Interplay of Post-Traumatic Stress Disorder, General Anxiety Disorder and Resilience among Earthquake Survivors in Zinda Jan District of Herat Province
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Abstract
Background: Frequent earthquakes that hit Herat province in October 2023 resulted in considerable loss of lives and massive property damage. They caused massive physical and psychosocial injuries; while physical injuries could be treated by healthcare professionals, psychological injuries could be neglected. This study aimed to assess the prevalence and associated factors of post-traumatic stress disorder (PTSD) and general anxiety disorder (GAD); and their association with resilience among earthquake survivors in Zinda Jan district.
Materials and Methods: This community-based cross-sectional study was conducted during October and November 2023, among 418 cases -including 206 (49.3%) males and 212 (50.7%) females- with a mean age of 40.16±14.17 years. Sociodemographic data was collected via a structured questionnaire, data on PTSD was collected using the PTSD Checklist for DSM-5 (PCL-5), and data on GAD was collected via the Dari-version of GAD-7 questionnaire.
Findings: GAD was detected in all (100%) participants, of whom 6 (1.4%), 29 (6.9%), and 383 (91.6%) had mild, moderate, and severe anxiety, respectively. Furthermore, 153 (36.6%), 134 (32.1%) and 131 (31.3%) participants suffered from mild, moderate and severe PTSD. As per resilience, 153 (36.6%) had low resilience, 142 (34.0%) had moderate resilience, and 123 (29.4%) had high resilience. There was a significant association between resilience and PTSD (p=0.011), but no significant association was observed between resilience and GAD (p=0.515). GAD was significantly associated with gender, marital status, and participants’ access to mental health. A significant association was found between PTSD and participants’ occupation, nutrition status, and access to mental health.
Conclusion: The interplay between post-traumatic stress disorder, generalized anxiety disorder and resilience among earthquake survivors in the Zinda Jan district is a complex and multifaceted issue that demands further research and intervention. While the experiences of an earthquake can lead to the development of PTSD and GAD, resilience plays a crucial role in helping individuals overcome these challenges and rebuild their lives. A comprehensive understanding of this interplay can inform the development of effective interventions and prevention programs to support earthquake survivors and promote their overall well-being.
Keywords
Earthquake, GAD, PTSD, Herat, Resilience##plugins.themes.academic_pro.article.details##
References
- Acharya Pandey, R., Chalise, P., Khadka, S., Chaulagain, B., Maharjan, B., Pandey, J., Nepal, J., & Pandey, C. (2023). Post-traumatic stress disorder and its associated factors among survivors of 2015 earthquake in Nepal. BMC Psychiatry, 23(1), 340. https://doi.org/10.1186/s12888-023-04836-3
- Ahmed, M., Alzoubi, K. H., & Khabour, O. F. (2020). Vitamin E prevents the cognitive impairments in post-traumatic stress disorder rat model: behavioral and molecular study. Psychopharmacology (Berl), 237(2), 599-607. https://doi.org/10.1007/s00213-019-05395-w
- Brown, M., Agyapong, V., Greenshaw, A., Cribben, I., Brett-MacLean, P., & Drolet, J. (2019). Significant PTSD and other mental health effects present 18 months after the Fort McMurray wildfire: findings from 3,070 grades 7–12 students. Front Psychiatry, 10, 623. https://doi.org/10.3389/fpsyt.2019.00623
- Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76-82. https://doi.org/ https://doi.org/10.1002/da.10113
- Farooqui, M., Quadri, S. A., Suriya, S. S., Khan, M. A., Ovais, M., Sohail, Z., Shoaib, S., Tohid, H., & Hassan, M. (2017). Posttraumatic stress disorder: a serious post-earthquake complication. Trends Psychiatry Psychother, 39(2), 135-143. https://doi.org/10.1590/2237-6089-2016-0029
- Gerstner, R. M. F., Lara-Lara, F., Vasconez, E., Viscor, G., Jarrin, J. D., & Ortiz-Prado, E. (2020). Earthquake-related stressors associated with suicidality, depression, anxiety and post-traumatic stress in adolescents from Muisne after the earthquake 2016 in Ecuador. BMC Psychiatry, 20(1), 347. https://doi.org/10.1186/s12888-020-02759-x
- He, L., Lai, K., Lin, Z., & Ma, Z. (2018). Media Exposure and General Trust as Predictors of Post-traumatic Stress Disorder: Ten Years after the 5.12 Wenchuan Earthquake in China. Int J Environ Res Public Health, 15(11). https://doi.org/10.3390/ijerph15112386
- Hikichi, H., Aida, J., Tsuboya, T., Kondo, K., & Kawachi, I. (2016). Can Community Social Cohesion Prevent Posttraumatic Stress Disorder in the Aftermath of a Disaster? A Natural Experiment From the 2011 Tohoku Earthquake and Tsunami. Am J Epidemiol, 183(10), 902-910. https://doi.org/10.1093/aje/kwv335
