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Mental Health Problems Among Adults in Tsunami-Affected Areas in Southern Thailand
Frits van Griensven, PhD;
M. L. Somchai Chakkraband, MD;
Warunee Thienkrua, MSc;
Wachira Pengjuntr, MD;
Barbara Lopes Cardozo, MD, MPH;
Prawate Tantipiwatanaskul, MD;
Philip A. Mock, MAppStat;
Suparat Ekassawin, MD;
Anchalee Varangrat, MSc;
Carol Gotway, PhD;
Miriam Sabin, PhD;
Jordan W. Tappero, MD, MPH; for the Thailand Post-Tsunami Mental Health Study Group
JAMA. 2006;296:537-548.
Context On December 26, 2004, an undersea earthquake occurred off the northwestern coast of Sumatra, Indonesia. The tsunami that followed severely affected all 6 southwestern provinces of Thailand, where 5395 individuals died, 2991 were unaccounted for, and 8457 were injured.
Objective To assess the prevalence of symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression among individuals residing in areas affected by the tsunami in southern Thailand as part of a public health emergency response and rapid assessment.
Design, Setting, and Participants A multistage, cluster, population-based mental health survey was conducted from February 15 to 22, 2005, of random samples of displaced (n = 371) and nondisplaced persons in Phang Nga province (n = 322) and nondisplaced persons in the provinces of Krabi and Phuket (n = 368). Data were collected using an interviewer-administered questionnaire on handheld computers. A surveillance follow-up survey of the displaced persons (n = 371) and nondisplaced persons (n = 322) in Phang Na was conducted in September 2005.
Main Outcomes Measures Medical Outcomes Study-36 Short-Form Health Survey SF-36 to assess self-perceived general health, bodily pain, and social and emotional functioning; the Harvard Trauma Questionnaire to assess tsunami-specific traumatic events; and the Hopkins Checklist-25 to detect symptoms of anxiety and depression.
Results Participation rates for displaced and nondisplaced persons in the rapid assessment survey were 69% and 58%, respectively. Symptoms of PTSD were reported by 12% of displaced and 7% of nondisplaced persons in Phang Nga and 3% of nondisplaced persons in Krabi and Phuket. Anxiety symptoms were reported by 37% of displaced and 30% of nondisplaced persons in Phang Nga and 22% of nondisplaced persons in Krabi and Phuket. Symptoms of depression were reported by 30% of displaced and 21% of nondisplaced persons in Phang Nga and 10% of nondisplaced persons in Krabi and Phuket. In multivariate analysis, loss of livelihood was independently and significantly associated with symptoms of all 3 mental health outcomes (PTSD, anxiety, and depression). In the 9-month follow-up surveillance survey of 270 (73%) displaced and 250 (80%) nondisplaced participants in Phang Nga, prevalence rates of symptoms of PTSD, anxiety, and depression among displaced persons decreased to 7%, 24.8%, and 16.7%, respectively, and among nondisplaced persons, prevalence rates decreased to 2.3%, 25.9%, and 14.3%, respectively.
Conclusions Among survivors of the tsunami in southern Thailand, elevated rates of symptoms of PTSD, anxiety, and depression were reported 8 weeks after the disaster, with higher rates for anxiety and depression than PTSD symptoms. Nine months after the disaster, the rates of those reporting these symptoms decreased but were still elevated. This information is important for directing, strengthening, and evaluating posttsunami mental health needs and interventions.
Author Affiliations: Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand (Drs van Griensven and Tappero, Mss Thienkrua and Varangrat, and Mr Mock); Department of Mental Health, Thailand Ministry of Public Health, Nonthaburi, Thailand (Drs Chakkraband, Pengjuntr, Tantipiwatanaskul, and Ekassawin); and Centers for Disease Control and Prevention, Atlanta, Ga (Drs van Griensven, Lopes Cardozo, Gotway, Sabin, and Tappero).
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