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Abstract

Floods can lead to direct economic and property losses and result not only in physical injuries and deaths but also in psychological trauma. Post-traumatic stress disorder (PTSD) is a commonly used indicator to evaluate psychological injuries after disaster. This study aimed to determine the relationship between PTSD prevalence and related perceived severity of post flood impact by economical, non-economical and flood status severity domains besides relevant socio-demographic factors according to gender specific analysis. This cross-sectional study was conducted among community in Kampung Hulu Takir, Kuala Terengganu, Malaysia in 2015 two weeks after flood. It included a total of 98 males and 110 females aged 18 years and above. Data was collected by interview-guided questionnaire to determine the prevalence of PTSD. SPSS version 21.0 was used for analysis of the relationship between socio demographic factors, perceived economic, non-economic and flood severity with PTSD. Finally chi square test was used to assess the predictors of PTSD according to gender. The prevalence of PTSD was 9.2% in males and 10.9% in females, giving a total of 10.1%. Significantly higher prevalence of PTSD was found in severely perceived economic and flood impact categories (33.3% and 23.8% in males; 23.8 % and 37.5% in females) and giving in overall 44.0% and 31.3 % respectively. Effective PTSD management strategies targeting females post flood victims who severely perceived economically and nature flood impact should be implemented in order to prevent further consequences of PTSD.
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
ORIGINAL ARTICLE
PREVALENCE AND PERCEIVED SEVERITY OF POST-TRAUMATIC STRESS
DISORDER AMONG FLOOD VICTIMS IN KUALA TERENGGANU, MALAYSIA
San San Oo1, Rahmah Binti Mohd Amin 1,Aniza Binti Abd Aziz 1, Myat Moe Thwe Aung1, Rohayah Binti Husain2
1Department of Community Medicine,Faculty of Medicine, Universiti Sultan Zainal Abidin,Kuala Terengganu, Terengganu.
2Department of Psychological Medicine, Faculty of Medicine, Universiti Sultan Zainal Abidin,Kuala Terengganu,
Terengganu.
ABSTRACT
Floods can lead to direct economic and property losses and result not only in physical injuries and deaths but
also in psychological trauma. Post-traumatic stress disorder (PTSD) is a commonly used indicator to evaluate
psychological injuries after disaster. This study aimed to determine the relationship between PTSD prevalence
and related perceived severity of post flood impact by economical, non-economical and flood status severity
domains besides relevant socio-demographic factors according to gender specific analysis. This cross-sectional
study was conducted among community in Kampung Hulu Takir, Kuala Terengganu, Malaysia in 2015 two
weeks after flood. It included a total of 98 males and 110 females aged 18 years and above. Data was
collected by interview-guided questionnaire to determine the prevalence of PTSD. SPSS version 21.0 was used
for analysis of the relationship between socio demographic factors, perceived economic, non-economic and
flood severity with PTSD. Finally chi square test was used to assess the predictors of PTSD according to
gender. The prevalence of PTSD was 9.2% in males and 10.9% in females, giving a total of 10.1%. Significantly
higher prevalence of PTSD was found in severely perceived economic and flood impact categories (33.3% and
23.8% in males; 23.8 % and 37.5% in females) and giving in overall 44.0% and 31.3 % respectively. Effective
PTSD management strategies targeting females post flood victims who severely perceived economically and
nature flood impact should be implemented in order to prevent further consequences of PTSD.
Keywords: Post traumatic stress disorder (PTSD), prevalence, perceived severity, gender specific analysis
INTRODUCTION
Flood is a regular natural disaster in Malaysia
which happens nearly every year during the
monsoon season. A flood can devastate homes,
commercial buildings, agricultural and pastoral
lands, public goods, and other physical properties.
However, during the flood and its aftermath, there
are also threats to one‟s health and safety.
As part of the northeast monsoon, heavy rains
since 17 December 2014 forced 3,390 people in
Kelantan and 4,209 people in Terengganu to flee
their homes. By 23 December, most rivers in
Kelantan, Pahang, Perak and Terengganu had
reached dangerous levels. Due to rising water
levels, most businesses were affected and about
60,000 people were displaced in the next day. The
state of Kelantan had the most evacuees (20,468
to 24,765), followed by Terengganu (21,606),
Pahang (10,825), Perak (1,030), Sabah (336) and
Perlis (143) The situation continues to worsen in
Kelantan and Terengganu, due to heavy rain. Most
roads in Kelantan have been closed. The worst-hit
district in Terengganu is Kemaman, followed by
Dungun, Kuala Terengganu, Hulu Terengganu,
Besut and Marang1.
