Prevalence and determinants of posttraumatic stress in adolescents following an earthquake.

CONTEXT: The 2016 Aceh earthquake causes a significant mental health impact in adolescents. However, the prevalence and determinants have never been reported. AIMS: The study aimed to estimate the prevalence rate and determinants of posttraumatic stress symptoms in adolescents following an earthquake. SETTINGS AND
DESIGN: This cross-sectional study was conducted in Pidie Jaya district approximately 6 months following the earthquake.
MATERIALS AND METHODS: The Trauma Screening Questionnaire (TSQ) was distributed to adolescents living around the earthquake-affected area. STATISTICAL ANALYSIS: The Chi-square test and binomial logistic regression were performed using GNU PSPP statistical software.
RESULTS: The prevalence of posttraumatic stress disorder (PTSD) was 47%, and the mean score of TSQ was 5.11 (standard deviation = 2.3). The presence of PTSD was associated with gender and age (P = 0.001). Logistic regression analysis confirmed that gender, being injured, witnessing someone injured, feeling stressed after the earthquake, and feeling scared of staying inside a building following the earthquake were independently and significantly associated with PTSD (P = 0.001).
CONCLUSION: The prevalence of PTSD at 6 months following an earthquake is relatively high, and many factors are associated with the presence of PTSD. Copyright:

INTRODUCTION

On December 7, 2016, an earthquake measuring 6.5 on the Richter scale occurred in the district of Pidie Jaya, Aceh Province, Indonesia. The earthquake killed 103 people, injured approximately 700 people, destroyed more than 16,000 houses, and caused more than 85,000 people to be temporarily displaced.[1] Such a natural disaster might lead to the mental and psychological problems among the survivors.

Posttraumatic stress disorder (PTSD) is among the most common mental disorders that arise following a traumatic event. A systematic review reveals that the prevalence of PTSD among survivors of a natural disaster ranges between 30% and 40%.[2] A recent study even found it as low as 13.10% rates of PTSD following an earthquake.[3] Factors such as age, traumatic event before and after the earthquake, and traumatic exposure to the earthquake are associated with the presence of PTSD in adolescents.[4] Furthermore, having felt scared, witnessed someone killed, having a family member killed, and having a close friend killed from the earthquake were also independently associated with PTSD.[5] Nevertheless, the prevalence and determinants of PTSD among adolescents who experienced the 2016 Aceh earthquake have rarely been studied. The present study, therefore, aimed at examining the prevalence and factors associated with the presence of PTSD among adolescents following the earthquake.

MATERIALS AND METHODS

Data collection

This cross-sectional study was conducted 6 months following the 2016 Aceh earthquake. A multistage random sampling method was employed to select adolescents who were directly exposed to the earthquake. In the first stage, three out of seven high schools in the area were randomly selected. In the second stage, four classes from each school were randomly selected. A total of 321 samples from 12 selected classes were included in the study. A local institutional ethical committee approved the study. The guardians of the students gave informed consent.

Measurements

The first part of the survey questionnaire includes demographic information and some questions regarding the adolescents' experience from the earthquake. The demographic information includes the age, gender, the number of siblings, and age and occupation of parents. Regarding the experience with the earthquake, they were asked whether they were injured, trapped, witnessed someone injured or trapped, feeling stressed after the earthquake, had nuclear family passed away, had friends or relatives passed away, and feeling afraid of staying inside a building since the earthquake.

A brief PTSD screening tool, the Trauma Screening Questionnaire (TSQ),[6] was used to screen the presence of PTSD. TSQ is a brief self-report measure of reaction to a traumatic experience. It consists of 10 questions regarding the feeling of an individual related to a traumatic event. The score of six or more is considered as PTSD.[6] The tool has good psychometric properties and has been used to study PTSD in adolescents elsewhere.[78] Cronbach's alpha of TSQ in the present study was 0.73.

Statistical analysis

GNU PSPP statistical software (https://www.gnu.org/software/pspp/) was used to analyze the data. The association between demographic variables and PTSD was tested using a Chi-square test. The binomial logistic regression was performed to predict variables that are independently associated with the presence of PTSD.

