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Prevalence of and Sex Disparities in Posttraumatic Stress Disorder in an Internally Displaced Sri Lankan Population 6 Months After the 2004 Tsunami

Published online by Cambridge University Press:  08 April 2013

Padmini D. Ranasinghe  and
Becca R. Levy
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Abstract

Background: When the 2004 Indian Ocean tsunami suddenly hit unsuspecting coastal populations in Sri Lanka, it inflicted unprecedented devastation including 35,000 deaths and 500,000 people displaced. Evaluating the psychological impact of this natural disaster provides valuable insights into planning interventions and disaster preparedness.

Methods: A cross-sectional survey was conducted among 264 adult males and females ≥16 years old living in temporary shelters housing tsunami survivors at 6 months. Interviewer-administered structured interviews were conducted to measure posttraumatic stress disorder (PTSD) and its risk factors.

Results: The participation rate was 97%. Of the subjects, 56% met criteria for symptoms of PTSD, with females at 64% and males at 42%. Females had at least twice the risk of experiencing PTSD (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.37–3.76). This sex difference persisted after adjusting for age, marital status, being a parent, loss of family members, amount of social support, education level, and level of depression (OR 2.14, 95% CI 1.21–3.80). Depression was significantly associated with PTSD (OR 7.19, 95% CI 3.83–13.52).

Conclusions: In this directly affected population, a majority met criteria for PTSD, indicating a significant long-term public health burden. The findings also confirm that females are at much higher risk for PTSD than males, suggesting that special mental health efforts should be targeted at women exposed to trauma. (Disaster Med Public Health Preparedness. 2007;1:34–43)

Keywords

posttraumatic stress disordertsunamiSri Lanka
Type
Original Research and Critical Analysis
Information
Disaster Medicine and Public Health Preparedness , Volume 1 , Issue 1 , July 2007 , pp. 34 - 41
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2007

