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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.
    Author: Rajkumar AP, Mohan TS, Tharyan P.
    Journal: Int J Soc Psychiatry; 2013 Mar; 59(2):123-9. PubMed ID: 21997766.
    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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