Long-reaching damage of the tsunami on mental health

The December 2004 tsunami which devastated the coastal areas of Indonesia, Sri Lanka, India, Thailand, and many other countries has left behind more than just untold damage to the environment, property and communities.

The massive undersea earthquake northwest of Sumatra, Indonesia, caused a giant ocean shockwave that killed more than 200,000 individuals and in Thailand alone an estimated 5,395 individuals died, 2,991 were unaccounted for and 8,457 were injured.

According to two new studies adult and children in the tsunami-affected areas in Thailand had elevated rates of mental health problems such as symptoms of post-traumatic stress disorder and depression up to 9 months after the disaster.

Previous assessments among survivors of natural disasters have shown that post-traumatic stress disorder (PTSD) and other mental health problems are common following natural disasters but the prevalence has never been previously assessed.

Thailand's Post-Tsunami Mental Health Study Group has now done just that in the three Thai provinces which were the most severely affected by the tsunami.

According to the study anxiety symptoms were reported by 37 percent of displaced people and 30 percent of non displaced people in Phang Nga and by 22 percent of non displaced people in Krabi and Phuket.

Depression symptoms were reported by 30 percent of displaced and 21 percent of non displaced people in Phang Nga and by 10 percent of non displaced people in the two other provinces.

Loss of livelihood was independently and significantly associated with symptoms of all three mental health problems.

The authors say that the restoration of peoples livelihoods is of the utmost importance to prevent and diminish mental health problems among populations affected by natural disasters.

In a 9-month follow-up survey of 73 percent of displaced participants and 80 percent of non displaced participants in Phang Nga, prevalence rates of symptoms of PTSD, anxiety, and depression decreased among displaced and non displaced persons, but still remained elevated.

The signs of recovery will be to some extent due to improving social and environmental conditions, such as more permanent housing for displaced persons, continued mental health support and occupational training, and restoration of livelihood programs.

The second study examined the prevalence of symptoms of PTSD and depression 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 non affected villages.

The researchers found that 13 percent of children living in displacement camps, 11 percent of non displaced children from tsunami-affected villages, and 6 percent of children from non affected villages had PTSD symptoms; while for depression symptoms, 11 percent, 5 percent, and 8 percent, respectively had depression symptoms.

Factors linked to PTSD symptoms were a delayed evacuation, families lives having been in danger, and having felt extreme panic or fear.

Being older or 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 and it was found that prevalence rates of symptoms of PTSD and depression among these children did not decrease significantly over time.

The researchers say better therapeutic approaches may be needed to help children understand and manage their feelings and family counseling may be necessary to make sure that parents are able to recognize and address mental health problems.

Schools too may play a crucial role in the support and referral of affected children and appropriate sensitivity training for mental health–related problems is recommended for school-based staff, say the authors.

The study is published in the current issue of the Journal of the American Medical Association.