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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

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

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.

Suggested Citation

  • A. P. Rajkumar & T. S. P. Mohan & P. Tharyan, 2013. "Lessons from the 2004 Asian tsunami: Epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities," International Journal of Social Psychiatry, , vol. 59(2), pages 123-129, March.
    • Handle: RePEc:sae:socpsy:v:59:y:2013:i:2:p:123-129
    DOI: 10.1177/0020764011423468
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    1. Kumar, M.S. & Murhekar, M.V. & Hutin, Y. & Subramanian, T. & Ramachandran, V. & Gupte, M.D., 2007. "Prevalence of posttraumatic stress disorder in a coastal fishing village in Tamil Nadu, India, after the December 2004 tsunami," American Journal of Public Health, American Public Health Association, vol. 97(1), pages 99-101.
    2. Rajkumar, Anto P. & Premkumar, Titus S. & Tharyan, Prathap, 2008. "Coping with the Asian tsunami: Perspectives from Tamil Nadu, India on the determinants of resilience in the face of adversity," Social Science & Medicine, Elsevier, vol. 67(5), pages 844-853, September.
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    1. Anto P Rajkumar & Titus SP Mohan & Prathap Tharyan, 2015. "Lessons from the 2004 Asian tsunami: Nature, prevalence and determinants of prolonged grief disorder among tsunami survivors in South Indian coastal villages," International Journal of Social Psychiatry, , vol. 61(7), pages 645-652, November.

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