RESULTS

From the total of 321 respondents, 65.7% were female, and the mean age was 16.7 years (standard deviation = 0.6). More than half (61%) of respondents were in Grade 11, and the remaining (39%) respondents were in Grade 10. The majority (97.5%) of respondents had none of their nuclear family killed by the earthquake. Five (1.56%) respondents had one family member and three (0.93%) respondents had two family members died from the earthquake. Some of respondents were injured (9.97%) and trapped under the ruins (18.07%). The majority of respondents did not attend the class few days following the earthquake (89.72%), had to move somewhere else such as to temporary displaced camp (70.09%), and felt scared of staying inside the building after the earthquake (82.24%). Around half of respondents had their home damaged (46.73), had friends or neighbors passed away (44.24%), or felt stressed following the earthquake (52.96%).

Furthermore, almost half (47.04%) of respondents met the criteria for PTSD according to TSQ. The presence of PTSD was significantly associated with gender (χ2= 19.51, P = 0.001) and age (χ2= 15.42, P = 0.001). The details of the association between PTSD and demographic variables are presented in Table 1.

Table 1

Demographic and clinical variables of posttraumatic stress disorder

Parameters	PTSD, n (%)	No PTSD, n (%)	χ2	P
Gender
Female	118 (55.92)	93 (44.08)	19.51	0.001*
Male	33 (30)	77 (70)
Age (years)
16	66 (56.41)	51 (43.59)	15.42	0.001*
17	110 (62.50)	66 (37.50)
18	19 (67.85)	9 (32.14)
Grade
10	64 (51.20)	61 (48.80)	1.42	0.233
11	87 (44.39)	109 (55.61)
Injured during the earthquake
Yes	24 (75)	8 (25)	11.15	0.001*
No	127 (43.94)	162 (56.06)
Directly witness someone wounded or trapped
Yes	96 (56.14)	75 (43.86)	12.16	0.001*
No	55 (36.67)	95 (63.33)
Feeling stressed after the earthquake
Yes	109 (64.12)	61 (35.88)	42.31	0.001*
No	42 (27.81)	109 (72.19)
Afraid of staying inside the building following the earthquake
Yes	145 (54.92)	119 (45.08)	37.09	0.001*
No	6 (10.53)	51 (89.47)

*Significant at <0.001. PTSD – Posttraumatic stress disorder

Binary logistic regression confirmed that PTSD was independently associated with gender, being injured, witnessing someone injured, feeling stressed after the earthquake, and fear of staying inside the building since the earthquake (P = 0.001). Someone who fears to stay indoors was 6.5 times more likely to suffer from PTSD. Meanwhile, those who were injured had almost 4 times more likely to suffer from PTSD. The details of binomial regression analysis are presented in Table 2.

Table 2

Binomial logistic regression analysis for posttraumatic stress disorder

Variables	β	SE	P	AOR	95% CI
Female gender	1.01	0.29	0.001	2.74	1.54-4.88
Injured during the earthquake	1	0.49	0.005	3.97	1.52-10.38
Directly witness someone injured or trapped	1.06	0.27	0.001	2.90	1.71-4.94
Feeling stressed after the earthquake	1.07	0.28	0.001	2.91	1.68-5.06
Fear to stay inside a building following the earthquake	1.87	0.49	0.001	6.55	2.53-16.97

SE – Standard error; CI – Confidence interval; AOR – Adjusted odds ratio

DISCUSSION

The present study reveals the prevalence rate and factors associated with PTSD among adolescents 6 months following an earthquake. It was found that the prevalence of PTSD was 47%. This rate seems to be slightly higher than previously reported.[3459] Different point of time and measurement tools used to estimate PTSD might be among the explanation. Besides, the severity of symptom of PTSD improves over time, and the prevalence decreases up to 50% 6 months after the traumatic event.[10]

This study also reveals that someone who is scared of staying inside a building following an earthquake is 6.5 times more likely to have PTSD. Furthermore, someone who was injured in an earthquake is almost 4 times more likely to develop PTSD. These findings are exceptional to the field of psychiatry and disaster management. The disaster preparedness plan, therefore, should highly consider the possible psychological impact on the affected population. Early mental and psychological interventions are necessary to prevent more threatening effects in the community, especially the adolescents. The outcome of these interventions on the long term too is an area for further studies.

CONCLUSION

The prevalence of PTSD among adolescents at around 6 months following an earthquake is relatively high. Several factors are associated with the presence of PTSD in adolescents, including gender, being injured, witnessed someone injured, felt stressed after the earthquake, and fear to stay inside the building following the earthquake.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.