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Mental Health in Sumatra After the Tsunami
Abstract
We assessed the levels and correlates of posttraumatic stress reactivity (PTSR) of more than 20,000 adult tsunami survivors by analyzing survey data from coastal Aceh and North Sumatra, Indonesia.
A population-representative sample of individuals interviewed before the tsunami was traced in 2005 to 2006. We constructed 2 scales measuring PTSR by using 7 symptom items from the Post Traumatic Stress Disorder (PTSD) Checklist-Civilian Version. One scale measured PTSR at the time of interview, and the other measured PTSR at the point of maximum intensity since the disaster.
PTSR scores were highest for respondents from heavily damaged areas. In all areas, scores declined over time. Gender and age were significant predictors of PTSR; markers of socioeconomic status before the tsunami were not. Exposure to traumatic events, loss of kin, and property damage were significantly associated with higher PTSR scores.
The tsunami produced posttraumatic stress reactions across a wide region of Aceh and North Sumatra. Public health will be enhanced by the provision of counseling services that reach not only people directly affected by the tsunami but also those living beyond the area of immediate impact.
... Similarly, Kar et al. (2007) found that residents of Jagatsinghpur in India, who lived in areas susceptible to tidal surges, were more prone to post-traumatic stress disorder (PTSD). In a separate longitudinal study, Frankenberg et al. (2008) showed that individuals in tsunami-affected areas of Aceh and North Sumatra had high post-traumatic stress reactivity (PTSR) scores in the immediate aftermath of the tsunami, which later declined. Factors such as proximity to the coast, exposure to traumatic events, gender, age, loss of loved ones, and property damage were significantly associated with elevated PTSR scores. ...
... Guleria and Edward (2011) underscored the factors affecting community resilience in India's coastal community, including coastal resource management, societal and economic factors, risk knowledge, emergency response, and disaster recovery. Frankenberg et al. (2008) argued that areas with tsunami produced flooding had higher vulnerability, pointing to the need for better infrastructure and public education to mitigate risks in Indonesia. However, Uddin et al. (2020) highlighted that the resilience of coastal communities is influenced by their economic foundation, diversity of occupations available, and their vulnerabilities. ...
... This systematic review synthesised evidence from studies of various coastal communities within the Asia-Pacific region, highlighting the association between coastal hazards and psychological health. More than three quarters (77%) of the examined studies spotlighted a tangible relationship between environmental hazards such as sea-level rise, floods, and typhoons, and psychological concerns such as distress, depression, anxiety, and stress (Acosta et al., 2016;Chowdhury et al., 2020;Frankenberg et al., 2008;Gibson et al., 2019;Kim et al., 2018;Saha, 2017). These findings were obtained in studies conducted in seven Asia-Pacific countries (Bangladesh, India, Indonesia, Philippines, Solomon Islands, Tuvalu, and Vietnam) examining different settings in which coastal hazards were associated with psychological health outcomes. ...
This systematic review assesses the relationship between climate induced coastal hazards and psychological well-being of communities in the Asia-Pacific region. The review synthesizes findings from 13 peer-reviewed articles published between 2007 and 2020, encompassing data from seven countries: Bangladesh, India, Indonesia, Philippines, Solomon Islands, Tuvalu, and Vietnam. Results reveals a robust negative association between exposure to coastal hazards and psychological outcomes, notably stress, depression, anxiety, and distress. Most of the studies (77%) corroborate negative impacts of coastal hazards on psychological health. Additionally, 69% of the reviewed articles suggest a correlation between coastal hazards and negative outcomes for community livelihoods and essential resources. The review highlights increased psychological vulnerability among marginalized subpopulations, such as economically disadvantaged communities, a trend supported by 92% of the examined articles. The findings indicates that factors such as environmental vulnerability, resource availability, community traits, and coping methods are important in determining whether a community can effectively handle coastal hazards or face increased psychological health risks. This research aligns with international health frameworks, including the World Health Organization’s Health Emergency and Disaster Risk Management guidelines. However, a notable research gap emerges - the absence of studies that specifically explore psychological responses of communities to ongoing climate-related coastal hazards, such as sea-level rise. These findings emphasize an urgent need for targeted research to guide comprehensive, multidisciplinary policy interventions aimed at mitigating the psychological and socio-economic repercussions of climate-related coastal hazards.
