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 and P. Tharyan

International Journal of Social Psychiatry, 2013, vol. 59, issue 2, 123-129

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.

Keywords: Post-traumatic stress disorder; epidemiology; false positive; predictive value of tests; logistic models (search for similar items in EconPapers)
Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:sae:socpsy:v:59:y:2013:i:2:p:123-129

DOI: 10.1177/0020764011423468

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