The Iraqi People Impact of Six Decades of Trauma; on the Health

The Iraqi People Impact of Six Decades of Trauma; on the Health Presenter Hikmet Jamil, MD, DVD, DIH, MSc, PhD, AFOM, MFOM, FFOM, FPH

2nd IFSFMCI Conference held at Holy Karbala/ Iraqi Secretariat of the Imam Hussain Holy shrine 6-7 December 2017

Research Team • Hikmet J. Jamil, MD, PhD1; Manhel Reemon Aziz, PhD2; Nadia Al-Noor, PhD3; Taghreed Al Noor, PhD4; Thamer Hamdan, MD, FRCS5 • Michigan State University, Department of Family Medicine, Michigan, U.S. • Wayne State University, Department of Nutrition and Food Science, Michigan, U.S (Volunteer adjunct faculty).

• Mustansiriyah University, Department of Mathematics, College of Science, Baghdad, Iraq.

• University of Baghdad, Department of Chemistry, Education for Pure Science College, Ibn- Al Haitham, Baghdad, Iraq.

• University of Basra, Department of Surgery, Basra Iraq

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Conference Aims The Conference Designed To Bring Together:– Fingerprint Practitioners, – Educators And – Researchers

To Enhance Information-sharing & Promote Collaboration Among The Forensic, Law Enforcement, Academic, Biometric, And Legal Communities Nationwide.

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Presentation & Conference

The Presentation Will Explore The Relation Between The Trauma That The Iraqis Exposed In The Last Six Decades & Its

Risk Factors, To Enhance The Iraqi Government To Establish Public Health Program Leading To Wellbeing of Iraqi

People.

Study Objectives •

To Explore The Prevalence of Trauma

Through Mental Dis. & Substance Abuse Among Iraqis Inside & Outside Iraq,

•

To Explore The Risk Factors For Mental Diseases, Substance Abuse & Wellbeing

(Through Self-rated Health) Among Iraqis

Inside & Outside Iraq.

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Hypothesis

We Hypothesis That ❖Iraqi People Inside Iraq Will (1) Suffer More Mental Diseases, (2) Use More Substance Abuse & (3) Have Worse Health

❖Compare To Iraqi Outside Iraq (USA).

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Introduction

Literature Reviews Indicate: ❖Relationship Between Mental Diseases & Crime ❖Relationship Between Using Extensive Illicit Drugs & Crine ❖One of The Most Significant Areas of Risk With The Use of Alcohol & Drugs Is The Connection Between Alcohol, Drugs & Crime.

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Introduction

• 1.9 Million Of 2.4 Million Juvenile Arrests Had Substance Abuse & Addiction Involvement • Each Year, More Than 600,000 Students Between The Ages of 18 & 24 Are Assaulted By Another Student Who Has Been Drinking.

• 95% of All Violent Crime on College Campuses Involves The Use of Alcohol 8

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2003-14

2014-17 Civil War against ISIS

instability

After U.S. Invasion

1990-91 IraqKuwait War

Sources of Trauma on Iraqi People 1963 -2017 1963-2003 Iraq under Dictatorship

19912003 Iraq Under Sanction

1980-88 IraqIran War 10

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TV

Political

Violence

Power

Poverty

Illicit Drugs

Major

Child Abuse, Rape women, Widow, Divorce

Exposure To

Victim Unfair Ruling from Court

Trauma

Disable & Injured Person

Death of Love Person

Discrimination

Overcrowd At Household 12

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Physical Damages

Emotional Shocks

Denial, Anger

Response To Trauma

Acute Stress Disorder

Secondary Injuries 14

Method / Study Population

❖ Data of Four Scientific Researches Which Were Conducted In Michigan USA, Between 2000 & 203 & One Scientific Research Was

Conducted In 2001 In The South of Iraq, Will Form The Data of Presentation

❖ Several articles were published from these data

Method / Study Population • There Were No Significant Difference Between The Four Extracted Data From The Original Data Which Was Conducted In Michigan, USA, When We Applied ANOVA Analysis, for that reason we combined them as one group vx the study nwhich was conducted inside Iraq 16

Method / Study Population ❖ Only Iraqis Male Were Selected From the four Studies which were conducted in USAn ❖ The other one study was conducted in the South of Iraq among Iraqi people. ❖ Only Related Variables To The Study Objective Were Selected From These Studies 17

Methods/ Cont.

