Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities

A. P.  Rajkumar; T S P Mohan; P Tharyan

doi:10.1177/0020764011423468

Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities

A. P. Rajkumar, T S P Mohan, P Tharyan

Old Age Psychiatry

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

Abstract

BACKGROUND: The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings.

AIMS: To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates.

METHODS: We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale - Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS.

RESULTS: The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91).

CONCLUSIONS: Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.

Original language	English
Pages (from-to)	123-9
Number of pages	7
Journal	The International journal of social psychiatry
Volume	59
Issue number	2
DOIs	https://doi.org/10.1177/0020764011423468
Publication status	Published - Mar 2013

Keywords

Activities of Daily Living
Adult
Brief Psychiatric Rating Scale
Case-Control Studies
Cost of Illness
Disasters
Female
Grief
Humans
India
Logistic Models
Male
Mass Screening
Middle Aged
Predictive Value of Tests
Prevalence
Psychological Tests
Risk Factors
Socioeconomic Factors
Stress Disorders, Post-Traumatic
Survivors
Terminology as Topic
Tsunamis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/0020764011423468

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title = "Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities",

abstract = "BACKGROUND: The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings.AIMS: To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates.METHODS: We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale - Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS.RESULTS: The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91).CONCLUSIONS: Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.",

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author = "Rajkumar, {A. P.} and Mohan, {T S P} and P Tharyan",

year = "2013",

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doi = "10.1177/0020764011423468",

language = "English",

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Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities. / Rajkumar, A. P. ; Mohan, T S P; Tharyan, P.
In: The International journal of social psychiatry, Vol. 59, No. 2, 03.2013, p. 123-9.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Lessons from the 2004 Asian tsunami

T2 - epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities

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AU - Mohan, T S P

AU - Tharyan, P

PY - 2013/3

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N2 - BACKGROUND: The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings.AIMS: To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates.METHODS: We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale - Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS.RESULTS: The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91).CONCLUSIONS: Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.

AB - BACKGROUND: The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings.AIMS: To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates.METHODS: We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale - Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS.RESULTS: The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91).CONCLUSIONS: Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.

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KW - Logistic Models

KW - Male

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KW - Terminology as Topic

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SP - 123

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JO - The International journal of social psychiatry

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ER -

Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities

Abstract

Keywords

UN SDGs

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