Volume 23, Issue 3 (Fall 2017)                   IJPCP 2017, 23(3): 348-361 | Back to browse issues page


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Rezapour Mirsaleh Y, Ahmadi K. Psychometric Characteristics of Secondary Trauma Questionnaire (STQ) in Warfare. IJPCP. 2017; 23 (3) :348-361
URL: http://ijpcp.iums.ac.ir/article-1-2407-en.html
1- PhD of Counseling, Assistant Professor Department of Counseling, Faculty of Psychology and Educational Sciences, Ardakan University, Ardakan, Iran
2- PhD of Counseling, Professor Behavioral Sciences Research Center, Institute of Neuroscience and Behavioral Sciences, Baqiyatallah University of Medical Sciences, Tehran, Iran , Email: kh_ahmady@yahoo.com
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Extended Abstract
1. Introduction

Effects of traumatic events of wars are not only limited to veterans but also affect their close relatives. Spouses of veterans are more exposed to physical violence, and emotional and verbal abuses [2]. Psychological distress experienced by spouses of veterans results from life with veterans who themselves are victims of war trauma, known as secondary traumatic stress [3]. Secondary traumatic stress is a syndrome of Post-Traumatic Stress Disorder (PTSD), which results from spending life with a person who has experienced some kind of psychological trauma [10]. 
Studies about secondary traumatic stress were seriously carried out in the 1990s, until then limited studies had been carried out about secondary trauma [10] because only limited scales were designed to measure secondary trauma [11]. Before specialized scales were designed to measure the symptoms of secondary traumatic stress, PTSD symptom scales were often used to measure it. But, researchers have suggested that a special scale is needed to evaluate the special symptoms exhibited by people with secondary traumatic stress disorders, which is very different from PTSD [18]. Iran has experienced a prolonged war that lasted for eight years and therefore has many war veterans. Therefore, a scale to evaluate the secondary traumatic stress symptoms of spouses of veterans is necessary. 
One of the most prevalent scales used to measure symptoms of secondary traumatic stress and used in many studies is Secondary Trauma Questionnaire (STQ). STQ was designed by Motta, Joseph, Rose, Suozzi, Leiderman [12] based on PTSD symptoms in DSM-IV and Figley’s Compassion Fatigue Self-Stress Test [10]. The purpose of present study was to investigate some psychometric characteristics of STQ in wives of warfare victims.
2. Methods
Target population of this study included spouses of warfare victims living in Yazd, Esfahan, Shiraz, and Ahvaz and whose one of the children studied at Shahed and Isargar schools (special school for children of warfare victims in Iran) present in these cities, in the 2012-2013 academic year. Sample selection between veterans who their children studies in special schools for veterans caused by better availability to target population and sampling in schools. Criterion for being a war veteran victim was physical or psychological injuries caused by war accidents, which was documented in the academic records of the students. Spouses of veterans who were selected for inclusion in the target population of the study included women who married men injured in war, were aware of injuries caused to their future husbands at the time of marriage, and those who shared life with their husbands at the time of the study. Of this population, 379 subjects were selected by cluster sampling method. STQ, Secondary Traumatic Stress Scale (STSS), Mississippi PTSD Scale, and Depression Anxiety Stress Scale (DASS) were used to collect the data. First, STQ was carefully translated and then the translations were evaluated for their correctness by two English literature experts. The Translated items were again translated back to English by a specialist to confirm the Persian translation. Confirmation factor analysis, Pearson correlation, and independent samples t-test were used to analyze the obtained data.
3. Results
Face validity of STQ using item impact method and content validity of this scale using Content Validity Index (CVI) and Content Validity Ratio (CVR) were confirmed. Face validity of STQ was used to evaluate 22 spouses. They were asked to indicate the importance of the items on 5 Likert range from 1 (not important) to 5 (very important). Impact item method was used to calculate face validity of the items [29]. The results show that all scores were above 1.5 (Acceptable minimum score was 1.5).
