Assessment of stressful life events for patients with substance abuse in Baghdad city

present

Introduction: tress plays an important role in our life that produces a negative outcome and makes most common causing of physiological and psycho-pathological disorder depends on some factors related to the stress and to the person (1) .
The term stress has been used to describe a variety of negative feelings and reactions that accompany threatening or challenging situations, however, not all stress reactions are negative. A certain type of stress is necessary for survival, for example, pregnancy is one of the most stressful experiences of life (2) . Stress refers to conditions or events experienced by people during their lives that are not compatible with their current abilities and facilities and therefore it causes change on individual's health (3) .
The stress is very significant in the health; therefore it has been the subject of considerable research in the last few years. Any environmental stimulus is considered as stressor (4) .
The individuals can feel stressed when they exposed to major life events such as the death of parent, illness or change in residence. The stress occurs when individuals perceive an event as overly challenging and beyond their ability to cope. The occurrence of stress is one of the major contributors to mental health difficulties, especially with Iraq environment. These difficulties arise after the U.S.A invasion Iraq in March 2003, such as bombing accident, kidnapping etc. (5) .
Negative or stressful life events may associate with a variety of health problems. For example, there is abundance of literature that identifies negative or stressful life events as a risk factor for substance abuse and adverse health outcome. Problems that are associated with stressful life events include drug overdose, suicide attempts, and depression (6) .
The DSM-IV-TR (APA, 2000) identifies substance abuse as a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use of the substance. Substance abuse has also been referred to as any use of substances that poses significant hazards to health. The DSM-IV-TR classified substances in eleven category including alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, Inhalants, nicotine, opioids, phencyclidine, and sedatives, hypnotics, or anxiolytics (7) . The extant literature shows that stress is a predictor of initial drug and alcohol abuse (8) . Substance abuse has become one of the main problems affecting the Iraqi population in addition, drugs are affect Iraq due to their direct health effects and many crimes and terrorist attacks are committed under the influence of drugs (9) .

Methodology:
The present study was carried out through the application of a descriptive study design which uses the assessment approach, and it was conducted on patients with substance abuse in Baghdad city starting from 1 st of December 2012 to 3 rd of July 2013. Non-probability (purposive) sample of 64 patients diagnosed with substance abuse by psychiatrist selected for the purpose of the study. Data were collected in both (in patients and out patients departments) from Ibn-Rushd Psychiatric hospital and from the Baghdad Teaching Hospital (Psychiatric ward) at the 10 th Floor in addition to the outpatient clinic. A questionnaire was developed by researcher for the purpose of the study. It was comprised of three parts; the first part includes demographic data for patients; second part includes medical information and; third part includes stressful life events scale was developed by researcher throughout review of literature and related study it comprised of six domain: family and social domain, health status domain, security, legal and criminal domain, work and school domain, financial domain, and change of residency domain. A pilot study was carried out for the period of 12 th to 24 th Feb. 2013, conducted on ten patients who were selected randomly seven patients from Ibn-Rushed Psychiatric hospital, and three patients from Baghdad teaching hospital. The validity of the questionnaires was obtained through thirteen expert and the reliability was achieved through the application of Cronbach alpha correlation coefficient (r =0.70) which was statistically acceptable.
Data were analyzed by use of statistical package social sciences (spss.) through following descriptive statistical data analysis approach (frequency, percentages, mean of score, standard deviation), and inferential statistical (Cronbach alpha correlation coefficient, and one way analysis of variance). The result shows that about half (47.7%) of the sample were below 30 years old, while the lowest number is shows at age group (40 years and above) and they are accounted (20%).  The result indicated that more than half (50.8%) of the sample is from educational group of " read and write" followed by group of illiterate (21.5%) then group of secondary level (20%) while lowest percentages of the sample (7.7%) is from educational group of " institute or college".  The results reveals that the more effect of social and family domain related stressful life events on substance abusers is from "family arguments" "death of one family member" and" death of one relative . Whereas the less effect is coming from "family member gain new" ,"death of spouse" and "son or daughter leave home".  The result reveals that the more effect of health status domain related stressful life events on substance abusers is from "change in sleeping habits "and" personal illnesses ". Whereas the less effect is coming from "change in eating habits ". The result shows that the more effect of Security, criminal and legal, domain related stressful life events on substance abusers is from "unsafe felling" while lowest effect from Kidnapping of one family member or Kidnapping of close friend". The results reveal that the more effect of work and school domain related stressful life events on substance abusers are from "unemployment" Whereas the less effect is coming from "retired ".  The result reveals that more effect of financial domain related stressful life events on substance abusers is from "Change in financial status " Whereas the less effect is coming from "Taking out a big loan for purchase house or car ". The results reveal that the more effect of residence domain related stressful life events on substance abusers is from "transfer to new house". This table reveals that the " Heath domain" related to stressful life events gets higher mean (1.61) which indicates that it has more effects on patients with substance abuser followed by "family and social domain" whereas" residence domain" gets lower mean which indicates that it has lower effects on patients with substance abuser. The result reveals that there is a significant in the residence domain of substance abuser with regard to age significant at p≤0.05, while there is no significant difference in the other stressful life events domain of substance abuser with regard to age. The result reveals that there is no significant difference in the stressful life events domains of substance abusers with regard to their educational level at p≤0.05.

