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Symptoms of Posttraumatic Stress Disorder and Depression Among Children in Tsunami-Affected Areas in Southern Thailand
Warunee Thienkrua, MSc;
Barbara Lopes Cardozo, MD, MPH;
M. L. Somchai Chakkraband, MD;
Thomas E. Guadamuz, MHS;
Wachira Pengjuntr, MD;
Prawate Tantipiwatanaskul, MD;
Suchada Sakornsatian, MOT;
Suparat Ekassawin, MD;
Benjaporn Panyayong, MD;
Anchalee Varangrat, MSc;
Jordan W. Tappero, MD, MPH;
Merritt Schreiber, MD;
Frits van Griensven, PhD; for the Thailand Post-Tsunami Mental Health Study Group
JAMA. 2006;296:549-559.
Context On December 26, 2004, an undersea earthquake occurred off the northwestern coast of Sumatra, Indonesia. The tsunami that followed severely impacted all 6 southwestern provinces of Thailand, where approximately 20 000 children were directly affected.
Objective To assess trauma experiences and the prevalence of symptoms of posttraumatic stress disorder (PTSD) and depression among children in tsunami-affected provinces in southern Thailand.
Design, Setting, and Participants Population-based mental health surveys were conducted among children aged 7 to 14 years in Phang Nga, Phuket, and Krabi provinces from February 15-22, 2005 (2 months posttsunami), and September 7-12, 2005 (9 months posttsunami).
Main Outcome Measures Trauma experiences and symptoms of PTSD and depression as measured by a tsunami-modified version of the PsySTART Rapid Triage System, the UCLA PTSD Reaction Index, and the Birleson Depression Self-Rating Scale.
Results A total of 371 children (167 displaced and living in camps, 99 not displaced from villages affected by the tsunami, and 105 not displaced from unaffected villages) participated in the first survey. The prevalence rates of PTSD symptoms were 13% among children living in camps, 11% among children from affected villages, and 6% among children from unaffected villages (camps vs unaffected villages, P = .25); for depression symptoms, the prevalence rates were 11%, 5%, and 8%, respectively (P = .39). In multivariate analysis of the first assessment, having had a delayed evacuation, having felt one's own or a family member's life to have been in danger, and having felt extreme panic or fear were significantly associated with PTSD symptoms. Older age and 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% (151/210) of children from Phang Nga participated. Prevalence rates of symptoms of PTSD and depression among these children did not decrease significantly over time.
Conclusions This assessment documents the prevalence of mental health problems among children in tsunami-affected provinces in southern Thailand at 2 and 9 months posttsunami. Traumatic events experienced during the tsunami were significantly associated with symptoms of PTSD and depression. These data may be useful to target mental health services for children and may inform the design of these interventions.
Author Affiliations: Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand (Mss Thienkrua and Varangrat, Mr Guadamuz, and Drs Tappero and van Griensven); US Centers for Disease Control and Prevention, Atlanta, Ga (Drs Lopes Cardozo, Tappero, and van Griensven); Department of Mental Health, Ministry of Public Health, Nonthaburi, Thailand (Drs Chakkraband, Pengjuntr, Tantipiwatanaskul, Ekassawin, and Panyayong and Ms Sakornsatian); and Neuropsychiatric Institute and Hospital, David Geffen School of Medicine at the University of California at Los Angeles (Dr Schreiber). Dr Schreiber is now at the Center for Public Health and Disasters, School of Public Health, University of California, Los Angeles.
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