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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 4  |  Page : 237-240

Assessment of Post-traumatic stress disorder among disaster affected children in a high school in Uttarkashi district, Uttarakhand, India


Department of Community Health, Disaster Management Unit, St. John's Medical College, Bengaluru, Karnataka, India

Date of Web Publication11-Nov-2014

Correspondence Address:
Catherin Nisha
Department of Community Health, St. John's Medical College, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.144411

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  Abstract 

Introduction: Disasters are traumatic events, which when experienced may result in a wide range of mental and physical health consequences. Information on mental health disorders among adolescents following natural disasters from developing countries is scant. Objective: The objective was to determine the prevalence of post-traumatic stress disorder (PTSD) among disaster-affected children in a high school in Uttarkashi district, Uttarakhand. Materials and Methods: This was a cross-sectional study, at a high school in Uttarkashi district, Uttarakhand between October and November 2013, 3 months after the disaster. Two hundred and sixty-eight adolescents participated in the study. Institutional ethical clearance was obtained. After obtaining consent from the principal and assent from the students, the Trauma Screening Questionnaire was administered to assess PTSD, and a structured questionnaire was used to ascertain the socio demographic variables. Results: The mean age of the study population was 14.48 with a standard deviation 0.87 years. Of all the adolescents, 166 (61.9%) were males, and 102 (38.1%) were females. The prevalence of probable PTSD was found to be 32.8% with a mean score being 4.3 with a standard deviation of 2.61. There were no statistically significant association between PTSD and specific socio demographic factors. Conclusion: Of all the adolescents studied, 32.8% continued to suffer from trauma-related stress disorder after 3 months of the disaster. As victims continue to suffer from stress disorder even after 3 months, the need for screening continues to be significant especially so when the mental health care has not been in place from the beginning along with other disaster-related support. The findings of the study highlight the need for recognition of post-disaster stress disorders and subsequently providing interventions in adolescent victims in developing countries.

Keywords: Adolescents, disaster, post-traumatic stress disorder, trauma screening questionnaire


How to cite this article:
Nisha C, Kiran P, Joseph B. Assessment of Post-traumatic stress disorder among disaster affected children in a high school in Uttarkashi district, Uttarakhand, India. Int J Health Syst Disaster Manage 2014;2:237-40

How to cite this URL:
Nisha C, Kiran P, Joseph B. Assessment of Post-traumatic stress disorder among disaster affected children in a high school in Uttarkashi district, Uttarakhand, India. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2020 Mar 29];2:237-40. Available from: http://www.ijhsdm.org/text.asp?2014/2/4/237/144411


  Introduction Top


India has been traditionally vulnerable to natural disasters on account of its unique geo-climatic conditions. Both natural and manmade disasters occur quite regularly in India, like many other countries in the developing world .[1],[2],[3] About 60% of the Indian landmass are prone to earthquakes of various intensities; over 40 million hectares are prone to floods and about 8% of the total area are prone to cyclones. [1] Recent major natural disasters in the country included the Marathwada earthquake (1993), Andhra Pradesh cyclone (1996), Jabalpur earthquake (1997), super cyclone in Orissa (1999), Gujarat earthquake (2001), tsunami in Tamil Nadu (2004), and floods in Uttarakhand (2013). More than two-thirds of persons in the general population may experience a significant traumatic event at some point in their lives.

