This document presents research on the trauma experienced by the Iraqi people over four decades and its impact on their mental health and well-being. A team of researchers from universities in Iraq and the US studied over 4,000 Iraqis both inside and outside of Iraq. They found that Iraqis in Iraq had higher rates of mental illness, substance abuse, and poorer self-rated health compared to Iraqis living in the US. The researchers hypothesized that exposure to war and political instability in Iraq contributed to these health issues. They recommend the Iraqi government establish a new Institute of Health and Productivity to fund community health research and education programs aimed at improving public health.

1. The Iraqi People
Impact of Four Decades of Trauma;
The Road to Wellbeing
Hikmet Jamil,
MD, DVD, DI,, MSc, PhD, AFOM, MFOM, FFOM, FPH
Research Team
Hikmet Jamil (1); Thamer Hamdan (2), Taghreed Al Noor (3) Nadia
Al-Noor(4), Bengt Arnetz (1) et al
(1) Michigan State University, Dept. Family Med. USA
(2) Basrah University, Department of Surgery. Basrah, Iraq
(3) University of Baghdad Dept. of Chemistry, Education for Pure
Science College, Ibn- Al Haitham, Baghdad, Iraq
(4) Al-Mustansiriyah University, Dept. of Mathematics, College of
Science, , Baghdad, Iraq.

2. Presentation & Conference
The Presentation will Explore the Relation
Between: the Trauma that Iraqis have
been exposed to over 40 years & Its Risk
Factors, To help the Iraqi Government to
Establish Public Health Programs for the
well-being of the people.

3. Study Objective
• To Explore the Prevalence of Trauma
through Mental Dis. & Substance Abuse
among Iraqis Inside & Outside Iraq,
• To Explore the Risk Factors for Mental
Disease, Substance Abuse & Wellbeing
(Self-rated Health) among Iraqis Inside
& Outside Iraq. 3

4. Hypothesis
We Hypothesize that:
Iraqi People In Iraq will
•(1) Suffer More Mental Disease,
•(2) Use More Harmful Substances, and
•(3) Have Worse Health
Compared to Iraqis Outside Iraq (USA).
4

5. Introduction
Literature Reviews Indicate:
Relationship Between:
 Mental Dis. & Crime
Using Illicit drugs & Crime
One of the Most Significant areas of
Risk with the Use of Alcohol and
Drugs is the Connection Between
their use and Crime.
5

6. Source on Illicit Drugs in Iraq
http://www.rudaw.net/arabic/opinion/20102015
https://www.iraqpressagency.com/?p=2794
In 2005….7000 persons registered
addicted in Baghdad. Now? 25,000
(National Institute on Drug Abuse)
UN reports that Iraq is a main bridge for
drugs, due to its location between
countries producing and using drugs.
I.M.H. Announced its concern of Iraq
becoming the Biggest Drug User in the
Middle East 6

7. 77
2003-14
Instability
After U.S.
Invasion
2014-17
War
Against
ISIS
1991-2003
Iraq
Under
Sanction
1990-91
War
Iraq-Kuwait
War
1963-2003
Iraq under
Dictator-ship
1980-88
Iraq-Iran
War
Sources of Trauma on
Iraqi People
1963 -2017

8. 88
Political
Power
Child,
Woman
Abuse
Marriage
Break
Victim
Unfair
In
Prison
Using
Drugs
Poverty
Media
Violence
Disable
Injurie
Person
Love
Person
Die
Discrim-
ination
War
????
Major
Exposure
To
Trauma

9. 9
Anxiety
Trauma
Outcome
PTSD
Other
Mental
Pain ?
Depression
Sleep
Disturbance
Somatic
Disease
Stress

10. Methods
10

11. Methods
 Data of five studies conducted between
2000-2007 and one study conducted at
2013 were reviewed
 A joint Research between Wayne State
University and Basrah University to
conduct research in 2001
 Only Related Variables to the study
objective were selected

12. Methods/ Cont.
Data were collected from the
community either as
Convenience sample (2452)
Random sample (1803) were selected
from a list of Iraqi 5990
Making a Total of 4255 participants in
which 1155 participants were from Iraq
12

13. Methods/ Cont.
Major Variables were as follows:
Mental Diseases (Depression, PTSD,
Anxiety)
Substance Abuse (Illicit Drugs,
Alcohol, Tobacco)
Somatic Diseases Which Could be
Related to Mental Diseases (Diabetes,
Heart Problems, Hypertension, Sexual
Problems)
13

14. Methods/ Cont.
All these studies have Institute Review Board
(IRB) approval from Wayne State University
and Basra University
All Participants in these studies sign Consent
forms, and are all Volunteer
Chi-square test and Analysis Of Variance –
“ANOV” were used
14

15. Results
15

16. Number of Iraqi Population (4255)
Studied by Period Studied &
Location (P < 0.001)
16
1155
754
1983
363
1981-1990 1991-2003 2005-2011 2001
In Iraq In U.S.