Discussion:
Throughout the course of data analysis the result indicates that all of the study samples (100%) were males. This finding comes along with result obtained from other study which indicated that majority of the study subjects with substance abuse were male (10,11) . In relation to age most of the study sample were (20-29) years old who were a counted (56.3%). This result is compatible with other study which indicated that more than half patients (56.41%) was in age level 20-30 years old (12) . Regarding to marital status more than half of study sample (57.8%) were married whereas the divorced and widowed take the lowest percentage in study. This findings supported by result obtained from other study which indicated most of addict patients were married (13) . Relative to educational level result indicates that more half of patient (59.9 %) of study sample with primary level. This finding agrees with other worker he reported that the majority of study sample with low level of education (14) . Concerning to occupation results of study shows (45.3%) of sample were un-skilled worker. This result is agree with result obtain from other study which indicated that majority of the study sample with substance abuse were unskilled workers (15). Regarding to residence area the result shows majority of sample (95.3%) were living in urban area. This result is compatible with another worker he indicated that majority of drug abuser were living in urban area (16) .
In regard to family and social domain, the result indicated that the event " family arguments " more effects life event among sample is agree with other study results they found family arguments more prevalent given cause to substance abuse (17) .
The result reveals that change in " sleeping habits " more life event among sample than other health problems this result is supported by other workers they found that sleep disturbances was more common life event in addict patients (18) .
The finding indicated that the " unsafe felling " more effect life event among patients than other life event, this result agrees with the current security situation according to the researcher's point of view.
The result shows that the event "unemployment" was more effects life event among patients than other stressful life events related to work and school domain, another researcher found there was a link between drug and unemployment which is consistent with the present study findings (19) .
The result reveals that the event " change in financial status more effects in the life of sample, this result is supported by other workers they found change in economic status relate to drugs abuse (20) .
The finding indicated that the "transfer to new house" more life event among patients, this result agrees with the current situation because instability of security according to the researcher's point of view.
The result reveals that the " health domain " gets higher mean (1.61) which indicates that it has more effects on patients with substance abuse followed by" family and social domain" whereas " residence domain" gets lower mean which indicates that it has lower effects on patients with substance abuse. Many researchers had got similar results, they mentioned that the most stressing life events in the first place their health problems such as a family member's disease, and in the second place the family problems such divorce, arguments and problems between the couple or with their children regarding with alcohol consumption (21) .
The study found significant differences relative to patients' age at P≤ 0.05 level with regard to residency domain .This finding is supported by many workers they reported there was a positive and significant association between the life stress and age (21) .
The study found no significant differences relative to educational level at P≤ 0.05, this finding is agreed with other workers. They found marital, occupational, and educational status did not reveal any significant difference regarding to substance abuse (22) .

Recommendations:
Increase an individual, family and community awareness about stress management to reduce the impact of life events upon their psychological health. Educational programs about substances abuse can be constructed and implemented from primary school to educate the students about the problems that associated with abuse substance.