- Honda, Y., Fujiwara, T., Yagi, J., Homma, H., Mashiko, H., Nagao, K., Okuyama, M., Ono-Kihara, M., & Kihara, M. (2019). Long-Term Impact of Parental Post-Traumatic Stress Disorder Symptoms on Mental Health of Their Offspring After the Great East Japan Earthquake. Front Psychiatry, 10, 496. https://doi.org/10.3389/fpsyt.2019.00496
- Ide-Okochi, A., Samiso, T., Kanamori, Y., He, M., Sakaguchi, M., & Fujimura, K. (2022). Depression, Insomnia, and Probable Post-Traumatic Stress Disorder among Survivors of the 2016 Kumamoto Earthquake and Related Factors during the Recovery Period Amidst the COVID-19 Pandemic. Int J Environ Res Public Health, 19(7). https://doi.org/10.3390/ijerph19074403
- Kim, Y., Roberts, A. L., Rimm, E. B., Chibnik, L. B., Tworoger, S. S., Nishimi, K. M., Sumner, J. A., Koenen, K. C., & Kubzansky, L. D. (2021). Posttraumatic stress disorder and changes in diet quality over 20 years among U.S. women. Psychol Med, 51(2), 310-319. https://doi.org/10.1017/S0033291719003246
- Kvestad, I., Ranjitkar, S., Ulak, M., Chandyo, R. K., Shrestha, M., Shrestha, L., Strand, T. A., & Hysing, M. (2019). Earthquake Exposure and Post-traumatic Stress Among Nepalese Mothers After the 2015 Earthquakes. Front Psychol, 10, 734. https://doi.org/10.3389/fpsyg.2019.00734
- Leiva-Bianchi, M., Cornejo, F., Fresno, A., Rojas, C., & Serrano, C. (2018). Effectiveness of cognitive-behavioural therapy for post-disaster distress in post-traumatic stress symptoms after Chilean earthquake and tsunami. Gac Sanit, 32(3), 291-296. https://doi.org/10.1016/j.gaceta.2017.07.018
- Li, G., Wang, L., Cao, C., Fang, R., Liu, P., Luo, S., Zhang, J., Hall, B. J., & Elhai, J. D. (2018). DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors. Eur J Psychotraumatol, 9(1), 1468710. https://doi.org/10.1080/20008198.2018.1468710
- Li, L., Reinhardt, J. D., Van Dyke, C., Wang, H., Liu, M., Yamamoto, A., Chen, Q., & Hu, X. (2020). Prevalence and risk factors of post-traumatic stress disorder among elderly survivors six months after the 2008 Wenchuan earthquake in China. BMC Psychiatry, 20(1), 78. https://doi.org/10.1186/s12888-020-2474-z
- Li, X., Aida, J., Hikichi, H., Kondo, K., & Kawachi, I. (2019). Association of Postdisaster Depression and Posttraumatic Stress Disorder With Mortality Among Older Disaster Survivors of the 2011 Great East Japan Earthquake and Tsunami. JAMA Netw Open, 2(12), e1917550. https://doi.org/10.1001/jamanetworkopen.2019.17550
- Liang, Y., Cheng, J., Zhou, Y., & Liu, Z. (2019). Trajectories of posttraumatic stress disorders among children after the Wenchuan earthquake: a four-year longitudinal study. Eur J Psychotraumatol, 10(1), 1586266. https://doi.org/10.1080/20008198.2019.1586266
- Liberty, K., Tarren-Sweeney, M., Macfarlane, S., Basu, A., & Reid, J. (2016). Behavior Problems and Post-traumatic Stress Symptoms in Children Beginning School: A Comparison of Pre- and Post-Earthquake Groups. PLoS Curr, 8. https://doi.org/10.1371/currents.dis.2821c82fbc27d0c2aa9e00cff532b402
- Liu, S., Lu, L., Bai, Z. Z., Su, M., Qi, Z. Q., Zhang, S. Y., Chen, Y., Ao, B. Y., Cui, F. Z., Lagarde, E., & Lii, K. (2019). Post-Traumatic Stress and School Adaptation in Adolescent Survivors Five Years after the 2010 Yushu Earthquake in China. Int J Environ Res Public Health, 16(21). https://doi.org/10.3390/ijerph16214167
- Lu, B., Zeng, W., Li, Z., & Wen, J. (2020). Prevalence and Influencing Factors of Post-Traumatic Stress Disorder Among Survivors in the Hard-Hit Areas Ten Years After the Wenchuan Earthquake: A Cross-Sectional Study. Neuropsychiatr Dis Treat, 16, 933-941. https://doi.org/10.2147/ndt.S247527
- Marthoenis, M., Nirwana, A., & Fathiariani, L. (2019). Prevalence and determinants of posttraumatic stress in adolescents following an earthquake. Indian J Psychiatry, 61(5), 526-528. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_35_19
- Masten, A. S. (2021). Resilience of children in disasters: A multisystem perspective. Int J Psychol, 56(1), 1-11. https://doi.org/10.1002/ijop.12737
- Resnik, J., Miller, C. J., Roth, C. E., Burns, K., & Bovin, M. J. (2023). A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD Military Medicine, 1-9. https://doi.org/https://doi.org/10.1093/milmed/usad376
- Rutter, M. (2012). Resilience as a dynamic concept. Dev Psychopathol, 24(2), 335-344. https://doi.org/10.1017/s0954579412000028
- Sharma, V., Levin, B. L., Rahill, G. J., Baldwin, J. A., Luitel, A., & Marhefka, S. L. (2021). Post-earthquake Self-Reported Depressive Symptoms and Post-Traumatic Stress Disorder and their Correlates among College-Youths in Kathmandu, Nepal. Psychiatr Q, 92(4), 1595-1609. https://doi.org/10.1007/s11126-021-09928-5
- Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. Eur J Psychotraumatol, 5, 25338. https://doi.org/10.3402/ejpt.v5.25338.
- Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Itern Med, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092.
- Terock, J., Hannemann, A., Van der Auwera, S., Janowitz, D., Spitzer, C., Bonk, S., Völzke, H., & Grabe, H. J. (2020). Posttraumatic stress disorder is associated with reduced vitamin D levels and functional polymorphisms of the vitamin D binding-protein in a population-based sample. Prog Neuropsychopharmacol Biol Psychiatry, 96, 109760. https://doi.org/10.1016/j.pnpbp.2019.109760
- The Khaama Press News Agency. (2023). 4,000 killed and injured in Herat earthquake: Ministry. https://www.khaama.com/4000-killed-and-injured-in-herat-earthquake-ministry/ (retrieved on 21 Nov, 2023).
- The National Statistics and Information Authority. (2023). Estimated Population of Afghanistan 2023 - 24. Kabul: NSIA Retrieved from http://nsia.gov.af:8080/wp-content/uploads/2023/07/%D8%A8%D8%B1%D8%A7%D9%88%D8%B1%D8%AF-%D9%86%D9%81%D9%88%D8%B3-%DA%A9%D8%B4%D9%88%D8%B1-%D8%B3%D8%A7%D9%84-1402-1.pdf (Retrieved on 21 Nov, 2023).
- The Times of India. (2023). Afghanistan: Death toll in Herat earthquakes surpasses 4,000. Times Syndication Service. Retrieved October 13, 2023 from https://timesofindia.indiatimes.com/world/south-asia/afghanistan-death-toll-in-herat-earthquakes-surpasses-4000/articleshow/104323135.cms?from=mdr (retrieved on 21 Nov, 2023).
- Timalsina, R., Sangwathana, P., & Sae-Sia, W. (2021). Resilience and its associated factors among older disaster survivors. Geriatric Nursing, 42(6), 1264-1274. https://doi.org/https://doi.org/10.1016/j.gerinurse.2021.08.008
- Ungar, M. (2011). The social ecology of resilience: addressing contextual and cultural ambiguity of a nascent construct. Am J Orthopsychiatry, 81(1), 1-17. https://doi.org/10.1111/j.1939-0025.2010.01067.x.
- Valladares-Garrido, M. J., Zapata-Castro, L. E., Peralta, C. I., García-Vicente, A., Astudillo-Rueda, D., León-Figueroa, D. A., & Díaz-Vélez, C. (2022). Post-Traumatic Stress Disorder after the 6.1 Magnitude Earthquake in Piura, Peru: A Cross-Sectional Study. Int J Environ Res Public Health, 19(17). https://doi.org/10.3390/ijerph191711035
- Wahab, S., Yong, L. L., Chieng, W. K., Yamil, M., Sawal, N. A., Abdullah, N. Q., Muhdisin Noor, C. R., Wd Wiredarma, S. M., Ismail, R., Othman, A. H., & Damanhuri, H. A. (2021). Post-traumatic Stress Symptoms in Adolescents Exposed to the Earthquake in Lombok, Indonesia: Prevalence and Association With Maladaptive Trauma-Related Cognition and Resilience. Front Psychiatry, 12, 680393. https://doi.org/10.3389/fpsyt.2021.680393
- Wang, W., Wu, X., & Lan, X. (2020). Rumination mediates the relationships of fear and guilt to posttraumatic stress disorder and posttraumatic growth among adolescents after the Ya'an earthquake. Eur J Psychotraumatol, 11(1), 1704993. https://doi.org/10.1080/20008198.2019.1704993
- Wang, W., Wu, X., & Tian, Y. (2018). Mediating Roles of Gratitude and Social Support in the Relation Between Survivor Guilt and Posttraumatic Stress Disorder, Posttraumatic Growth Among Adolescents After the Ya'an Earthquake. Front Psychol, 9, 2131. https://doi.org/10.3389/fpsyg.2018.02131
- Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schurr, P. P. (2013). PTSD Checklist for DSM-5 (PCL-5). In Measurement Instrument.
- Xu, J. J., & Ou, L. (2014). Resilience and quality of life among Wenchuan earthquake survivors: the mediating role of social support. Public Health, 128, 430-437. https://doi.org/10.1016/j.puhe.2014.03.002
- Yang, Y., Zeng, W., Lu, B., & Wen, J. (2021). The Contributing Factors of Delayed-Onset Post-traumatic Stress Disorder Symptoms: A Nested Case-Control Study Conducted After the 2008 Wenchuan Earthquake. Front Public Health, 9, 682714. https://doi.org/10.3389/fpubh.2021.682714.