{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:12:21Z","timestamp":1788959541468,"version":"build-2803163510"},"reference-count":31,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec id=\"S2056472426120961_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Survivors of the 1988 Halabja chemical attack have experienced severe, chronic trauma, yet limited research has examined the long-term psychological and biological consequences of chemical warfare exposure more than three decades later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120961_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine long-term post-traumatic stress disorder (PTSD) symptoms, depression\/anxiety symptoms, somatic symptoms and perceived stress among survivors of the Halabja chemical attack, and to investigate the associations of trauma exposure, sociodemographic factors and hair cortisol concentrations (HCCs) with psychological symptom severity and symptom profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120961_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      A total of 209 survivors of the Halabja chemical attack participated in structured interviews using culturally adapted and field-tested instruments, including the Post-Traumatic Stress Disorder Checklist for DSM-5, Hopkins Symptom Checklist-25, the Patient Health Questionnaire-13, the Perceived Stress Scale-14 and an adapted War and Adversity Exposure Checklist-26. Hair cortisol and cortisone concentrations were assessed as biomarkers of chronic stress. Data were analysed using correlations, independent-samples\n                      <jats:italic>t<\/jats:italic>\n                      -tests, multiple linear regression analyses, multinomial logistic regression and latent profile analysis (LPA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120961_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Survivors demonstrated a substantial long-term psychological symptom burden. Overall, 87.6% of participants exceeded the cut-off for probable PTSD symptoms, and 75.1% exceeded the cut-off for elevated depression\/anxiety symptoms. Most participants (81.8%) reported exposure to 11 or more lifetime traumatic events. Men reported significantly greater cumulative trauma exposure, whereas women reported significantly greater somatic symptom severity. Higher educational attainment and employment were consistently associated with lower psychological symptom severity across multiple outcomes. HCCs were not significantly associated with PTSD symptoms or latent symptom-profile membership after adjustment for trauma exposure and psychosocial variables. The LPA identified four symptom-severity classes characterised by differing levels of PTSD and depression\/anxiety symptoms. Greater cumulative trauma exposure and lower social support were associated with membership in more severe symptom classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120961_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Survivors of the Halabja chemical attack continue to experience substantial psychological distress more than three decades after exposure. Long-term symptom severity appears to be more strongly associated with cumulative trauma exposure and psychosocial adversity than with HCCs. The findings highlight substantial heterogeneity in symptom presentation and support the need for long-term, culturally sensitive and trauma-informed mental health interventions for survivors of chemical warfare and mass violence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12096","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:04:08Z","timestamp":1788959048000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Persistent trauma three decades after the Halabja massacre: psychological symptom profiles and hair cortisol levels in gas attack survivors"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6816-8859","authenticated-orcid":false,"given":"Hataw Ahmed","family":"Sharif","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03a1kwz48","id-type":"ROR","asserted-by":"publisher"}],"name":"Eberhard Karls University of T\u00fcbingen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Mohammed","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03a1kwz48","id-type":"ROR","asserted-by":"publisher"}],"name":"Eberhard Karls University of T\u00fcbingen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e234"}}