Post-Traumatic Stress Disorder (PTSD) following
floods is not uncommon and particularly prevalent
when the loss is severe and recovery difficult.
PTSD is a severe anxiety disorder that can develop
after exposure to any event resulting in
psychological trauma2. The consequences flood
may involve the threat of death to oneself or to
someone else, or to one‟s own or someone else‟s
physical, sexual, or psychological integrity,
overwhelming the individual‟s ability to cope. As
an effect of psychological trauma, PTSD is less
frequent and more enduring than the more
commonly seen acute stress response.
During the flood crisis community support is high
and the event receives prominence in the media.
However, once the event has passed the sense of
loss and withdrawal of support can be profound.
PTSD is a serious condition that requires
professional intervention and management. It is
vital that victims of the flood should be
encouraged to seek such help.
In Malaysia, the government has established the
Natural Disaster Management and Relief
Committee (NDMRC) in 1972 and it was given the
task of coordinating flood relief operations at
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
every stage of national, state and district levels
with the combined aims of reducing flood damage
and to preventing loss of human life. However, the
devastating flood in 2014 showed poor
coordination at local level and has contributed to
poor response following the disaster3. This can
have psychological consequences such as PTSD
among flood victims. After immediate needs are
met and before survivors can return home, there is
often a period ranging from a few days to several
months where a large number of people are
housed in temporary facilities. In such a situation,
survivors require not only material relief but also
psychological support to reduce the psychological
trauma arising from the event.
Regarding the global prevalence of PTSD, the
prevalence of PTSD documented after natural
disasters is often lower than the rates documented
after human-made and technological disasters4.
This may stem from a lower average dosage of
exposure among people exposed to the disaster
and it is supported by a study in Turkey
earthquakes that showed a higher prevalence of
PTSD closer to the epicenter compared to 100km
away4. Overall studies of natural disaster reported
prevalence of PTSD ranging from 3.7% to 60% in the
first 1-2 years after the disaster, with most studies
reporting prevalence estimates in lower half of
this range5,6,7.
Thus, intervention strategies must be planned to
help victims cope with the psychological trauma
such as PTSD which may interfere with their lives.
Eventhough existing health sector collaborating
and coordinating with partners, devastating effects
of disaster (flood) to such a mass vulnerable
population, it is required to plan this post-disaster
(flood) preventable health care services project.
Other than that, there are very few studies that
had been conducted in Malaysia previously
regarding natural disaster and the prevalence of
PTSD. Not much literature review can be found
regarding post disaster PTSD as compared to post
war PTSD. Thus, the knowledge on PTSD is also
relatively low among Malaysians and many do not
realize that they even have PTSD. This study is also
important as it sends a crucial message to the
Malaysian government regarding the prevalence of
PTSD and related factors, states that this issue
needs proper attention from the medical
community as well as the government.
MATERIALS AND METHODS
This cross-sectional study was conducted at
Kampung Hulu Takir, Kuala Terengganu. Kampung
Hulu Takir is composed of 7 small villages. Out of
them, only 4 villages were affected by the flood.
Kampung Hulu Takir, with a population of 250
people, was selected for this study survey
purposively based on accessibility and availability.
Study participants were every adult (18 years old
and above) from each house in this area was
interviewed by using the questionnaires related to
prevalence and predictors of post-traumatic stress
disorder among victims in flood affected areas.
The questionnaires comprised of 3 main sections
with 34questions all in all: 9 questions in section A
for personal identification data and socio-
demographic data, 16 questions in section B for
the severity of the flood, and 9 questions in
section C to for PTSD screening. To check the
validity and reliability of the questionnaires, a
pilot study had been conducted among 75 adults in
Kampung Lembah Harapan, Seberang Takir. Verbal
consent had been taken from all respondents prior
to the interview conducted by trained third year
medical students from Universiti Sultan Zainal
Abidin. All interviewees were explained in details
about full description of the research,
confidentiality and voluntary participation.
