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    Him ORIGINAL CONTRIBUTION Mental Health Problems Among Adults in Tsunami-Affected Areas in Southern Thailand Suparat Ekassawin, MD Jordan W. Tappero, MD, MPH Tor the Thailand Posi-Tsanami Mental Health Study Croup THE MORNING OF DECEM- ber 26, 2004, a massive undersea earthquake north- west of Sumatra, Indone- sia, witha Richter-scale magnitude of9 3, ccaused.a giant ocean shockwave or tst= nami that devastated the shorelines of Indonesia, Sri Lanka, India, Thailand, and many other countries.* More than 200 000 individualsareestimated tohave lied from the tsunami, making it one of the deadliest natural disast tory. In Thailand, all provinces facing the Andaman Sea (Ranong, Phang Nga, Phuket, Krabi, Trang, and Satul) wer affected but human losses and damages varied considerably. Phang Nga prov- ince was the most severely alfected, fol- lowed by Krabi and Phuket In Phang, Nga alone, more than 4200 individuals died and about 4250 individuals became displaced after their houses were destroyed; 721 individuals died in Krabi and 279 individuals died in Phuket. In sin his- See also pp 549 and 576 and Patient Page. (©2006 American Medical Assoc Context On December 26, 2004, an undersea earthquake occured off the north- western coast of Sumatra, Indonesia. The tsunami that flowed severely affected all 6 southwestem provinces of Taland, where 5395 individual died, 2991 were un- accounted for, and 857 wer inured Objective To asses the prevalence of symptoms of posttraumatic stress disorder (PTSD), anvity and depression among Individual resting in areas affected by the tsunamin southern Thaland as part ofa publicheath emergency response and rapid assessment Design, Setting, and Participants A multistage, cluster, population-based men- talhetth survey was conducted fom February 15 to 2, 2003, of random samples of displaced (n= 371) and nondsplaced persons in Phang Nga province (1=32) and non- diplaced persons in the provinces of Krabi and Phuket (n~ 368), Data were calected Using an intrveweradmiistered quesionnae on handheld computers A suvel- lance follow-up survey ofthe dsplaced persons (n=371) and nondsplaced persons (322) n Phang Na was conducted in September 2005 Main Outcomes Measures. Medical Outcomes Study-36Short-Form Healh Su- vey S-36 to ates selperceived general health, bodly pan, and soil and emo- tonal functioning the Harvard Trauma Questionnaire to tsess unamespectic trai malic events andthe Hopkins Checklist 25 to delet symptoms of arxety and depression, Results. Paticpation rates for asplaced and nondlsplaced person inthe rapid as- sessment survey were 69% and 58%, respectively Symptoms of PTSD were reported by 12% of displaced and 7% of nondsplaced persons in Phang Nga and 3% ofnon- displaced persons in Krab and Phuket. Anxiety symptoms were reported by 37% of displaced and 30% of nondplaced persons in Phang Nga and 22% of nondisplaced perons in Krabl and Phuket. Symptom of depression were reported by 30% of ix placed and 21% ofnondsplaced persons in Phang Nga and 10% of nndiplaced pe fons in Kral and Phuket. In multivariate analysis oss of vethood was indepen- deni andsirifcaly soit with symptoms fa’ mental health outcomes (PTSD, anwely, and depression. n the -month folw-up suvellance suvey of 270 (73%) displaced and 250 (80%) nondsplaced patipants in Phang Ne, prevalence ates of sgtams of PTSD, any, anddepresion aang dilaed persone deed to Fscr24.8%, and 167%, especbvely and among Nondsplaced persons, prevalence rates decreased to 23%, 25.9%, and 14.3%, respectively Conclusions Among survivors ofthe tsunami in southern Thaland, elevated rates af symptoms of PTSD, anlety, and depression were reported 8 weeks afer the de ‘aster, lth higher ates for anety and depression than PTSD symptoms, Nine months after the disaster, the rates of those reporting these symptoms decreased but were sil elevated. Th informations