Tsunami in Kerala, India: Long-Term Psychological Distress, Sense of Coherence, Social Support, and Coping in a Non-Industrialized Setting

Description

This study assesses the long-term psychological consequences after the 2004 Asian tsunami in Kerala, India. Participants are the inhabitants of Kerala’s coastal regions. The results indicated that the participants who were affected by the tsunami showed significantly greater psychological distress and symptoms of post-traumatic stress disorder (PTSD) than a control group. In addition, it could be shown that protective factors, such as perceived social support, certain coping strategies, and a sense of coherence, could decrease the level of symptoms. Perceived social support, in particular, decreased symptoms of post-traumatic stress disorder and a strong sense of coherence mitigated psychological distress. Avoidance coping was found to be more effective in decreasing levels of traumatic stress in this non-industrialized, collectivistic cultural setting. Cover Acknowledgements Preface Abbreviations Contents 1 Introduction: Tsunami in Kerala 2 Description of Post-Traumatic Stress Disorder (PTSD) 2.1 Historical Development of the PTSD Construct 2.2 Definition of Trauma 2.3 Criteria for Diagnosis According to ICD-10 and DSM-IV 2.3.1 PTSD in the ICD-10 2.3.2 PTSD in the DSM-IV 2.4 Cross-Cultural Validity of the PTSD Construct 2.5 Epidemiology 2.5.1 Community-Based Studies 2.5.2 Studies with High-Risk Groups 2.5.3 Studies with Disaster Victims 2.5.4 Studies in Non-Industrialized Settings 2.6 Prognosis and Duration of PTSD 2.7 Comorbidity with other Mental Disorders 3 Risk Factors and Predictors of PTSD 3.1 Socio-Demographic Factors 3.1.1 Gender 3.1.2 Age 3.1.3 Education 3.1.4 Earlier psychiatric disorders 3.1.5 Exposure 3.2 Predictors of PTSD: A Meta-Analysis 4 Protective Factors 4.1 Resilience, Hardiness, and Sense of Coherence in the Salutogenesis Model 4.1.1 Resilience 4.1.2 Hardiness 4.1.3 Sense of Coherence 4.2 Coping Strategies 4.2.1 Coping Efficacy 4.2.2 PTSD and Coping after Natural Disasters 4.2.3 Cultural Aspects of Coping 4.3 Social Support 4.3.1 Empirical Evidence 4.3.2 Social Support and the Family 4.3.3 Community Support and PTSD 4.3.4 Cultural Aspects of Social Support 5 Etiology of PTSD 5.1 Neurobiological Models 5.1.1 Neurotransmitters 5.1.2 Memory 5.2 Behavioral and Cognitive Models 5.2.1 Appraisals of the Trauma and/or its Conse-quences 5.2.2 The Characteristics of the Trauma Memory 5.2.3 Dysfunctional Behavior and Cognitive Pro-cessing Styles 6 Research Questions and Hypotheses 6.1 Research Questions 6.2 Hypotheses 7 Methods 7.1 Setting 7.1.1 Social Structure in an Indian Village 7.1.2 Religion and Ideology in Kerala 7.1.3 Cultural Beliefs about the Tsunami 7.2 Procedure 7.3 Participants 7.4 Instruments 7.4.1 Impact of Event Scale-Revised 7.4.2 Brief Symptom Inventory 7.4.3 Sense of Coherence Questionnaire 7.4.4 Brief COPE Scale 7.4.5 Social Support Questionnaire (Fragebogen zur Sozialen Unterstützung, F-SOZU; SOZU-K-22) 8 Results 8.1 Exploratory Factor Analyses 8.1.1 A Justification for the Choice of Factor Extrac-tion and Rotation Methods 8.1.2 Approach to Calculation of Factor-Based Scores 8.1.3 Factor Analysis of the Impact of Event Scale – Revised (IES-R) 8.1.4 Factor Analysis of the Brief Symptom Inventory (BSI) 8.1.5 Sense of Coherence Scale (SOC Scale) 8.1.6 Brief COPE 8.1.7 Social Support Scale 8.2 Between-Group Comparisons 8.2.1 Effect Size and Test Power 8.3 Correlations 8.4 Regression Analyses 8.5 Comparing Demographic Factors in Relation to PTSD 8.6 Path Analysis Model 8.6.1 The Hypothesized Model 8.6.2 Data Analysis 8.6.3 Results of Path Analysis 9 Overview on the Confirmation of or Contradiction to the Hypotheses 10 Discussion 10.1 SOC and Traumatic Stress 10.2 Social Support and Traumatic Stress 10.3 Coping and PTSD 10.4 Risk and Protective Factors for Developing PTSD 10.5 Conclusions from the Path Analysis Model 10.6 Trauma from a Cultural Perspective 10.7 Critical Voices Against Using the PTSD Construct in a Non-Western Setting 10.8 Disaster Relief within a Collectivistic Context 10.9 Disaster Aid and Rehabilitation after the 2004 Tsunami: Lessons to be Learned 11 Conclusions 11.1 Implications for Practice 11.2 Limitations of the Study 11.3 Suggestions for Future Research 12 References 13 Appendix: Example of Efficient Disaster Relief Aid for Long- and Short-Term Rehabilitation