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In December 2004, a massive tsunami devastated parts of Indonesia, Thailand, Sri Lanka and other countries, killing more than 200,000 people.
Many of the survivors were traumatized by the catastrophe and its aftermath, and a new study conducted in Thailand and published this week has for the first time attempted to quantify the mental health problems afflicting these survivors.
In interviews with hundreds of adults and children who lived through the tsunami, the researchers found significant evidence of anxiety, depression and post-traumatic stress disorder, known as PTSD. I spoke with researcher Frits Van Griensven in Bangkok, Thailand, where he is part of a collaborative project involving the Thai Ministry of Public Health and the U.S. Centers for Disease Control.
VAN GRIENSVEN: "Basically what we found in our survey were higher levels of mental health problems in people affected by the tsunami disaster, in a sense that those who lived closer to the sea or closer to where the disaster actually happened had higher levels of mental health problems than those who were more distant."
As many as 13 percent of the children showed signs of PTSD, for example. Among adults, as many as 37 percent reported symptoms of anxiety.
Van Griensven says his team identified a key risk factor in many of these mental health problems.
VAN GRIENSVEN: "From our research we know that loss of livelihood is the strongest predictor of having mental health problems. So if you lose your house, your boat, your work ? you are at much more higher risk to develop post-disaster mental health problems or anxiety and depression."
The study of tsunami survivors, which was published in , the Journal of the American Medical Association, found lower rates of PTSD than were seen in previous studies in postwar Kosovo and Afghanistan. Van Griensven says that could be explained in part by the Thais' Buddhist-based belief system, which provides them with a framework for making sense out of a random disaster.
VAN GRIENSVEN: "A lot of people that I talked to in the camps or in the area, they felt that the sea was being over-exploited, and they were taking so much out of the sea that the sea was no longer able to cope with it. And so it had to react to it. For them, that was then the reason why this happened to them. And that's also something that people can understand." Q: "It wasn't just a random event, in other words." "No, no, in their belief system this was not just like a random event. It was the revenge of the spirits of the sea."
There has been relatively little study of the psychological impacts of disasters for reasons including the difficulty of organizing a research program on short notice in chaotic, post-disaster conditions. Although it's a matter of common sense that survivors would be depressed or anxious, Frits Van Griensven points out that having more detailed, quantitative information is key to an effective response.
VAN GRIENSVEN: "You can imagine post-disaster there is a lot of chaos, there is not a lot of coordination, and there [are] people lost and missing, people going through grief. So systematically assessing the mental health problems of these people is a challenge. So in the first place, to describe them, to know what they are and to what extent they exist, that's needed before we can move on to intervention and programs for these people."
There's no way to prevent tsunamis, but given the consequences ? psychological and otherwise ? the next best thing is to give people living in vulnerable areas as much advance warning as possible.
Countries rimming the Indian Ocean are making progress towards a regional warning and alert center, but there are cultural and political obstacles, more than technical roadblocks, to completing an effective system that can deliver a timely warning of an impending tsunami.
David McAlary narrates our story, which was written by VOA's Frank Ling.