❖Participants Of Theses Studies Were Collected From The Community On The Following Bases: ❑Convent Sample (642 Participants) ❑Random Sample (1727 Participants) ❑Making A Total Of 2369participants 18

Method / Study Population

❖Major Variables Were As Follows: ❑Mental Diseases (Depression, PTSD, Anxiety) ❑Substances Abuse (Illicit Drugs, Alcohol, Tobacco) ❑Somatic Diseases Which Could Related To Mental Diseases (Diabetes, Heart Problems, Hypertension, Sexual Problems) 19

Method / Study Population ❖All These Studies Have Got Approval From

Institute Review Board (IRB) From Wayne State University &From Basra University,

❖All Participants In These Studies Sign Consent &Voluntarily Participates In These Studies,

❖Chi-square Test, Logistic Regression & Analysis Of Variance – “ANOV” Were Used 20

Results

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Numbers of Study Population

by Location 2301

1155

1146

Iraqis In Iraq

Iraqis in USA

Total

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Number of Study Population

by Period Left Iraq to USA & Study Population 1146

711 403 32 1981-1990

1991-2003

2004 -2007

Total

Years Arrive USA

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% of Iraqi at Outside Iraq

by Legal Status (P< 0.001) Iraqis in USA

Immigrants 35% Refugees 65%

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Study Population

by Age Group (P<0.001) Iraqis In Iraq

Iraqis in USA

91.5

65.9

34.1

8.5

18-29 Age

30 + Age

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Study Population

by Marital Status (P < 0.001) Iraqis In Iraq

Iraqis in USA

71.3 62.4

37.6 28.7

Married/Other

Single

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Study Population

by Level of Education (P < 0.04) Iraqis In Iraq 59.4

Iraqis in USA

55.8

44.2

40.6

< H.S

HS +

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Study Population

by Employment Status (P < 0.001) Iraqis In Iraq

Iraqis in USA

95.9

63.8

36.2

4.1 Unemployed

Employed

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Prevalence of Tobacco Smoke among Study Population (P < 0.001) smoke Tobacco 51.3 40.7

Iraqis In Iraq

Iraqis in USA

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Respond of Study Population by Those who Drink Alcohol (P < 0.001) Drink Alcohol 28.0

1.9 Iraqis In Iraq

Iraqis in USA

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Prevalence of Using Street Drugs*

by Study Population (P < 0.001) Use Street drugs 15.6

11.5

Iraqis In Iraq

Iraqis in USA

Note: Cocaine / Margarine / Tranquilizer / Amphetamine / Pain Killers / Crack, Hallucinogens, Heroin, Narcotics

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Prevalence of All Substance Abuse*

by Study Population (P< 0,001) One or more Substance Abuse 60.5

55.0

Iraqis In Iraq

Iraqis in USA

* Smoke Tobacco + Drink Alcohol + Use Street Drugs

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Linear regression Analysis to Predict Risk Factors for All Substance Abused* 95% C.I. for OR

Risk Factors

Iraqi in Iraq Age Married/Other Have less than H.S. Employed Have stress of life One or more Mental dis one or more somatic dis

B

Sig.

OR Lower

Upper

1.10

0.000

3.01

1.89

4.78

0.02

0.022

1.02

1.00

1.04

0.28

0.048

1.32

1.00

1.74

-0.30

0.027

0.74

0.57

0.97

1.08

0.000

2.95

1.78

4.89

0.38

0.022

1.47

1.06

2.04

0.47

0.001

1.60

1.21

Dis.

0.40

0.039

1.50

1.02

2.20

* Variables in Equation: Age, Study Population, Marital Status, Education, Legal status, Employment, All Chronic diseases, All Somatic All Mental Diseases, Chemical Exposure, Non-Chemical Exposure, Stress of life 33

Prevalence of Depression* among Study Population (P < 0.001) Depression 37.2 30.0

Iraqis In Iraq

* M Minor depression

Iraqis in USA

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Prevalence of PTSD among Study Population (P < 0.001) PTSD 13.6

0.5 Iraqis In Iraq

Iraqis in USA

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Prevalence of Anxiety among Study Population (P < 0.001) Anxiety 22.7

10.1

Iraqis In Iraq

Iraqis in USA

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Prevalence of All More Mental Disease* among Study Population (P < 0.001) One or more Mental dis 57.1

38.5

Iraqis In Iraq

Iraqis in USA

* Depressionâ&#x20AC;&#x2122; PTSD; Anxiety; Other Mental diseases

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Binomial Logistic Regression Analysis to Predict Risk Factors for All Mental Diseases 95% C.I.for OR Risk Factor

Iraqi in USA one or more somatic dis One or more substance abuse Employed

B

Sig.