Twelve faculty members specializing in PTSD were asked to assess content validity. They confirm items about difficulty level, ambiguity (flute interpret about items and incorrect meaning), Persian grammar, use appropriate words and item allocation. Waltz & Bausell method [30] was used to assess Content Validity Index (CVI). Experts evaluate “Relevance”, “Clarity” and “Simplicity” of items on 4-point Likert scale. The results show that all scores were above the acceptable criteria (regarding number of experts) 0.79 [31-33]. The scores ranged from 0.84 to 1 for relevance, clarity, and simplicity. Finally, CVR was calculated by ­Lawshe formula [34]. The results show that the scores were above acceptable criteria of 0.49. 
In the present study, confirmatory factor analysis was used to evaluate factorial structure of STQ. Findings of the confirmation factor analysis revealed that STQ, which is similar to the one approved by the developers of this scale has a one-factor structure in Iranian samples. Model fitness indices are shown in Table 1. Correlation of STQ scores with STSS, PTSD, and DASS scores was calculated to assess convergent validity of STQ (Table 2). All correlations are high and significant (P<0.01), showing that STQ has appropriate convergent validity with STSS, DASS, and PTSD scales. 
To evaluate the discriminant validity of STQ, and DASS scores considered as mental health criteria we hypothesized individuals having high scores in DASS (have low mental health) than who have low scores in DASS, and also have high scores in STQ. First, the discriminant validity of individuals is evaluated and then arranged from bottom to top based on DASS scores. Fifty subjects who had high scores in DASS and another 50 who had low scores in DASS were considered as low and high mental health groups respectively. STQ can help in discriminating high mental health groups from low mental health groups (Table 3).
Cronbach alpha for total items was 0.92. Test-retest reliability of STQ was assessed by administrating the scale twice at an interval of one week. Correlation between the two scores was 0.81 (P<0.01). This result shows that Farsi version of STQ has appropriate reliability quotient. 
4. Conclusion
Results show that Farsi version of the secondary trauma scale is valid and reliable for wives of Iranian warfare victims. Therefore, instead of using PTSD scales to evaluate the symptoms of secondary trauma in the wives of veterans, STQ can be used as a special scale. However, due to the limitations of the present research, it is necessary to take precautions while generalizing the results. One of the limitations of the present study was that veterans with PTSD were not separated from veterans without PTSD because of the limitations of the researcher and the need for a high sample for standardization. Limitation in sampling such as including only those spouses in the study who had married their husbands after they were victimized, or spouses of veterans who had a child in Shaheh and Isargar schools (not including spouses of all veterans), and sampling only from four cities of Iran, generalization of the results of the study was limited to all Iranian veteran spouses.
Acknowledgments
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We thank spouses of all the veterans who par­ticipated in the study. We are also immensely grateful to the school administrators for selecting the participants.
Conflict of Interest
The authors declared no conflicts of interest.
 
References
  1. Evans L, Mchugh T, Hopwood M, Watt C. Chronic posttraumatic stress disorder and family functioning of vietnam veterans and their partners. Australian & New Zealand Journal of Psychiatry. 2003; 37(6):765–72. doi: 10.1080/j.1440-1614.2003.01267.x
  2. Solomon Z. The impact of posttraumatic stress disorder in military situations. Journal of Clinical Psychiatry. 2001; 62(17):11-5.
  3. Figley CR. Burnout as systematic traumatic stress: A model for helping traumatized family members. In: Figley CR, editor. Burnout in families: The systemic costs of caring. New York: CRC Press; 1998.
