Elevated rates of mental health problems among survivors of tsunami

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. (JAMA. 2006;296:537-548. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: The research for this article was funded by the U.S. Centers for Disease Control and Prevention and the Thailand Ministry of Public Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

PTSD and Depression Symptoms Among Children Who Survived Tsunami

There has been increase in the rate of depression and posttraumatic stress disorder among children in the tsunami-affected areas of Southern Thailand, according to a study in the August 2 issue of JAMA.

Warunee Thienkrua, M.Sc., 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, conducted an assessment of symptoms of mental illness among children after the tsunami. This study examines the prevalence of symptoms of PTSD and depression, and associated risk factors among children aged 7 to 14 years in tsunami-affected provinces in southern Thailand, where approximately 20,000 children were directly affected. The mental health surveys were conducted in Phang Nga, Phuket, and Krabi provinces from February 15-22, 2005 (2 months post-tsunami), and September 7-12, 2005 (9 months post-tsunami). A total of 371 children participated in the first survey (167 living in displaced guest camps, 99 not displaced from villages affected by the tsunami, and 105 not displaced from nonaffected villages).

The prevalence rates of PTSD symptoms were 13 percent among children living in displacement camps, 11 percent among nondisplaced children from tsunami-affected villages, and 6 percent among children from nonaffected villages; for depression symptoms, the prevalence rates were 11 percent, 5 percent, and 8 percent, respectively. Having had a delayed evacuation, having felt one's own or a family member's life to have been in danger, and having felt extreme panic or fear were significantly associated with PTSD symptoms. Older age and having felt that their own or a family member's life had been in danger were significantly associated with depression symptoms.

In the follow-up survey, 72 percent of children from Phang Nga participated. Prevalence rates of symptoms of PTSD and depression among these children did not decrease significantly over time.

"Findings in our assessment may provide a better understanding of post-tsunami mental health problems and associated risk factors among children. Therapeutic approaches may be needed to help children understand and manage their feelings of fear, so that possible negative impacts on their development are minimized. Family counseling may be necessary to make sure that parents are able to recognize and address mental health problems, and schools may be another important venue for affected children to be identified and provided with services to reduce PTSD and depression. Teachers, in particular, may play a crucial role in the support and referral of affected children; hence, appropriate sensitivity training for mental health–related problems is recommended for school-based staff," the authors write. (JAMA. 2006;296:549-559. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This assessment was supported by the U.S. Centers for Disease Control and Prevention and the Thailand Ministry of Public Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Rapid Assessments of Mental Health Needs After Disasters

In an accompanying editorial, Derrick Silove, M.D., and Richard Bryant, Ph.D., of the University of New South Wales, Sydney, Australia comment on the studies in this week's JAMA on tsunami survivors and mental health.

"A critical question is whether survivors with early symptoms of PTSD, depression, and anxiety warrant psychological interventions, particularly the nonspecific counseling that commonly is offered in these settings. Studies in Western settings have shown that generic forms of counseling are ineffective in reducing early PTSD symptoms. It may be that, more than receiving counseling, what most survivors need to facilitate natural recovery from trauma exposure and the resulting stress is the restoration of conditions of safety and predictability. Stabilizing the social environment and creating opportunities for survivors to resume their livelihoods and take control of their lives may be the best 'therapy' for the community as a whole." (JAMA. 2006;296:576-578. Available pre-embargo to the media at www.jamamedia.org)

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Editor's Note: Financial disclosures - none reported.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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