17. An ova Analysis for the Four Study
between those done at U.S. & In Iraq
17
‫مجاميع‬‫البحث‬ Sig.
95% Confidence Interval
Lower Bound Upper Bound
(1)
Study 1981-
1990
2.00 .526 -118.0901- 226.8901
3.00 .501 -114.6901- 230.2901
4.00 .002 -461.5901- -116.6099-
(2)
Study 1991-
2003
1.00 .526 -226.8901- 118.0901
3.00 .968 -169.0901- 175.8901
4.00 .000 -515.9901- -171.0099-
(3)
Study 2007-
2013
1.00 .501 -230.2901- 114.6901
2.00 .968 -175.8901- 169.0901
4.00 .000 -519.3901- -174.4099-
(4)
Study Inside
Iraq 2001
1.00 .002 116.6099 461.5901
2.00 .000 171.0099 515.9901
3.00 .000 174.4099 519.3901

18. Numbers of Iraqi Population
Studied by Location
18
1155
3100
4255
In Iraq In U.S. Total

19. Percentage of
Iraqi Study Population (4255)
19
Variable In Iraq In U.S.
Age***
18-39 Y 72.1 35
40 + Y 27.9 65
Gender***
Female 53.3
Male 100 46.7
Marital
status***
Widow/Divorce/Ot
her
37.6 8.2
Single or Married 62.4 41.9
E
Education
Less thank H.S 59.4 58.2
More than H.S 40.6 41.8
Work***
No Work 95.9 73
Have Work 4.1 27

20. Prevalence of Stress in Daily Live
among Iraqi Population (P<0.001)
20
85.8
53.7
In Iraq In U.S.

21. Prevalence of War Exposure
(Chemical & Psychological
Stressors) * among Iraqi Population
(1505) by Location(P < 0.001)
21
18.2
42.0
In Iraq In U.S.

22. Prevalence of Substance Abuse
among Iraqi Population by Location
22
84.4
51.3
1.9
10.9
28.6 28.2
Illicit drug* Tobacco* Alcohol*
In Iraq In U.S.

23. Logistic Regression Analysis To Predicting
Risk Factor For All Substance Abuse
23
Risk Factor Sig. OR
95% C.I.for OR
Lower Upper
Iraqi in Iraq 0.000 19.95 9.54 41.70
Expose To War 0.000 0.33 0.19 0.57
Age 18-39 Years 0.000 0.42 0.27 0.66
Male More Prone 0.003 0.45 0.27 0.77
Un-employed 0.004 0.44 0.26 0.77
Have Hypertension 0.009 0.45 0.24 0.82
Less High School 0.028 1.49 1.04 2.14
Have Depression 0.059 1.47 0.99 2.20
* Variables in Equation: Age, Gender, Marital Status, Education, Legal status, Employment, All Chronic diseases,
All Illicit drugs, Chemical Exposure, Non-Chemical Exposure, Stress of life

24. Prevalence of Mental Disease* among
Iraqi Population (2836) By Location (*P < 0.001)
24
37.2
10.1
0.5
22.7
13.0
2.2
Depression* Anxiety* PTSD*
In Iraq In U.S.

25. Logistic Regression Analysis to Predict
Risk Factors for All Mental Diseases
25
* Variables in Equation: Age, Gender, Marital Status, Education, Legal status, Employment, All Chronic
diseases, All Illicit drugs, Chemical Exposure, Non-Chemical Exposure, Stress of life
Risk Factor Sig. OR
95% C.I.for OR
Lower Upper
Have Anxiety 0.000 0.08 0.05 0.14
Have Somatic dis. 0.000 3.35 1.83 6.15
Smoke Tobacco 0.001 0.63 0.47 0.83
Use Illicit Drugs 0.002 1.87 1.25 2.80
Un-employed 0.006 0.46 0.27 0.80

26. Prevalence of Iraqi Population Who
Have Somatic disease*
(2539) by Location (*P< 0.0001)
26
2.3
9.0
2.8
18.5
16.1
7.8
Heart Problem* Hypertension* Diabetes*
In Iraq In U.S.

27. Logistic Regression Analysis to Predict
Risk Factor for Somatic Diseases
27
* Variables in Equation: Age, Gender, Marital Status, Education, Legal status, Employment, All
Chronic diseases, All Illicit drugs, Chemical Exposure, Non-Chemical Exposure, Stress of life
Risk Facto Sig. OR
95% C.I.for OR
Lower Upper
Have Depression 0.000 0.53 0.39 0.73
Female more prone 0.007 2.07 1.22 3.49
Tobacco Smokers 0.007 0.67 0.49 0.90
Expose to War 0.010 0.65 0.47 0.90
Have Anxiety 0.033 0.67 0.46 0.97

28. % of Iraqi Population (1951) Who
Respond to Question?
How You Evaluate Your Health
Today (P < 0.001)
28
13.0
40.8
87.0
59.2
In Iraq In U.S.
Poor to Bad Excellent to Good

29. •1st Hypothesis (Mental Illness)
Accepted
•Mental Illness is more prevalent
among Iraqis in Iraq (39%) Versus
25% in U.S.
•However, PTSD is more prevalent
among Iraqis in U.S. (2%) Versus
(.5%) in Iraq
29
Conclusion

30. •2nd Hypothesis Accepted
• Illicit Drug
•84% Among Iraqis inside Iraq,
•11% Among those in U.S.
•Tobacco
•51% Among those in Iraq
•29% among those in U.S.
•However, Alcohol
•28% Among Iraqis in U.S.
•2% Among Iraqi In Iraq,
30
Conclusion

31. Conclusion
•3rd Hypothesis (Wellbeing) was
Rejected
•40% of Iraqis in U.S. Reported Their
Health Fair To Poor,
• Compared to 13% of Iraqis in Iraq
31

32. Conclusion
The Results of the Study Identify
Several Risk Factors which could
be related to what Iraqis face face
Today & Iraqi Inside Iraq in which
need attention & Right Planning
for Wellbeing of Iraqis 32

33. Recommendation
33

34. 34
Council of Prime Ministers
Establish Institute of Health &
Productivity With Budget = Part of
GNP
Council of the Institute
Consist of All Province Governors
Staff consist
(1) Academic (Part time ,
(2) Post graduates of different specialty,
(3) Assistant professional staff,
(4) Other as needed

35. Recommendation
Its first task is to start community-based
research in each Province concerning
health assessment of the population
Establishing Educational Programs for
Kindergarten, Primary School & Public
Based on the Outcome of the Research
35

36. Thank you
Welcome for Any
Questions
36