INTRODUCTION

Earthquake and its consequences present a major public health problem. Like other natural disasters, often without warning, they strike quickly, and are uncontrollable, affecting large population and leaving injury, death, and destruction subsequently. After earth quick, with

Age may impact the course of the disorders, with elderly subjects having been found to show a significant decrease in posttraumatic symptoms that may be due to lower psychological stress and successful coping in previous disasters experiences (2). Children and adolescents because of their developmental status are more emotionally vulnerable to the devastating effects of a disaster (3). Not only there is a high rate of sever to mild PTSD symptoms in the earth quick exposed children and adolescents but a substantial proportion of them are compatible with the criteria for depression (3).

On 26 December, 2003 at 5.26 Am, an earthquake with a magnitude of 6.3 on the Richter scale struck Bam a city located in Southern Iran, while much of the population were asleep. At least 26000 people were killed during the earth quake and 30000 injuries were reported officially. Also more than 100000 people almost became homeless. According to the Director of the Centre for Humanitarian Psychology In spite of the fact that 6.6 does not seem to be a large earthquake, it killed so many people because it occurred in a city built of adobe (4). This research was conducted to investigate the prevalence of PTSD and its correlates among high school students in Bam.

MATERIALS AND METHODS

This cross sectional survey was conducted 10 months after earthquake on all 466 high school students of Bam who remained in the City after the earthquake. Data was colleted by a self-administered questionnaire consisting a batteries of questions in three parts after obtaining informed consent: (1) Demographic data including age, educational level, the person's relationship to victims, and the number of relatives lost in the earthquake; (2) Structured PTSD questionnaire according to DSM IV-TR; (3) The Davidson trauma Scale (DTS) a 17 item scale to determine the severity of PTSD symptoms. Each item was rated on 5-point frequency (0 = not at all to 4 = every day) and severity scales (0 = not at all distressing to 4 = extremely distressing). The DTS yields a frequency score (ranging from 0 to 68), severity score (ranging from 0 to 68), and total score (ranging from 0 to 136). A cut off of [greater than or equal to]44 was considered (4). (4) The Beck Depression inventory (BDI), a 21 item self report instrument which is used to the severity of depression (minimal, mild. moderate) .Each item was rated from 0 to 3 with the maximum possible scale being 63. Evidence of the reliability and validity of DTS (4) and Beck depression inventory (5) were previously established. Using multivariate logistic regression the association between socio-demographic variable and PTSD were analyzed. The Hosmer-Lemeshow test was used to assess model fit. Statistical analyses were performed using SPSS V.14.

RESULTS AND DISCUSSION

All of the 466 students completed the questionnaires, of them 60.7% were female (Table 1). The mean ([+ or -]SD) age of the participants were 15.9([+ or -]1). According to DSM-IV-TR criteria 311 students (66.7%) met the criteria for PTSD. As shown in Table 2 the prevalence of depression among high school students was 70.4% (n = 327). The frequency of subjects answering yes and the mean score for DTS Items is shown in Table 3.

Table 1: Frequency distribution of study participations according to
selected characteristics (n = 466)

Characteristic                                No.  (%)
Sex
Female                                        283  60.7
Male                                          183  39.3

High school grade

9                                             162  34.7
10                                             88  19.0
11                                            150  32.2
12                                             66  14.1

Death of at least one first degree relative

No                                            364  78.1
Yes                                           102  21.9

Confronting with dead bodies

No                                            110  23.6
Yes                                           356  76.4

Living status

With parents                                  411  88.2
With relatives                                 51  10.9
Lonely                                          4   0.9

General family income

Low                                           218  46.8
Mid                                           168  36.1
High                                           80  18.7

Table 2: Frequency of depression with respect to scores on the Beck
Depression Inventory by severity

(%)    No.        Severity of depression

29.6  139     Normal
20     93     Mild depression
11.4   53     Consultation need with psychiatrist
20.7   96     Moderate depression
11.6   54     Sever depression
6.7    31     Very sever depression
100   466     Total

Table 3: Percentage of students answering yes and mean severity scores
for post traumatic stress events in the previous 7 days

Statement                                       Percent of      Mean
                                                 students     severity
                                                answering      score
                                                   yes

Have you painful imaginations in relation to        83.2       4.2
painful event?

Have you had painful dreams of events?              83.2       4.0

Have you had feeling the event is repeating ?       71.8       3.7

Have you had serious problem in confronting         91.8       4.2
with reminders?

When you remember the event, have you had           39.1       1.7
reactions like sweating, palpitation, and
shortness of breath?

Have you had avoiding from any thought about        72.7       3.5
event?

Have you had avoiding from anything or              64.1       3.1
participating in situation those are
remembering the event?

Have you had realized that you are not able to      50.9       2.2
remember of important parts of event?

Have you had many problems in relation to           64.1       3.2
pleasurable things?

Have you had feeling of strangeness or              61.4       2.9
disruption in interpersonal relationship?

Have you had being unable to love people?           70.5       3.5

Have you had feeling of shortness of the            27.3       3.7
future?

Have you had trouble in getting/continuing the      69.5       3.4
sleep?