important for drectng strengthening, and evalt- ing postsunam! mental heath neds and interventions psi 2006296597548 wacom Author Affllations: Thaland Ministry of Puble van Ginste, Lopes Cadoze, Golay, Sain and Heaths Center for Dense Contre and Pres Tapper Vertion Colaboration Nonthabar, Thaland (D's Members ofthe Thalnd Pst Tsuna Mental Heath Van Greneven and Tapper, Ms Thenkrun anid Study Groups ste the ena of heat, Vareneratand Mr Mock: Deparment of Mental Conespondng Author tora Lopes Cardozo, MO, Heath, Thaland Mansy of Pubic Heath, Non- MP, Center fr Dsease Cnt and Peveston thabur, Thaland (Ors Chekraband, Penguntr, Nabonal Center for Envonmental Heath 1600, ‘Tanipstaasl and Ease and Cen for Con NE, Maton £97, Aa, GASO333 ot Disaee Control and Prevention, Alans, Ca (re ede gv). tion. Al rights reserved. (Reprinted) JAMA, Aug 2, 2006 Vol 296, No.5 $87 MENTAL HEALTH PROBLEMS AMONG ADULTS IN SOUTHERN THAILAND Figure 1: Tainan’ Affected Provnceron te Souther Thai Penmeu tna Stay Survey ster all 6 provinces combined, 5395 indi- viduals died, 2001 were unaccounted for, and 8457 were injured? Previous assessments among survi- vors of natural disasters, wars, and con- Mets have shown that posttraumatic stress disorder (PTSD) and other men- lal health problemsare common"? How= cever, the types of mental health prob- lems and reported prevalence rates vary, possibly due to variation in study meth- ods, disaster type and magnitude, and ceultural differences in somatization and coping with disaster. Thailand does not hhave a history of natural disasters and the prevalence of PTSD among individ als exposed to traumatic events has not been assessed previously. Understand- ing basic postisunami mental health in- dicators is essential for identifying vul- nerable populations and developing ceulturally specific mental health inter- ventions. As part ofa public health emer- gency response, we conducted a rapid assessment of the prevalence of symp- toms of PTSD, anxiety, and depression and associated factors among random 588 JAMA, August 2, 2006Vol 290, No.5 Reprinted) ‘ad Suv Stee ovilages [A Camps for Displaced Persons saruples of dlplaced and nondisplaced petsonsin the3 Tha provinces of Phang Nga Krabi and Phuket, which were the most severely affected by the tsunami GFicune 1). METHODS study Design Wesimed to enroll random samples of 392 displaced and 323 nondisplaced persons from Phang Ngx and 323 non- fisplaced persons from Krabi and Phuket exch, The sample size was cal culated on the basis of an assutmed PTSD prevalence of 15% in displaced petsonsand 12.5% innondisplaced per- sons, design eect of 2 and 495% con- fidence interval (CD. Estimates of PTSD prevalence in exst-Astan populations postdisaster typically vary between 5% md 30%" hence we used 15% preva- lence calculate the sample size of our survey. Households were used as the primary sampling unit and were de- fined as any group of persons (some- times multiple fatsilies) sharing the same structure (usually a tent or other Downloaded From: https:/jamanetwork.com/ by a Monash University Library User on 02/20/2020 form of temporary housing) and re- sources, such as food or bedding. Household members were not neces- sarily relatives by blood oF marriage Wedrewasystematicsampleof house hholds from camps for the displaced in Phang Nga (range for household size, 15-520; range for population size, 73-1353). Of 16 camps registered in Phang Ngaby February 14,2005, 10 were selected. One camp, Bang Moung,admin- Istratively consisted of3 subcamps (Bang ‘Moung, Wat Samakheetham, and Ban ‘Tung Livong), each with separate house- thold registration lists. Por sampling par- poses, these 3 subeamps were consi cred individual camps and are depicted separately in Figure 1. Six eamps were excluded for reasons of efficiency; they had fewer than 50 households (FicuRE 2). Camp household registra tion data showed a mean (SD) house- hold size