Bondan Sikoki

Mental Health in Sumatra after the Tsunami

OBJECTIVES We assessed the levels and correlates of posttraumatic stress reactivity (PTSR) of more than 20,000 adult tsunami survivors by analyzing survey data from coastal Aceh and North Sumatra, Indonesia. METHODS A population-representative sample of individuals interviewed before the tsunami was traced in 2005 to 2006. We constructed 2 scales measuring PTSR by using 7 symptom items from the Post Traumatic Stress Disorder (PTSD) Checklist-Civilian Version. One scale measured PTSR at the time of interview, and the other measured PTSR at the point of maximum intensity since the disaster. RESULTS PTSR scores were highest for respondents from heavily damaged areas. In all areas, scores declined over time. Gender and age were significant predictors of PTSR; markers of socioeconomic status before the tsunami were not. Exposure to traumatic events, loss of kin, and property damage were significantly associated with higher PTSR scores. CONCLUSIONS The tsunami produced posttraumatic stress reactions across a wide region of Aceh and North Sumatra. Public health will be enhanced by the provision of counseling services that reach not only people directly affected by the tsunami but also those living beyond the area of immediate impact.

Education, Vulnerability, and Resilience after a Natural Disaster

The extent to which education provides protection in the face of a large-scale natural disaster is investigated. Using longitudinal population-representative survey data collected in two provinces on the island of Sumatra, Indonesia, before and after the 2004 Indian Ocean tsunami, we examine changes in a broad array of indicators of well-being of adults. Focusing on adults who were living, before the tsunami, in areas that were subsequently severely damaged by the tsunami, better educated males were more likely to survive the tsunami, but education is not predictive of survival among females. Education is not associated with levels of post-traumatic stress among survivors 1 year after the tsunami, or with the likelihood of being displaced. Where education does appear to play a role is with respect to coping with the disaster over the longer term. The better educated were far less likely than others to live in a camp or other temporary housing, moving, instead, to private homes, staying with family or friends, or renting a new home. The better educated were more able to minimize dips in spending levels following the tsunami, relative to the cuts made by those with little education. Five years after the tsunami, the better educated were in better psycho-social health than those with less education. In sum, education is associated with higher levels of resilience over the longer term.

Indonesian Living Standards Before and After the Financial Crisis

The Asian financial crisis in 1997-98 was a serious blow to what had been a thirty-year period of rapid growth in East and Southeast Asia. This book uses the Indonesia Family Life Surveys (IFLS) from late 1997 and late 2000 to examine changes in many different dimensions of living standards of Indonesians from just before the start of the crisis to three years after. As of late 2000, almost three years after the economic crisis began, individuals in the IFLS data appear to have recovered in their living standards to the levels seen immediately prior to the crisis. This is the case for many dimensions of their standard of living: poverty, incomes, wages, child school enrolments, child and adult health status and health care utilization, and contraception use. Indonesian Living Standards: Before and After the Financial Crisis uses the rich data in IFLS to present a true to life overview of living conditions in rural and urban Indonesia. It is an important reference for policy-makers and those who work on a range of development and economic issues affecting Indonesia.

Mortality, The Family and The Indian Ocean Tsunami*

Over 130,000 people died in the 2004 Indian Ocean tsunami. The correlates of survival are examined using data from the Study of the Tsunami Aftermath and Recovery (STAR), a population-representative survey collected in Aceh and North Sumatra, Indonesia, before and after the tsunami. Children, older adults and females were the least likely to survive. Whereas socio-economic factors mattered relatively little, the evidence is consistent with physical strength playing a role. Pre-tsunami household composition is predictive of survival and suggests that stronger members sought to help weaker members: men helped their wives, parents and children, while women helped their children.

Socioeconomic Success and Health in Later Life: Evidence from the Indonesia Family Life Survey

Indonesia has been undergoing a major health and nutrition transition over the past twenty or more years and there has begun a significant aging of the population as well. In this paper the authors focus on documenting major changes in the health of the population aged 45 years and older, since 1993. They use the Indonesia Family Life Survey (IFLS), a large-scale, broad-based panel survey of households and individuals, covering 4 full waves from 1993 to 2007/8. Much of the changes can be seen as improvements in health, such as the movement out of undernutrition and communicable disease as well as the increasing levels of hemoglobin. On the other hand, other changes such as the increase in overweight and waist circumference, especially among women, and continuing high levels of hypertension that seems to be inadequately addressed by the health system, indicate that the elderly population in Indonesia is increasingly exposed to higher risk factors that are correlated with chronic problems such as cardiovascular diseases and diabetes. In addition to documenting long-run changes in health and its distribution among the elderly Indonesian population, they examine correlations between socio-economic status, principally education and percapita expenditure, and numerous health outcome and behavioral variables.