Post traumatic stress disorder in children after Tsunami disaster in Thailand: 2 years follow-up. Journal of the Medical Association of Thailand, 90(11), 2370-2376

Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet 11/2007; 90(11):2370-6.
Source: PubMed


On December 26, 2004, the tsunami destroyed many families, communities, and residential areas. Adverse psychological impact on children and adolescents due to a natural disaster of this magnitude has never been reported in Thailand's history particularly as Post-Traumatic Stress Disorder (PTSD).
Investigate clinical symptoms and develop a 2-year monitoring and intervention program for PTSD in children affected by the December 26, 2004 tsunami natural disaster The study period started six weeks after the event and was completed after two years.
One thousand six hundred and twenty five surviving students from two schools in Takuapa district, Phang-nga Province, were enrolled. Screening tests using Pediatric symptom checklists, Childhood depressive intervention (CDI), and Revised child impact of events scales (CRIES) were done. Psychiatric evaluations were done by child and adolescent psychiatrists. Post Traumatic Stress Disorder (PTSD) was diagnosed using criteria from Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
The prevalence of PSTD in the affected students were 57.3, 46.1, 31.6, 10.4, and 7.6% at 6 weeks, 6 months, 1 year, 1 1/2 years, and 2 years, respectively. The female: male ratio was 1.7:1. The peak age was 9-10 years old. Threatened situations were studied. Of the 176 students who risked their lives in the waves, 48 (27.3%) suffered from PTSD. Meanwhile, of the 1314 students who were not hit by the waves but were among affected friends and relatives, 42 students (3.1%) suffered from PTSD. The prevalence of PTSD in those hit by the waves were significantly higher than those who were not [p-value < 0.01, RR = 5.16 (4.04-.6.6)].
The prevalence of PSTD in children who suffered from the tsunami disaster was as high as 57.3% at six weeks after the incident. It declined sharply at two years (7.6%) with the help of integrated welfare. The children continue to get financial, rehabilitation, and mental health support to prevent long-term adverse outcomes.

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    • "The majority of disaster survivors do not develop chronic reactions of distress and do not need professional help, whereas a sizeable minority may suffer for a prolonged period of time (Norris, Murphy, Baker, & Perilla, 2004; North, Kawasaki, Spitznagel, & Hong, 2004). Distressing psychological reactions are often most distinct during the first weeks after a traumatic event and gradually decrease during the following two years (Connor, Foa, & Davidson, 2006; Ford, Adams, & Dailey, 2007; Meewisse, Olff, Kleber, Kitchiner, & Gersons, 2011; Piyasil et al., 2007). "
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    ABSTRACT: Background: The characteristics of long-term trajectories of distress after disasters are unclear, since few studies include a comparison group. This study examines trajectories of recovery among survivors in comparison to individuals with indirect exposure. Methods: Postal surveys were sent to Swedish tourists, repatriated from the 2004 Indian Ocean tsunami (n=2268), at 1, 3, and 6 years after the tsunami to assess posttraumatic stress (PTS) and poor mental health. Items were used to ascertain high and moderate disaster exposure groups and an indirect exposure comparison group. Results: Long-term PTS trajectories were best characterized by a resilient (72.3%), a severe chronic (4.6%), a moderate chronic (11.2%) and a recovering (11.9%) trajectory. Trajectories reported higher levels of PTS than the comparison group. Exposure severity and bereavement were highly influential risk factors. Conclusions: These findings have implications regarding anticipation of long-term psychological adjustment after natural disasters and need for interventions after a single traumatic event with few secondary stressors.
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    • "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.
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    • "To avoid problems with memory and to enhance the accuracy of data, Kessler et al. (2008) recommended short time intervals between assessments (1–6 months) to capture information that reflects the entire postdisaster period that could have been missed if information was collected for specific time points only. In this review, six of the eight longitudinal studies on the September 11 attacks (Garrett et al. 2007; Gil-Rivas et al. 2007; Holmes et al. 2007; Malin and Fowers 2004; Pfeffer et al. 2007; Stein et al. 2004) and three of the seven longitudinal 2004 Tsunami studies (Hafstad et al. 2010; John et al. 2007; Piyasil et al. 2007) used short time intervals between assessments (6 months or less). Average time intervals were longer (more than 6 months) in all of the longitudinal studies assessing Hurricane Katrina. "
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    ABSTRACT: Background A comprehensive review of the design principles and methodological approaches that have been used to make inferences from the research on disasters in children is needed. Objective To identify the methodological approaches used to study children’s reactions to three recent major disasters—the September 11, 2001, attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. Methods This review was guided by a systematic literature search. Results A total of 165 unduplicated empirical reports were generated by the search and examined for this review. This included 83 references on September 11, 29 on the 2004 Tsunami, and 53 on Hurricane Katrina. Conclusions A diversity of methods has been brought to bear in understanding children’s reactions to disasters. While cross-sectional studies predominate, pre-event data for some investigations emerged from archival data and data from studies examining non-disaster topics. The nature and extent of the influence of risk and protective variables beyond disaster exposure are not fully understood due, in part, to limitations in the study designs used in the extant research. Advancing an understanding of the roles of exposure and various individual, family, and social factors depends upon the extent to which measures and assessment techniques are valid and reliable, as well as on data sources and data collection designs. Comprehensive assessments that extend beyond questionnaires and checklists to include interviews and cognitive and biological measures to elucidate the negative and positive effects of disasters on children also may improve the knowledge base.
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