Ways of Coping to deal with Stress used by The Iraqi Repatriated Prisoners of the Iran-Iraq War, 1980-1988 ﻦﯾﺪﺋﺎﻌﻟا ﻦﯿﯿﻗاﺮﻌﻟا

Objective : To find out the ways of coping to deal with stress used by the Iraqi repatriated prisoners of Iran-Iraq war, and also to find out the relationship between these ways and some demographic characteristics. Methodology : A descriptive study was carried out from Oct. 18th, 2010 through Jan. 10 th , 2011. A Snowball sampling as a non-probability sampling technique was used to recruit 92 repatriates who had visited Ministry of Human Rights. An instrument was constructed for the purpose. The constructed instrument consisted of six demographic characteristics, and twenty eight items for measuring the level coping in POWs. Data were collected with using the constructed instrument and the process of the interview as means for data collection. Data were analyzed through the application of descriptive statistical analysis, which are; percentages, frequencies and inferential statistic analysis (Pearson correlation coefficient). Results : The study revealed that the majority of IRPOWs have some levels of coping that 31.5% (n= 29) of IRPOWs have weak level of c oping; 64.1% (n= 59) have medium level of coping; and only 4.3% (n= 4) have good level of coping. The findings also indicated that there is no significant relationship between coping relative to; current age, age at capture, duration of captivity, marital status, and level of education. Conclusions: The present study concluded that all the IPOWS were males and married, the majority were stayed in captivity sixteen years and more, high percentage of them had Bachelor degree. The study indicated that the majority of IPOWS used the religious commitment and mediation as a mean of coping to deal with stress. Recommendations : The study recommends


INTRODUCTION
It is repeatedly supposed that stress is present when people tackle circumstances that surpass their ability to manage these circumstances (1) .At any time an individual is pushed to deal with some problems or obstacle or alarming threat, the experience is stressful and it is not uncommon to believe of stress as being a particular set of experiences, however it may be that stress is not more than the experience of coming across or expecting difficulty in individual's goal-related efforts (2) .
Stress is an idiom which is frequently employed nowadays but has increasingly turned out to be hard to describe.Stress classically explains a negative idea that may have a shock on individual's psychological and physical welfare, however it is not clear what accurately describes stress and whether it is a cause or an effect (3) .
It is concluded that in moving from mere difficulty to stress; at least three conditions are possible: firstly, threat is the looming incidence of an event that is anticipated to have awful consequences; secondly, damage is the perception that these awful consequences are already present, and thirdly, loss is the perception that a desired thing has been missed.These unpleasant experiences are all stressful, but they differ in their motivational underpinnings (2) .
Coping is defined as efforts to prevent or reduce threat, harm, and loss, or to diminish associated distress.Some prefer to limit the concept of coping to voluntary responses (4) ; others include automatic and involuntary responses within the coping construct (5) .Individuals react to perceptions of threat, harm, and loss using different behaviours and many of them receive the label of coping.Certainly, differentiating between voluntary and involuntary responses to stress is not easy, in fact, responses that begin as intentional and effortful may become involuntary with repetition.Here individuals limit themselves only to responses that are identified by the person engaging in them, therefore eliminating unconscious defensive reactions from the realm of consideration (6) .Objectives: To find out the ways of coping to deal with stress used by the Iraqi repatriated prisoners of Iran-Iraq war, and also to find out the relationship between these ways and some demographic characteristics.