Universal sampling was applied for the survey.
Those who failed to answer all questions and those
who were not at home during the study period will
be excluded in this study. Samples were collected
by means of an interview-guided semi-structured
questionnaire for PTSD prevalence.
Data analysis was done using „Statistical Package
for Social Sciences‟ (SPSS) Version 21.0.
Descriptive and statistics analytical tests were
computed using this software. Statistical
significance level was taken at the p value < 0.05
with 95% confidence intervals (CI). Data screening
and exploration was done with normality test for
continuous data distribution using the Kolmogorov-
Smirnov test and found that the data was normally
distributed. The continuous variables was
summarized by using means and standard
deviations (SD) and mostly categorized as required
and presented as the number (n) and percentage
(%). Pearson‟s chi-square test or Fisher‟s exact test
was applied for categorical variables and Pearson‟s
correlation test for numerical variables.
RESULTS
Characteristics of Respondents
A total of 208 respondents of 98 (47.1%) males and
110 (52.9%) females were included in this study
(Table 1). Most of them were married (77.9%)
rather than being single or had divorced or
separated. In terms of educational level, 75.0%
had low education (up to secondary school only)
and it was similarly distributed in both genders.
Forty five percent of the respondents were not
working; however unemployed females had rather
higher proportion (63.6%) rather than males
(24.5%).
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
Figure (1) Prevalence of PTSD (%)
Majority of respondents come from low income
family and it was similarly distributed in both
genders. Ten percent of the respondents had
PTSD; however females had rather higher
proportion (10.9%) rather than males having PTSD
(9.2%) (Figure 1).
Table 1. Characteristics of Respondents by gender (n = 208)
Characteristics
Total
Male
Female
(n=208)
n(%)a
n(%)a
(n=98)
(n=110)
Age (Years)
42(16)b
41(16)b
43(16)b
Age group
18 to 25 (Young
adult)
41(19.7)
18(18.4)
23(20.9)
26 to 55 (Middle
age)
125(60.1)
63(64.3)
62(56.4)
56 and above
42(20.2)
17(17.3)
25(22.7)
Marital Status
Single
46(22.1)
26(26.5)
20(18.2)
Married/
Widow/Widower
162(77.9)
72(73.5)
90(81.8)
Occupations
unemployed
94(45.2)
24(24.5)
70(63.6)
employed
114(54.8)
74(75.5)
40(36.4)
Education Level
Low Education
Level
156(75.0)
77(78.6)
79(71.8)
High Education
Level
52(25.0)
21(21.4)
31(28.2)
Income Status
Below RM2000 (Low
Income Status)
175(84.1)
83(84.7)
92(83.6)
RM2000 and above
(High Income
Status)
33(15.9)
15(15.3)
18(16.4)
Prevalence of PTSD
PTSD
21(10.1)
9(9.2)
12(10.9)
Not PTSD
187(89.9)
89(90.8)
98(89.1)
a= Number (percentage), b = Mean (standard deviation), PTSD = Post Traumatic Stress Disorder
Table 2 showed the perceived severity of post
flood economic impact by gender. The
questionnaire includes the house ownership, living
years in house, type of house, furniture damage,
electric applicants and vehicles accessibility and
availability, direct post flood loss cost and indirect
cost of post flood loss such as abstinence from
work in days. All questionnaires were responded as
“Yes” and “No” and scored 1 for “Yes” and 0 for
“No” response, then sum up and did cutoff score
at 6 and categorized sever (=>6) and non-severe (<
6). Twelve percent (25 persons) of overall
respondents perceived severely towards post flood
economic impact and it was similarly distributed in
both genders.
