Symptoms of posttraumatic stress disorder and depression among children in Tsunami-affected areas in Southern Thailand. Journal of the American Medical Association, 296(5), 549-559

University of California, Los Angeles, Los Ángeles, California, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 09/2006; 296(5):549-59. DOI: 10.1001/jama.296.5.549
Source: PubMed


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.
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.
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).
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.
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.
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.

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Available from: Frits van Griensven, Apr 02, 2014
    • "After the devastating tsunami that struck Asian and African coastlines on 26 December 2004, several articles reported psychiatric consequences, particularly post-traumatic stress disorder (PTSD) among children and adolescents (Jensen, Dyb and Nygaard, 2009; John, Russell and Russell, 2007; Kristensen, Weisaeth and Heir, 2009; Neuner, Schauer, Catani, Ruf and Elbert, 2006; Piyasil et al., 2007; Thienkrua et al., 2006; Ularntinon et al., 2008). PTSD can lead to substantial functional impairments. "
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    ABSTRACT: Post-traumatic stress disorder (PTSD) is a common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT) is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the tsunami hit several Asian countries in 2004, poses a major problem. Aims: This randomized controlled trial aimed to test for the efficacy of the modified version of CBT for children and adolescents with PSTD. Method: Thirty-six children (aged 10–15 years) who had been diagnosed with PSTD 4 years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-month posttreatment self-monitoring and daily homework. Results: Compared to the wait list, participants who received CBT demonstrated significantly greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done immediately posttreatment. Conclusions: Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction with posttreatment self-monitoring and daily homework.
    Behavioural and Cognitive Psychotherapy 09/2015; 43(05):549-561. DOI:10.1017/S1352465813001197 · 1.69 Impact Factor
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    • "From a general psychopathology perspective, 9.3% of 4–17-year-old children were described as experiencing a “serious emotional disturbance” 18–27 months after Hurricane Katrina (McLaughlin et al., 2009). This is consistent with large sample cross-sectional research following a range of different disasters that has reported approximately 5–15% of children experience significant mental health symptoms following disaster exposure (McDermott & Palmer, 1999; Roussos et al., 2005; Shaw, Applegate, & Schorr, 1996; Thienkrua, Cardozo, Chakkraband, Guadamuz, & Thailand Post-Tsunami Mental Health Study Group, 2006; Vernberg, Silverman, La Greca, & Prinstein, 1996). Posttraumatic stress (PTS) symptoms have been frequently reported: 6 and 57% of children exposed to the 2004 Tsunami disaster experienced significant PTS symptoms (Thienkrua et al., 2006; Wickrama & Kaspar, 2007); 35% of children exposed to hurricanes (La Greca, Silverman, Lai, & Jaccard, 2010) and 4.5–95% of children exposed to earthquakes (Eksi & Braun, 2009; Roussos et al., 2005). "
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    ABSTRACT: BackgroundFrom a global perspective, natural disasters are common events. Published research highlights that a significant minority of exposed children and adolescents develop disaster-related mental health syndromes and associated functional impairment. Consistent with the considerable unmet need of children and adolescents with regard to psychopathology, there is strong evidence that many children and adolescents with post-disaster mental health presentations are not receiving adequate interventions.ObjectiveTo critique existing child and adolescent mental health services (CAMHS) models of care and the capacity of such models to deal with any post-disaster surge in clinical demand. Further, to detail an innovative service response; a child and adolescent stepped-care service provision model.MethodA narrative review of traditional CAMHS is presented. Important elements of a disaster response – individual versus community recovery, public health approaches, capacity for promotion and prevention and service reach are discussed and compared with the CAMHS approach.ResultsDifficulties with traditional models of care are highlighted across all levels of intervention; from the ability to provide preventative initiatives to the capacity to provide intense specialised posttraumatic stress disorder interventions. In response, our over-arching stepped-care model is advocated. The general response is discussed and details of the three tiers of the model are provided: Tier 1 communication strategy, Tier 2 parent effectiveness and teacher training, and Tier 3 screening linked to trauma-focused cognitive behavioural therapy.ConclusionIn this paper, we argue that traditional CAMHS are not an appropriate model of care to meet the clinical needs of this group in the post-disaster setting. We conclude with suggestions how improved post-disaster child and adolescent mental health outcomes can be achieved by applying an innovative service approach.
    European Journal of Psychotraumatology 07/2014; 5. DOI:10.3402/ejpt.v5.24294 · 2.40 Impact Factor
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    • "Children and adolescents tend to be the most vulnerable members of communities affected by natural disasters and are particularly prone to resulting mental disorders [6]. Developing in the weeks and months following the traumatic event, the severity of their psychological symptoms vary as a function of their level of exposure to the event, loss of loved ones, personal injury, level of parental support and sense of dislocation [7]. Once established, the mental disorders can produce a range of consequences including relationship difficulties, poor educational and vocational outcomes, recurrent illnesses and substance abuse. "
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    ABSTRACT: The purpose of this study was to determine the utility of salivary cortisol levels for screening mental states such as depression in adolescents following a natural disaster. We examined the relationship of salivary cortisol levels in adolescent survivors of the 2011 Tohoku Earthquake with the depression subscale of the 28-item General Health Questionnaire (GHQ). Subjects were 63 adolescent survivors (age = 14.29 years ± 0.51) who were administered the GHQ and provided saliva samples thrice daily (morning, afternoon and evening) over the course of 3 days. Based on the GHQ-depression subscores, subjects were divided into low and high depression groups. About 22 % of the subjects were classified into the high symptom group. When data collected over 3 days were used, a significant difference was observed between the two groups in the salivary cortisol levels at the evening time point as well the ratio of the morning/evening levels (p < 0.05). Analyzed by means of receiver-operating characteristic curves, the morning/evening ratios showed a good power in discriminating between subjects with and without depressive symptoms. Our study suggests that repeated measurement of salivary cortisol levels over 3 days has utility in screening for depressive states in adolescents following a natural disaster.
    The Journal of Physiological Sciences 04/2014; 64(4). DOI:10.1007/s12576-014-0315-x · 1.90 Impact Factor
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