... Despite the realization that weather shocks have multiple effects on a wide range of indicators of children's well-being, research in LMICs continues to be almost exclusively focused on nutritional and health outcomes (Currie and Vogl 2013;Frankenberg et al. 2008;Rosales-Rueda 2018). Relatively few studies have investigated the schooling and educational attainment of children living in flood-prone areas, even though, according to EM-DAT (2021), floods are the most frequently reported natural disaster worldwide. ...
... One is an indicator of general damage to the community, which we constructed by triangulating across information from knowledgeable community informants, direct observations by field supervisors, and high-resolution satellite imagery from which we assessed the degree of change in land cover to a reflection pattern consistent with bare earth in the period just after the tsunami (Gray et al., 2014). The measure is closely correlated with levels of tsunami mortality, injuries, post-traumatic stress, and damage to the built and natural environments (Frankenberg et al., 2008a(Frankenberg et al., , 2011. In addition to our measure of general damage, we constructed an indicator of whether the community's schools were damaged in the disaster, as reported in interviews with the village leader and his or her staff. ...
The 2004 Indian Ocean tsunami was an extremely destructive event in Aceh, Indonesia, killing over 160,000 people and destroying infrastructure, homes, and livelihoods over miles of coastline. In its immediate aftermath, affected populations faced a daunting array of challenges. At the population level, questions of how the disaster affected children’s and parents’ aspirations for education and whether it permanently disrupted schooling progression are critical in understanding how shocks affect human capital in the short and long term. We use longitudinal data from the Study of the Tsunami Aftermath and Recovery (STAR) to examine how disaster exposure affects educational aspirations and eventual attainment. We find that damage to one’s community depresses aspirations in the short term but that this weakens with time. With respect to educational attainment 15 years after the event, children’s aspirations, parents’ education, and family socioeconomic status are more important determinants of whether children complete high school and go on to tertiary schooling than is disaster exposure. While these results likely reflect, at least in part, the successful post-tsunami reconstruction program, they also establish enormous resilience among survivors who bore the brunt of the tsunami.
... Для всієї України подібна ситуація нова, але є досвід регіонів, де з 2014 року проходили військові операції. Відомо, що розлади психіки можуть викликати загострення хронічних захворювань (онкологічних хвороби, серцево-судинних), збільшувати рівень зловживання психоактивними речовинами [4][5][6]. ...
In press За розрахунками Міністерства охорони здоров'я нашої країни, у зв’язку з війною у 15 млн громадян України можуть згодом з’явитися розлади психіки. Від 3 до 4 млн осіб будуть потребувати психофармакологічного лікування. У свою чергу розлади психіки можуть спричинити появу хімічних залежностей, загострення хронічних серцево-судинних захворювань та прискорити розвиток онкологічних. Дослідження було проведене для розробки персоніфікованої системи терапії стрес-асоційованих розладів у осіб, які постраждали від бойових дій. Було обстежено 299 чоловіків і жінок середнього віку (30,6±4,7) років, хворих на непсихотичні психічні розлади, з використанням анамнестичного, клініко-психопатологічного та психодіагностичного методів. За результатами психодіагностичного дослідження з використанням шкал Гамільтона та госпітальної у обстежених хворих спостерігалось зниження показників тривоги та депресії; зниження показників інтенсивності клінічних проявів за Міссісіпською шкалою посттравматичного стресового розладу та зниження показників за шкалами «вторгнення» та «уникнення» за шкалою оцінки впливу травматичної події; відновлення соціальної активності та покращення якості життя пацієнтів на стрес-асоційовані розлади. Ключові слова: тривога, депресія, ПТСР, психотерапія, психоосвіта, фармакотерапія.
