The Trauma screening questionnaire (TSQ) is also a standardized questionnaire to briefly measure the level of post-traumatic stress disorders (Brewin.
IJEP 36 (11) : 888-894 (2016)
(International Conference)
The Association Between KAP on Disasters with Depression, GAD and PTSD Among Flood Victims Irniza R., Emilia Z.A., Sharifah Norkhadijah S.I., Vivien H., S.M. Praveena, Karmegam K., Yu Bin H., Nik Nurul Aizzah NA, Syukriah MH, Suriani I. and Zailina H. Universiti Putra Malaysia (UPM), Department of Environmental and Occupational Health, Faculty of Medicine and Helath Sciences, 43400 Serdang, Selangor, Malaysia Flood disaster is detrimental to mental health of victims and the importance of knowledge, attitude and practice (KAP) in minimizing this impact seldom gets due attention. This study aims to explore the association between knowledge, attitude and practice on flood disasters and mental health of flood victims. This is a cross-sectional study among 150 flood victims in Kelantan, Malaysia. Standardized questionnaires were used to assess their levels of depression (PHQ-9), general anxiety disorders (GAD-7) and post-traumatic stress disorders (PTSD) (TSQ). Questions on knowledge, attitude and practice were adapted and customized for local victims. Face-to-face interview using these questionnaires were conducted for each respondent. The respondents were 100% Malay and Muslim. Majority of them were female (59.3%) and the average age was 48.44 years. Results showed that 29% of the respondents experienced mild to moderate depression with 2% of severe depression. Fourteen respondents (9.33%) had severe level of general anxiety disorders and 28% of the respondents were suspected to have post-traumatic stress disorders. The time of receiving information about flood is the most significant factor predicting depression, general anxiety disorders and post-traumatic stress disorders. This study highlights the significance of information dissemination within 6 months KEYWORD KAP (knowledge, attitude and practice), Depression, GAD (General anxiety disorders), PTSD (Post, traumatic stress disorders), flood disaster victims. INTRODUCTION Flood is the worst natural disaster recorded in Malaysia affecting almost 4.82 million people which is around 22% of the total population of the country (D/iya et al., 2014). People in Kelantan are among those Malaysian who suffered from such impact annually. The flood in 2014 was the most disastrous occurrence in Kelantan which was considered as ‘tsunami,like disaster’ involving the displacement of 202,000 people and 13 deaths (Su-Lyn, 2015). This flood is also known as ‘Bah Kuning’ (yellow flood) that reflects the high content of mud. During the disaster, 180 flood victims were received by Hospital University Sains Malaysia daily and those cases were generally acute problems from underlying chronic medical 888
conditions, such as acute exacerbation of chronic obstructive airway disease and heart failure (Baharuddin et al., 2015). However, the state of psychological and mental health of the affected population remains unknown. There is no such studies being conducted among Kelantanese flood victims. In-depth interview were conducted among 5 flood victims in Johor and results showed that they were suffered from cognitive emotional and behavioural shortfalls, such as fear, anxiety, hopelessness, helplessness and depression (Nasir et al., 2012). Meanwhile, in a neighbour country, Thailand, cases of probable mental health problems was reported to be 40% among flood victims (Assanangkornchai et al., 2004). About 10 years ago, findings of a similar interview but in a large study in Yunan (N= 33 340) indicated that 2875 (8.6%) had symptoms of posttraumatic stress disorder (PTSD) (Liu et al., 2006).
INDIAN J. ENVIRONMENTAL PROTECTION, VOL. 36, NO. 11 NOVEMBER 2016 © 2016 - Kalpana Corporation
This study also identified its significant factors which were female, older age, flood type and flood severity. A lower post-traumatic stress disorders prevalence (2.6%) was found in Vietnam among flood victims of Typhoon Xangsane (Amstadter et al., 2009). It was also recorded that the prevalence of depression and general anxiety disorders was 5.9% and 2.2%, respectively. Although the number of studies seems high but these previous studies covers a few flood disasters in a few countries and it is small considering the number of such occurrence throughout the worlds (Crabtree, 2012). Moreover, how knowledge, attitude and perception (KAP) on the impacts of flood among victims seldom gets due attention. Findings of a study in Thailand, where flood is also an annual occurrence showed that people who did not know how flood would impact on them were unprepared and suffered loses and commotion in their routine life (Wisitwong and McMillan, 2010). Baan and Klijn (2004) concluded that people living in floodplain are more familiar with flooding, know the behaviour of the river and have experienced evacuation are better prepared and experienced less psychological stress. It is evident that understanding the state of knowledge, attitude and perception among flood victims are essential to help them managing psychological stress better in future flood disaster. Therefore, this study aims to explore how knowledge, attitude and practice affect mental health of flood victims in Kelantan, Malaysia where flood is an annual episode. Findings of this study will assist in prioritising the potential intervention strategies. MATERIAL AND METHOD This is a cross-sectional study involving 150 flood victims in Kuala Krai, Kelantan, Malaysia 3 months after the yellow flood. Seventy people at the recovery centre were recruited to participate in this study. They were living in temporary houses or tents provided by the government or the NGOs. Another 80 participants were selected from 5 villages which included Kampung Tualang, Kampung Bekok, Kampung Sg. Durian, Kampung Batu Lada and Kampung Guchil. These villages were located at riverine areas and experienced annual river flooding including the yellow flood.