During June 14 th to 17 th 2013, a multiday cloud burst centered in the North Indian state of Uttarakhand caused devastating floods and landslides in what is considered the country's worst natural disaster since the 2004 tsunami. This heavy rainfall caused the melting of Chorabari glacier at the height of 3800 meters above sea, and eruption of the Mandakini River, leading to heavy floods near Gobindghat, Kedarnath, Rudraprayag, Uttarkashi districts and nearby regions. Entire village settlements were obliterated resulting in a loss of innumerable lives. The Hindu pilgrim centers in the region namely Kedarnath, Badrinath, Gangotri, and Yamunotri, were also greatly affected. Over 70,000 were stranded in many places due to damaged roads and lack of transport facility. Even after a week, dead bodies were found to be floating in the river in a highly decomposed state, causing contamination of water and resulting in various health problems in the people. [4]

Beyond the immediate medical consequences of injuries and bad hygienic conditions, natural disasters can cause lasting mental disorders for significant proportions of the survivors. Disasters are traumatic events that are experienced by many people and may result in a wide range of mental and physical health consequences. [5] In the last decade, the knowledge about the mental health consequences of natural disasters for the affected populations has been growing rapidly. In general, research has shown that post-traumatic stress disorder (PTSD) is the most prevalent psychological disorder after disaster. Mental Health, primarily PTSD was among the various problems that people reported to disaster relief teams while working in these areas following a disaster.

Studies have shown that PTSD prevalence ranged between 14% and 56% among children living in different communities that were affected by disasters. The prevalence differs depending upon various factors, e.g. severity of exposure, duration from the event, and the methodology used, [6],[7] besides the differential response to trauma depending upon developmental level. [8] Reports have suggested post-disaster psychiatric morbidity in adolescents continues for years. [9] However, studies have noted that parents, teachers, and even mental health professionals significantly underestimate both the intensity and the duration of the stress reaction. [10] Studies have shown that adolescents present different type of psychopathology following disasters which are characterized by symptoms of PTSD, depression, anxiety, aggressive and regressive behaviors. [11],[12] Depending upon the developmental stage, level of cognitive and emotional maturity, and coping strategies, the psychological reactions among adolescents are expected to be different from those in adults.

The majority of disaster studies have focused on adults, although adolescents seem to be more vulnerable to psychological impairment after disaster which manifests in a variety of complex psychological and behavioral manifestations. However, often the post-disaster psychological reactions among adolescents are not identified. This is indeed the case, and one cannot generalize adult findings to adolescents. Studies of child victims of natural disasters in developing countries show inconsistent results. This study was undertaken in the flood affected areas of Uttarkashi district, Uttarakhand to assess PTSD among disaster-affected adolescents in a high school in Uttarkashi district.


  Materials and Methods Top


This was a descriptive cross-sectional study. All the students studying in standard 8, 9 and 10 of a high school (268) in the severely affected Uttarkashi district were included as subjects of the study. Students who were continuously absent during the study period was excluded from the study. The study was conducted from October to November 2013, 3 months after the disaster. The adolescents and their teachers' were briefed about purpose, procedure, confidentiality, risks, and benefits of the study. The evaluation of adolescents was undertaken in the school premises itself. The participants were administered the Trauma Screening Questionnaire (TSQ) in English by trained research assistants. TSQ is a validated tool for screening for PTSD. The 10 item scale gauges stress based on recall of mood and feelings; each item scored on a scale of 0 or 1, giving a total score ranging from 0 to 10. At cut-off score of 6, it has 76% specificity and sensitivity of 94%.

Statistical analysis

Data were entered in Microsoft Excel and analyzed using SPSS version 16. Data was described using mean, median, mode and standard deviations. Bivariate analysis was done using Chi-square tests following which variables with a significance level of <0.05 were included in a logistic regression model to assess the factors associated with stress.

Ethics statement

Ethical approval for the study was obtained from the Institutional Ethics Committee, St. John's Medical College, Bangalore, Karnataka, India. The study protocol was approved by the school management. Written informed consent was collected from the school principal and assent from the adolescents were taken. Confidentiality of the collected data was maintained.


  Results Top


The demographic details of the participants are described in [Table 1].
Table 1: Sociodemographic profile of the study population

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Of all the adolescents interviewed, 60% of them reported significant damage to their houses and lack of treatment for physical ailments in the initial few days after the floods. The victims had to depend on outside relief in the initial phase. Some of them had to live in the shelters for weeks to months. None of the adolescents had exposure to any other psychiatric evaluation or formal intervention before the study.

