Psychological Distress in a Natural Literature Review

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By the values established in the GHQ, 64% of those interviewed who had been flooded out -- and were evaluated six months later -- had a score of 4 or more, which is taken to mean there was significant psychological distress (that is juxtaposed with 25% that showed significant psychological distress at the time of the event). In addition, one-quarter of the 983 people interviewed experienced "deterioration" in their health since the flooding (Tunstall, 368).

The question posed to those that were flooded: "As the result of the flood, did you personally experience intense fear, helplessness or horror?" More than two-fifths of those who answered that question (using the GHQ) reflected that the flood was a "possible source" of PTSD (Tunstall, 370). That said, only ten respondents reported "high" stress levels (judged to be PTSD) and just 4 showed "extreme" levels of stress -- clearly cases of PTSD.

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Meanwhile, a research article in the scholarly journal BMC Public Health reviews the research conducted following the 1998 floods in Hunan, China. There were a total of 25,478 study subjects in this research, and 9.2% of those 25,478 people (2,336) were diagnosed as "probable PTSD-positive" individuals (Huang, et al., 2010, p. 1). The face-to-face interviews with Chinese citizens (age 16 or older) were diagnosed using DSM-IV criteria, and the seven independent predictive factors included: age, gender, education, severity of flood, type of flood, flood experience and the mental status each participant had prior to the flood (Huang, 1). This was a monster flood, affecting more than 180 million Chinese; it destroyed 6.85 million homes, caused 4,150 deaths and displaced more than 18 million people (Huang, 2).

The response rate in this research (87%) was far better than most response rates when researchers wish to interview or have questionnaires filled out by those who have been negatively impacted by a disaster. Perhaps that is because the loss was so great and the flood so absolutely devastating.

Literature Review on Psychological Distress in a Natural Assignment

A study was conducted on the children that became victims of the Hunan, China flood; a questionnaire was given to 7,038 children (from 13,450 households) ages 7-15 using the DSM-IV criteria. And in order to determine the association between PTSD and behavior before the flood, a questionnaire was given to the children's parents as well (Peng, 2011). Using a multivariate logistic regression, the authors determined that

Still on the subject of that terrible flood in Hunan, China, an article in the Canadian Journal of Psychiatry reports on research involving 33,340 individuals that had been impacted by the flood. Of those 33,340 people, 86% were 7 years of age or older and 8.6% showed clear symptoms that met all the diagnostic criteria for PTSD (Liu, 2006). How were the investigators certain that individuals were suffering from PTSD? In fact the diagnoses used the DSM-IV criteria, which include 17 symptoms.

The researchers scored the PTSD symptoms in three groups, B, C, and D. The B. section had to do with "re-experiencing" the flood. B1 was "intrusive recollections"; B2 involved nightmares about floods; B3 was a person acting as though a flood was occurring at that moment; B4 was when a person became miserable just being reminded about the flood; and B5 was a reaction to a reminder about floods (Liu, p. 2). The risk of PTSD was higher in females interviewed (consistent with other research reflected in this paper), and of the 33,340 citizens interviewed, 2,875 could be diagnosed as having PTSD (just 8.6% of the total). And of those 8.6% that were diagnosed with PTSD, 16.8% feared flash-flooding; and 10.4% had a terrible fear of embankments collapsing.

Literature Review -- Asian Tsunami, 2004

Another study conducted that investigated the psychological problems people suffered from after a major natural disaster is reported in the Journal of Psychosomatic Research. In this instance, over 200,000 people died but those that survived the terrible Indian Ocean tsunami that washed ashore in 2004 were evaluated fourteen months after the disaster. The authors queried 1,505 survivors of the tsunami, residents of Stockholm, who had been visiting the Indian Ocean area as tourists when the tsunami struck (Keskinen-Rosenqvist, et al., 2011, p. 180).

