NIMHANS: Tsunami trauma still haunts victims

June 1, 2008
By Syed Akbar
Hyderabad: The Tsunami that hit the Indian Ocean in December 2004 is now history. But
four years after the devastation, people affected by Tsunami are still in trauma. Their psychiatric morbidity is quite high and children are the worst-hit. The Bangalore-based National Institute of Mental Health and Neuro Sciences conducted a study on people affected by Tsunami and compared the data with those of normal
population. About 12,000 victims were interviewed as part of the study to establish psychiatric morbidity and the extent of mental trauma they had undergone.
"People are still traumatised. The effect will continue for some more time. In case of children, it may continue for life," NIMHANS assistant professor of psychiatry Dr
Suresh Bada Math, told this correspondent. A meta-analysis of 160 studies of disaster victims found that post-traumatic stress disorder, major depressive disorder, generalised anxiety disorders, and panic disorders were identified.
The factors that most consistently increased the risk for adverse outcome were severity of the exposure to the disaster; living in a highly disrupted or traumatised community; lack of social support; belonging to an ethnic minority group; post-traumatic stress; and being female.
Psychiatric morbidity was 5.2 per cent in the displaced population and 2.8 per cent in the non-displaced population. The overall psychiatric morbidity was 3.7 per cent. The displaced survivors had significantly higher psychiatric morbidity than did the non-displaced population. The disorders included panic disorder, anxiety disorders not otherwise specified, and somatic complaints. The existence of an adjustment disorder was significantly higher in the non-displaced survivors. Depression and post-traumatic stress disorder were distributed equally in both groups.
According to Dr Suresh, one of the study team members, psychiatric morbidity was found to be the highest in the displaced population. However, the incidence of
depression and PTSD were distributed equally in both groups. Involvement of community leaders and survivors in shared decision-making processes and culturally
acceptable interventions improved the community participation.
"Cohesive community, family systems, social support, altruistic behaviour of the community leaders, and religious faith and spirituality were factors that helped survivors cope during the early phase of the disaster," he said.
The NIMHANS study suggested that in a developing country like India there is a high need for psychosocial rehabilitation from day one of the disaster. "Our observations
clearly depicts that the presence of a mental health team in the early phase of disaster is definitely required for treating the immediate needs of the patients and planning long-term psychosocial rehabilitation as per the local need. The ‘mental health/psychiatric’ label needs to be avoided in the country".
The initial assessment by the team revealed that five to eight per cent of the population were suffering from mental health issues following the disaster. This may increase as time passes. Psychiatric morbidity is expected be around 25 to 30 per cent in the disillusionment phase. A notable feature was the high resilience
observed in the joint family system during the early phase of the disaster.
The NIMHANS experiences emphasised the point that in the formulation of any psychosocial rehabilitation plan, due consideration should be given to the local
culture, traditions, language, belief systems and local livelihood patterns. Any rehabilitation programmes need to be flexible, locally adaptable and acceptable. Utilisation of local community resources and community participation should be emphasised, leading towards community empowerment.
The team found that 475 survivors had at least one psychiatric diagnosis. Of these, 244 were displaced survivors residing in the Port Blair relief camps, and 231 were in the Non-Displaced Survivors Group from Car-Nicobar Island. The most common psychiatric problems observed in the survivors’ group were adjustment disorder in 178 (37.5 per cent), depression in 102 (21.5 per cent), panic disorder in 57 (12 per cent), PTSD in 53 (11.2 per cent), anxiety disorder not otherwise specified (NOS) in 26 (5.5 per cent), and other disorders in 16 (3.4 per cent). The "other" disorders were noted in children and adolescents by their parents, and included dizziness, vertigo, startle response, sleep-wake cycle disturbance.