  4. Dekel R. Posttraumatic distress and growth among wives of prisoners of war: The contribution of husbands' posttraumatic stress disorder and wives' own attachment. American Journal of Orthopsychiatry. 2007; 77(3):419. doi: 10.1037/0002-9432.77.3.419
  5. Dirkzwager AJE, Bramsen I, Adèr H, van der Ploeg HM. Secondary traumatization in partners and parents of dutch peacekeeping soldiers. Journal of Family Psychology. 2005; 19(2):217–26. doi: 10.1037/0893-3200.19.2.217
  6. Figley CR. Compassion fatigue: Psychotherapists' chronic lack of self care. Journal of clinical psychology. 2002; 58(11):1433-41. doi: 10.1002/jclp.10090
  7. Goff BSN, Crow JR, Reisbig AMJ, Hamilton S. The impact of soldiers’ deployments to Iraq and Afghanistan: Secondary traumatic stress in female partners. Journal of Couple & Relationship Therapy. 2009; 8(4):291–305. doi: 10.1080/15332690903246085
  8. Canfield J. Secondary traumatization, burnout, and vicarious traumatization. Smith College Studies in Social Work. 2005; 75(2):81–101. doi: 10.1300/j497v75n02_06
  9. Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: A validational study. Journal of Traumatic Stress. 2002; 15(5):423–32. doi: 10.1023/a:1020193526843
  10. Figley CR. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (Psychosocial stress series). New York: Brunner/Mazel; 1995.
  11. Bride BE, Robinson MM, Yegidis B, Figley CR. Development and validation of the secondary traumatic stress scale. Research on Social Work Practice. 2004; 14(1):27–35. doi: 10.1177/1049731503254106
  12. Motta RW, Joseph JM, Rose RD, Suozzi JM, Leiderman LJ. Secondary trauma: Assessing inter generational transmission of war experiences with a modified Stroop procedure. Journal of Clinical Psychology. 1997; 53(8):895-903. doi: 10.1002/(sici)1097-4679(199712)53:8<895::aid-jclp14>3.0.co; 2-f
  13. Motta R. Discriminant validation of the modified secondary trauma questionnaire. Journal of Psychotherapy in Independent Practice. 2002; 2(4):17–24. doi: 10.1300/j288v02n04_02
  14. Motta RW, Kefer JM, Hertz MD, Hafeez S. Initial evaluation of the secondary trauma questionnaire. Psychological Reports. 1999; 85(3):997–1002. doi: 10.2466/pr0.1999.85.3.997
  15. Lombardo KL, Motta RW. Secondary trauma in children of parents with mental illness. Traumatology. 2008; 14(3):57–67. doi: 10.1177/1534765608320331
  16. Motta RW. Secondary trauma in children and school personnel. Journal of Applied School Psychology. 2012; 28(3):256–69. doi: 10.1080/15377903.2012.695767
  17. Zimering R, Munroe J, Gulliver SB. Secondary traumatization in mental health care providers. Psychiatric Times. 2003; 20(4):24-36.
  18. Renshaw KD, Allen ES, Rhoades GK, Blais RK, Markman HJ, Stanley SM. Distress in spouses of service members with symptoms of combat-related PTSD: Secondary traumatic stress or general psychological distress. Journal of Family Psychology. 2011; 25(4):461–9. doi: 10.1037/a0023994
  19. Human HA. [Educational and psychological measurement and technique of developing the test (Persian)]. Tehran: Selseleh; 2001.
  20. Crowne DP, Marlowe D. A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology. 1960; 24(4):349–54. Doi: 10.1037/h0047358
  21. Motta RW, Newman CL, Lombardo KL, Silverman MA. Objective assessment of secondary trauma. International Journal of Emergency Mental Health. 2004; 6(2):67-74. PMID: 15298077
  22. Gawrych AL. PTSD in firefighters and secondary trauma in their wives. New York: Hofstra University; 2010.
  23. Ahmadi K, Rezapour Y, Davoudi F, Saberi M. [Investigate of validity and reliability of secondary trauma stress scale for evaluation of PTSD symptoms in samples of warfare victims’ wives (Persian)]. Iranian Journal of War and Public Health. 2013; 5(3):47-57.
  24. Rezapour Mirsaleh Y, Ahmadi K, Davoudi F, Mousavi SZ. [Validity, reliability, and factor structure of secondary trauma stress scale (stss) in a sample of warfare victims’ children (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2014; 20(2):134-43.
  25. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy. 1995; 33(3):335–43. doi: 10.1016/0005-7967(94)00075-u
  26. Sahebi A, Asghari MJ, Salari RS. [Validation of depression anxiety and stress scale (DASS-21) for an Iranian population (Persian)]. Iranian Psychologists. 2005; 4(1):299-313.
