Two studies in the current issue of JAMA address the current mental health problems of Southeast Asian tsunami survivors. Understanding post-tsunami mental health indicators is essential for identifying vulnerable populations and developing culturally specific mental health interventions.

Researchers discovered adult and children in the tsunami-affected areas of Thailand have elevated rates of mental health problems including posttraumatic stress disorder and depression. While symptoms of PTSD and depression have declined among adults, symptoms have not reduced among displaced children nine months after the disaster.

In the studies, researchers assessed the prevalence of symptoms of PTSD, anxiety, and depression 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.

Loss of livelihood was independently and significantly associated with symptoms of all 3 mental health outcomes (PTSD, anxiety, and depression). Among adults, “‘Restoration of persons’ livelihoods to prevent and diminish mental morbidity among populations affected by natural disasters is therefore of utmost importance,” the authors write.

For children, 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.

A 9-month follow-up survey among adults for prevalence rates of symptoms of PTSD, anxiety, and depression show that although the symptoms have decreased among displaced and nondisplaced adults, they continue to 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 implemented by multiple governmental and nongovernmental organizations,” the researcher add.

As for children, “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.

Source: JAMA and Archives Journals