of 3.5 (1.3). To account for ineligibility, refusal, and absence, we estimated that 200 households were needed to enroll 392 persons. Todo this, ‘we first calculated a sampling ratio” (tar- {get number of houscholds/total num- ber of households in all of the camps) and then multiplied this ratio by the number of households in each of the ‘camps. This provided us with the num- ber of households to be enrolled from every camp, proportional to its size. Next, we calculated a sampling inter val” (number ofhouseholdsin the camp! number of households to be sampled from the camp), which provided us with, the distance (or the number of house- holds) between the 2 households to be selected in the sample, AC the start of data collection, a daily generated ran- dom number between | and Lowas used to determine which housing structure ‘was sampled first; this number was then increased systematically by the sam- pling interval. For example, the sam- pling ratio of camp households was (200/1595=0.125), hence froma camp with 240 houschalds we needed to enroll (0.125X240=30) households. In this example, the sampling interval is (240/30=8), meaning that 8 housing structuresneeded tobe skipped between the 2 selected households. In every (©2006 American Medical Association, All rights reserved. household, consent to participate was requested from individuals aged 15 years or older. Ifa household member ‘was not present but would return later, the household was revisited on the same day for a maximum of 2 times. House- hhold membersattending school orocet- pational training were approached for enrollment at that venue. Household members were ineligible if they were younger than 15 years old, unable to speak Thai, or if they did not have a That national identification card (eg, That nationality). If household mem bers were present, refusal to partici- pate was rare To obtain our sample of nondis- placed persons, we drew a multistage cluster sample from households of non- displaced persons (FIGURE 3). In the lirst stage, we used the number of ts nami-related deaths to define Phang Nes asa high-impact cluster (4224 deaths) and Krabi and Phuket as a lower- impact cluster (721 and 270 deaths, respectively). In Thailand, every prov- ince is administratively organized atthe district, subdistrict, and village levels. Inthesecondstage, villages werestrali- lied by whether they were affected oF unaffected by the tsunami. We then ran- domly sampled a cluster of 3 subdis- tricts with affected villages and 3 sub- districts with nonalfected villages from both the high-impact and lower-impact clusters (avillage was clasifiedasaffected itithad been flooded by the tsunami) In the third stage, 8 villages with, more than 200 households were ran- domly sampled from each cluster of 3 subdistricts, resulting in 16 villages Irom the Phang Nga province and 16 villages from the Krabi and Phuket provinces, Provincial registration data showed a mean household size of 3.5 for Phang Nga and 2.5 for Krabi and Phuket. To account forineligibility, re fusal, and absence, we estimated that 150 houscholds were needed from Phang Nga and 200 from Krabi and Phuket to enroll 323 persons [rom each, of the high-tmpact and lower-impact clusters. In the fourth stage, we ap- plied a sampling ratio and sampling in- terval? to determine the number of (©2006 American Medical Assoc 1, All rights reserved. ‘MENTAL HEALTH PROBLEMS AMONG ADULTS IN SOUTHERN THAILAND households tobe enrolled from each v lage to get the desired sample size. The procedure for the selection and sys- tematic sampling of households in the villages was the same as that used in the camps for displaced persons (Figure 2) Instruments and Data Collection Before conducting the survey, we col- lected information from key informants (persons affected by the tsunami, health care workers, and community leaders) about traumatic experiences, cultural- specific coping mechanisms (suchas see- ing ghosts or hearing voices of the deceased), and tsunami-related mental health and subsistence issues. We also reviewed popullation and health statis- ties about displaced and nondisplaced persons. We used this information to develop questions regarding tsunami specific traumatic events, coping mecha- nisms, and to determine the sampling design. The Medical Outcomes Study-36 Short-Form Health Survey (SF-30),"*" the Harvard Trauma Questionnaire (HTQ)."and the Hopkins Checklis-25 (HSCL-25)""" were used to assess mer tal health conditions, For our survey, we selected four S5-point seales from the SF-30 to assess sel: perceived general health, bodily pain, and social and emotional functioning. Each raw score was then transformedon, 0 10 100 scale using a standard for- mula, with the higher scores represent- ing better functioning.'*"* Symptoms of PTSD, anxiety, and depression were all measured on 4-point scales with responses ranging [rom “not at all” to “extremely.” The SP-36 was con- structed from the Medical Outcomes surdy and developed in the United States The validity and reliability of the SF-36have been extensively tested in the United States and several other coun- twies, and the instrument had good rel ability and validity. The SP-36 has been widely translated and used in diverse ul- tural groups." The US Centers for Dis- case Control and Prevention has used selected questions from the SF-36 in ‘mental health population surveysin post- war Kosovo, Afghanistan, and in refu- gee populations in Thailand. Figure 2. sanping stages for Deplacea ‘Adults in Phang Nea Province Households were used asthe pinay camping unit and were defied as any soup of persons (ome ies mute amie sharing same sbuctreand rerouces such food or bedaeg We used the HTQ to assess tsunami specific traumatic events (part 1, 13 questions) BOX, which were selected a- ler interviews with key informants in the tsunami-alfected ares, and PTSD symptoms according to the Diagnostic and Statistical Manual of Mental Disor~ ders (part 3, 16 questions).” We defined PTSD as. score of 3 or 4 nat least 1 of 4 reoccurring symptoms, atleast 3 of 7 avoidance and numbing symptoms, and at least 2 of 5 arousal symptoms.**! The HTQ was developed by Mollica etal" and has been widely translated and used in diverse eultural ‘groupsand validated agains clinical diag- noses." The HT has demonstrated high internal consistency and reliability in studies of Bosnian- and Croatian- speaking individuals and in Cambo- dan refugee populations. (Repited) JAMA, August 2, 2006 29, No.5 $39 MENTAL HEALTH PROBLEMS AMONG ADULIS IN SOUTHERN THAILAND The HSCL-25, a sercening tool to diagnoses of these disorders."* The in the 3 Indo-Chinese groups showed detect symptoms ofansieyanddepres- HSCL-25 has been validated in the US excellent test and retest reliability and son, comprises a 10-tem subscale for population and used in many refugee good validity inpredictingdepression and anxilyanda 1S4temsubscalefordepres- studies. The content and design of a anxiety diagnoses. sion. Mean cumulauivesympiomscores 4-pointsevertyscaleisacceplableto the The recall period forthe standard Jhigher than 1.75 indicated the presence Indo-Chinese populations, and reviews strument questions was 4 weeks. In ade ofanxietyand depressionandhavebeen inthecultural psychiauy literature con- dition, we asked several yes or no ques- found to be valid in predicting clinical —sidcrthemeasurevalid The HSCL-25 ons about culture-specific coping Zmping Stages for Nondisplaced Adulte in Phang Nas, Phuket and Krabi Provinces, rn ey) : T a» “Fight duster was used to deserve th ge amber tarred detn the Phang Nga Province G4 death Kab and Phuket weve caaceraed ‘lower-npat cers (721 and 279 eae respecte, “Housel were sed the primary samping unt and wee defined say group of persons (sometimes mui failis) sharing th same uctre and resources, ‘eh as food or bedding