0
10
20
30
40
50
60
70
80
90
100
Overall (n = 208)
Male (n = 98)
10.1
9.18
10.91
89.9
90.82
89.09
PTSD
Normal
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
Table 2. Gender specific perceived severity of post flood economic impact
Characteristics
Total
(n =208)
Male
n(%)a
Female
n(%)a
(n=98)
(n=110)
House ownership
Rent
6(2.9)
2(2.0)
4(4.36)
Own
202(97.1)
96(98.0)
106(96.4)
Live in house (Yrs)
> 5 years
183(88.0)
88(89.8)
95(86.4)
< 5 years
25(12.0)
10(10.2)
15(13.6)
Type of house
Detached/wooden
199(95.7)
94(95.9)
105(95.55)
Terrace
1(0.5)
0(0.0)
1(0.9)
Bungalow
8(3.8)
4(4.1)
4(3.6)
Furniture
Yes
36(17.3)
81(82.7)
19(17.3)
No
172(82.7)
17(17.3)
91(82.7)
Electric applicants
Yes
14(6.7)
5(5.1)
9(8.2)
No
194(93.3)
93(94.9)
101(91.8)
Vehicles
Yes
19(9.1)
11(11.2)
8(7.3)
No
189(90.9)
87(88.8)
102(92.7)
Others
Yes
3(1.4)
2(2.0)
1(0.9)
No
205(98.6)
96(98.0)
109(99.1)
Household damage
Yes
58(27.9)
29(29.6)
29(26.4)
No
150(72.1)
69(70.4)
81(73.6)
Direct cost of post flood loss
No loss
151(72.6)
70(71.4)
81(73.6)
RM <1000
35(16.8)
16(16.3)
19(17.3)
RM 1000-3000
21(10.1)
12(12.2)
9(8.2)
RM >3000
1(0.5)
0(0.0)
1(0.9)
Indirect cost of post flood loss (Abstainance
from work_days)
>= 3 days
58(27.9)
36(36.7)
22(20.0)
< 3 days
150(72.1)
62(63.3)
88(80.0)
Perceived economic impact
Severe
25(12.0)
12(12.2)
13(11.8)
Non-severe
183(88.0)
86(87.8)
97(88.2)
a= Number (percentage)
Table 3 showed the perceived severity of post
flood non-economic impact by gender. The
questionnaire includes the water supply,
electricity, food and any depletion of basic
amenities; flood related family member loss and
health impairment. All questionnaires were
responded as “Yes” and “No” and scored 1 for
“Yes” and 0 for “No” response, then sum up and
did cutoff score at 3 and categorized sever (=>3)
and non-severe (< 3). Only one percent (only two
persons) of overall respondents perceived severely
towards post flood non-economic impact and it
was similarly distributed in both genders.
Table 3. Gender specific perceived severity of post flood non-economic impact
Characteristics
n(%)a
Total
Male
Female
(n=208)
(n=98)
(n=110)
Water supply
Yes
1(0.5)
0(0.0)
1(0.9)
No
207(99.5)
98(100.0)
109(99.1)
Electricity
Yes
5(2.4)
3(3.1)
2(1.8)
No
203(97.6)
95(96.9)
108(98.2)
Food
Yes
1(0.5)
1(1.0)
0(0.0)
No
207(99.5)
97(99.0)
110(100.0)
other
Yes
3(1.4)
1(1.0)
2(1.8)
No
205(98.6)
97(99.0)
107(98.2)
Depleted basic amenities
Yes
10(4.8)
5(5.1)
5(4.5)
No
198(95.2)
93(94.9)
105(95.5)
Flood related family member loss
Yes
1(0.5)
0(0.0)
1(0.9)
No
207(99.5)
98(100.0)
109(99.1)
Health Impairment
Yes
10(4.8)
7(7.1)
3(2.7)
No
198(95.2)
91(92.9)
107(97.3)
Perceived non-economic impact
Severe
2(1.0)
1(1.0)
1(0.9)
Non-Severe
206(99.0)
97(99.0)
109(99.1)
a= Number (percentage)
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
Figure (2) Perceived post flood impact severity (economic, non-economic, flood status & nature) by
respondents
Table 4 showed the perceived severity of post
flood nature impact by gender. The questionnaire
includes the individualized opinion of flood nature
severity, frequency of flood experience, flooded
inside house, flood level inside house, non-
governmental social support, governmental social
support, land transportation availability during
flood. All questionnaires were responded as “Yes”
and “No” and scored 1 for “Yes” and 0 for “No”
response, then sum up and did cutoff score at 4
and categorized sever (=> 4) and non-severe (< 4).
Twenty two percent (45 persons) of overall
respondents perceived severely towards post flood
nature impact and it was similarly distributed in
both genders (Figure 2).