METHODS
A non-probability convenience sample of 92 repatriates who visited Ministry of Human Rights/ POWs and Missing section.The sample of this study was taken from Iraqi repatriated prisoners of Iran-Iraq war, 1980-1988 who had been captured during the 8-year war between the two countries and were set free from 1990 to 2003.This sample was recruited using snowball sampling.The constructed questionnaire as an instrument for data collection consists of two parts.Firstly; the Demographic data sheet which consists of 6 items which included; current age, age at capture, duration of captivity, rank, marital status, level of education, and secondly: the Brief COPE consists of 14 dimensions, of two items each and each item is with four responses ranged from (1) indicates that the respondent usually does not do this at all; (2) usually does this a little bit; (3) usually does this a medium amount; and (4) usually does this a lot.These items were measured, scored, and rated on 3-level Likert rating scale (7) of weak with cut-off point ranged (1-1.8) that indicates that the level of coping is weak; moderate with cutoff point ranged (1.9-2.9) that indicates that the level of coping is moderate; and good with cutoff point ranged (3-4) that indicates that the level of coping is good (7) .Data were analyzed through the application of the descriptive data analysis (frequency, and percentage), and inferential data analysis (correlation coefficient).   .٦٦.٢ % and 22.9% of IRPOWs who spent 16 years and more and 8-11 years in captivity have weak and medium levels of coping respectively.And for those who were repatriated before 6-10 years have weak and medium levels of coping.The study shows that 33.0% of IRPOWs with Bachelor and postgraduate degree and 28.2% with primary school have weak and medium levels of coping respectively.And 25.0% of officers, 33.7% of reserved, and 18.3% of recruit have weak and medium levels of coping respectively.Table 4 shows the different levels of coping strategies used by the study subjects.Most of those strategies used by those repatriates ranged between medium and good levels; 88.0% (n= 81) for active coping; 84.8% (n= 78) for planning; 85.8% (n= 79) for positive reframing; 83.7% (n= 77) for acceptance; 74.0% (n= 68) for humour; 96.7% (n= 89) for religion; 91.3% (n= 84) for emotional support; 94.6% (n= 87) for instrumental support; 96.7% (n= 89) for selfdistraction; 78.3% (n= 72) for denial; 74.3% (n= 72) for venting; 79.3% (n= 73) for behavioural disengagement; 70.7% (n= 65) for self-blame; but for substance use ranged between weak and medium 90.2% (n= 83).

RESULTS:
For Planning strategy the table shows that the more planning the Iraqi POWs use in the stressful circumstances the more strategies of reframing (r= 0.60, p= 0.01), acceptance (weak correlation: 0.38, p= 0.01), and self-distraction (weak correlation: r= 0.30, p= 0.01) occur.Regarding Reframing strategy the results of this study indicates that the Iraqi POWs who use reframing also use, acceptance (weak correlation: r= 0.50, p= 0.01), religion (weak correlation: r= 0.32, p= 0.01), self-distraction (weak correlation: r= 0.35, p= 0.01, and venting (weak correlation: r= 0.38, 0.01) in dealing with stress.
And for Acceptance table 4.25 shows that the higher the strategy of acceptance the more the use of strategies of religion (weak correlation: r= 0.32, p= 0.01, self-distraction (weak correlation: r= 0.40, p= 0.01, and venting (weak correlation: r= 0.23, p= 0.03).For the strategy of Humour, the study indicates that the use of humour is associated with using other strategies such as self-distraction (r= 0.26, p= 0.01), venting (weak correlation: r= 0.30, p= 0.01), and self-blame (weak correlation: r= 0.30, p= 0.01).For those who use the strategy of religion they tend to also use the other strategies such as instrumental support (weak correlation: r= 0.31, p= 0.01) and venting (weak correlation: r= 0.31, p= 0.02).
For emotional support strategy the results show that this strategy associates positively with the some other strategies: instrumental support (r= 0.65, p= 0.01), self-distraction (weak correlation: r= 0.24, p= 0.02), and venting (weak correlation: r= 0.21, p= 0.05).Table 6 shows a non-significant relationship between demographic characteristics and total coping.

