Ajmal Hussain

Psychiatric disorders and functional impairment among disaster victims after exposure to a natural disaster: A population based study

OBJECTIVE We aimed to examine psychiatric morbidity and functional impairment after a natural disaster. METHOD Norwegian tourists who survived the 2004 tsunami in Khao Lak (n = 63), a severely affected area in Thailand, were interviewed in person 2.5 years after the disaster. The examination included the Mini International Neuropsychiatric Interview, the PTSD module of the Structured Clinical Interview for DSM-IV Axis I disorders, the Work and Social Adjustment Scale (WSAS), the Global Assessment of Functioning function score (GAF-F), and questions covering background characteristics and disaster exposure. RESULTS The most prevalent disorders were specific phobia (30.2%), agoraphobia (17.5%), social anxiety disorder (11.1%), PTSD (11.1%), major depressive disorder (MDD, 11.1%), and dysthymic disorder (DD, 11.1%). In 24 of the 40 respondents with a current psychiatric disorder, symptoms had originated after the tsunami. The post-tsunami 2.5 year incidence of PTSD and MDD was 36.5% and 28.6%, respectively. Multivariable regression analysis showed that the depressive disorders (MDD and DD) and PTSD were associated with self-reported functional impairment (WSAS), and the depressive disorders were associated with clinician assessed functional impairment (GAF-F). LIMITATIONS Small sample size and high education may limit the generalizability of the results. CONCLUSIONS Depression and anxiety disorders were common among disaster victims 2.5 years after the 2004 tsunami. Psychiatric disorders other than PTSD, especially depressive disorders, are of clinical importance when considering long-term mental health effect of disasters.

The Norwegian version of the PTSD Checklist (PCL): Construct validity in a community sample of 2004 tsunami survivors

Background: The PTSD Checklist (PCL) is a widely used self-administered measure of post-traumatic stress disorder (PTSD) and it has been validated in a variety of languages and cultures. Aim: Evaluate the diagnostic validity of the Norwegian version of a specific PCL (PCL-S) for detecting PTSD in epidemiological research. Methods: Participants were severely exposed Norwegian survivors from the 2004 South-East Asian tsunami. Of 75 individuals asked to participate, 63 responded (84%). PTSD was assessed by PCL-S and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). These instruments were compared to evaluate the diagnostic validity of the PCL. We used two different scoring methods to diagnose PTSD based on PCL. The first method was based on the dichotomized sum score (cut-off ≥ 50) and the second was based on the flowchart method following DSM-IV symptom criteria. Area under the curve (AUC), Cohens kappa, sensitivity and specificity were used to evaluate the agreement between the PCL and SCID-I. Results: According to the clinical interview, 11.3% of the participants met the diagnostic criteria for PTSD. The two scoring methods of PCL-S revealed similar results: according to both methods, 14.5% were categorized with PTSD. AUC was 0.98 (95% CI 0.93–1.00). For Cohens kappa, the agreement was 0.71. Sensitivity was 0.86 and specificity 0.95. Agreement between PCL and SCID-I investigated for each of the three symptom clusters of PTSD and for the 17 individual items showed mostly a moderate to substantial agreement. Conclusions: The Norwegian version of the PCL-S performed well as a diagnostic instrument for detecting PTSD in epidemiological research.

Prevalence of psychiatric disorders and functional impairment after loss of a family member: a longitudinal study after the 2004 Tsunami.

Bereavement following disasters is a devastating experience for family members. The aim of this study was to examine the long‐term mental health effects of losing a loved one in a natural disaster.

