Prevalence, comorbidity and predictors of post-traumatic stress disorder, depression, and anxiety in adolescents following an earthquake

Highlights

• On 7^th of December 2016, a 6.5 on the Richter scale earthquake occurred in Pidie Jaya district, Indonesia.

• The prevalence of PTSD and anxiety are relatively high in the current study population.

• Being afraid to stay inside a building since the earthquake is significant predictor for PTSD and anxiety.

Abstract

Background

This study sought to assess prevalence rate, comorbidity and predictors of Post-Traumatic Stress Disorder (PTSD), depression and anxiety among adolescents affected by the 2016 Aceh Earthquake.

Methods

A cross-sectional study was conducted six months after the earthquake. The multi-stage random sampling method was applied to a selection of respondents from district schools. A total of 321 students participated in the study. In addition to generating demographic data, a brief PTSD inventory, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorder (GAD-7) questionnaire and the Disaster Impact Questionnaire (DIQ) were administered.

Results

Approximately 58.3%, 16.8% and 32.1% of adolescents reported the clinical symptoms of PTSD, depression and anxiety, respectively. The associations and comorbidity between PTSD, depression, and anxiety were statistically significant (p = 0.001). Gender, depression, having directly seen someone injured or trapped, the injury or hospitalization of a member of the nuclear family and being afraid to stay inside a building since the earthquake were demonstrated to be the significant predictors for PTSD. The injury and hospitalization of a member of the nuclear family and feeling stressed after the earthquake were significant predictors for depression. Having been injured, having one’s house destroyed; being afraid to stay inside a building and gender were significant predictors for generalized anxiety disorder.

Conclusions

The prevalence of PTSD in the current study population is relatively high and the fact that a significant number of adolescents were afraid to stay inside a building following the earthquake calls for further investigation and treatments.

Introduction

The 2016 Aceh earthquake, measuring 6.5 on the Richter scale, occurred on the 7^th of December 2016, in the district of Pidie Jaya, Aceh province, Indonesia. The Indonesian National Board for Disaster Management (BNPB) reported that approximately 103 people were killed, around 700 injured, more than 16.238 buildings destroyed and around 85.161 people temporarily displaced (Tim PusGen, 2017). In modern history, it was considered as the second largest earthquake to occur in the province of Aceh after the 2004 Indian Ocean earthquake and tsunami. In addition to deaths, injuries, the destruction of buildings and livelihoods, and financial losses, the earthquake has had serious psychological consequences for the community living in the area.

Post-Traumatic Stress Disorder (PTSD) is a common psychiatric problem as a result of an event or events that are so painful or stressful that they pose an exceptional threat to someone’s life. The individual may develop a variety of symptoms, including re-experiencing the aspects of the traumatic event, feelings of helplessness, intense fear, frightening dreams, or avoidance of the source of trauma (NICE, 2005). These symptoms seriously disturb the functions of the victim’s daily life. In adolescents, declining school performance (Shannon et al., 1994) and increased days off from school have been associated with exposure to traumatic events (Strøm et al., 2016). The presence of post-traumatic stress symptoms, therefore, must be managed as soon as possible to avoid further suffering. The lack of appropriate treatment can lead to serious functional and emotional impairments for the individual, and create negative consequences for the community (Stein et al., 2003).

The comorbidity between PTSD, depression, and anxiety among children and adolescents following a disaster is evident (Kar and Bastia, 2006; Lai et al., 2015; Pan et al., 2015). Their prevalence rate, however, varies between studies and settings. A study conducted one year after the October 1999 super-cyclone in Orissa, India, found rates of 26.9%, 17.6% and 12.2% respectively for PTSD, major depression and generalized anxiety (Kar and Bastia, 2006). Higher rates of these mental disorders were found in a later report in China. A study conducted three years after the Wenchuan Earthquake revealed rates of 29.6%, 44.8% and 37.6%, respectively, for PTSD, depression, and anxiety (Pan et al., 2015). Lower rates of PTSD and anxiety but relatively higher depression rate was found among street children who survived the 2010 Haiti earthquake. PTSD and anxiety were found among 14.8% and 13.3% of the children, respectively, where approximately 29.7% of them had depression (Derivois et al., 2017). A significantly higher mean of PTSD-RI-5 score was also found among Japanese children who lived in a tsunami-affected compared to those who lived in a disaster-free area (Takada et al., 2018). In addition to the settings, the type of disaster and the consequences of disasters, different tools used to study these mental disorders could be responsible for the different prevalence rates found in these studies.

The determinants or predictors of PTSD, depression, and anxiety following a disaster exposure are numerous. Variables such as age, pre- and post-disaster traumatic event, enduring violence, peritraumatic distress, family violence, and street violence are major predictors of PTSD, depressive and anxiety symptoms in survivors of an earthquake (Derivois et al., 2017). Among burn survivors, the variable of negative appraisal of symptoms and maladaptive cognitive coping mechanisms are the most significant PTSD predictors (Su, 2018). Meanwhile, among a community exposed to a wildfire, pre-existing anxiety disorder, seeing homes destroyed by fire, receiving limited support either from the government or other family members and even after having consultation with regard to the disaster, were significant predictors of anxiety disorders (Agyapong et al., 2018). A study investigating the long-term effect of relocation following a natural disaster also found that the survivors who stayed in the earthquake affected area had a higher rate of PTSD compared to those who moved to other areas (Najarian et al., 2017). Studies examining the predictors of mental disorders among adolescent living in disaster-prone regions of Asia appear to be rare.

To add to the limited literature on the predictors of trauma-related mental disorders among adolescents living in the developing country of Indonesia, this study examines the impact of the 2016 Aceh earthquake on the prevalence and comorbidity of PTSD, depression and anxiety, and researches the question as to whether socio-demographic, exposure-related and clinical factors are associated with the presence of mental disorders. Consistent with previous literature concerning mental health following a traumatic event, it has been hypothesized that the prevalence of PTSD, depression, and anxiety will increase following the earthquake. It has been also hypothesized that socio-demographic, exposure-related, and clinical variables would predict the presence of PTSD, depression, and anxiety among adolescents affected by the Pidie Jaya earthquake in Indonesia.