Table 4. Gender specific perceived severity of post flood nature impact
Characteristics
n(%)a
Total
Male
Female
(n=208)
(n=98)
(n=110)
Individual opinion of flood severity
Mild
125(60.1)
54(55.1)
71(64.5)
Moderate
62(29.8)
35(35.7)
27(24.5)
Severe
21(10.1)
9(9.2)
12(10.9)
Frequency of flood experience
>=3
149(71.6)
71(72.4)
78(70.9)
<3
59(28.4)
27(27.6)
32(19.1)
Flooded inside house
Yes
68(32.7)
33(33.7)
35(31.8)
No
140(67.3)
65(66.3)
75(68.2)
Flood wave high inside house
Yes
19(9.1)
12(12.2)
7(6.4)
No
189(90.9)
86(87.8)
103(93.6)
Non-Governmental social support
Yes
28(13.5)
15(15.3)
13(11.8)
No
180(86.5)
83(84.7)
97(88.2)
Governmental social support(Food, Money, Clothes)
Yes
49(23.6)
27(27.6)
22(20.0)
No
159(76.4)
71(72.4)
88(80.0)
Land transportation availability during flood
Yes
141(67.8)
62(63.3)
79(71.8)
No
67(32.2)
36(36.7)
31(28.2)
Perceived flood status
Severe
45(21.6)
21(21.4)
24(21.8)
Non-severe
163(78.4)
77(78.6)
86(78.2)
a= Number (percentage)
Table 5 showed the association between socio
demographic profile and predictors of perceived
severity of post flood (economic, non-economic
and flood nature) with PTSD of the respondents.
There was significant association between
perceived severity of post flood economic impact
with PTSD among overall, males and females (p =
0.000, p = 0.012, p = 0.000) and perceived severity
of post flood nature impact with PTSD among
overall, males and females (p = 0.000, p = 0.02, p
= 0.000). Almost all PTSD prevalent people were
perceived not severely towards non-economic post
flood impact.
0
50
100
150
200
250
Perceived
economically
loss
Perceived non-
economically
loss
Perceived Flood
status and
nature
Severe
25
2
45
Not severe
183
206
163
25
2
45
183
206
163
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
There was no significant association with age,
marital status, education, occupation, total family
income and non-economic domain of post flood
perceived severity with PTSD of respondents. The
respondents who were 18 to 25 years old had
higher prevalence of PTSD (12.2%) overall, and
among females (17.4%) compared to older age
group (9.6%) and (9.2%) respectively, however
among men had lower prevalence of PTSD (5.6%)
compared to older aged men (10.0%). The
respondents who currently married had higher
prevalence of PTSD (10.5%) overall, and among
males (11.1%) compared to unmarried respondents
(8.7%) and (3.8%) respectively, however among
females had lower prevalence of PTSD (10.0%)
compared to unmarried females (15.0%). The
respondents who were passed secondary education
level only had higher prevalence of PTSD (13.5%)
overall, among males (14.3%) and among females
(12.9%) compared to higher educated respondents
with PTSD (9.0%) overall, men (7.8%) and women
(10.1%) respectively. Employed people had higher
prevalence of PTSD among over all (12.3%), men
(10.8%) and women (15.0%) compared to
unemployed of those groups (7.4%), (4.2%) and
(8.6%) respectively. The respondents who come
from low income family had higher prevalence of
PTSD (10.3%) overall, and among females (12.0%)
compared to high income respondents (9.1%) and
(5.6%) respectively, however among males had
lower prevalence of PTSD (8.4%) compared to
counterparts males (13.3%).