These tourists (after having been back in Sweden for 14 months) were given the General Health Questionnaire and the Impact of Events Scale, to determine the proportion of those individuals impacted psychologically by the tsunami. The results showed that 300 of the 1,505 people had physical symptoms only; and 123 people only had psychological symptoms (Keskinen-Rosenqvist, 182). The four physical symptoms that were found to have been associated with the tsunami were: threat to life only; threat to life and presence in the water or beach; threat to life and loss of a loved one. Those physical symptoms were linked by the authors to "psychological distress and post traumatic stress" thanks to the GHQ-12 and IES-R evaluative surveys (Keskinen-Rosenqvist, 183).

Interestingly, there were people that completed the surveys who were not injured in the tsunami but who complained of physical symptoms but did not report any psychological symptoms, which suggest that indeed these individuals suffered from psychological issues.

An article in the International Journal of Social Psychiatry shows that of 643 survivors of the 2004 tsunami (in five Indian villages), 15.1% suffered what researchers called post traumatic stress symptoms (PTSS). That is, these individuals suffered from "traumatic grief" because of the loss of children, because of financial losses, and due to physical injuries as well. But to elevate the 15.1% from "symptoms" to actual "disorder" was "questionable" (Rajkumar, et al., 2011). The scales used by the researchers -- the IES-R and the Complicated Grief Assessment scale (CGA) -- and the data was collected by a 10-member team (including two psychiatrists, a professor of psychiatry, social workers, psychiatric nurses and an occupational therapist) (Rajkumar, 3).

Interviews were conducted in the homes of the survivors -- or in the temporary shelters many were living in -- nine months after the Asian tsunami. Each interview lasted between an hour and 90 minutes, and if the person being interviewed showed fatigue or had trouble staying in good concentration, another interview was scheduled for later. The statistics that were accumulated show that 65% of those that showed PTSS were female and that 68% of the participants experienced fear, helplessness and horror while 87% were afraid they were going to die when the tsunami hit. The authors believe that too often researchers believe they are recording instances of PTSD when in fact the individuals were only showing symptoms (Rajkumar, 5). So great care was taken in this research not to over-report a symptom that cannot be wholly validated; in other words, the authors avoided "false positives" and moreover, they believe that the validity of existing screening instruments when verifying PTSD is still "questionable" (Rajkumar, 6).

Additional research on survivors of the Asian tsunami (Heir, et al., 2011) indicates that predictably, some tourists from Norway, Denmark and Sweden that were in the region when the tsunami roared ashore suffered symptoms of PTSD. Those individuals that were "danger exposed" (either caught in the waves or chased inland by waves), not surprisingly, reported to have suffered more post-traumatic stress than those tourists in the "non-danger exposed" (not directly affected by the giant waves but in the region and hence psychologically impacted) (Heir, 9). The scale that was used was the IES-R, which revealed that the lower the level of education and the fact that the individual was female determined the degree to which PTSD was detected.

The Norwegian survey using IES-R was conducted 6 months after the tsunami; the Danish survey was done 10 months after the tsunami and the survey in Sweden took place 14 months following the disastrous tsunami. In summation, Heir and colleagues determined that the tourists that returned home from the Asian experience showed "long-term" post traumatic stress disorder "symptoms" based upon the severity of their exposure to the deadly waves (9).

Meanwhile, that December tsunami in the Indian Ocean in 2004 -- the day after Christmas, when millions of people were on the long sandy beaches, including tourists from all over the world -- had a profound impact on adolescents, according to a peer-reviewed article in the Journal of Loss and Trauma (Bhushan, et al., 2007, p. 245). In this research paper 130 adolescents (61 girls and 69 boys between the ages of 10 to 16 years) were studied in order to determine the prevalence of PTSD; as has been noted in previous research, female adolescents exhibited more likelihood of trauma than males did. The adolescents surveyed were from the Nagapatinan district of Tamilnadu, India, which was powerfully impacted by the tsunami. The IES scale was used, along with the Children's Revised Impact of Event Scale (CRIES) -- which has been used in many instances as a valid screening tool for PTSD -- and also the Pediatric Emotional Distress Scale (PEDS) was employed for this research, Bhushan writes… [END OF PREVIEW] . . . READ MORE

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