Risk Factors of Post-Traumatic Stress Disorder in Tsunami Survivors of Kanyakumari District, Tamil Nadu, India

Article excerpt

Byline: T. Pyari, Raman. Kutty, P. Sarma

Context: In this study, we assessed the relation of possible risk factors with post-traumatic stress disorder (PTSD) in the survivors of December 2004 tsunami in Kanyakumari district. Materials and Methods: We identified cases (n=158) and controls (n=141) by screening a random sample of 485 tsunami survivors from June 2005 to October 2005 using a validated tool, "Impact of events scale-revised (IES-R)," for symptoms suggestive of PTSD. Subjects whose score was equal to or above the 70 [sup]th percentile (total score 48) were cases and those who had score below or equal to 30 [sup]th percentile (total score 33) were controls. Analysis was done using statistical package for the social sciences to find the risk factors of PTSD among various pre-disaster, within-disaster and post-disaster factors. Results: Multivariate analysis showed that PTSD was related to female gender [odds ratio (OR) 6.35, 95% confidence interval (CI) 3.26-12.39], age 40 years and above (OR 2.38, 95% CI 1.23-4.63), injury to self (OR 2.97, 95% CI 1.55-5.67), injury to family members (OR 2.09, 95% CI 1.05-4.15), residence in urban area (area of maximum destruction) (OR 3.37, 95% CI 1.35-8.41) and death of close relatives (OR 3.83, 95% CI 1.91-7.68). Absence of fear of recurrence of tsunami (OR 0.32, 95% CI 0.17-0.60), satisfaction of services received (OR 0.57, 95% CI 0.36-0.92) and counseling services received more than three times (OR 0.45, 95% CI 0.26-0.78) had protective effect against PTSD. Conclusions: There is an association of pre-disaster, within-disaster and post-disaster factors with PTSD, which demands specific interventions at all phases of disaster, with a special focus on vulnerable groups.

Introduction

The tsunami waves that devastated the shorelines of several countries of South and Southeast Asia were triggered by a massive undersea earthquake of magnitude 9 in the Richter scale, off the west coast of northern Sumatra, Indonesia, on December 26, 2004. [sup][1] This tsunami, the worst ever in human history, decimated Southeast Asia, killing more than 300,000 people in 12 countries and leaving more than 1 million people homeless. [sup][2] In India, the devastating tidal waves lashed several coastal districts of Andhra Pradesh, Andaman and Nicobar Islands, Kerala, Tamil Nadu and Pondicherry. Of these, the worst hit regions were the Andaman and Nicobar Islands, followed by the state of Tamil Nadu. [sup][3] Kanyakumari district was the second most affected district in Tamil Nadu in terms of population affected and lives lost. [sup][3]

Many studies suggest the occurrence of specific mental health disorders such as post-traumatic stress disorder (PTSD), grief, depression, anxiety and substance abuse following disasters. [sup][4],[5],[6],[7],[8] PTSD was the most commonly found psychological problem in 81% of investigations from developing countries following natural disasters. [sup][9] The risk factors for PTSD can be grouped into pre-disaster, within disaster and post-disaster factors. [sup][10] Since there are only limited data on PTSD and related factors from developing countries, more evidence is required to assist in the development of culturally sensitive strategies to combat the mental health problems. The present study was based on a community sample survey of tsunami survivors in selected villages of Kanyakumari district. Since all the people in the selected area were victims of the tsunami, this population can be thought of as a cohort of tsunami survivors. We did a further case-control analysis on a subsample of subjects, comparable to a nested case-control design. This paper presents the findings of the case-control study in relation to the risk factors of PTSD in the tsunami survivors.

Materials and Methods

The study was conducted from June 2005 to October 2005, 6 months after the disaster. The cases in the study population were defined as survivors of tsunami, who had PTSD as evidenced by a total score of 48 or more on administration of an instrument, Impact of events scale-revised (IES-R), [sup][11] in Kanyakumari. …