Have you had being aroused, or suddenly to          68.2       3.3
become angry?

Have you had trouble in concentration?              93.2       4.3

Have you had feeling as if you are on the edge      52.5       2.4
of precipice and easily become petrified?

Have you had sever restlessness?                    62.7       3.6

The final results of the multivariate logistic regressions are shown in Table 4. The highest odds of PTSD was associates with female sex (OR: 2.9, 95% CI: 1.9-4.5). Those confronted with dead bodies were more likely to express PTSD (OR: 1.9, 95% CI: 1.2-3.2).

The prevalence of PTSD was 66.7% which is remarkable in comparison to studies elsewhere (6). It was comparable to studies done after large disasters such as tsunami (7). The differences between these numbers may be due to the different methodologies between surveys and the difference between the nature and severity of the disaster. The severity of trauma in this study may be to some extent, due to the time of earthquake, when the most people were asleep. Concentration difficulties and upsetting by reminders were the two most frequently reported symptoms (Table 3), which was compatible with the findings of Yang et al. (8).

About 70% of subjects showed some degree of depression (Table 2). A study conducted on students about two months after the 1999 earthquake in Marmara, Turkey revealed that 71.5% of the students` scores for depression were below the average based on BDI (9). It is noteworthy that despite several international and national efforts to control psychiatric morbidity in the post earthquake period, such a high burden of depression in the Bam community warrants a revision of the psychiatric and psychological techniques and interventions.

According to logistic regression analysis age and income were not associated with PTSD (Table 4). Girls were up to three times more likely to suffer from PTSD than boys which is consistent with several other studies (10). In most studies conducted on PTSD in post disaster period, females were significantly more susceptible to serious psychiatric morbidity than males (8-10). It was the most significant associated factor for PTSD. The next most important associated factors were confronting with dead bodies and loss of first degree relative(s) carrying odds ratio of 1.9 (Table 4).

Table 4: Logistic regression analysis to assess the association between
selected characteristics and PTSD occurrence

Characteristic                  Adjusted  95% confidence
                                   OR       intervals         P

Age                               1.03      0.07-1.23        0.72

Sex

Male                              1         -
Female                            2.92      1.9-4.5          0.001
Loss of first degree lative(s)    61        15
No                                1         -
Yes                               1.9       1.1-3.3          0.02

Confronting with dead bodies

No                                1         -
Yes                               1.9       1.2-3.6          0.008
Living status
With parents                      1         -
Others                            1.2       0.6-2.3          0.79

Income

Low                               1         -
Mid                               0.8       0.5-1.2          0.27
High                              1.1       0.6-2.0          0.72

CONCLUSION

According to the higher proportion of PTSD in females and those who lost first degree relatives through disaster more social support should be provided for these high risk groups considering evidence based techniques.

REFERENCES

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(2.) Ohta, Y., K. Araki and N. Kawasaki, 2003. Psychological distress among evacuees of a volcanic eruption in Japan: A follow-up study. Psychiatry Clin. Neurosci., 57 (1): 105-111.

(3.) Kolaitis, G., J. Kotsopoulos and J. Tsiantis, 2003. Posttraumatic stress reactions among. Children following the Athens earthquake. Eur. Child Adolesc. Psychiatry, 12: 273-280.

(4.) Colliard C., 2005. Evaluation of the Tdh Psychosocial Programme of Recreational Centres in Bam, Iran. Centre for Humanitarian Psychology, Geneva, Switzerland.

(5.) Ghassemzadeh, H., R. Mojtabai and N. Karamghadiri, 2005. Psychometric properties of a Persian-language version of the Beck Depression Inventory-2nd Edn. BDI-II-PERSIAN. Depress. Anxiety, 21(4): 185-192.

(6.) Bokszczanin, A., 2007. PTSD symptoms in children and adolescents 28 months after a flood: Age and gender differences. J. Trauma. Stress., 20: 347-351.

(7.) John, P.B., S. Russell and P.S. Russell, 2007. The prevalence of posttraumatic stress disorder among children and adolescents affected by Tsunami disaster in Tamil Nadu. Disaster Manag. Response, 5: 3-7.

(8.) Yang, Y.K., T.L., Yeh and C.C., Chen, 2003. Psychiatric morbidity and posttraumatic symptoms among earthquake victims in primary care clinics. Gen. Hosp. Psychiatry, 25(4): 253-261.

(9.) Vehid, H.E., B. Balyanak and A. Eksi, 2006. Suicide ideation after the 1999 earthquake in Marmara, Turkey. Tohoku J. Exp. Med., 208 (1): 19-24.

(10.) Aksaray, G., G. Kortan and H. Erkaya, 2006. Gender differences in psychological effect of the August 1999 earthquake in Turkey. Nord. J. Psychiat., 60 (5): 387-391.

(1), (2) Hassan Ziaaddini, (1), (2) Nouzar Nakhaee, (2) Kolsoom Behzadi

(1) Kerman Neuroscience Research Center

(2) Kerman University of Medical Sciences, Kerman, Iran

Corresponding Author: Hassan Ziaaddini, Shahid Beheshti Hospital, Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran Tel: +983412111010