Tsunami Survivors Face Increased Risk of Mental Disorders
Aug 3, 2006 - 2:51:37 PM

Adult and children in the tsunami-affected areas in Thailand have elevated rates of mental health problems such as symptoms of posttraumatic stress disorder and depression up to 9 months after the disaster, according to two studies in the August 2 issue of JAMA, a theme issue on violence and human rights.

On December 26, 2004, a massive undersea earthquake northwest of Sumatra, Indonesia, caused a giant ocean shockwave or tsunami that devastated the shorelines of Indonesia, Sri Lanka, India, Thailand, and many other countries. More than 200,000 individuals are estimated to have died from the tsunami, making it one of the deadliest natural disasters in history. In Thailand, the tsunami severely affected all 6 southwestern provinces, where 5,395 individuals died, 2,991 were unaccounted for, and 8,457 were injured, according to background information in the article.

Previous assessments among survivors of natural disasters have shown that posttraumatic stress disorder (PTSD) and other mental health problems are common. Thailand does not have a history of natural disasters and the prevalence of PTSD among individuals exposed to traumatic events has not been assessed previously. Understanding post-tsunami mental health indicators is essential for identifying vulnerable populations and developing culturally specific mental health interventions.

Frits van Griensven, Ph.D., of the Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand, and colleagues with the Thailand Post-Tsunami Mental Health Study Group, assessed the prevalence of symptoms of PTSD, anxiety, and depression and associated factors among random samples of displaced and nondisplaced persons in the three Thai provinces of Phang Nga, Krabi, and Phuket, which were the most severely affected by the tsunami. The population-based mental health survey was conducted from February 15 to 22, 2005, of displaced (n = 371) and nondisplaced persons in Phang Nga province (n = 322) and nondisplaced persons in the provinces of Krabi and Phuket (n = 368). Data were collected using an interviewer-administered questionnaire on handheld computers. Participation rates for displaced and nondisplaced in the survey were 69 percent and 58 percent, respectively. A follow-up survey was conducted in September 2005.

The researchers found that symptoms of PTSD were reported by 12 percent of displaced and 7 percent of nondisplaced persons in Phang Nga and 3 percent of nondisplaced persons in Krabi and Phuket. Anxiety symptoms were reported by 37 percent of displaced and 30 percent of nondisplaced persons in Phang Nga and 22 percent of nondisplaced persons in Krabi and Phuket. Symptoms of depression were reported by 30 percent of displaced and 21 percent of nondisplaced persons in Phang Nga and 10 percent of nondisplaced persons in Krabi and Phuket. Loss of livelihood was independently and significantly associated with symptoms of all 3 mental health outcomes (PTSD, anxiety, and depression).

“Restoration of persons’ livelihoods to prevent and diminish mental morbidity among populations affected by natural disasters is therefore of utmost importance,” the authors write.

In the 9-month follow-up survey of 73 percent of displaced participants and 80 percent of nondisplaced participants in Phang Nga, prevalence rates of symptoms of PTSD, anxiety, and depression decreased among displaced and nondisplaced persons, but remain elevated.

“This decrease may be due to spontaneous recovery under improved social and environmental conditions, such as more permanent housing for displaced persons, continued mental health support and occupational training, and restoration of livelihood programs, which were implemented in Phang Nga province by multiple governmental and nongovernmental organizations,” the researcher add.

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