Post-traumatic stress and depression following a landslide linked to the 2018 floods in Kerala, India: Relevance of screening

Authors

  • Manoj Therayil Kumar, MD, FRCPsych
  • Nilamadhab Kar, MD, DPM, DNB, MRCPsych https://orcid.org/0000-0002-8801-9245
  • Vasudevan Namboodiri, MD, MRCPsych
  • Aloka Joy, MD, DNB
  • Dhanya Sreeenivasan, MPhil
  • Sebind Kumar, DPM, DNB
  • Tine Van Bortel, PhD, FRTC, FRSA

DOI:

https://doi.org/10.5055/jem.0728

Keywords:

depression, flood, Kerala, landslide, post-traumatic stress disorder

Abstract

There is scant information on early manifestation of trauma due to catastrophic natural events and its relation with stress-related disorders. The specific objective of this study was to estimate and compare the prevalence of post-traumatic stress and depression on day 3 (D3) and week 6 (W6) following the 2018 flood in Kerala, India. In a cross-sectional study, symptoms of post-traumatic stress and depression were studied at D3 using primary care Post-Traumatic Stress Disorder screen for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PC-PTSD-5), and then at W6 using PC-PTSD-5, Screening Questionnaire for Disaster Mental Health, PTSD Checklist for DSM-5 (PCL-5), and Becks Depression Inventory. Majority (70 percent) were screen positive at D3 (n = 20) compared with 30 percent at W6 (n = 50), with a decreased frequency of all symptoms. Being PC-PTSD-5 screen positive at W6 was significantly associated with the presence of threat to life, physical injury, and death of relatives or neighbors. According to PCL-5, at W6, 46 percent had possible PTSD. Except damage to property, other disaster related or sociodemographic variables were not associated with the risk of having PTSD. Positive predictive value of PC-PTSD-5 (D3) for PTSD (PCL-5) at W6 was 64.3 percent. Depression and possibility of PTSD were significantly associated. A considerable proportion of victims continued to have posttraumatic stress and depression although the frequency decreased over time. A simple screening measure may help to identify victims with possible PTSD.

 

Author Biographies

Manoj Therayil Kumar, MD, FRCPsych

Hon Consultant Psychiatrist, MPFT, Stafford, Hon Senior Lecturer, Keele University, Keele, Newcastle ST5 5BG, United Kingdom; Director, Institute for Mind and Brain, Thrissur, Kerala, India

Nilamadhab Kar, MD, DPM, DNB, MRCPsych

Consultant Psychiatrist and College Tutor, Black Country Partnership NHS Foundation Trust, Honorary Professor, University of Wolverhampton, Wolverhampton, United Kingdom; Honorary Professor, Sri Sri University, Cuttack, Odisha, India

Vasudevan Namboodiri, MD, MRCPsych

Consultant Psychiatrist, Institute for Mind and Brain, Thrissur, Kerala, India

Aloka Joy, MD, DNB

Consultant Psychiatrist, Institute for Mind and Brain, Thrissur, Kerala, India

Dhanya Sreeenivasan, MPhil

Clinical Psychologist, Institute for Mind and Brain, Thrissur, Kerala, India

Sebind Kumar, DPM, DNB

Assistant Professor, Department of Psychiatry, Government Medical College, Thrissur, Kerala, India

Tine Van Bortel, PhD, FRTC, FRSA

Professor of Global Health & Wellbeing, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom; Principle Investigator in Public Mental Health & Wellbeing, Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom

References

Rajkumar AP, Premkumar TS, Tharyan P: Coping with the Asian tsunami: Perspectives from Tamil Nadu, India on the determinants of resilience in the face of adversity. Soc Sci Med. 2008; 67: 844-853.

Neria Y, Nandi A, Galea S: Post-traumatic stress disorder following disasters: A systematic review. Psychol Med. 2008; 38: 467-480.

Kar N, Krishnaraaj R, Rameshraj K: Long-term mental health outcomes following the 2004 Asian tsunami disaster. Disaster Health. 2014; 2: 35-45.

Kar N: Natural disasters in developing countries: Mental health issues. Indian J Med Sci. 2009; 63: 327.

Sharan P, Chaudhary G, Kavathekar SA, et al.: Preliminary report of psychiatric disorders in survivors of a severe earthquake. Am J Psychiatry. 1996; 153: 556-558.