0.00 0 0.00 0.70 0 0.00 -0.46 1 0.00 0.77 4 -1.40

OR Lower

Upper

0.25

0.15

0.39

2.02

1.36

2.99

0.63

0.48

0.83

2.15

1.27

3.63

* Variables in Equation: Age,, Marital Status, Education, Legal status, Employment, All Chronic diseases, All substance abuse, Chemical Exposure, Non-Chemical Exposure, Stress of life

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Prevalence of Hypertension among Study Population P < 0.001) Hypertension 19.5

9.0

Iraqis In Iraq

Iraqis in USA

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Prevalence of Heart Problems among Study Population (P < 0.001) Heart Problems 9.2

2.3

Iraqis In Iraq

Iraqis in USA

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Prevalence of Diabetes Mellitus among Study Population P < 0.001) Diabetes 12.2

2.8

Iraqis In Iraq

Iraqis in USA

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Prevalence of All Somatic disease*

by Study Population (2539) (P< 0.0001) one or more somatic dis.

28.4

11.9

Iraqis In Iraq

Iraqis in USA

* Hypertension + Heart Problems + Diabetes + Sexual Problems

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Binomial Logistic Regression Analysis to Predict Risk Factors for All Somatic Diseases Risk Factor

B

Sig.

OR

95% C.I.for OR Lower

Upper

Poor to Bad Health

0.87

0.000

2.40

1.60

3.60

One or more Mental diseases

-0.63

0.002

0.53

0.36

0.79

Variables in Equation: Study population, Age,, Marital Status, Education, Legal status, Employment, All substance abuse, Chemical Exposure, Non-Chemical Exposure, Stress of life 43

% of Stress of Daily Life among Study Population ( (P< 0.001)

85.8 53.7

Inside

Outsode

Iraqi Population Studied 44

Prevalence of Chemical Exposure* during Gulf War 91 among Study Population (P < 0.001)

42 18.2

Inside

Outsode

Iraqi Population Studied * E.g. smoke from oil well fires, and other petrochemical fuels.

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% of Study Population to How they Evaluate Their Current Health (P < 0.001) SRH Iraqis In Iraq

Iraqis in USA

87.0 60.5 39.5 13.0

Poor to Bad Health

Good to Excellent Health

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Linear regression Analysis to Predict Risk Factors for Excellent Health 95% C.I.for OR

Risk Factor

No Chemical Exp. No Somatic Disease No Mental Disease Iraqi in Iraq

B

Sig.

OR Lower

Upper

0.97

0.000

2.64

1.80

3.87

-0.90

0.000

0.41

0.27

0.61

0.73

0.000

2.06

1.42

3.01

0.91

0.000

2.49

1.50

4.13

Variables in Equation: Study population, Age,, Marital Status, Education, Legal status, Employment, All Mental diseases, All substance abuse, All Somatic Dis., Chemical Exposure, Non-Chemical Exposure, Stress of life 47

Conclusion â&#x20AC;˘ The results showed that Iraqi who were resident in U.S. (G2) have higher

prevalence rate of all somatic diseases studied

â&#x20AC;˘ Also, two out of mental diseases and substance abuse compared to G1.

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Conclusions â&#x20AC;˘ In addition, G2 reported worse health than Iraqis who are residents in Iraq

(G1) â&#x20AC;˘ Several risk factors predicted for mental

diseases, somatic disease, substance abuse and self-rated health, 49

Road to Wellbeing â&#x20AC;˘ The results could help the policy maker to improve the wellbeing of Iraq in general and those who are still residents in Iraq in particular especially if the government considers rebuilding of health and educational system in particular and all the other infrastructure of the country.

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