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References

REFERENCES

1. US Geological Survey. The December 26, 2004 Indian Ocean tsunami: initial findings on tsunami sand deposits, damage, and inundation in Sri Lanka. February 14, 2005. http://walrus.wr.usgs.gov/tsunami/srilanka05/index.html. Accessed March 28, 2007.Google Scholar
2. National Oceanic and Atmospheric Administration. Tsunami event–December 26, 2004 Indonesia (Sumatra). http://nctr.pmel.noaa.gov/indo_1204.html. Accessed March 28, 2007.Google Scholar
3. World Health Organization. Country report: Sri Lanka, from relief to recovery, the WHO tsunami operations. May 2007. http://www.searo.who.int/LinkFiles/Publication_&_Documents_countryreportsrilanka.pdf. Accessed May 15, 2007.Google Scholar
4. World Health Organization. Tsunami wreaks mental health havoc. June 2005. http://www.who.int/bulletin/volumes/83/6/infocus0605/en/index.html. Accessed March 28, 2007.Google Scholar
5. Norris, FH, Friedman, MJ, Watson, PJ. 60,000 disaster victims speak: II. Summary and implications of the disaster mental health research. Psychiatry Fall. 2002;65 (3):240–260.Google Scholar
6. Foa, EB, Stein, DJ, McFarlane, AC. Symptomatology and psychopathology of mental health problems after disaster. J Clin Psychiatry. 2006;67 (Suppl 2):15–25.Google ScholarPubMed
7. Brady, KT, Killeen, TK, Brewerton, T, Lucerini, S. Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry. 2000;61 (Suppl 7):22–32.Google ScholarPubMed
8. American Psychiatric Association. Diagnostic Criteria from DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.Google Scholar
9. Galea, S, Nandi, A, Vlahov, D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005;27:78–91.CrossRefGoogle ScholarPubMed
10. Tolin, DF, Foa, EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132:959–992.CrossRefGoogle ScholarPubMed
11. Halligan SL, Yehuda R. Risk Factors for PTSD. National Center for Post-traumatic Stress Disorder. June 2000. http://www.ncptsd.va.gov/ncmain/nc_archives/rsch_qtly/V11N3.pdf. Accessed May 15, 2007.CrossRefGoogle Scholar
12. Foa, EB, Riggs, DS, Dancu, CV, Rothbaum, BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993;6:459.Google Scholar
13. Foa, EB, Tolin, DF. Comparison of the PTSD Symptom Scale-Interview Version and the Clinician-Administered PTSD scale. J Trauma Stress. 2000;13:181–191.CrossRefGoogle ScholarPubMed
14. Thomas, JL, Jones, GN, Scarinci, IC, Mehan, DJ, Brantley, PJ. The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics. The Center for Epidemiologic Studies-Depression. Int J Psychiatry Med. 2001;31:25–40.CrossRefGoogle ScholarPubMed
15. Mackinnon A, Fau-McCallum J, McCallum J, et al. The Center for Epidemiological Studies Depression Scale in older community samples in Indonesia, North Korea, Myanmar, Sri Lanka, and Thailand. 1998: (1079–5014 (Print)).CrossRefGoogle Scholar
16. Department of Census and Statistics-Sri Lanka. Education statistics. May 2004. http://www.statistics.gov.lk/education/index.htm. Accessed March 28, 2007.Google Scholar
17. Jaycox, LH, Marshall, GN, Orlando, M. Predictors of acute distress among young adults injured by community violence. J Trauma Stress. 2003;16:237–245.CrossRefGoogle ScholarPubMed
18. Marshall, GN, Orlando, M, Jaycox, LH, Foy, DW, Belzberg, H. Development and validation of a modified version of the Peritraumatic Dissociative Experiences Questionnaire. Psychol Assess. 2002;14:123–134.CrossRefGoogle ScholarPubMed
19. Kessler, RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000;61 (Suppl 5):4–14.Google Scholar
20. Wickrama, KA, Kaspar, V. Family context of mental health risk in tsunami-exposed adolescents: findings from a pilot study in Sri Lanka. Soc Sci Med. 2007;64:713–723.CrossRefGoogle ScholarPubMed
21. Kumar, MS, Murhekar, MV, Hutin, Y, Subramanian, T, Ramachandran, V, Gupte, MD. Prevalence of posttraumatic stress disorder in a coastal fishing village in Tamil Nadu, India, after the December 2004 tsunami. Am J Public Health. 2007;97:99–101.CrossRefGoogle Scholar
22. van Griensven, F, Chakkraband, ML, Thienkrua, W, et al Mental health problems among adults in tsunami-affected areas in southern Thailand. JAMA. 2006;296:537–548.CrossRefGoogle ScholarPubMed
23. Goenjian, AK, Najarian, LM, Pynoos, RS, et al Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. Am J Psychiatry. 1994;151:895–901.Google ScholarPubMed
24. Cao, H, McFarlane, AC, Klimidis, S. Prevalence of psychiatric disorder following the 1988 Yun Nan (China) earthquake—the first 5-month period. Soc Psychiatry Psychiatr Epidemiol. 2003;38:204–212.CrossRefGoogle Scholar
25. Carr, VJ, Lewin, TJ, Webster, RA, Hazell, PL, Kenardy, JA, Carter, GL. Psychosocial sequelae of the 1989 Newcastle earthquake: I. Community disaster experiences and psychological morbidity 6 months post-disaster. Psychol Med. 1995;25:539–555.CrossRefGoogle ScholarPubMed
26. Perilla, JL, Norris, FH, Lavizzo, EA. Ethnicity, culture, and disaster response: identifying and explaining ethnic differences in PTSD six months after Hurricane Andrew. J Soc Clin Psychol. 2002;21:20–45.CrossRefGoogle Scholar
27. Staab, JP, Grieger, TA, Fullerton, CS, Ursano, RJ. Acute stress disorder, subsequent posttraumatic stress disorder and depression after a series of typhoons. Anxiety. 1996;2:219–225.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
28. McMillen, C, North, C, Mosley, M, Smith, E. Untangling the psychiatric comorbidity of posttraumatic stress disorder in a sample of flood survivors. Compr Psychiatry. 2002;43:478–485.CrossRefGoogle Scholar
29. Sharan, P, Chaudhary, G, Kavathekar, SA, Saxena, S. Preliminary report of psychiatric disorders in survivors of a severe earthquake. Am J Psychiatry. 1996;153:556–558.Google ScholarPubMed
30. Norris, FH, Friedman, MJ, Watson, PJ, Byrne, CM, Diaz, E, Kaniasty, K. 60,000 disaster victims speak: I. An empirical review of the empirical literature, 1981-2001. Psychiatry. 2002;65:207–239.CrossRefGoogle Scholar
31. Galea, S, Nandi, A, Vlahov, D. The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev. 2005;27:78–91.CrossRefGoogle ScholarPubMed
32. Bogner, HR, Gallo, JJ. Are higher rates of depression in women accounted for by differential symptom reporting? Soc Psychiatry Psychiatr Epidemiol. 2004;39:126–132.CrossRefGoogle ScholarPubMed
33. McMillen, JC, North, CS, Smith, EM. What parts of PTSD are normal: intrusion, avoidance, or arousal? Data from the Northridge, California, earthquake. J Trauma Stress. 2000;13:57–75.CrossRefGoogle ScholarPubMed
34. Van Griensven, F, Chakkraband, MLS, Thienkrua, W, et al Mental health problems among adults in tsunami-affected areas in southern Thailand. JAMA. 2006;296:537–548.CrossRefGoogle ScholarPubMed
35. Kohn, R, Levav, I, Garcia, ID, Machuca, ME, Tamashiro, R. Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country. Int J Geriatr Psychiatry. 2005;20:835–841.CrossRefGoogle ScholarPubMed
36. Chou, FH, Su, TT, Chou, P, Ou-Yang, WC, Lu, MK, Chien, IC. Survey of psychiatric disorders in a Taiwanese village population six months after a major earthquake. J Formos Med Assoc. 2005;104:308–317.Google Scholar
37. Brommelhoff, JA, Conway, K, Merikangas, K, Levy, BR. Higher rates of depression in women: role of gender bias within the family. J Womens Health (Larchmt). 2004;13:69–76.CrossRefGoogle ScholarPubMed
38. Vieweg, WV, Julius, DA, Fernandez, A, Beatty-Brooks, M, Hettema, JM, Pandurangi, AK. Posttraumatic stress disorder: clinical features, pathophysiology, and treatment. Am J Med. 2006;119:383–390.CrossRefGoogle ScholarPubMed
39. Armenian, HK, Morikawa, M, Melkonian, AK, et al Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy. Acta Psychiatr Scand. 2000;102:58–64.CrossRefGoogle Scholar
40. United Nations Development Programme. Human Development Indicators. Country Fact Sheets. Sri Lanka. Human Development Report 2006. http://hdr.undp.org/hdr2006/statistics/countries/country_fact_sheets/cty_fs_LKA.html. Accessed March 28, 2007.Google Scholar
41. World Health Organization. Sustaining Recovery Six Months On: The Role of Health Professionals. Geneva: WHO; 2006.Google Scholar
42. Chandra, V, Pandav, R, Bhugra, D. Mental health and psychosocial support after the tsunami: observations across affected nations. Int Rev Psychiatry. 2006;18:205–211.CrossRefGoogle ScholarPubMed
43. Sumathipala, A, Siribaddana, S. Research and clinical ethics after the tsunami: Sri Lanka. Lancet. 2005;366 (9495):1418–1420.CrossRefGoogle ScholarPubMed