Table (5) Gender specific analysis for associated factors
Variables
Overall(n=208)
Male(n=98)
Female(n=110)
n (%)
Pa
n (%)
Pa
n (%)
Pa
PTSD
No
PTSD
No
PTSD
No
Age
Young age
5(12.2)
36(87.8)
.400b
1(5.6)
17(94.4)
.479b
4(17.4)
19(82.6)
.220b
Old age
16(9.6)
151(90.4)
8(10.0)
72(90.0)
8(9.2)
79(90.8)
Marital
status
Single
4(8.7)
42(91.3)
.485b
1(3.8)
25(96.2)
.252b
3(15.0)
17(85.0)
.377b
Married
/divorce /
widow
17(10.5)
145(89.5)
8(11.1)
64(88.9)
9(10.0)
81(90.0)
Education
status
Low level
7(13.5)
45(86.5)
.247b
3(14.3)
18(85.7)
.296b
4(12.9)
27(87.1)
.452b
High level
14(9.0)
142(91.0)
6(7.8)
71(92.2)
8(10.1)
71(89.9)
Occupation
Unemployed
7(7.4)
87(92.6)
.179b
1(4.2)
23(95.8)
.300b
6(8.6)
64(1.4)
.232b
Employed
14(12.3)
100(87.7)
8(10.8)
66(89.2)
6(15.0)
34(85.0)
Income
status
Low
18(10.3)
157(89.7)
.565b
7(8.4)
76(91.6)
.415b
11(12.0)
81(88.0)
.378b
High
3(9.1)
30(90.9)
2(13.3)
13(86.7)
1(5.6)
17(94.4)
Perceived
economic
impact
severity
Severe
11(44.0)
14(56.0)
.000*b
4(33.3)
8(66.7)
.012*b
7(53.8)
6(46.2)
.000*b
Non-severe
10(5.5)
173(94.5)
5(5.8)
81(94.2)
5(5.2)
92(94.8)
Perceived
non-
economic
impact
severity
Severe
0(0.0)
2(100.0)
.808b
0(0.0)
1(100.0)
.908b
0(0.0)
1(100.0)
.891b
Non-severe
21(10.2)
185(89.8)
9(9.3)
88(90.7)
12(11.0)
97(89.0)
Perceived
post flood
severity
Severe
14(31.3)
31(68.9)
.000*b
5(23.8)
16(76.2)
.020*b
9(37.5)
15(62.5)
.000*b
Non-severe
7(4.3)
156(95.7)
4(5.2)
73(94.8)
3(3.5)
83(96.5)
n (%) = Number (Percentage), a = Pearson Chi-Square Test, b = Fisher’s Exact Test
DISCUSSION
Related socio-demographic factors
Based on this study, the prevalence of PTSD was
9.2% in males and 10.9% in females, giving a total
of 10.1%. Significantly higher prevalence of PTSD
was found in severely perceived economic and
flood impact categories (33.3% and 23.8% in males;
23.8 % and 37.5% in females) and giving in overall
44.0% and 31.3 % respectively from 208
respondents of Kg Hulu Takir, Seberang Takir.
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
PTSD is a common psychological disorder in
disaster affected populations. It has been widely
used to evaluate the psychological impact of
natural disasters, accidents, and war8-16. The 10.1
% PTSD rate found in the flood-affected victims
observed this study was lower than that found by
Wang and others among earthquake victims
(24.2%) or than that observed by Zhou and others
among rock-fall victims (43%)17,18. Similarly, it was
lower than that estimated by Liu and others for
victims of traffic accident (38.27%)19. Differences
in the nature and severity of different types of
disasters, in populations studied, and in study
methodology make it difficult to reconcile the
results from different studies. This study found
that the risk of PTSD was higher in female victims
than in male victims. Prevalence between genders
was not significantly different. This finding is
consistent with previous studies20-24 and suggests
that women may be more sensitive to the impact
of flood than men. This study also found that
males victims aged 25 years and above had higher
PTSD rates than did males victims under aged 18 to
25 years while females victims aged 18 to 25 years
had higher PTSD rates than did females victims
aged 25 years and above but there was no
significantly different between age groups. Several
studies had also observed an increased risk of PTSD
after natural catastrophes in victims aged 35 to 54
years25-28. Possibly, the explanation for the
observed association between age and PTSD is,
again, that older victims are more sensitive than
younger victims to floods or other natural disasters
for men and since being young females are more
sensitive than older female victims.
According to this study, there was no significant
association between marital status of respondents
and presence of PTSD. Result concluded that there
is higher proportion of having PTSD is found in
married, divorced and widow respondents (10.5%)
compared to the single respondents (8.7%) in
overall, (11.1%) compared to (3.8%) in men and
(15.0%) compared to (10.0%) for women29,30.
