Psychiatric disorders and functional impairment among disaster victims after exposure to a natural disaster: A population based study

Norwegian Centre for Violence and Traumatic Stress Studies, Kirkeveien 166, N-0407 Oslo, Norway.
Journal of Affective Disorders (Impact Factor: 3.38). 01/2011; 128(1-2):135-41. DOI: 10.1016/j.jad.2010.06.018
Source: PubMed


We aimed to examine psychiatric morbidity and functional impairment after a natural disaster.
Norwegian tourists who survived the 2004 tsunami in Khao Lak (n = 63), a severely affected area in Thailand, were interviewed in person 2.5 years after the disaster. The examination included the Mini International Neuropsychiatric Interview, the PTSD module of the Structured Clinical Interview for DSM-IV Axis I disorders, the Work and Social Adjustment Scale (WSAS), the Global Assessment of Functioning function score (GAF-F), and questions covering background characteristics and disaster exposure.
The most prevalent disorders were specific phobia (30.2%), agoraphobia (17.5%), social anxiety disorder (11.1%), PTSD (11.1%), major depressive disorder (MDD, 11.1%), and dysthymic disorder (DD, 11.1%). In 24 of the 40 respondents with a current psychiatric disorder, symptoms had originated after the tsunami. The post-tsunami 2.5 year incidence of PTSD and MDD was 36.5% and 28.6%, respectively. Multivariable regression analysis showed that the depressive disorders (MDD and DD) and PTSD were associated with self-reported functional impairment (WSAS), and the depressive disorders were associated with clinician assessed functional impairment (GAF-F).
Small sample size and high education may limit the generalizability of the results.
Depression and anxiety disorders were common among disaster victims 2.5 years after the 2004 tsunami. Psychiatric disorders other than PTSD, especially depressive disorders, are of clinical importance when considering long-term mental health effect of disasters.

Download full-text


Available from: Trond Heir, May 23, 2014
  • Source
    • "We focus on the above disorders because they are among the most prevalent of the primary anxiety disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5); specific phobia was excluded due to its relatively low levels of impairment (e.g. Hussain et al. 2011) and because it has heterogeneous subtypes that complicate latent variable modeling (see below for our approach). For descriptive purposes, we quantify mean impairment for individuals with a principal diagnosis of one of these three disorders, assessing overall impairment as well as impairment across five life domains (i.e. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Anxiety disorders are highly prevalent disorders associated with substantial psychosocial impairment, but few studies have examined impairment within specific anxiety disorders. Furthermore, it is unclear how change in different types of anxiety has an impact on change in impairment, particularly given high rates of co-morbidity. The current study assessed the temporal associations of impairment and symptoms of three common anxiety disorders in a large, diagnostically heterogeneous clinical sample. Method Data were collected from 606 treatment-seeking individuals at an anxiety clinic, most of whom subsequently enrolled in cognitive-behavioral therapy. Symptoms of panic, social anxiety and generalized anxiety disorder (GAD), as well as levels of impairment, were assessed three times over 2 years. In addition to examining levels of impairment across diagnostic groups, latent growth modeling was used to evaluate the longitudinal associations of anxiety symptoms and impairment. Those with a principal diagnosis of GAD reported higher levels of impairment in some domains at baseline; however, at follow-up assessments individuals with social anxiety disorder reported greater impairment than those with panic disorder. Anxiety symptoms and impairment both declined over time. Change in all three anxiety symptoms was closely associated with change in impairment, but only GAD remained a significant (positive) predictor of change in impairment after accounting for co-morbidity. Impairment and all three anxiety disorders were closely associated, both cross-sectionally and longitudinally. Because change in GAD was most specifically related to change in impairment, treatment for those with multiple anxiety disorders could focus on treating GAD symptoms first or treating transdiagnostic processes.
    Full-text · Article · Jun 2014 · Psychological Medicine
  • Source
    • "The prevalence of MDD after Hurricane Katrina in this study is greater than what has been reported in the general population (6.6%; Kessler et al., 2003) but is similar to reports after other natural disasters (11.1%; Hussain et al., 2011; 11.7%; Onder et al., 2006). However, the prevalence of current MDD in this study (9.1%) is significantly greater than what has been documented in the general population (2.2%; Regier et al., 1993) and after other natural disasters (4.9%; Tracy et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The current study examined demographic and psychosocial factors that predict major depressive disorder (MDD) and comorbid MDD/posttraumatic stress disorder (MDD/PTSD) diagnostic status after Hurricane Katrina, one of the deadliest and costliest hurricanes in the history of the United States. This study expanded on the findings published in the article by Galea, Tracy, Norris, and Coffey (J Trauma Stress 21:357-368, 2008), which examined the same predictors for PTSD, to better understand related and unique predictors of MDD, PTSD, and MDD/PTSD comorbidity. A total of 810 individuals representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina were interviewed. Ongoing hurricane-related stressors, low social support, and hurricane-related financial loss were common predictors of MDD, PTSD, and MDD/PTSD, whereas educational and marital status emerged as unique predictors of MDD. Implications for postdisaster relief efforts that address the risk for both MDD and PTSD are discussed.
    Full-text · Article · Oct 2013 · The Journal of nervous and mental disease
  • Source
    • "We did not measure details about the treatment received in specialist mental health care, but other studies of Norwegian tsunami survivors imply that common treatment received in specialised setting was supportive psychotherapy with or without the use of psychotropic drugs [53]. Our results may question the effectiveness of psychiatric treatment of enduring posttraumatic stress symptoms. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mental health consequences of disasters are frequently studied. However, few studies have investigated symptom improvement in victims after natural disasters. This study aimed to identify predictors of 6 months post-disaster stress symptoms and to study 6 months and 24 months course of symptoms among Norwegian tourists who experienced the 2004 tsunami. Norwegian tourists (>=18 years) who experienced the 2004 tsunami (n = 2468) were invited to return a postal questionnaire at two points of time. The first data set was collected at 6 months (T1, n = 899) and the second data set at 24 months post-disaster (T2, n = 1180). The population studied consisted of those who responded at both assessments (n = 674). Impact of Event Scale Revised (IES-R) was used to measure posttraumatic stress symptoms. IES--R score >=33 (caseness) was used to identify various symptom trajectories from T1 to T2. Multiple linear regression was used to determine predictors of posttraumatic stress at T1 and to identify variables associated with symptom improvement from T1 to T2. The majority was identified as non-case at both assessments (57.7%), while 20.8% of the respondents were identified as case at both assessments. Symptoms at T1 were positively related to female gender, older age, unemployment, being chased or caught by the waves, witnessing death or suffering, loss of loved ones, experiencing intense fear during the disaster, low conscientiousness, neuroticism and low levels of social support. The IES-R sum score declined from 24.6 (SD = 18.5) at T1 to 22.9 (SD = 18.3) at T2, p < 0.001. Emotional stability and high IES-R scores at T1 were positively related to symptom improvement, while received social support was not. Being referred to a mental health specialist was negatively related to symptom improvement. A significant minority (20-30%) among Norwegian tourists developed enduring posttraumatic stress symptoms in the aftermath of the 2004 tsunami. Tsunami exposure, peritraumatic fear, neuroticism and low levels of social support were the strongest predictors of posttraumatic stress at 6 months post-disaster. Decrease in posttraumatic stress was related to emotional stability and higher symptom levels at T1. Being referred to a mental health specialist did not facilitate symptom improvement.
    Full-text · Article · Sep 2013 · BMC Psychiatry
Show more