Background
Exposure to extreme weatherly events potentially develops mental disorders among affected individuals.
Aim
To synthesize the burden of mental disorders following impact of extreme weather events in South-east Asian (SEA) countries.
Methods
Proposal was registered in PROSPERO register [CRD42023469788] and reported as per PRISMA-2020 guidelines. Studies reporting prevalence of mental health disorders following extreme weather events from SEA countries during 1990 and 2023 were searched on Embase, PubMed, and Scopus databases. Study quality was assessed using Appraisal tool for Cross-Sectional Studies. Overall pooled prevalence was computed using DerSimonian–Laird method for random-effects model and reported as 95% confidence intervals.
Results
On screening 12,046 records, we included 155 studies (2,04,474 participants) for analysis. Overall burden of mental disorders was 35.31% (95%CI: 30.42%–40.21%). In subgroup analysis, studies on cyclones, India, local residents, children and adolescents, rural settings, and community settings reported higher burden of mental disorders. Depression (28.58%; 95%CI: 24.05%–33.1%) and PTSD (29.36%; 95%CI: 26.26%–32.46%) had similar prevalence. Visiting tourists to SEA region experienced fear, fear of recurrence of tsunami, nightmares, and sense of helplessness. Mental health outcomes were relatively higher in studies conducted within 1 year of events. Heterogeneity and possibility of publication bias exists among the reported studies.
Conclusion
With the significant rise in episodes of extreme weather events in SEA region over the last three decades, mental disorders are documented in different proportions. We suggest prioritizing well-informed policies to formulate inclusive and resilient strategies on effectively identifying and treating mental health concerns among victims of extreme weather events.
Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoon, cyclone, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Further high-quality studies are needed to validate our findings, and future research should focus on investigating the impacts of other types of extreme weather events in this region.
Mental health professionals have debated whether posttraumatic stress disorder (PTSD) can be qualitatively distinguished from normal reactions to traumatic events. This debate has been fueled by indications that many trauma-exposed individuals evidence partial presentations of PTSD that are associated with significant impairment and help-seeking behavior. The authors examined the latent structure of PTSD in a large sample of male combat veterans, Three taxometric procedures-MAMBAC, MAXEIG, and L-Mode-were performed with 3 indicator sets drawn from a clinical interview and a self-report measure of PTSD. Results across procedures, consistency tests, and analysis of simulated comparison data all converged on a dimensional solution, suggesting that PTSD reflects the upper end of a stress-response continuum rather than a discrete clinical syndrome.
A sample of 935 participants from the general population completed a mail‐out questionnaire containing the Trauma Symptom Inventory (J. Briere, 1995) and the Traumatic Events Survey (D. M. Elliott, 1992). The lifetime seif‐reported prevalence of natural disasters in this sample was 22%. Although time from the last disaster to involvement in the study was an average of 13 years, previous disaster was associated with significantly higher scores on 6 of 10 symptom scales. Disaster characteristics (especially the presence of physical injury, fear of death, and property loss) were better predictors of symptomatology than was disaster type. Disaster exposure continued to predict symptomatology after controlling for interpersonal violence history, although interpersonal violence accounted for more overall symptom variance.
The psychometric properties of the PTSD Checklist (PCL), a new, brief, self-report instrument, were determined on a population of 40 motor vehicle accident victims and sexual assault victims using diagnoses and scores from the CAPS (Clinician Administered PTSD Scale) as the criteria. For the PCL as a whole, the correlation with the CAPS was 0.929 and diagnostic efficiency was 0.900 versus CAPS. Examination of the individual items showed wide ranging values of individual item correlations ranging from 0.386 to 0.788, and with diagnostic efficiencies of 0.700 or better for symptoms. We support the value of the PCL as a brief screening instrument for PTSD.
This article describes the implementation of mental health intervention programs for children, adolescents,and their families exposed to natural disaster and violence. Recommendations are made regarding needed levels of organization, methods of screening and triage, training and supervision of mental health staff, design and implementation of treatment approaches, and longitudinal monitoring of course of recovery and intervention outcome.