Family structure and posttraumatic stress reactions: a longitudinal study using multilevel analyses

BackgroundThere is limited research on the relevance of family structures to the development and maintenance of posttraumatic stress following disasters. We longitudinally studied the effects of marital and parental statuses on posttraumatic stress reactions after the 2004 Southeast Asian tsunami and whether persons in the same households had more shared stress reactions than others.MethodThe study included a tourist population of 641 Norwegian adult citizens, many of them from families with children. We measured posttraumatic stress symptoms with the Impact of Event Scale-Revised at 6 months and 2 years post-disaster. Analyses included multilevel methods with mixed effects models.ResultsResults showed that neither marital nor parental status was significantly related to posttraumatic stress. At both assessments, adults living in the same household reported levels of posttraumatic stress that were more similar to one another than adults who were not living together. Between households, disaster experiences were closely related to the variance in posttraumatic stress symptom levels at both assessments. Within households, however, disaster experiences were less related to the variance in symptom level at 2 years than at 6 months.ConclusionsThese results indicate that adult household members may influence one anothers posttraumatic stress reactions as well as their interpretations of the disaster experiences over time. Our findings suggest that multilevel methods may provide important information about family processes after disasters.

Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-analysis

Objective To summarize evidence for the prevalence of posttraumatic stress disorder (PTSD) among persons with chronic pain (CP). Methods We searched databases for studies published between January 1995 and December 2016, reporting the prevalence of PTSD in persons with CP. Two reviewers independently extracted data and assessed the risk of bias. We calculated the pooled prevalence using a random-effects model and performed subgroup analyses according to pain location, the population and assessment method. Results Twenty-one studies were included and the PTSD prevalence varied from 0–57%, with a pooled mean prevalence of 9.7%, 95% CI (5.2–17.1). In subgroup analysis, the PTSD prevalence was 20.5%, 95% CI (9.5–39.0) among persons with chronic widespread pain, 11.2%, 95% CI (5.7–22.8) among persons with headache, and 0.3%, 95% CI (0.0–2.4) among persons with back pain. The prevalence in clinical populations was 11.7%, 95% CI (6.0–21.5) and in non-clinical populations 5.1%, 95% CI (0.01–17.2). In studies of self-reported PTSD symptoms, PTSD prevalence was 20.4%, 95% CI (10.6–35.5), and in studies where structured clinical interviews had been used to assess PTSD its prevalence was 4.5%, 95% (CI 2.1–9.3). The risk of bias was medium for most studies and the heterogeneity was high (I2 = 98.6). Conclusion PTSD is overall more prevalent in clinical cohorts of persons with CP and particularly in those with widespread pain, but may not always be more prevalent in non-clinical samples of persons with CP, compared to the general population. There is a large heterogeneity in prevalence across studies. Future research should identify sources of heterogeneity and the mechanisms underlying the comorbidity of the two conditions.

Longitudinal Relationship between Self-efficacy and Posttraumatic Stress Symptoms 8 Years after a Violent Assault: An Autoregressive Cross-Lagged Model

Self-efficacy is assumed to promote posttraumatic adaption, and several cross-sectional studies support this notion. However, there is a lack of prospective longitudinal studies to further illuminate the temporal relationship between self-efficacy and posttraumatic stress symptoms. Thus, an important unresolved research question is whether posttraumatic stress disorder (PTSD) symptoms affect the level of self-efficacy or vice versa or whether they mutually influence each other. The present prospective longitudinal study investigated the reciprocal relationship between general self-efficacy (GSE) and posttraumatic stress symptoms in 143 physical assault victims. We used an autoregressive cross-lagged model across four assessment waves: within 4 months after the assault (T1) and then 3 months (T2), 12 months (T3) and 8 years (T4) after the first assessment. Stress symptoms at T1 and T2 predicted subsequent self-efficacy, while self-efficacy at T1 and T2 was not related to subsequent stress symptoms. These relationships were reversed after T3; higher levels of self-efficacy at T3 predicted lower levels of posttraumatic stress symptoms at T4, while posttraumatic tress symptoms at T3 did not predict self-efficacy at T4. In conclusion, posttraumatic stress symptoms may have a deteriorating effect on self-efficacy in the early phase after physical assault, whereas self-efficacy may promote recovery from posttraumatic stress symptoms over the long term.