There were 78 children and adolescents, including 67 (85.9 %) male and 11 (14.1 %) female subjects, who participated in this study. The age of the study group ranged between 9 and 18 years old, with a mean of 16.1 ± 1.9 years old. At the time of injury, most of the participants were between 2 and 15 years old (89.5 %), and the mean age at the time of injury was 8.27 ± 3.12 years old. Sixty-three percent of the victims continued their educations after injury and 37 % quit their school training immediately or over the years after the injury. The socio-demographic characteristics are presented in Table 1. The mean interval between the injuries and the interviews was 7.86 ± 3.14 years.
Classification of the adolescents according to the type of injury showed that most of injuries led to amputation (52.6 %), and 25 (32.0 %) victims suffered from multiple physical injuries (Table 2) .
Nine (12 %) victims previously visited hospitals due to psychiatric disorders. Psychiatrists assessed thirteen mental health elements, as shown in Figure. 1. While more than half of the participants were abnormal in temperament, all were completely normal in five aspects: perception, illusion, thinking, insight and reliability. The abnormal characters were as follows: temperament in 42 (54.6 %), appearance in 6 (7.8 %), short-term memory in 5 (6.5 %), long-term memory in 3 (3.9 %), affection in 2 (2.6 %) and 1 (1.3 %) in language, orientation and judgment each.
The study showed that 37 (47.4 %) victims were affected by psychological disorders: anxiety disorders in 27 (34.6 %), mood disorders, including mild to moderate depression, in 5 (6.4 %), cognitive disorders in 2 (2.6 %) and other disorders in 3 (3.8 %). The anxiety disorders included PTSD in 20 (25.6 %) and generalized anxiety disorder (GAD) in 7 (9.0 %) (Fig. 1).
Significant relationships were observed of psychiatric disorders on Axis I with age of casualty and duration of injuries (χ
(0.95,169) = 246.53, P = 0.03 and χ
(0.95,52) = 69.83, P = 0.05, respectively). Landmine casualties at the age of 5 to 9 years old caused approximately one third of the mental disorders (40.9 %, n = 18). However, psychiatric disorders due to landmine incidents at younger than 5 years old (66.7 %, n = 4) and older than 9 years old (60.0 %, n = 15) were also quite common. In addition, the prevalence of mental disorders was inversely related to the duration of injury. Participants with anxiety or depression diagnoses totaled 8 (25.0 %) girls and 24 (75.0 %) boys, with a significant difference between genders (χ
(0.95,4) = 13.031, P = 0.01). A more detailed analysis showed that two-thirds (63.4 %, n = 7) of girls suffered from anxiety disorders, while fewer than one third (29.8 %, n = 20) of boys were affected by this complication. Similar proportions were observed for depression in boys (5.0 %, n = 4) and girls (9.1 %, n = 1). Additionally, no significant relationships were found of age, age at the time of injury, education and disability rate with PTSD. The same results were observed in terms of other psychiatric disorders (P > 0.05). The chi-square test showed a significant relationship between amputation and type of psychological disorder (χ
(0.95,12) = 28.85, P = 0.004), with more than one third (n = 14, 37.8 %) of amputees diagnosed as anxious.
Regarding Axis II, two patients (2.6 %) with mental retardation were detected. Axis III was positive for the entire group because all of the subjects had one or more physical injuries that were caused by landmine explosions. Regarding Axis V, only seven patients (9 %, n = 7) were normal and received the maximum score (91–100) (Fig. 2). More than two-thirds had scores of 80–90, indicating few or no symptoms, good functioning in several areas and no more than everyday problems or concerns. One of the new mental patients, with a score of 41-50, showed serious problems in school functioning and required educational support and counseling. The only person who had a history of psychiatric hospitalization had a score of 51–60 on Axis V. He expressed an anger disorder and limited affect, with impaired long- and short-term memory, orientation and judgment.
Thirty-eight (48.7 %) participants were mentally healthy, and 29 (37 %) required psychiatric treatment. Based on the analysis of DSM-IV diagnoses by psychiatrists, the following treatments were advised. Among the previously diagnosed participants, 3 (3.8 %) were advised to continue the previous therapy, 5 (6.4 %) needed to change their medications and psychotherapy, and 1 (1.3 %) was recommended to start psychotherapy and medications; among the victims never treated before, 5 (6.4 %) required pharmacotherapy, 12 (15.4 %) psychotherapy, 1 (1.3 %) cognitive behavioral therapy, 3 (3.8 %) psychological counseling, and 8 (10.2 %) were advised to start medications and psychiatric consultations.