  27. Vreven DL, Gudanowski DM, King LA, King DW. The civilian version of the Mississippi PTSD scale: A psychometric evaluation. Journal of Traumatic Stress. 1995; 8(1):91–109. doi: 10.1002/jts.2490080107
  28. Gudarzi MA. [Reliability and validity of Mississippi PTSD Scale (Persian)]. Journal of  Psychology. 2003; 7(2):153-78. 
  29. Broder HL, McGrath C, Cisneros GJ. Questionnaire development: face validity and item impact testing of the child oral health impact profile. Community Dentistry and Oral Epidemiology. 2007; 35(s1):8–19. doi: 10.1111/j.1600-0528.2007.00401.x
  30. Yaghmale F. Content validity and its estimation. Journal of Medical Education. 2009; 3(1):25-27. doi: 10.22037/jme.v3i1.870
  31. Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and health research. New York: Springer Publishing Company; 2010.
  32. Polit DF, Beck CT. The content validity index: Are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health. 2006; 29(5):489-97. doi: 10.1002/nur.20147
  33. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health. 2007; 30(4):459–67. doi: 10.1002/nur.20199
  34. Lawshe CH. A qualitative approach to content validity. Personnel Psychology. 1975; 28(4):563–75. doi: 10.1111/j.1744-6570.1975.tb01393.x
  35. Ghasemi V. [Structural modeling in social science research (Persian)]. Tehran: Jame'e Shenasan Pub; 2010.
  36. Hope NL. When caring hurts: The significance of personal meaning for wellbeing in the presence of secondary traumatic stress [Master thesis]. British Columbia: Trinity Western University; 2006.
  37. Horowitz M, Wilner N, Alvarez W. Impact of event scale: A measure of subjective stress. Psychosomatic Medicine. 1979; 41(3):209–18. doi: 10.1097/00006842-197905000-00004
  38. Sabin Farrell R, Turpin G. Vicarious traumatization: Implications for the mental health of health workers. Clinical Psychology Review. 2003; 23(3):449–80. doi: 10.1016/s0272-7358(03)00030-8
  39. Suozzi JM, Motta RW. The relationship between combat exposure and the transfer of trauma like symptoms to offspring of veterans. Traumatology. 2004; 10(1):17–37. doi: 10.1528/trau.10.1.17.31151
  40. Ahmadi KB, Reshadatjoo M, Karami GR, Anisi J. [Vicarious PTSD in Sardasht chemical warfare victims’ wives (Persian)]. Journal of Behavioral Sciences. 2009; 3(3):195-199.
  41. Kh A, Reshadatjoo M, Anisi J. [Evaluation of secondary post traumatic stress disorder in chemical warfare victims' children (Persian)]. Journal of Military Medicine. 2010; 12(3):153-9.
Type of Study: Original Research | Subject: General
Received: 2015/12/13 | Accepted: 2017/01/17 | Published: 2017/10/1

References
1. Evans L, Mchugh T, Hopwood M, Watt C. Chronic posttraumatic stress disorder and family functioning of vietnam veterans and their partners. Australian & New Zealand Journal of Psychiatry. 2003; 37(6):765–72. doi: 10.1080/j.1440-1614.2003.01267.x [DOI:10.1080/j.1440-1614.2003.01267.x]
2. Solomon Z. The impact of posttraumatic stress disorder in military situations. Journal of Clinical Psychiatry. 2001; 62(17):11-5. [PMID]
3. Figley CR. Burnout as systematic traumatic stress: A model for helping traumatized family members. In: Figley CR, editor. Burnout in families: The systemic costs of caring. New York: CRC Press; 1998.