Result for women was supported by one research
in California where unmarried women were having
more stress than married women in whom married
couple have most of their time together and they
often supporting each other. While in unmarried
women, living alone to handle all trouble and daily
life activity make them easily stresses31. There was
no significant association between educational
level of respondents and presence of PTSD. There
was higher proportion of having PTSD was found in
low educational level respondents (13.5%)
compared to the high educational level
respondents (9.0%) among overall and 14.3%, 7.8%
for men and 12.9% , 10.1% for momen respectively.
Education without self-motivation means nothing
unless the individual forced himself to do so. This
study was supported by a statement in a journal;
Int. J. Environ. Res. Public Health 2010 where
those who are uneducated engage in the least
stress , 31.7% compared with 54.76% of those with
educations by factors that contributed to this
matter are exposure to their status as being a
student, office worker. On top of that, educated
people are more likely to be involved in high level
of work which requires a lot complicated solution
while those who are uneducated are more towards
simple daily work without stress.
The study revealed that there was no significant
association between type of occupations of
respondents and presence of PTSD. In conclusion,
there is higher proportion of having PTSD was
found in respondents who was employed (12.3%) as
compared to unemployed respondents (7.4%)
among overall and 10.8%, 4.2% for men and 15.0%,
8.6% for momen respectively. From other study, it
stated that employed person have 2.86 times more
PTSD than that is not employed. This situation
could be related to the job stress at work32.
There was no significant relationship between
household income and the presence of PTSD. In the
literature review, people with lower income are
expected to have PTSD compare to those with
higher income. This is because, people with lower
income are more likely to have problem to recover
their loss. The difference in the results may be due
to the limitation that occurs during the research32.
Related perceived severity of post flood
economic, non-economic and flood status
Findings revealed that economic loss had a highly
significant relationship with the presence of PTSD.
The result is similar with previous study33, 34.
Respondent with higher economic loss are more
likely to develop PTSD compare to those with
lower economic loss. This is because they have to
spend more money to recover from their loss.
Besides, there was no significant association
between non-economic loss factor and the
presence of PTSD (p value is >0.95). The
occurrence of PTSD is higher in respondents who
were having lesser loss (10.2%) while there is no
PTSD in respondents with higher loss. As there are
only 2 respondents who were having PTSD
associated to less non economical loss, this result
is considered not significant and this may because
of people there are rarely have any non-economic
loss as shown in our result.
Furthermore, there was a significant association
between flood status and PTSD (p value is
<0.000).The occurrence of PTSD is higher among
respondents who thought that the flood was severe
(31.3%) as compared to those who thought that the
flood was not severe (4.3%). This was because the
gradient of severity of the disaster is directly
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (2): 30-40
proportional to the stress endure by the victim33.
The associations between perceived flood status
severity and PTSD and perceived post flood
economic impact severity and PTSD are expected
and lend validity to these study findings. If floods
cause PTSD, there should be a gradient of the
relation from floods that are mild to intermediate
to severe34.
CONCLUSION
This cross-sectional community-based study
suggested that PTSD occurred in 9.2% in males and
10.9% in females, giving a total of 10.1% of flood
victims at Kampung Hulu Takir was discovered to
be suffering from PTSD after the flood that
occurred on Disember 2014. The findings of this
study can provide baseline data for monitoring the
effectiveness of national programs for the
prevention and control of PTSD in Malaysia,
especially among women aged 18 to 25 years old,
single, unemployed, and come from low income
status family with low education status. Resources
for the prevention and control of PTSD can be
mobilized and allocated based on the factors
mainly need to emphasize that prevalence of PTSD
varies according to perceived severity of post flood
economic impact and type, nature and status of
flood impact identified significantly with PTSD.
Further studies need to be done to assess the main
predictors associated with PTSD in this community.
ACKNOWLEDGEMENT
We would like to express our gratitude and
generous acknowledge to Faculty of Medicine,
UniSZA Medical Centre for the support and
providing the golden opportunity for me to
conduct this community study project. We are
grateful to Professor Dr Nordin Bin Simbak, Dean,
Faculty of Medicine, UniSZA, Kuala Terengganu
Kampus for his support and permission to publish.
This study was conducted using the Year 3 M.B.,
B.S program requisite of community oriented
survey data. So our sincerely heartfelt thanks go to
year 3 students who involved actively and helpfully
during study conduct period.
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