Discussion of the Demographic Characteristics
At the time of Iran-Iraq war, 1980-1988 about five cohorts of recruits were in the army (born between 1957 and 1961) with about the same number of reserved and graduates.As the war lasted for eight years, the majority of captured soldiers were still young; range ≤19-≤39 (table 1).This result is supported by the study of, Hassan and Hassan (1995) who found that the age at capture was 20 to 50 years (8) ; Al-Samarai (1994) who reported that the age of his sample at capture was 27 to 45 years (9) ; and Hamzah (1994) who found that the average of the age at capture of the sample was 34 years (10) .For the POWs of other wars; Rintamaki et al. (2009) found that the average age of POWs in the Second World War was 23.9 years (11) ; for those held in Germany, their average age at capture was 24.2 years, for those held in Japan is 23.6 years (12) ; for POWs held in Vietnam the average age at capture was somewhat older at 30.6 years (13) ; and for those who captured in Korean Conflict the average of age at capture was 23 years (14) .The differences between Iraqi studies and other studies are due to the time elapsed since release from captivity and the date of those studies; for the POWs of the Second World War the study of Rintamaki was in 2009 and the time elapsed since release was about 65 years which indicated that just those who were the youngest during their repatriation were still alive because the study participants completed a mailed survey.This may also be the case for other studies except the POWs of Vietnam War which ended in 1975 and perhaps POWs with different age joined in Feder's study in 2008 (13) .The period Iraqi POWs stayed in captivity show different durations (table 1) and is supported by previous studies of the author (Al-Ameri, 2008) who reported that 87% of the total sample spent between six to 21 years in captivity (15) .About half of the Iraqi POWs (42,000) were captured during 1982, coinciding with a major Iranian offensive and 41 thousands Iraqi prisoners of war were released in 1990 (16) , meaning that approximately half of Iraqi prisoners of war had spent 6 to 13 years in captivity.Iran began to release prisoners again in a large numbers after 1998 and so the rest spent 14 to 21 years in prison (16) .According to the study of Zeiss et al. (1985) the POWs of the Second world War stayed for a period ranging from 6-26 months (17) ; the average length of captivity the POWs held in Vietnam was five years and three months (18) ; and for Croatian POWs duration of captivity ranged from 6-9 months (19) .Regarding the Time elapsed since release the formal release of POWs took place in August, 1990 (41,000 IPOWs were released) and continued until May, 2003 (55 IPOWs) after Iraq was invaded by a coalition led by the USA (16) .Within the 23 years (1990 to 2003) most the Iraqi prisoners of Iran-Iraq war (about 75,000) had been released and about 10 thousand chose to stay in Iran (16) .The study also revealed that more than half of those (table 1) who joined in the study were released after the year 2000.This high percentage of participants from those released after year 2000 could be because many were not able to finish all the requirements of their retirement, as a result of the invasion by the USA led coalition, and also would be in contact with the authorities in Baghdad.The Iraqi Ministry of Defence was dissolved and they began again to follow up the process of the retirement after reforming a new Ministry of Human Rights which shouldered the responsibility of the IRPOWs.

Discussion of coping strategies used by the IRPOWs
Coping strategies can operate in combination with one another, and the effectiveness of these strategies might differ as a result of other strategies that are adopted at the same time or in sequence (20) .Therefore, if there are additive effects then it might be counter-productive to examine the effectiveness of one strategy against another (21) .As an alternative, it might be favourable to examine the combinations of coping strategies used (22) .For example, even if two persons both use active coping as a main strategy, one of those persons might accompany the active coping with humour, while the other person might accompany it with religion (22) .The latter combination may lead to an ability to find meaning and value in the situation (23) .Obviously, much information can be missed if coping strategies are tested separately and in isolation of one another, as this does not include the complete nature of coping, including the interaction among strategies (22) .In addition to being situation-specific, coping strategies may differ with the passage of time and with changes within the person (20) .
The findings of table 3 indicate that, for general coping, most of the sample copes at a medium level but table 4 shows the levels of coping for all 14 items individually.This study is the first study in Iraq that includes an assessment of coping strategies within the Iraqi prisoners of Iran-Iraq war, 1980-1988 and the effects of a rehabilitation programme for those repatriates.So there is no Iraqi study to compare these results with.
The study indicates that most of the IRPOWs adopt more problem-focused strategies (active coping, planning, positive reframing, and instrumental support) in dealing with the stressful situation.The participants were able to concentrate, focus and take active steps to reduce or remove the effect of stressor in order to make the matter be better (active coping); furthermore, a high percentage of the repatriates think about the necessary and organized steps of how to cope and think about what steps are to be taken in order to handle the problem and have the insight to decide to overcome the problems that cause stressors (planning); to see the situation in different view and more positively to try to find something good in what happens.This gives the ability to reframe what is considered to be a stressful situation (active reframing); and finally seeking specific kinds of assistance and advice from others, such as family members and friends, to help them change different situations that might cause stress, for example: information, financial support, or expertise, and asserting opinions and boundaries that lead them to not only change their circumstances, but also feel more empowered (instrumental support).This could be explained by the long sufferings mixed with hardships, difficulties, and problems which may help them learn strategies for coping that serve them well in life once.
IRPOWs also adopt emotion-focused strategies (table 4) side by side with the problem-focused strategies in dealing with the stressful situations which could not be changed, so they believe that they cannot change everything which happens but they can accept the fact that it has happened and what they need to do is to live with it (acceptance); IRPOWs use jokes, fun, and good humour in order to reduce the effects of stressor on their life.They use this strategy when they cannot change the situations which cause more stress (humour).This result is supported by Fairbank and his colleagues (1991); and Henman (2001) when indicated in their studies that former American POWs of Vietnam War used social humour as one of the coping strategies with stress (24,25) .One of the most effective strategies to cope with stressful situations for the IRPOWs could be religion (96.7% of them have medium to good levels) (table 4).Because religion plays a huge role in all directions of their life; beliefs, tenets, commitments, morals, education so most IRPOWs find their relief from stressors or difficult circumstances by praying and repeating rituals.These results are supported by Noorbala and Narimani (2005) who revealed that the majority of Iranian POWs (89%) have used praying and meditation as coping style to deal with stress (26) .In contrast, the results of table 4.8 show that when considering substance use (alcohol or drugs) only 9.7% of IRPOWs adopt this strategy in coping with stress.This is because most of them believe that having alcohol or other drugs is prohibited by their religion and against the wish of God.91.3% of IRPOWs use emotional support (medium and good levels) as means to cope with stress and this could be related to Islamic teachings, which motives Muslims to help each other and to build brotherly relationships within the society.IRPOWs feel that it is an ordinary thing to go to friends or other family members in order to get support, help or advice in time of stressful situations.This is supported by Fairbank and his colleagues (1991) and Ursano and his colleagues (1996) when they indicated that former American POWs of Vietnam War used social support in coping with stress (24,27) .Distracting themselves through different actions as emotionfocused strategies 91.7% of IRPOWs use this strategy in medium and good levels and may help them feel relatively better in the short time, but can be disturbing in the long time.This might be due to the many problems they face during their lives so they cannot manage all of them as problem-focused strategies.Another strategy is coping by denying the existence of problems and more than half of IRPOWs use this strategy at a medium level.This could be as result of not be able to overcome or face the problems directly.Using magnification with reciting some rituals or reading some verses from Qur'an or to pray to God as means of relief from stress is the way that many IRPOWs vent in order to lessen the effects of stressful situations.That is because most of them believe that in doing these commitments the God would help them surpass these difficulties.Finally some IROPWs blame themselves for the existence of problems that cause stress.Fairbank and his colleagues (1991) also indicated that former American POWs of the Vietnam War were used to coping with stress by blaming themselves (24) .