S540. JAMA, fg 2, 2006 Vol 290, No.5 Reprinted) (©2006 American Medical Association. All rights reserved. jamanetvrork.com/ by a Monash University Library User om 02/20/2020 ‘MENTAL HEALTH PROBLEMS AMONG ADULTS IN SOUTHERN THAILAND mechanisms, previous diagnoses of tment illness snd mental health sap~ | Box, Tsumami-Specific Traumatic Events Assessed by 13 Questions Portsubstanceabuse,andsuicideide- | onthe Harvard trauma Questionnaire Aion and attempts 1. Did 1 or mor of your children die during the tsunami disaster? All questions were translated from 2. Di your spouse de daring the nant dsr English to Thal and pl ested amon , English to Thal and pilovissted among | 3. pid othe family members die during the tsunami disaster? Riel coprepeincne eederseedd | 4: Were you injured aa result ofthe nant dsster? tbiliy, and aceepubty. Instruments | 5. Were members of your aml injured aa resul of th tsunamt dsser? ‘were not backtranslated but their trans 6. Are there individuals missing in your family as a result ofthe tsunami disaster? Jation was verified for accuracy by local 7. individuals died in your family as a result of the tsunami disaster were the bilingual mental health experts Ques- |” joqae'tags Lionnaires were programmed {or useon |g handheld computers and administered duringa face-to-face interviewby trained Interviewers who were psychologists, social workers, or psychiatric nurses, Did someone you know (like a neighbor or someone from your village) die asa result of the tsunami disaster? 9, Is someone you know missing asa result ofthe tsunami disaster? 10, Did you lose your home as a result ofthe tsunami disaster? Because interviews Were conducted on | 11. Was this house your or your familys propery? location interviewers were not blinded | 12. Did you lose other belongings asa result ofthe tsunami disaster? with respect to displacement stats. At | 13, pid you lose yourliveihood as result ofthe tsunami disster?* the end ot each day all completed ques- “For the purpose of this quesonnaite, livelihood was defined asa persons main way to tionnaires were downloaded on a lap- | (EEG PMP top computer using Hotsyne (process of synchronizing information between handheld computers and desktop com- puters) andelectronically transported to Data Analysis ‘were Tha thelr mean (SD) age was 39.5 the Bangkok-based data management Prevalence rates forsymptomsof PTSD, (15) years (range, 15-90 years). Of the centerusing the Global Packet Radio Ser- anxiety, depression, and other charac- 600 eligible nondisplaced persons (par~ vice (a wireless telephony network). teristics were calculated and analyzed ticipation rate, 58%), 37% were male, Data for the rapid assessment survey using SPSS version 12.0 (SPSSInc,Chi- 62% were Buddhist, 98% were Thai: ‘were collected between February 15and cago, IID. x* Tests were used to evalu- their mean (SD) age was 42 years (15.5, 22, 2005, 8 weeks after the tsunami, A ale differences in categorical variables years) (TABLE 1). In almost all cases, surveillance fllow-upsurvey ofthedis- and (tests and I-way analysis of vari- absence at the time of the interview was placed and nondisplaced participantsin ance tests were used to evaluate differ the reason for nonparticipation. The Phang Nga(the high-impact cluster) was eRcesin continuous variables, correct mean age and sex of displaced and non- conducted between September 7and 12, ing for multiple comparisons if displaced participants were not signifi- 2005, 9 months alter the disaster. necessary. I'continuous variables were cantly different from the nonpartici- The protocol of this study was notnormally distributed, nonparamet- pants, reviewed by the US Centers for Disease Tle tests were applied. Backward step- Before the tsunami, mean income did Control and Prevention and by the Wise multivariate logistic regression not dilfer significantly between dis- Department of Mental Health, Thai- analysis was used to