4. Dekel R. Posttraumatic distress and growth among wives of prisoners of war: The contribution of husbands' posttraumatic stress disorder and wives' own attachment. American Journal of Orthopsychiatry. 2007; 77(3):419. doi: 10.1037/0002-9432.77.3.419 [DOI:10.1037/0002-9432.77.3.419]
5. Dirkzwager AJE, Bramsen I, Adèr H, van der Ploeg HM. Secondary traumatization in partners and parents of dutch peacekeeping soldiers. Journal of Family Psychology. 2005; 19(2):217–26. doi: 10.1037/0893-3200.19.2.217 [DOI:10.1037/0893-3200.19.2.217]
6. Figley CR. Compassion fatigue: Psychotherapists' chronic lack of self care. Journal of clinical psychology. 2002; 58(11):1433-41. doi: 10.1002/jclp.10090 [DOI:10.1002/jclp.10090]
7. Goff BSN, Crow JR, Reisbig AMJ, Hamilton S. The impact of soldiers' deployments to Iraq and Afghanistan: Secondary traumatic stress in female partners. Journal of Couple & Relationship Therapy. 2009; 8(4):291–305. doi: 10.1080/15332690903246085 [DOI:10.1080/15332690903246085]
8. Canfield J. Secondary traumatization, burnout, and vicarious traumatization. Smith College Studies in Social Work. 2005; 75(2):81–101. doi: 10.1300/j497v75n02_06 [DOI:10.1300/J497v75n02_06]
9. Jenkins SR, Baird S. Secondary traumatic stress and vicarious trauma: A validational study. Journal of Traumatic Stress. 2002; 15(5):423–32. doi: 10.1023/a:1020193526843 [DOI:10.1023/A:1020193526843]
10. Figley CR. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (Psychosocial stress series). New York: Brunner/Mazel; 1995.
11. Bride BE, Robinson MM, Yegidis B, Figley CR. Development and validation of the secondary traumatic stress scale. Research on Social Work Practice. 2004; 14(1):27–35. doi: 10.1177/1049731503254106 [DOI:10.1177/1049731503254106]
12. Motta RW, Joseph JM, Rose RD, Suozzi JM, Leiderman LJ. Secondary trauma: Assessing inter generational transmission of war experiences with a modified Stroop procedure. Journal of Clinical Psychology. 1997; 53(8):895-903. doi: 10.1002/(sici)1097-4679(199712)53:8<895::aid-jclp14>3.0.co; 2-f
13. Motta R. Discriminant validation of the modified secondary trauma questionnaire. Journal of Psychotherapy in Independent Practice. 2002; 2(4):17–24. doi: 10.1300/j288v02n04_02 [DOI:10.1300/J288v02n04_02]
14. Motta RW, Kefer JM, Hertz MD, Hafeez S. Initial evaluation of the secondary trauma questionnaire. Psychological Reports. 1999; 85(3):997–1002. doi: 10.2466/pr0.1999.85.3.997 [DOI:10.2466/pr0.1999.85.3.997]
15. Lombardo KL, Motta RW. Secondary trauma in children of parents with mental illness. Traumatology. 2008; 14(3):57–67. doi: 10.1177/1534765608320331 [DOI:10.1177/1534765608320331]
16. Motta RW. Secondary trauma in children and school personnel. Journal of Applied School Psychology. 2012; 28(3):256–69. doi: 10.1080/15377903.2012.695767 [DOI:10.1080/15377903.2012.695767]
17. Zimering R, Munroe J, Gulliver SB. Secondary traumatization in mental health care providers. Psychiatric Times. 2003; 20(4):24-36.
18. Renshaw KD, Allen ES, Rhoades GK, Blais RK, Markman HJ, Stanley SM. Distress in spouses of service members with symptoms of combat-related PTSD: Secondary traumatic stress or general psychological distress. Journal of Family Psychology. 2011; 25(4):461–9. doi: 10.1037/a0023994 [DOI:10.1037/a0023994]
19. Human HA. [Educational and psychological measurement and technique of developing the test (Persian)]. Tehran: Selseleh; 2001.
20. Crowne DP, Marlowe D. A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology. 1960; 24(4):349–54. Doi: 10.1037/h0047358 [DOI:10.1037/h0047358]
21. Motta RW, Newman CL, Lombardo KL, Silverman MA. Objective assessment of secondary trauma. International Journal of Emergency Mental Health. 2004; 6(2):67-74. PMID: 15298077 [PMID]
22. Gawrych AL. PTSD in firefighters and secondary trauma in their wives. New York: Hofstra University; 2010.
23. Ahmadi K, Rezapour Y, Davoudi F, Saberi M. [Investigate of validity and reliability of secondary trauma stress scale for evaluation of PTSD symptoms in samples of warfare victims' wives (Persian)]. Iranian Journal of War and Public Health. 2013; 5(3):47-57.