Prevalence of post-traumatic stress disorder and associated factors

The prevalence of PTSD in our study was found to be 32.83% with a mean score being 7.1 (±2.61) with a median score of seven. There were no statistically significant association between PTSD and age, gender, and type of family. While there was a significant association between religion and PTSD, the numbers are too small to make a conclusion of the same. Only three Muslim students were present in the study population. [Table 2] depicts PTSD and associated factors for it.
Table 2: Post-traumatic stress disorder as an outcome and associated factors

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  Discussion Top


The study demonstrated that adolescents exposed to disaster exhibited a wide range of PTSD after 3 months of exposure. Prevalence of PTSD was lower than that reported after Northridge earthquake 46% [13] but higher to that following Hurricane Hugo 28% [14] It has been reported that post-disaster psychosocial support influences the psychiatric morbidity. [15],[16] Subjects of this study received no formal psychological support. As meeting basic needs were the obvious priority following the disaster and the external support struggled to meet these demands, the mental health needs of the victims could never come to focus. There was no way obviously for the existing mental health care system with services only at tertiary level or in private practice, to meet the demands of post-disaster mental health problems. Psychological support through disaster workers was minimal if any and was restricted by training, preparedness and resource issues in this developing state. It resulted in situations where there was no evaluation or management of psychiatric sequel following the disaster in most areas, which may be one of the reasons for a high prevalence of psychiatric morbidity. However, there is a possibility of many mechanisms of informal psychological support from close-knit social network in Indian villages.

In our study, females had less PTSD compared to males; however, the difference was not statistically significant. Many previous studies have failed to demonstrate gender differences; [17],[18] while some have reported females are more likely than males to report symptoms of post-traumatic stress. [15] Significantly more females in our study reported insomnia; and more males reported "hard to stop worrying" and concentration problems. Similar symptoms were reported to be significantly associated with males following Hurricane Hugo. [16] Reported gender differences in PTSD symptoms in children exposed to trauma have been variable across studies. It has been suggested that gender difference if existent, may depend upon various factors, and may get obliterated by the higher exposure to trauma.

Limitation

Absence of standardized screening instrument in the vernacular language may be a limitation of this study; however, the medium of instruction in the school is English, and thus the same limitation is largely negated. There is no information on pre-disaster psychiatric morbidity, which is known to influence the post-disaster psychiatric morbidity. [19] Influence of various other risk factors such as death of family members, serious physical trauma, and supportive factors were not noted. Comparative study with a unexposed control population could have suggested the risk attributable to the disaster and secondary traumas associated with it. The study focused only on PTSD. The presence of other disorders and co-morbidities is a likely possibility in the studied population.


  Conclusion and Recommendations Top


The prevalence of PTSD in the study was found to be 32.8%. The findings of the study highlight the need for identification and intervention for post-disaster stress disorder in adolescent victims as a considerable proportion of adolescents suffered from stress-related disorder even after 3 months of the disaster. In future disasters, this highlights the need for trained counselors in disaster management teams, screening, and intervention for PTSD, especially so since mental health care is not usually instituted - from the beginning along with other disaster-related support.

 
  References Top

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Sathyanarayana Rao TS. Managing impact of natural disasters: Some mental health issues. Indian J Psychiatry 2004;46:289-92.  Back to cited text no. 2
    
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Khandelwal SK. The joy of mental health: Some popular writings of Dr. NN Wig Book review. Indian J Psychiatry 2006;48:207-8.  Back to cited text no. 3
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Goenjian AK, Pynoos RS, Steinberg AM, Najarian LM, Asarnow JR, Karayan I, et al. Psychiatric comorbidity in children after the 1988 earthquake in Armenia. J Am Acad Child Adolesc Psychiatry 1995;34:1174-84.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2]


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