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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 6-9

Resilience and posttraumatic stress disorder among disaster affected persons attending Primary Health Care, Uttarakhand, India


1 Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
2 Department of Emergency Medicine, St. John's Medical College, Bengaluru, Karnataka, India

Date of Web Publication5-Feb-2016

Correspondence Address:
Nisha Catherin
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: 10.4103/2347-9019.175676

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  Abstract 


Background: Disasters are either natural or man-made and are all but inevitable in the present day life. Resilience refers to an individual's ability to thrive despite adversity. There is a paucity of information on resilience to disaster and posttraumatic stress disorder (PTSD) following natural disasters from developing countries. Methods: We conducted a research to determine resilience among disaster-affected persons availing Primary Health Care Services following floods in the State of Uttarakhand, India, and to assess the prevalence of PTSD among them. A cross-sectional study was conducted at Primary Health Care Centers of Uttarkashi and Rudraprayag Districts of Uttarakhand, India, between October and December 2013, 3 months after the floods. Results: One hundred and twenty-seven patients consented to participate in the study. The Connor–Davidson Resilience Scale and the Trauma Screening Questionnaire (TSQ) were administered along with a structured questionnaire to ascertain the sociodemographic variables. Of the 127 patients studied, 50 (39.3%) were males and 77 (61.7%) were females. The median age of the study population was 34 years. Of these, 27 (21.3%) were resilient (score ≥71 out of 100) to disaster and the probable prevalence of PTSD by the TSQ was found to be 86 (67.7%) (score ≥6 out of 10). Conclusion: The need for confirming resilience and treating PTSD is particularly significant, especially when mental health care has not been focused on along with other disaster-specific measures. The findings of the study thus highlight the need for early recognition of psychiatric disorders following disasters and subsequently providing interventions for the same among victims.

Keywords: Disaster, posttraumatic stress disorder, resilience, Trauma Screening Questionnaire


How to cite this article:
Deiveegan C, Catherin N, Navya C J, Alan P, Pretesh K, Joseph B. Resilience and posttraumatic stress disorder among disaster affected persons attending Primary Health Care, Uttarakhand, India. Int J Health Syst Disaster Manage 2016;4:6-9

How to cite this URL:
Deiveegan C, Catherin N, Navya C J, Alan P, Pretesh K, Joseph B. Resilience and posttraumatic stress disorder among disaster affected persons attending Primary Health Care, Uttarakhand, India. Int J Health Syst Disaster Manage [serial online] 2016 [cited 2019 Jun 18];4:6-9. Available from: http://www.ijhsdm.org/text.asp?2016/4/1/6/175676




  Introduction Top


Disasters are either natural or man-made and are all but inevitable in the day-to-day life. Natural disasters such as flood, earthquake, or cyclone are becoming more common in these changing climatic conditions worldwide.[1] The American Psychiatric Association defines traumatic event as psychologically distressing, outside the range of usual human experience markedly distressing to almost everyone.[2] During their life time, 50.2% of women and 60.7% of the men are estimated to have experienced at least one traumatic event.[3] Further, the lifetime prevalence of posttraumatic stress disorder (PTSD) in South Eastern Cities of the United States was found to be 69%, which is a public health problem of serious magnitude.[4] This increasing trend of disastrous incidents in this contemporary setting alerts us to focus on the consequence of traumatic events. Although the effect of these events can lead to a wide range of psychopathology, the most commonly studied phenomenon is PTSD. PTSD is the outcome measurement of the individuals who could not adapt to the sudden change in the level of stress.

Resilience refers to the capacity of an individual, household, population group, or system to anticipate, absorb, and recover from hazards and/or effects of climate change and other shocks and stresses without compromising their mental health status. Resilience is not a fixed end state, but is a dynamic set of conditions and processes.[5] There is dearth of knowledge in the field of PTSD following disasters, especially from developing countries. Hence, we conducted the research to assess resilience among disaster-affected persons availing Primary Health Care Services following floods in Uttarakhand, India, and the prevalence of PTSD among them.


  Methodology Top


This was a cross-sectional study carried out during the month of October to December 2013 which was 3 months post disaster. All the individuals who attended the selected Primary Health Care Centers in Uttarkashi and Rudraprayag District had been included in this study. The patients were briefed regarding the risks and benefits of participating in this study. Interview schedule was administered by the medical officers, which included a sociodemographic component comprising questions about age, gender, educational status, income, marital status, household size, Connor–Davidson Resilience Scale (CD-RISC), and Trauma Screening Questionnaire (TSQ). Consecutive sampling was done and all individuals residing in the region at the time of disaster and then availing medical help were included in the study. Those who were not able to comprehend and those who had known psychiatric morbidities were excluded from the study. TSQ is a validated tool for screening 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 cutoff score of 6 is considered positive for PTSD and the tool has sensitivity of 94% and specificity of 76%. CD-RISC (2003) is a 25-item scale which was used in the study. Each of the items was rated on a 5-point scale (0–4), with higher scores reflecting greater resilience. The full range is therefore from 0 to 100, with higher scores reflecting greater resilience. This is a validated tool among the Indian population.[6]

Statistical analysis

Data were entered in Microsoft Excel and analyzed. Data were described using median and interquartile range. Bivariate analysis was done using Mann–Whitney U-test and Kruskal–Wallis test. Correlation was done using Spearman's correlation coefficient. The variables with a significance level of <0.05 were included in a logistic regression model to assess the factors associated with stress.