identify indepen- placed persons and nondisplaced pet land Ministry of Public Health, and was dent risk factors for symptoms of PTSD, sons in Phang Nga (17 127 vs 15085, determined to be an emergency public anxiety, and depression, while adjust- Thai Baht; P=.83) but was lower among, health response which, consequently, did ing for clustering of venues and calen- nondisplaced persons in Phang Nga not require review by an institutional dar dates using Stata version 8.1 (Stata- than among nondisplaced persons in review board. Prior toenrollmentinthe Corp, College Station, Tex). All Krabi and Phuket (15085 vs 18458 assessment, verbal informed consent was Variables that were theoretically rel- Thai Baht; P=.002). After the tsu- obtained from participants, who were evant and had P values of <.05 in bi- nami, the mean income of displaced reimbursed 100 Thai Baht (40 Thai variate analysis were entered into the persons (2010 Thai Baht) was signifi- Baht= US $1) for their ime and effort, models. cantly lower than that of nondis- All participants were referred for men- placed persons in Phang Nga (6885, tal health services available in mobile RESULTS: Thal Baht; P<.001), which was signif clinics provided by the Department of Of the 371 eligible displaced persons cantly lower than that of nondis- Mental Health ofthe Thailand Ministry (participation rate, 69%), 41% were placed persons in Krabi and Phuket of Public Health, male, 03% were Buddhist, and 95% (10037 Thai Baht; P<.001) (©2006 American Medical Assoc mn. All ight reserved. (Reprinted) JAMA, August 2, 2006 296, No.5 S44 MENTAL HEALTH PROBLEMS AMONG ADULTS IN SOUTHERN THAILAND Symptoms of PTSD were reported by 12% of displaced persons and 7% of rnondisplaced personsin Phang Ngaand 3% of nondisplaced persons in Krabi and Phuket. Anxiety symptoms were re- ported by 37% of displaced persons and 30% of nondisplaced persons in Phang Ngaand 22% of nondisplaced persons in Krabi and Phuket. Symptoms of de- pression were reported by 30% of dis- placed persons and 21% of nondis- placed persons in Phang Nga and 10% ‘of nondisplaced persons in Krabi and Phuket (TABLE 2). Prevalence rates for sympioms of PTSD, anxiety, and de- ‘Table 1. Demographic Characteristics of Aduts in TsunamivAMected Provinces in Souther Thailand, 2005 Displaced ‘Noneleplaced Phang Noa Phang Nga Krabi and Phuket Pp Characteristic waar nase) io 308) Valuet Tae Ne Pe] BSN CT 75 0-767 2T7 Ta ermeT AD] TOR OACATT ma ‘gs ean (5) Fangehy 355 (50) 75-90, HE T6.1 5-58, wos (1475-88 Dot Marre x Wng egeter, 2a (OS) SETH 22 (ZOO TTTAL Z6d FLT BBT TEAL a No.0 1% ‘Education pimary schoo BET TEE TOD 2 HATES THEA ROL DoT rlower No. (5) [5% Ci} gah region No.) B%CT SA BT RTEBET BOTTA] SATO Dat inca, man (SO) ange, Tha baht ‘afer tesa 17 127 46 165) 200-500000) 15085 2 884) [400-200000] _ 18468 23009) [1000-189000) 29 her tsar P3000 aa (BF |O-TOOCGN] TORT (T3523 (0-H, Dot ‘Table 2. Mental Health Outcomes, Culture-Specific Symptoms, Socal Functioning, and Traumatic Events Among Adults in Tsunami-Avfected Provinces in Southern Thailand, 2005 Displaced Nonaiapiaced Phang Nga Phang Nga Krabi and Phuket Pp Variable (naar nase) (n= 308) Value ental Heath PIso 44(119) 81-156) 22 (68)(38-09) 11 2009.50) ot Koaty FEEAOEERPE 36 2.9) BELGOA Bi e20169-27-] Dot Depresson TZ (S02) (DBZ aE 3103) (67 120) a] Tee oft dre TORT TBAT ESL TS GOB STa 7a Dink =2 gasses dat acoral TOBA TSS TOBA SES] 13 a)/1.66.) we Pr diagnosis ofmentar ness aaa seo Tea asa] Tereza) ca Feceved mental heath suppor Tis era EET ESTES BOIEETAA Dai ‘Teunami-Related Traumatic Events Famiy member de or missing 190 51.2) /446-57 8) 87 27.0) 208-232) 28 130)(88-173 ct ‘jury to sao fami mabe Bid Gr TISTS-BA] BETA TELAT O] BI 1S0) (9285) oy ‘eat heme or ropary 366 88-77 S-WOA] 102 (S.