Kar N, Das I, Misra B, et al.: Psychiatric morbidity after floods. Ind J Ment Health Disabil. 2002; 3: 3-7.

Kar N, Jagadisha, Sharma P, et al. Mental health consequences of the trauma of super-cyclone 1999 in Orissa. Indian J Psychiatry. 2004; 46: 228-237.

Chadda RK, Malhotra A, Kaw N, et al.: Mental health problems following the 2005 earthquake in Kashmir: Findings of community-run clinics. Prehosp Disaster Med. 2007; 22: 541-545.

Sharma A, Kar N: Posttraumatic stress, depression, and coping following the 2015 Nepal earthquake: A study on adolescents. Disaster Med Public Health Prep. 2019; 13: 236-242.

Math SB, Tandon S, Girimaji SC, et al.: Psychological impact of the tsunami on children and adolescents from the Andaman and Nicobar islands. Prim Care Companion J Clin Psychiatry. 2008; 10: 31-37.

Kar N, Samantaray NN, Kar S, et al.: Anxiety, depression, and post-traumatic stress a month after 2019 cyclone Fani in Odisha, India. Disaster Med Public Health Prep. 2022; 16(2): 670-677.

Becker SM: Psychosocial care for adult and child survivors of the 2004 tsunami disaster in India. Am J Public Health. 2006; 96: 1397-1398.

Maheshwari N, Yadav R, Singh NP: Group counseling: A silver lining in the psychological management of disaster trauma. J Pharm Bioall Sci. 2010; 2: 267-274.

Telles S, Singh N, Joshi M, et al.: Post traumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: A randomized controlled study. BMC Psychiatry. 2010; 10: 18.

Kar N: Psychosocial issues following a natural disaster in a developing country: A qualitative longitudinal observational study. Int J Disaster Med. 2006; 4: 169-176.

McFarlane AC, Williams R: Mental health services required after disasters: Learning from the lasting effects of disasters. Depress Res Treat. 2012; 2012: 970194.

Kar N: Disaster mental health in India: A long journey ahead. In Murthy RS, Gupta N (eds.): Leadership in Indian Psychiatry: Converting Thoughts into Practice. New Delhi, 2022: 312-332.

Vishnu CL, Sajinkumar KS, Oommen T, et al.: Satellite-based assessment of the August 2018 flood in parts of Kerala, India. Geomatics Nat Hazards Risk. 2019; 10: 758-767.

Government of Kerala: Statistics—stand with Kerala. 2018. Accessed June 9, 2019.

Elm EV, Altman DG, Egger M, et al.: Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ. 2007; 335: 806-808.

Prins A, Bovin MJ, Smolenski DJ, et al.: The primary care PTSD screen for DSM-5 (PC-PTSD-5): Development and evaluation within a veteran primary care sample. J Gen Intern Med. 2016; 31: 1206-1211.

Fujii S, Kato H, Maeda K: A simple interview-format screening measure for disaster mental health: An instrument newly developed after the 1995 great Hanshin earthquake in Japan—The screening questionnaire for disaster mental health (SQD). Kobe J Med Sci. 2008; 53: 375-385.

Weathers F, Litz B, Keane T, et al.: The PTSD Checklist for DSM-5 (PCL-5). 2013. Available at http://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp. Accessed April 6, 2015.

Beck AT, Ward CH, Mendelson M, et al.: An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561-571.

The Market Research Society of India: Socio-Economic Classification-2011: The New SEC system. Media Research Users Council. 2011. Available at http://mruc.net/uploads/posts/b17695616c422ec8d9dadafc1c3eec26.pdf. Accessed September 6, 2019.

Kar N: Indian research on disaster and mental health. Indian J Psychiatry. 2010; 52: 286.

Bravo M, Rubio-Stipec M, Canino GJ, et al.: The psychological sequelae of disaster stress prospectively and retrospectively evaluated. Am J Community Psychol. 1990; 18: 661-680.

Madakasira S, O’Brien KF: Acute posttraumatic stress disorder in victims of a natural disaster. J Nerv Ment Dis. 1987; 175: 286-290.

Cao H, McFarlane AC, Klimidis S: Prevalence of psychiatric disorder following the 1988 Yun Nan (China) earthquake—The first 5-month period. Soc Psychiatry Psychiatr Epidemiol. 2003; 38: 204-212.

