
City after the September 11 terrorist attacks. Am J
as Predictors of Intensity of Posttraumatic Stress
Epidemiol 2003;158:514-24.
Disorder Symptoms After Disaster. European Psy-
ch

35. Norris FH, Tracy M, Galea S. Looking for resilience: chologist 2005;10:124-35.
understanding the longitudinal trajectories of
47. Foy DW, Sipprelle RC, Rueger DB, Carroll EM. Etiol-
responses to stress. Soc Sci Med 2009;68:2190-8.
ogy of posttraumatic stress disorder in Vietnam
36. Kang HK, Natelson BH, Mahan CM, et al. Post- veterans: analysis of premilitary, military, and
traumatic stress disorder and chronic fatigue combat exposure influences. J Consult Clin Psychol
Ar

syndrome-like illness among Gulf War veterans: a 1984;52:79-87.

population-based survey of 30,000 veterans. Am J
48. Sadeghi-Bazargani H, Maghsoudi H, Soudmand-
Epidemiol 2003;157:141-8.
Niri M, et al. Stress disorder and PTSD after burn
37. Morina N, von Lersner U, Prigerson HG. War and injuries: a prospective study of predictors of PTSD
bereavement: consequences for mental and physi- at Sina Burn Center, Iran. Neuropsychiatr Dis
cal distress. PLoS One 2011;6:e22140. Treat;7:425-9.
38. Wisnivesky JP, Teitelbaum SL, Todd AC, et al. 49. De Graaf R, Bijl RV, Ravelli A, et al. Predictors of
Persistence of multiple illnesses in World Trade first incidence of DSM-III-R psychiatric disorders in
Center rescue and recovery workers: a cohort the general population: findings from the Nether-
study. Lancet;378:888-97. lands Mental Health Survey and Incidence Study.
Acta Psychiatr Scand 2002;106:303-13.
39. Nandi A, Galea S, Tracy M, et al. Job loss, unem-
ployment, work stress, job satisfaction, and the 50. Schnurr PP, Vielhauer MJ. Risk factors for posttrau-
persistence of posttraumatic stress disorder one matic stress disorder. In: Yehuda R, ed. Personality
year after the September 11 attacks. J Occup Envi- as a risk factor for PTSD. Washington,DC, Ameri-
ron Med 2004;46:1057-64. can Psychiatric Press, 2000: 191-222.
40. Brewin CR, Andrews B, Valentine JD. Meta-analysis 51. Parvaresh N, Bahramnezhad A. Post-traumatic
stress disorder in bam-survived students who

8 www.theijoem.com Vol 3 Number 1;www.SID.ir

January, 2012
 review

H. Javidi, M. Yadollahie

immigrated to Kerman, four months after the Public Health 2005;5:4.

earthquake. Arch Iran Med 2009;12:244-9.
53. Strelau J. People under Extreme Stress : An
52. Montazeri A, Baradaran H, Omidvari S, et al. Individual Differences Approach. Hauppauge, NY,
Psychological distress among Bam earthquake Nova Science Publishers, 2006.
survivors in Iran: a population-based study. BMC

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of
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Enamelled tiles mosaic on the roof of one of the entrances of Jāme Atigh Mosque, Shiraz, Iran (Photo courtesy of
Marjan Bayat Maku, Shiraz). For an article on lead poisoning among traditional tile workers in Iran see The Interna-
tional Journal of Occupational and Environmental Medicine 2010;1:29-38 (Available from www.theijoem.com/ijoem/
index.php/ijoem/article/view/6).

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