24. Rezapour Mirsaleh Y, Ahmadi K, Davoudi F, Mousavi SZ. [Validity, reliability, and factor structure of secondary trauma stress scale (stss) in a sample of warfare victims' children (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2014; 20(2):134-43.
25. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy. 1995; 33(3):335–43. doi: 10.1016/0005-7967(94)00075-u [DOI:10.1016/0005-7967(94)00075-U]
26. Sahebi A, Asghari MJ, Salari RS. [Validation of depression anxiety and stress scale (DASS-21) for an Iranian population (Persian)]. Iranian Psychologists. 2005; 4(1):299-313.
27. Vreven DL, Gudanowski DM, King LA, King DW. The civilian version of the Mississippi PTSD scale: A psychometric evaluation. Journal of Traumatic Stress. 1995; 8(1):91–109. doi: 10.1002/jts.2490080107 [DOI:10.1002/jts.2490080107]
28. Gudarzi MA. [Reliability and validity of Mississippi PTSD Scale (Persian)]. Journal of Psychology. 2003; 7(2):153-78.
29. Broder HL, McGrath C, Cisneros GJ. Questionnaire development: face validity and item impact testing of the child oral health impact profile. Community Dentistry and Oral Epidemiology. 2007; 35(s1):8–19. doi: 10.1111/j.1600-0528.2007.00401.x [DOI:10.1111/j.1600-0528.2007.00401.x]
30. Yaghmale F. Content validity and its estimation. Journal of Medical Education. 2009; 3(1):25-27. doi: 10.22037/jme.v3i1.870
31. Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and health research. New York: Springer Publishing Company; 2010.
32. Polit DF, Beck CT. The content validity index: Are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health. 2006; 29(5):489-97. doi: 10.1002/nur.20147 [DOI:10.1002/nur.20147]
33. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health. 2007; 30(4):459–67. doi: 10.1002/nur.20199 [DOI:10.1002/nur.20199]
34. Lawshe CH. A qualitative approach to content validity. Personnel Psychology. 1975; 28(4):563–75. doi: 10.1111/j.1744-6570.1975.tb01393.x [DOI:10.1111/j.1744-6570.1975.tb01393.x]
35. Ghasemi V. [Structural modeling in social science research (Persian)]. Tehran: Jame'e Shenasan Pub; 2010.
36. Hope NL. When caring hurts: The significance of personal meaning for wellbeing in the presence of secondary traumatic stress [Master thesis]. British Columbia: Trinity Western University; 2006.
37. Horowitz M, Wilner N, Alvarez W. Impact of event scale: A measure of subjective stress. Psychosomatic Medicine. 1979; 41(3):209–18. doi: 10.1097/00006842-197905000-00004 [DOI:10.1097/00006842-197905000-00004]
38. Sabin Farrell R, Turpin G. Vicarious traumatization: Implications for the mental health of health workers. Clinical Psychology Review. 2003; 23(3):449–80. doi: 10.1016/s0272-7358(03)00030-8 [DOI:10.1016/S0272-7358(03)00030-8]
39. Suozzi JM, Motta RW. The relationship between combat exposure and the transfer of trauma like symptoms to offspring of veterans. Traumatology. 2004; 10(1):17–37. doi: 10.1528/trau.10.1.17.31151 [DOI:10.1528/trau.10.1.17.31151]
40. Ahmadi KB, Reshadatjoo M, Karami GR, Anisi J. [Vicarious PTSD in Sardasht chemical warfare victims' wives (Persian)]. Journal of Behavioral Sciences. 2009; 3(3):195-199.
41. Kh A, Reshadatjoo M, Anisi J. [Evaluation of secondary post traumatic stress disorder in chemical warfare victims' children (Persian)]. Journal of Military Medicine. 2010; 12(3):153-9.

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