Kaiser CF, Sattler DN, Bellack DR, et al.: A conservation of resources approach to a natural disaster: Sense of coherence and psychological distress. J Soc Behav Personal. 1996; 11: 459-476.

Carr VJ, Lewin TJ, Webster RA, et al.: Psychosocial sequelae of the 1989 Newcastle earthquake: I. Community disaster experiences and psychological morbidity 6 months post-disaster. Psychol Med. 1995; 25: 539-555.

Eustace K, Macdonald C, Long N: Cyclone bola: A study of the psychological after-effects. Anxiety Stress Coping. 1999; 12: 285-298.

Staab JP, Grieger TA, Fullerton CS, et al.: Acute stress disorder, subsequent posttraumatic stress disorder and depression after a series of typhoons. Anxiety. 1996; 2: 219-225.

Winje D: Long-term outcome of trauma in adults: The psychological impact of a fatal bus accident. J Consult Clin Psychol. 1996; 64: 1037-1043.

Norris FH, Perilla JL, Riad JK, et al.: Stability and change in stress, resources, and psychological distress following natural disaster: Findings from Hurricane Andrew. Anxiety Stress Coping. 1999; 12: 363-396.

Wang X, Gao L, Shinfuku N, et al.: Longitudinal study of earthquake- related PTSD in a randomly selected community sample in North China. PubMed-NCBI. 2000. Available at https://www.ncbi.nlm.nih.gov/pubmed/?term=Longitudinal+study+of+earthquake-related+PTSD+in+a+randomly+selected+community+sample+in+North+China. Accessed March 3, 2019.

Kar N, Bastia BK: Post-traumatic stress disorder, depression and generalised anxiety disorder in adolescents after a natural disaster: A study of comorbidity. Clin Pract Epidemiol Ment Health. 2006; 2: 17.

Goenjian AK, Molina L, Steinberg AM, et al.: Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane mitch. AJP. 2001; 158: 788-794.

Thompson MP, Norris FH, Hanacek B: Age differences in the psychological consequences of Hurricane Hugo. Psychol Aging. 1993; 8: 606-616.

Garrison CZ, Weinrich MW, Hardin SB, et al.: Post-traumatic stress disorder in adolescents after a hurricane. Am J Epidemiol. 1993; 138: 522-530.

Caldera T, Palma L, Penayo U, et al.: Psychological impact of the hurricane mitch in Nicaragua in a one-year perspective. Soc Psychiatry Psychiatr Epidemiol. 2001; 36: 108-114.

Nahar N, Blomstedt Y, Wu B, et al.: Increasing the provision of mental health care for vulnerable, disaster-affected people in Bangladesh. BMC Public Health. 2014; 14: 708.

Vernberg EM, Silverman WK, LaGreca AM, et al.: Prediction of post-traumatic stress symptoms in children after Hurricane Andrew. J Abnorm Psychol. 1996; 105: 237-248.

La Greca A, Silverman WK, Vernberg EM, et al.: Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study. J Consult Clin Psychol. 1996; 64: 712-723.

Cagney KA, Sterrett D, Benz J, et al.: Social resources and community resilience in the wake of superstorm sandy. PLoS One. 2016; 11: E0160824.

Abraham K: Highly ‘impressed’: UNICEF team visits Alappuzha Relief Camp, praises Kerala govt. The News Minute. 2018. Available at https://www.thenewsminute.com/article/highly-impressed-unicefteam-visits-alappuzha-relief-camp-praises-kerala-govt-87229. Accessed June 9, 2019.

Bradburn IS: After the earth shook: Children’s stress symptoms 6–8 months after a disaster. Adv Behav Res Ther. 1991; 13: 173-179.

Published

01/02/2023

How to Cite

Kumar, MD, FRCPsych, M. T., N. Kar, MD, DPM, DNB, MRCPsych, V. Namboodiri, MD, MRCPsych, A. Joy, MD, DNB, D. Sreeenivasan, MPhil, S. Kumar, DPM, DNB, and T. Van Bortel, PhD, FRTC, FRSA. “Post-Traumatic Stress and Depression Following a Landslide Linked to the 2018 Floods in Kerala, India: Relevance of Screening”. Journal of Emergency Management, vol. 21, no. 1, Jan. 2023, pp. 85-96, doi:10.5055/jem.0728.