Prevalence and psychosocial risk factors of PTSD: 18 months after Kashmir earthquake in Pakistan

Abstract

Background

On average in a year 939 earthquakes of a magnitude between 5 and 8 on the Richter scale occur around the world. In earthquakes developing countries are prone to large-scale destruction because of poor structural quality of buildings, and preparedness for earthquakes. On 8th October 2005, a major earthquake hit the remote and mountainous region of northern Pakistan and Kashmir. We wanted to find out the rate of PTSD in a randomly selected sample of participants living in earthquake area and the correlates of the PTSD.

Method

The study was conducted 18 months after the earthquake. We selected a sample of men and women living in the houses and tents for interviews. Using well established instruments for PTSD and general psychiatric morbidity we gathered information from over 1200 people in face to face interviews. We gathered information about trauma exposure and loss as well.

Results

55.2% women and 33.4% men suffered from PTSD. Living in a joint family was protective against the symptoms of PTSD. Dose of exposure to trauma was associated with the symptoms of PTSD. Living in a tent was associated with general psychiatric morbidity but not with PTSD.

Limitations

We used questionnaire instead of interviews to detect the symptoms of psychiatric disorders.

Conclusions

The symptoms of PTSD are common 18 months after the earthquake and they are specifically associated with the dose of trauma exposure. This may have implications for rehabilitation of this population.

Introduction

Earthquake is a commonly occurring natural disaster. On average in a year 939 earthquakes of a magnitude between 5 and 8 on the Richter scale occur around the world. If we only consider those earthquakes that killed a minimum of 1000 people, then about 1.8 million people lost their lives in 108 earthquakes during the twentieth century (http://earthquake.usgs.gov).

A systematic review of PTSD after disasters identified 116 studies in the category of natural disasters (Neria et al., 2008). The prevalence of PTSD in the first two years after the disasters ranged between 3.7% (Canino et al., 1990) and 60% (Madakasira and O'Brien, 1987). In samples from areas that were heavily affected by the disaster the prevalence was even higher (Finnsdottir and Elklit, 2002, Najarian et al., 2001). Prevalence of PTSD reported after a natural disaster was often lower than the PTSD reported after human made and technological disasters. PTSD in adults in Armenia 1.5 years after an earthquake was found to be 49.7% (Goenjian et al., 1994), 86.7% (Goenjian et al., 2000) and after 18 months in Turkey 41.9% (Kilic and Ulusoy, 2003).

In the included studies the post earthquake psychological problems were related to exposure to threat of injury or actual injury, closeness to the epicenter, disruption in life, resource loss, female gender, financial loss, past emotional problems, disruption in social network, lack of governmental support, and lower education levels. These findings are difficult to compare with each other as there are differences in sampling, assessment methods, time since the earthquake, intensity of the earthquake, and the scale of devastation.

Ninety one of the 108 major earthquakes (with a death toll over 1000) in the twentieth century occurred in the developing countries, accounting for 83% of 1.8 million deaths worldwide (http://earthquake.usgs.gov). These countries are prone to large-scale destruction because of their geographical location, poor structural quality of buildings, and preparedness for earthquakes. In the studies related with natural disasters reviewed by Neria et al., 34 were from United States of America, 15 from Australia, 2 from Italy, one study each from Norway, 4 from Greece, United Kingdom and New Zealand, 2 from Iceland, 5 from Japan, 9 from Taiwan and 2 from South Korea. Seventy six out of 116 studies were from developed countries and 40 from developing countries. The distribution of studies from the developing world is 2 from Mexico, 2 from Puerto Rica, 3 from China, 6 from Armenia, 4 from India, 13 from Turkey, 3 from Thailand, 2 each from Sri Lanka, Nicaragua and Honduras and 1 from Indonesia (Neria et al., 2008). Considering these facts there is a need for more studies in developing countries.

On 8th October 2005, a major earthquake measuring 7.6 on the Richter scale hit the remote and mountainous region of northern Pakistan and Kashmir. The epicenter was just north of Muzzafarabad the capital city. Altogether 4000 villages were affected, 73,000 people killed, 79,000 injured and 3.3 million rendered homeless. Over 470,000 houses were completely destroyed, nearly 65% of the hospitals in the area were destroyed or badly damaged and an estimated 10,000 school buildings were affected. This caused widespread devastation in major towns of Balakot, Muzzafarabad, Bagh and Rawalakot(www.reliefweb.int).