Sixteen people were selected randomly from each village. A set of Malay version survey consisted of questions on socio-demographical data, knowledge, attitude and practice (KAP), Generalized anxiety disorder (GAD), post-traumatic stress disorders (PTSD), and depression. Questionnaires were translated from English to Malay and the translation was confirmed by experts. Respondents were approached door-to-door basis and face-to-face interview were conducted for each participant. Knowledge, attitude and practice (KAP) For the knowledge, attitude and practice part of the study, in total there were 8 questions for information resources, 10 questions on knowledge about natural disasters, 10 questions for attitude on natural disasters, 3 questions on perception of risk communication and 9 questions for practice on natural disasters. The reliability of this questionnaire was found to be acceptable (=0.71). A small part of the questions on knowledge, attitude and practice were based on a pilot survey for disaster preparedness on earthquake and tsunami that was used in Indonesia that was supported by United Nations Populations Fund (UNPFA) (National Board for Disaster Management Indonesia, 2013). More than half of the knowledge, attitude and practice questions were developed and customized for the local Malaysian scenario. Generalised anxiety disorders (GAD), post-traumatic stress disorders (PTSD) and depression The GAD-7 is a standardized questionnaire to measure the symptoms of generalised anxiety disorders, (Spitzer et al., 2006). General anxiety disorders is characterized by an excessive, inappropriate and chronic worrying about various matters accompanied by feeling restlessness difficulty in concentrating, irritability and disturbed sleep, fatigue and muscle tension which lead to impairment in person’s life (Rowa and Anthony, 2008). It has good reliability, as well as criterion, construct, factorial and procedural validity with 89% sensitivity and 82% specificity (Spitzer et al., 2006). The reliability of Malay version-GAD scale used for this study was tested and was found good (=0.84).
INDIAN J. ENVIRONMENTAL PROTECTION, VOL. 36, NO. 11, NOVEMBER 2016 © 2016 - Kalpana Corporation
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Table 1. Socio-demographical distribution of respondents (N = 150) Variable Age, years
f%
Mean (± SD)
MinMax
48.44 (15.74)
21-83
Gender Female 89 (59.3) Male 61 (47.7) Education levels No education 46 (30.7) Primary 30 (20) Secondary 63 (42) Tertiary 11 (7.3) Household income (RM) 934.03 (920) Marital status Single 5 (3.3) Married 145 (96.7) Occupation Self employed 28 (18.7) Rubber tappers 7 (4.7) Civil Servant 10 (6.7) Pensioners 14 (9.3) Housewife 43 (28.7) Businessman 10 (6.7) Unemployed 16 (10.7) Labour 6 (4) Contract-based 16 (10.7)
RESULT Socio-demographical characteristics 0-5400
The Trauma screening questionnaire (TSQ) is also a standardized questionnaire to briefly measure the level of post-traumatic stress disorders (Brewin et al., 2002). Post-traumatic stress disorders is a disorder that develop after a person have experienced a shocking or traumatic event which persist for over 1 month to years and it is severe enough to interfere with normal life (National Institute of Mental Health, 2016). It has 10 items asking whether or not participants have experienced any of the listed symptoms twice in the past week. The sensitivity of trauma screening questionnaire was from 0.57-0.86 and its specificity was 0.73-0.96 (Brewin et al., 2002). The reliability of Malay-version trauma screening questionnaire(TSQ) scale used for this study was tested was found acceptable (=0.77). The patient health questionnaire (PHQ) is a tool to assess the level of depression. Depression is a 890
serious mood disorders that disrupt the daily activities which includes symptoms but not limited to persistent sad, feelings of hopelessness, fatigue, loss of appetite and sleep difficulties (National Institute of Mental Health, 2016a). Patient health questionnaire consists of 9 items and has a sensitivity and a specificity of 88% for major depression (Kroenke et al., 2001). The reliability of the Malay version patient health questionnaire scale used for this study was tested and the Cronbach alpha was good (=0.83).
All respondents were Malay and Muslim. Majority of them were female (59.3%), married (96.7%). The average age and household income was 48.44 years old and RM934.03, respectively. About onethird of them (30.7%) have no education background. Their occupation were varied from selfemployed, rubber tappers to housewife and unemployed. Association between socio-demographical characteristics with depression, GAD and PTS Findings indicated that only 3 respondents (2%) experienced severe depression and one respondent had moderate to severe depression. About 31.33% of respondents had depression. Fourteen respondents (9.33%) were having severe anxiety and 16% of respondents were having moderate level of anxiety. Around 28% respondents were suspected to have post-traumatic stress disorders. Chi-square tests and correlation tests were run to explore the relationship between socio-demographic data and the level of depression, anxiety and post-traumatic stress disorders disorders. Female were found to be more depressed than male (2 = 11.12). Higher household income (r= -0.30) and higher educational levels (r = -0.22) were found to be significantly correlated with lower level of depression. Similar findings were found for anxiety. Female were also found to have higher level of anxiety than male ( = 8.54). Higher household income (r = -0.17) and higher educational levels (r = -0.20) were found to be significantly correlated with lower level of anxiety. There were more female have post-traumatic
INDIAN J. ENVIRONMENTAL PROTECTION, VOL. 36, NO. 11 NOVEMBER 2016 © 2016 - Kalpana Corporation
Table 2. Multiple linear regression predicting for PTSD among respondents (N = 150) Model
B
SE
(Constant) 1.07 1.08 Age 0.00 0.01 Gender 0.86 0.39 Household 0.00 0.00 income Information 1.09 0.39 received Medication 1.09 0.43 * p is significant when
