anxiety disorders, panic disorder, obsessive-compulsive disorder, phobias, post-traumatic stress disorder

Adult and children in the tsunami-affected areas in Thailand have elevated rates of mental health problems such as symptoms of posttraumatic stress disorder and depression up to 9 months after the disaster, according to two studies in the current issue of JAMA.

On December 26, 2004, a undersea earthquake northwest of Sumatra, Indonesia, caused a giant tsunami that devastated the shorelines of Indonesia, Sri Lanka, India, Thailand, and many other countries. More than 200,000 individuals are estimated to have died making it one of the deadliest natural disasters in history. In Thailand, the tsunami severely affected all 6 southwestern provinces, where 5,395 individuals died, 2,991 were unaccounted for, and 8,457 were injured, according to background information in the article.

Previous assessments among survivors of natural disasters have shown that posttraumatic stress disorder (PTSD) and other mental health problems are common. Thailand does not have a history of natural disasters and the prevalence of PTSD among individuals exposed to traumatic events has not been assessed previously. Understanding post-tsunami mental health indicators is essential for identifying vulnerable populations and developing culturally specific mental health interventions.

Frits van Griensven, Ph.D., and colleagues assessed the prevalence of symptoms of PTSD, anxiety, and depression and associated factors among random samples of displaced and nondisplaced persons in the three Thai provinces of Phang Nga, Krabi, and Phuket, which were the most severely affected by the tsunami. The population-based mental health survey was conducted from February 15 to 22, 2005, 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). A follow-up survey was conducted in September 2005.

The researchers found that symptoms of PTSD were reported by 12 percent of displaced and 7 percent of nondisplaced persons in Phang Nga and 3 percent of nondisplaced persons in Krabi and Phuket. Anxiety symptoms were reported by 37 percent of displaced and 30 percent of nondisplaced persons in Phang Nga and 22 percent of nondisplaced persons in Krabi and Phuket. Symptoms of depression were reported by 30 percent of displaced and 21 percent of nondisplaced persons in Phang Nga and 10 percent of nondisplaced persons in Krabi and Phuket. Loss of livelihood was independently and significantly associated with symptoms of all 3 mental health outcomes (PTSD, anxiety, and depression).

"Restoration of persons' livelihoods to prevent and diminish mental morbidity among populations affected by natural disasters is therefore of utmost importance," the authors write.

In the 9-month follow-up survey of 73 percent of displaced participants and 80 percent of nondisplaced participants in Phang Nga, prevalence rates of symptoms of PTSD, anxiety, and depression decreased among both displaced and nondisplaced persons, but remain elevated.

"This decrease may be due to spontaneous recovery under improved social and environmental conditions, such as more permanent housing for displaced persons, continued mental health support and occupational training, and restoration of livelihood programs, which were implemented in Phang Nga province by multiple governmental and nongovernmental organizations," the researcher add.

The research for this article was funded by the U.S. Centers for Disease Control and Prevention and the Thailand Ministry of Public Health.

In the second study Warunee Thienkrua, M.Sc., and colleagues found an increase in the rate of depression and posttraumatic stress disorder among children in the tsunami-affected areas of Southern Thailand.

The study examined the prevalence of symptoms of PTSD and depression, and associated risk factors among children aged 7 to 14 years in tsunami hit areas 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).

The prevalence rates of PTSD symptoms were 13 percent among children living in displacement camps, 11 percent among nondisplaced children from tsunami-affected villages, and 6 percent among children from nonaffected villages; for depression symptoms, the prevalence rates were 11 percent, 5 percent, and 8 percent, respectively. 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 percent of children from Phang Nga participated. Prevalence rates of symptoms of PTSD and depression among these children did not decrease significantly over time.

"Findings in our assessment may provide a better understanding of post-tsunami mental health problems and associated risk factors among children. Therapeutic approaches may be needed to help children understand and manage their feelings of fear, so that possible negative impacts on their development are minimized. Family counseling may be necessary to make sure that parents are able to recognize and address mental health problems, and schools may be another important venue for affected children to be identified and provided with services to reduce PTSD and depression. Teachers, in particular, may play a crucial role in the support and referral of affected children; hence, appropriate sensitivity training for mental health-related problems is recommended for school-based staff," the authors write.

van Griensven F, Chakkraband MLS, Thienkrua W, Pengjuntr W, Cardozo BL, et al.
Mental Health Problems Among Adults in Tsunami-Affected Areas in Southern Thailand
JAMA. 2006;296:537-548.   [Abstract]

Thienkrua W, Cardozo BL, Chakkraband MLS, Guadamuz TE, Pengjuntr W, et al.
Symptoms of Posttraumatic Stress Disorder and Depression Among Children in Tsunami-Affected Areas in Southern Thailand
JAMA. 2006;296:549-559.   [Abstract]