Mental health problems among adults in tsunami-affected areas in southern Thailand
Mental health problems among adults in tsunami-affected areas in southern Thailand
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DOI：
10.1001/jama.296.5.537
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发表时间：
2006-08-02
影响因子：
120.7
通讯作者：
Tappero, Jordan W.
中科院分区：
文献类型：
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作者：
van Griensven, Frits;Chakkraband, M. L. Somchai;Tappero, Jordan W.
2004年12月26日，印度尼西亚苏门答腊西北海岸附近发生海底地震。随后的海啸严重影响了泰国西南部所有6个省，其中5395人死亡，2991人下落不明，8457人受伤。作为公共卫生紧急反应和快速反应的一部分，设计、设置和参与者从2005年2月15日至22日，对攀牙省的流离失所者（n=371）和非流离失所者（n=322）以及甲米和普吉省的非流离失所者（n=368）的随机样本进行了多阶段、集群、基于人群的心理健康调查。数据收集使用的采访者管理的问卷调查的手持电脑。2005年9月，对攀牙县的流离失所者（n=371）和非流离失所者（n=322）进行了一项监测随访调查。主要结局指标：医疗结局研究-36健康调查简表SF-36，用于评估自我感觉的一般健康状况、身体疼痛以及社会和情感功能;哈佛创伤问卷，用于评估海啸特定的创伤事件;和霍普金斯检查表-25检测焦虑和抑郁症状。结果参与率为流离失所者和非流离失所者的快速评估调查分别为69%和58%。据报道，攀牙有12%的流离失所者和7%的非流离失所者有创伤后应激障碍症状，甲米和普吉岛有3%的非流离失所者有创伤后应激障碍症状。攀牙37%的流离失所者和30%的非流离失所者报告了焦虑症状，甲米和普吉岛22%的非流离失所者报告了焦虑症状。攀牙30%的流离失所者和21%的非流离失所者报告了抑郁症症状，甲米和普吉岛10%的非流离失所者报告了抑郁症症状。在多变量分析中，失去生计与所有3种心理健康结果（PTSD、焦虑和抑郁）的症状独立且显著相关。在对攀牙270名（73%）流离失所者和250名（80%）非流离失所者进行的9个月随访监测调查中，流离失所者的PTSD、焦虑和抑郁症状的患病率分别降至7%、24.8%和16.7%，非流离失所者的患病率分别降至2.3%、25.9%、结论：在泰国南部海啸的幸存者中，灾难发生8周后，PTSD、焦虑和抑郁症状的发生率升高，焦虑和抑郁的发生率高于PTSD症状。灾难发生九个月后，报告这些症状的比率下降，但仍然上升。这些信息对于指导、加强和评估海啸后的心理健康需求和干预措施非常重要。
Context On December 26, 2004, an undersea earthquake occurred off the northwestern coast of Sumatra, Indonesia. The tsunami that followed severely affected all 6 southwestern provinces of Thailand, where 5395 individuals died, 2991 were unaccounted for, and 8457 were injured.Objective To assess the prevalence of symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression among individuals residing in areas affected by the tsunami in southern Thailand as part of a public health emergency response and rapid assessment.Design, Setting, and Participants A multistage, cluster, population-based mental health survey was conducted from February 15 to 22, 2005, of random samples of displaced (n=371) and nondisplaced persons in Phang Nga province (n=322) and nondisplaced persons in the provinces of Krabi and Phuket (n=368). Data were collected using an interviewer-administered questionnaire on handheld computers. A surveillance follow-up survey of the displaced persons (n=371) and nondisplaced persons (n=322) in Phang Na was conducted in September 2005.Main Outcomes Measures Medical Outcomes Study-36 Short-Form Health Survey SF-36 to assess self-perceived general health, bodily pain, and social and emotional functioning; the Harvard Trauma Questionnaire to assess tsunami-specific traumatic events; and the Hopkins Checklist-25 to detect symptoms of anxiety and depression.Results Participation rates for displaced and nondisplaced persons in the rapid assessment survey were 69% and 58%, respectively. Symptoms of PTSD were reported by 12% of displaced and 7% of nondisplaced persons in Phang Nga and 3% of nondisplaced persons in Krabi and Phuket. Anxiety symptoms were reported by 37% of displaced and 30% of nondisplaced persons in Phang Nga and 22% of nondisplaced persons in Krabi and Phuket. Symptoms of depression were reported by 30% of displaced and 21% of nondisplaced persons in Phang Nga and 10% of nondisplaced persons in Krabi and Phuket. In multivariate analysis, loss of livelihood was independently and significantly associated with symptoms of all 3 mental health outcomes (PTSD, anxiety, and depression). In the 9-month follow-up surveillance survey of 270 (73%) displaced and 250 (80%) nondisplaced participants in Phang Nga, prevalence rates of symptoms of PTSD, anxiety, and depression among displaced persons decreased to 7%, 24.8%, and 16.7%, respectively, and among nondisplaced persons, prevalence rates decreased to 2.3%, 25.9%, and 14.3%, respectively.Conclusions Among survivors of the tsunami in southern Thailand, elevated rates of symptoms of PTSD, anxiety, and depression were reported 8 weeks after the disaster, with higher rates for anxiety and depression than PTSD symptoms. Nine months after the disaster, the rates of those reporting these symptoms decreased but were still elevated. This information is important for directing, strengthening, and evaluating posttsunami mental health needs and interventions.