A Cross-Sectional Community Study of Post-Traumatic Stress Disorder and Social Support in Lao People's Democratic Republic/Une Etude Communautaire Transversale Du Syndrome De Stress Post-Traumatique et Du Soutien Social En Republique Democratique Populaire Lao/Un Estudio Transversal De Base Comunitaria Sobre El Trastorno De Estres Postraumatico Y El Apoyo Social Recibido En la Republica Democratica Popular Lao

Article excerpt

Introduction

Landmines and unexploded ordnance (UXO) cause great suffering among civilian populations around the world. As of October 2012, 71 states and six other territories were suspected of being--and confirmed to be--mined. (1) In 2011, a total of 4286 new casualties, including at least 1320 deaths, were recorded in 61 states and territories; 72% of these occurred among civilians and 42% of all civilian casualties were children. (1) Most victims of landmine or UXO explosions suffer horrendous disfigurement and severe psychological sequelae. Work, education and opportunities for social interaction are largely beyond their reach and they require long-term health care for their recovery, which imposes a huge financial burden on them and their families. (2,3)

The Lao People's Democratic Republic is one of the countries that have been most heavily bombed. (4) From 1964 to 1973, during the Viet Nam War, more than 270 million cluster submunitions were dropped on the country. As many as 30% of the dropped bombs failed to detonate, became UXO, and caused many human casualties. Between the beginning of that war and 2008, landmines and UXO caused 50136 human casualties; 29 410 (59%) of them were deaths. Forty per cent of all the casualties--i.e. 20 008 casualties--have occurred since 1974. (5)

Although casualties caused by landmines and UXOs have been extensively documented, studies conducted so far have focused primarily on epidemiological patterns and risk factors. (6-9) Findings from these studies provide information that is useful for planning measures to prevent injuries caused by landmines and UXO and improving trauma care systems, but the psychosocial consequences of the injuries and the reintegration of victims into society require much further research. According to studies, injured victims are likely to develop mental health problems, such as depression and post-traumatic stress disorder (PTSD), as a result of their trauma. (10-12) Such victims often face societal barriers because of their physical and mental disabilities, despite the importance of support for their social reintegration. (2,3,13) So far, little research has been carried out on how victims view social support and its influence on their mental health. Moreover, previous studies, in which injured victims were not compared with non-injured controls, did not fully estimate the severity of the mental health problems among the victims. Absolute scores and their cut-off points in psychometric measurement scales may differ by culture. Thus, accurate estimation requires calibration in a general population by comparison with non-victims. (14) A recent study in Cambodia stands alone in having compared the mental health of landmine survivors with that of the general population. Its findings suggest that mental health status was worse among landmine survivors'. (15)

We conducted a cross-sectional community survey to compare people injured by landmines or UXO with non-injured counterparts with respect to their perceived social support and the severity of their PTSD symptoms and to determine whether a relationship exists between the degree of perceived support and PTSD symptom severity.

Methods

Setting

The Lao People's Democratic Republic is a landlocked country located in southeastern Asia. It has a population of approximately 6 million and shares borders with five countries, including Viet Nam. (16) During the Viet Nam War military supply lines known as the "Ho Chi Minh Trail" were established between North and South Viet Nam through Cambodia and the Lao People's Democratic Republic. From 1964 to 1973, aerial bombardments were conducted to destroy the trail and, since a large part of it was in the Lao People's Democratic Republic, the country suffered heavy bombing during the war.

Savannakhet is the largest province in the country, with a population of about 700 000. It was a focal point of the war and major land battles took place in its three eastern districts. …

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