Mental Health in Sumatra after the Tsunami

Objectives. We assessed the levels and correlates of posttraumatic stress reactivity (PTSR) of more than 20000 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 post traumnatic 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.

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Mental Health Recovery and Economic Recovery after the Tsunami : High-Frequency Longitudinal Evidence from Sri Lankan Small Business Owners
(2008) de Mel, S.; McKenzie, D.; Woodruff, C.
A sample of 561 Sri Lanka microenterprise owners affected to various extents by the December 2004 Indian Ocean tsunami were surveyed five times at quarterly intervals between March 2005 and April 2006. Mental health recovery was measured through questions on return to normalcy and change in life outlook. Business profits were used to measure livelihoods recovery. We find that these mental health process measures are correlated with post-traumatic stress disorder and general mental health in a validation survey, and display similar correlates to both in the cross-section. However, socioeconomic factors are not found to be significant in predicting the dynamics of mental health recovery in a fixed effects logistic regression. Mental health recovery from a given initial level therefore appears to depend largely on time since the disaster, and not on economic recovery of an individual's livelihood. (c) 2007 Elsevier Ltd. All rights reserved.
Psychological Health Before, During, and After an Economic Crisis : Results from Indonesia, 1993 - 2000
(World Bank, Washington, DC, 2007-11) Thomas, Duncan; Friedman, Jed
The 1997 Indonesian financial crisis resulted in severe economic dislocation and political upheaval, and the detrimental consequences for economic welfare, physical health, and child education have been previously established in numerous studies. We also find the crisis adversely impacted population psychological well-being. We document substantial increases in several different dimensions of psychological distress among male and female adults across the entire age distribution over the crisis period. In addition, the imprint of the crisis can be seen in the differential impacts of the crisis on low education groups, the rural landless, and residents in those provinces that were hit hardest by the crisis. Elevated levels of psychological distress persist even after indicators of economic well-being such as household consumption had returned to pre-crisis levels suggesting long-term deleterious effects of the crisis on the psychological well-being of the Indonesian population.
Psychological Health Before, During, and After an Economic Crisis : Results from Indonesia, 1993–2000
(World Bank, 2009-02-28) Thomas, Duncan; Friedman, Jed
The 1997 Indonesian financial crisis resulted in severe economic dislocation and political upheaval. Previous studies have established the detrimental consequences for economic welfare, physical health, and child education. The crisis also affected the psychological well-being of the Indonesian people. Comparing responses of the same individuals interviewed before and after the crisis, this study documents substantial increases in several dimensions of psychological distress among men and women across the age distribution. It shows larger impacts of the economic crisis on the more vulnerable groups, including those with low education, the rural landless, urban residents, and those in provinces most affected by the crisis. Elevated psychological distress persists even after the economy returns to precrisis levels, suggesting that the deleterious effects of the crisis may persist longer on the psychological well-being of the Indonesian population than on standard measures of economic well-being.
Utilization of Formal Health Services for Children Ages 1-5 in Aceh after the 2004 Tsunami : Which Children Did Not Receive the Health Care They Needed? Implications for Other Natural Disaster Relief Efforts
(Taylor & Francis, 2014-01-22) Rassekh, Bahie Mary; Santosham, Mathuram
On December 26, 2004 the Indian Ocean earthquake and massive tsunami caused one of the most devastating natural disasters in history, affecting hundreds of thousands of people. The hardest-hit country was Indonesia, and the province closest to the epicenter of the earthquake was Aceh, on the northern coast of Indonesia’s Sumatra island. These events caused great changes in the lives of the Acehnese, especially those populations who were displaced from their homes and patterns of life. In order to fully support Aceh’s reconstruction, health centers needed to be rebuilt and providers trained, but also more subtle behaviors of this vulnerable population had to be understood so that associated essential needs could be met. This historic event created a situation where living conditions, household structures, and household roles changed, and where trauma affected much of the population. With huge amounts of aid having been provided for Aceh, this evaluation of the situation in terms of children’s access and usage of necessary primary care is critical. This study was carried out in association with the Johns Hopkins University Center for Refugee and Disaster Response. It was part of the Center’s evaluation of the health status and living conditions of IDPs in the Aceh region of Indonesia, affected by the tsunami. In summary, this paper puts forth that, although utilization of formal health services for children was relatively high after the tsunami, there were certain children who received significantly less care, including those who were displaced, those who were being cared for by someone other than their mother, and those for whom one or both parents had died.
An Evaluation of Public, Private, and Mobile Health Clinic Usage for Children Under Age Five in Aceh After the Tsunami : Implications for Future Disasters
(Taylor and Francis, 2014-03-27) Rassekh, Bahie Mary; Shu, Winnie; Santosham, Mathuram; Burnham, Gilbert; Doocy, Shannon
Aceh, Indonesia, was the hardest-hit area in the 26 December 2004 Indian Ocean earthquake and tsunami, with more than 500,000 people displaced, 120,000 people dead, and total damages and losses estimated at $4.5 billion. The relief effort following the tsunami was also immense. This study aimed to determine and assess utilization patterns of formal public versus private and mobile health services for children under age 5 with diarrhea, cough and difficulty breathing, fever, or skin disease and to identify determinants of care usage. A household survey of 962 households was administered to caretakers of children aged 1–5 years. A sample of clusters within Banda Aceh and Aceh Besar were selected and those caretakers within the cluster who fit the inclusion criteria were interviewed. Of those caretakers who utilized formal health services as the first line of care for their sick child, 62% used a public health facility, 30% used a private health facility, and 8% used a mobile clinic. In terms of significant factors associated with public, private, and mobile care utilization, mobile clinics were at one side of the spectrum and private clinics were at the other side overall, with public care somewhere in between. This was true for several variables. Mobile clinic users reported the lowest cost of services and medicine and the highest perceived level of accessibility, and private care users reported the highest perceived level of satisfaction. Utilization of formal health services for children was quite high after the tsunami. The caretaker's perceived satisfaction with public health services could have been improved. Mobile clinics were an accessible source of health care and could be used in future disaster relief efforts to target those populations that seek less care for their sick children, including displaced populations, and those children whose parents have died.

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