Discussion of the association within coping strategies
Table 6 shows a significant association within the problem-focused strategies (active coping, planning, and reframing) used by IRPOWs.This could be as a result of believing that problem-focused coping is necessary to help them move through those hard times.In addition, the long and multi-faced experiences could make them struggle to solve their problems directly (24) .

CONCLUSIONS:
The present study concluded that all the IPOWS were males and married, the majority were stayed in captivity sixteen years and more, high percentage of them had Bachelor degree.The study indicated that the majority of IPOWS used the religious commitment and mediation as a mean of coping to deal with stress.

RECOMMENDATIONS:
The study recommends that it is very important to establish special mental health services centres within the primary health care centres deal with those repatriates for counselling and in order to diagnose and treat them and further studies in this field with follow-up studies for the repatriates.

Table 1
shows that most of the participants of this study were middle aged at the time of recruitment in 2009.The highest percentage is located in the age group 50-59 year (48.8%).The age at capture, 74% of the participants were aged between 20 to 39 years, Regarding the period of time the IPOWs had spent in captivity the study indicates that the period ranges from 8 to 21 year and 68.5% of them spent between 16 and 21 years.With regard to the time elapsed since release from captivity, the study revealed that the time ranged from 6-20 years and about 60% of the sample ranged 6-10 years.This time is calculated from the year of release until the time of recruitment.For the rank of the participants of this study the results show that 33.7% of the sample was from the Reserved; 27.2% were officers; 19.6% were Recruit; 13.0% were from Public army; and 3.3% is the same percentage of the Sub-officer and Civilians.The levels of education repatriates have, the study indicates that 28.3% have primary school (six years); 17.4% have intermediate school (nine years); and 8.7% have secondary school (12 years).

Table 2 . Distribution in levels of Coping scores according to demographic characteristics
Table(2)shows that 31.5% (n= 29) of IRPOWs have weak level of coping; 64.1% (n= 59) have medium level of coping; and only 4.3% (n= 4) have good level of coping The table shows that regarding current age 47.9% and 26.1% of IRPOWs with age ranged 50-59 years and ≥60 years have weak and medium levels of coping respectively.And 42.3% and 36.9% of IRPOWs with age ranged 20-29 years and 30-39 years have weak and medium levels of coping respectively.