-NES SEO] 75 (198) (74.7-25.0) Dot Teatineihaod TST Ba) RES SEST BF TS} 10-239] BTN (S272) Dot Fousshold member pared sade POTS RETO) Ben 0-86] TOSS Dot Culture/Content Specie Events Saw ghost To (199) 145.232) 22(68)(39-08) 17462370) ot Fred wae ATT aay TRAST ORE 0 General Health and Functioning Psychosomatic problem ‘Stomach pa or Peadache 247 (6.6) (616-71.6) 195 (67.8) (513-636) 165 44.8) (99-60.4) ot Trocbie seeping Tiago sa T Bal 185 67 8)/51 98ST] 175 76) 419-532] or Faeavotonal inelonngt TSB) TE RZO) Dot ‘General heath parceptont Et BB) BES, oF Bay pant 731 PBS) TO2 BT) cal Secal irctonnat CBT ES TESTS) Dat S542 JAMA, Agus 2, 2006 Vol 296, No.5 Reprinted) (©2006 American Medical Association, AU rights reserved ijamanetsrork.com by a Monash University Library User om 02/20/2020 ‘MENTAL HEALTH PROBLEMS AMONG ADULTS IN SOUTHERN THAILAND Pression were significantly higher T3bje'3, gvanate Analyse of Effects of Demographic and Exposure Variables on SmPIOMS among those who were displaced than 95 PTSD Among Adults in Tsunami-Affected Provinces in Southern Thailand, 2005 among those who were not displaced — in Phang Nga (all P<.05). Nondis- pe placed persons in Phang Nga, in turn, Wasi on(@s% cy | val had higher prevalence rates for symp. = P a « Venue toms of PTSD, anxiety, and depres: "Bos ago yaryiovay sion than nondisplaced personsin Krabi Reralaced Phang NET Zaermaesse | <001 and Phuket (all P<.02) = — Displaced persons experienced sig- nificantly more traumatic events. Pilly 1.00 fone percent of displaced persons re- TERE ported having had a family member Wwho died or was missing compared with 27% of nondisplaced persons in Phang Nga (P<.001) and 13% of nondis- placed in Krabi and Phuket (P<001), Waialeiiue Almost all (98.5%) displaced persons Mateo bing ogee had lost their home or property and ale = snost hall reported having lost theirlive- FH 100 ot ima school or louse 179 (108. ot Uhood (Table 2). Figher tan primary schoo 00 The mean (SD) score for role- Fz ger emotional functioning was lower Bugahist, 213 (105-425 ot among displaced persons (72.8 [23.6])_ Or 00 thanamongnondisplaced persons (77.8 Fadhcome ater na [22.6]) in Phang Nga (P<.005); there Ye ‘were no differences in this respect be _Y 0S tween nondisplaced persons in Phang Use eet aoae » Nga and in Krabi and Phuket (mean. ie [sb], 80.0 [23.5)) Fr agra aa The results of bivariate analysis for EOS effects of demographic and trauma 3g exposure variables on symptoms of | RagieeTTaia Raa appaTa ARS PTSD appear in Tanue 3 and anxiety Yoo oot and depression appear in Taste 4. We Symptoms of PTSD, anxiety, and Fan minis aida mig hg aa depression were significantly higher Y® 354 (2.13-587) =001 among displaced persons, those aged _® 100 35 10.54 years, those with lower edu SS ani nanbar rea poaii2e 0s cation, and those who had two incotne 5 Sferthctounam Rawsot second === mm tions were also significantly higher "yor 2aeiieesis —_<001 among repondents who reported see- Wes Ta ing ghosts or hearing volces and those [aelgathoodbecune Ta who received mental health support Y= aar(47e-1469 —_<001 Miter the tsunami. Anxiety and depres- We i Sion symptoms were significantly | Hagehodnanbe pamedwicie more common among women 2 ° 297 140-025 oo whereas PTSD symptoms were more 100 common among those who were =a “oot Buddhist. symptoms of PTSD and je depression were more common 7 fmong those with a prior diagnosis of | ™%aa gosiisesen ot mental illness. Respondents who had __ Re To experienced animale vents, such a2 Raeainw Gk Sears VaTNIOR SS a FE pra (©2006 American Medical Assoc tion. Al rights reserved. (Reprinted) JAMA, Aug 2, 2006 296, No.5 548 MENTAL HEALTH PROBLEMS AMONG ADULTS IN SOUTHERN THAILAND Table 4. Svarate Analyst of Elecls of Demographic and Exposure Valles on Symptoms of Arbiely and Depresion Among Adu hs Taunam-Affected Provinces in Sather Thailand, 2005 Analy Depression P e No.(%) OR (@5%)__Value__No.(%) OR (5%Cy Value aa eae) Bis ea] 89) 09 112002) a7 FNonaiplaced Phang NGS) Tamua—terirezz |

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