  Results Top


A total of 127 individuals were included in this study, of whom 50 (39.3%) were men and 77 (60.6%) were women. The median age of the population was 34 years with interquartile range of 29–40 years. The majority of the population 98 (77.2%) were above the age of 40 years. [Table 1] depicts the sociodemographic characteristics of the population. About one-third of the population were unemployed (39 [30.7%]). [Table 2] depicts the level of resilience where the median score was found to be 58 with the interquartile range being 6–88. About 27 (21.3%) participants were found to be resilient among the study population. The level of PTSD was found to be 86 (76.7%) [Table 3].
Table 1: Sociodemographic characteristics of the study population

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Table 2: Resilience and posttraumatic stress disorder level among the study population

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Table 3: Factors associated with posttraumatic stress disorder

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There was statistically significant association between gender and educational status with PTSD [Table 4]. The resilience among the study population was found to be significantly higher among the educationally well-qualified persons, viz., professionals and also the younger people categorized as <40 years had a significantly higher median score on the resilience scale. The people who were employed were found to be resilient and had a significantly higher median score. The income had a significant positive correlation with resilience.
Table 4: Factors associated with resilience

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  Discussion Top


The prevalence of probable PTSD among the individuals attending the two Primary Health Care Centers during the period of 3 months was found to be 67.7% and that of resilience was found to be 21.3%.

The proportion of probable PTSD in the study population was found to be 67.7%. As the disaster had a deleterious effect on the inhabitants, the stress associated with it was more. Prevalence of PTSD was much higher compared to the other studies done following Orissa floods and cyclones,[7],[8] which could be attributed to the fact that a different tool was used to assess PTSD. Educational level was found to be associated with PTSD which was similar to other studies.[9],[10] Educational status of the participants was inversely proportional to the stress levels.

The income was found to be negatively correlated with PTSD, implying that lower the income status, higher is the association with PTSD.[11] Gender was another factor found to be associated with PTSD, with which women being more prone to PTSD and this was consistent with other studies done following natural disasters in Poland, China, Honduras, and Myanmar.[12],[13],[14],[15] Resilience and PTSD were found to be inversely related which was seen in other studies.[16] Resilience was found to be higher among those who were professionals and employed. This is probably because of the good social and financial support which can help them to revive from the traumatic events. Similar results have been observed in other studies which showed full-time employment was a source of social support.


  Conclusion Top


To reduce the prevalence of PTSD and to improve resilience among disaster-affected people, incorporation of mental health care at primary level is essential. Women being at a higher risk compared to men deserve more focused care. The vulnerable groups of unemployed and uneducated segments being at higher risk also need special consideration.

Limitations

The inherent limitation of cross-sectional design limits the inference to association and causal relationship cannot be established. The study having been carried out in healthcare service delivery setting the observations is limited to the participants attending the service facility and generalization to the whole population is not possible.

Acknowledgment

We thank all the persons who participated in the research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Munich Re Group. Natural Disasters according to Country Income Groups. Munich: Munich Re Nat Cat Service; 2005.  Back to cited text no. 1
    
2.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1987.  Back to cited text no. 2
    
3.
Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001. Psychiatry 2002;65:207-39.  Back to cited text no. 3
    
4.
Neria Y, Bromet EJ, Sievers S, Lavelle J, Fochtmann LJ. Trauma exposure and posttraumatic stress disorder in psychosis: Findings from a first-admission cohort. J Consult Clin Psychol 2002;70:246-51.  Back to cited text no. 4
    
5.
Defining Disaster Resilience: A DFID Approach Paper. London, UK. Available from: https://www.gov.uk/.../defining-disaster-resilience-approach-paper (Last accessed on 2016 Jan 05].  Back to cited text no. 5
    
6.
Singh K, Yu XN. Psychometric evaluation of the Connor-Davidson resilience scale (CD-RISC) in a sample of Indian students. J Psychol 2010;1:23-30.  Back to cited text no. 6
    
7.
Suar D, Mandal MK, Khuntia R. Supercyclone in Orissa: An assessment of psychological status of survivors. J Trauma Stress 2002;15:313-9.  Back to cited text no. 7
    
8.
Suar D, Khuntia R. Caste, education, family and stress disorders in Orissa supercyclone. Psychol Dev Soc 2004;16:77.  Back to cited text no. 8
    
9.
Abuaku BK, Zhou J, Li X, Li S, Li X, Liu A, Yang T, Tan H. Morbidity and mortality among populations suffering floods in Hunan, China: The role of socioeconomic status. J Flood Risk Manag 2009;2:222-8.  Back to cited text no. 9
    
10.
Caldera T, Palma L, Penayo U, Kullgren G. Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective. Soc Psychiatry Psychiatr Epidemiol 2001;36:108-14.  Back to cited text no. 10
    
11.
Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000;68:748-66.  Back to cited text no. 11
    
12.
Bokszczanin A. PTSD symptoms in children and adolescents 28 months after a flood: Age and gender differences. J Trauma Stress 2007;20:347-51.  Back to cited text no. 12
    
13.
Liu A, Tan H, Zhou J, Li S, Yang T, Wang J, et al. An epidemiologic study of posttraumatic stress disorder in flood victims in Hunan China. Can J Psychiatry 2006;51:350-4.  Back to cited text no. 13
    
14.
Kohn R, Levav I, Donaire I, Machuca M, Tamashiro R. Psychological and psychopathological reactions in Honduras following Hurricane Mitch: Implications for service planning. Rev Panam Salud Publica 2005;18:287-95.  Back to cited text no. 14
    
15.
Kim H, Han SB, Kim JH, Kim JS, Hong E. Post-Nargis medical care: Experience of a Korean Disaster Relief Team in Myanmar after the cyclone. Eur J Emerg Med 2010;17:37-41.  Back to cited text no. 15
    
16.
Aslam N, Tariq N. Trauma, depression, anxiety and stress among individuals living in earth affected and unaffected areas. Pak J Psychol Res 2010;25:131-48.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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