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Tsunami in Kerala, India: Long-Term Psychological Distress, Sense of Coherence, Social Support, and Coping in a Non-Industrialized Setting

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Sophia von Lieres

This study assesses the long-term psychological consequences after the 2004 Asian tsunami in Kerala, India. Participants are the inhabitants of Kerala’s coastal regions. The results indicated that the participants who were affected by the tsunami showed significantly greater psychological distress and symptoms of post-traumatic stress disorder (PTSD) than a control group. In addition, it could be shown that protective factors, such as perceived social support, certain coping strategies, and a sense of coherence, could decrease the level of symptoms. Perceived social support, in particular, decreased symptoms of post-traumatic stress disorder and a strong sense of coherence mitigated psychological distress. Avoidance coping was found to be more effective in decreasing levels of traumatic stress in this non-industrialized, collectivistic cultural setting.

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1 Introduction: Tsunami in Kerala ................................................................... 1 2 Description of Post-Traumatic Stress Disorder (PTSD) ............................... 7 2.1 Historical Development of the PTSD Construct ........................................... 7 2.2 Definition of Trauma ............................................................................................ 8 2.3 Criteria for Diagnosis According to ICD-10 and DSM-IV ........................ 9 2.3.1 PTSD in the ICD-10 ............................................................................. 10 2.3.2 PTSD in the DSM-IV ........................................................................... 10 2.4 Cross-Cultural Validity of the PTSD Construct ................................... 15 2.5 Epidemiology ........................................................................................ 20 2.5.1 Community-Based Studies ........................................................ 21 2.5.2 Studies with High-Risk Groups ................................................ 22 2.5.4 Studies in Non-Industrialized Settings ...................................... 26 2.6 Prognosis and Duration of PTSD .......................................................... 28 2.7 Comorbidity with other Mental Disorders ............................................ 30 3 Risk Factors and Predictors of PTSD .......................................................... 35 3.1 Socio-Demographic Factors .................................................................. 35 3.1.1 Gender ....................................................................................... 37 3.1.2 Age ............................................................................................ 39 3.1.3 Education ................................................................................... 40 3.1.4 Earlier psychiatric disorders ...................................................... 41 3.1.5 Exposure .................................................................................... 41 3.2 Predictors of PTSD: A Meta-Analysis .................................................. 42 4 Protective Factors ........................................................................................ 43 4.1 Resilience, Hardiness, and Sense of Coherence in the Salutogenesis Model ............................................................................................................. 43 4.1.1 Resilience .................................................................................. 43 4.1.2 Hardiness ................................................................................... 45 4.1.3 Sense of Coherence ...................................................................... 46 4.2 Coping Strategies .................................................................................. 53 4.2.1 Coping Efficacy ........................................................................ 54 4.2.2 PTSD and Coping after Natural Disasters ................................ 56 4.2.3 Cultural Aspects of Coping ....................................................... 58 4.3 Social Support ....................................................................................... 62 4.3.1 Empirical Evidence ................................................................... 63 4.3.2 Social Support and the Family .................................................. 66 4.3.3 Community Support and PTSD ................................................ 67 4.3.4 Cultural Aspects of Social Support ........................................... 67 5 Etiology of PTSD ........................................................................................ 69 Contents xiv 5.1 Neurobiological Models ........................................................................ 70 5.1.1 Neurotransmitters ...................................................................... 70 5.1.2 Memory ..................................................................................... 72 5.2 Behavioral and Cognitive Models ......................................................... 73 5.2.1 Appraisals of the Trauma and/or its Consequences .................. 73 5.2.2 The Characteristics of the Trauma Memory ............................. 74 5.2.3 Dysfunctional Behavior and Cognitive Processing Styles...

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