Just 2 months after the tsunami struck countries bordering the Indian Ocean almost 2 years ago, rates of depression, anxiety, and posttraumatic stress disorder were elevated among adult survivors in Thailand, according to the findings of two studies.
At 9 months after the December 2004 tragedy, those rates had declined but were still somewhat elevated in adults. In children, the rates of depression and PTSD were also elevated at 2 months and remained high at 9 months, according to the findings from two Thailand Post-Tsunami Mental Health Study Group studies.
The researchers surveyed a random sample of 371 adults and 371 children who lived in the three provinces most severely affected by the tsunami in an effort to identify vulnerable populations and to develop culturally appropriate mental health interventions
In the adult study, at 2 months after the storm, the rate of anxiety was 37%, the rate of depression, 30%, and the rate of PTSD, 12%, in those who had been displaced from their homes. For those who had not been displaced, the corresponding rates were lower at 30%, 27%, and 7%, respectively, reported Dr. Frits van Griensven of the Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nontha- buri, Thailand, and his associates.
At the 9-month follow-up, the rates of anxiety, depression, and PTSD had declined significantly among displaced adults, at 25%, 17%, and 7%, respectively. For those who had not been displaced, less significant declines to 26%, 14%, and 2%, respectively, were observed (JAMA 2006;296:537–48).
The significant decrease over time in the prevalence of stress reactions, particularly among the displaced, may be attributable to “spontaneous recovery under improved social and environmental conditions,” the authors wrote. In the interval between the first assessment and the follow-up, numerous programs were established for mental health support, occupational training, restoration of livelihoods, and provision of more permanent housing.
The pediatric study focused on depression and PTSD. At 2 months after the storm, the rate of PTSD was 13% in children who had been displaced from their homes, and the rate of depression was 11%. For those who had not been displaced, the corresponding rates were 11% and 5%, for children who lived in affected villages, and 6% and 8% for children who lived in villages not directly affected by the tsunami (JAMA 2006;296:549–59).
At the 9-month follow-up, rates of PTSD and depression had not significantly declined in displaced children and remained high at 10% and 12%, respectively. Some of those symptoms may have been associated with the refugee camps themselves, not just with tsunami-specific trauma.
“Follow-up assessments must be conducted to assess the long-term mental health outcomes and the long-term need for mental health services” in this population, Warunee Thienkrua, also of the Thailand Ministry-CDC collaboration, and associates said.