Lessons from the 2004 Asian tsunami: Epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities

• Published in: International journal of social psychiatry 2013-03, Vol.59 (2), p.123-129
• Main Authors: Rajkumar, A. P., Mohan, T. S. P., Tharyan, P.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living - psychology; Adult; Asia; Brief Psychiatric Rating Scale; Case-Control Studies; Child Mortality; Cost of Illness; Disabled persons; Disasters; Epidemiology; Female; Gender; Grief; Handicapped; Humans; India - epidemiology; Logistic Models; Male; Mass Screening - methods; Medical diagnosis; Mental stress; Middle Aged; Natural Disasters; Physically Handicapped; Post traumatic stress disorder; Posttraumatic Stress Disorder; Predictive Value of Tests; Prevalence; Psychological Tests; Regression analysis; Risk Factors; Socioeconomic Factors; Stress; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; Stress Disorders, Post-Traumatic - psychology; Survivors - psychology; Survivors - statistics & numerical data; Symptoms; Terminology as Topic; Tsunamis
• ISSN: 0020-7640; 1741-2854
• DOI: 10.1177/0020764011423468

Background: The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings. Aims: To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates. Methods: We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale – Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS. Results: The prevalence of PTSS was 15.1% (95% CI 12.3%–17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91). Conclusions: Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.