title: Post-traumatic stress disorder in children and adolescents one year after a super-cyclone in Orissa, India: exploring cross-cultural validity and vulnerability factors.
abstract: BACKGROUND
  It has been asserted that psychological responses to disasters in children and adolescents vary widely across cultures, but this has rarely been investigated. The objectives of the study were to clinically evaluate the construct of traumatic stress symptoms and disorder in children and adolescents after a super-cyclone in Orissa, India; to find out the prevalence at one year; compare the effect in high and low exposure areas and study the factors associated with it.
  
  
  METHODS
  Clinical examination of children and adolescents (n = 447) was done, supplemented by a symptoms checklist based on International Classification of Mental and Behavioural Disorders, Diagnostic Criteria for Research and a semi-structured questionnaire for disaster related experiences.
  
  
  RESULTS
  A majority of children had post-traumatic symptoms. Post-traumatic stress disorder (PTSD) was present in 30.6% (95% confidence interval: 26.4 to 34.9), and an additional 13.6% had sub-syndromal PTSD. Parents or teachers reported mental health concerns in 7.2% subjects, who were a minor proportion (12.8%) of subjects with any syndromal diagnosis (n = 196). Significantly more (43.7%) children in high exposure areas had PTSD than that (11.2%) in low exposure areas (p < 0.001). Depression was significantly associated with PTSD. Binary logistic regression analysis indicated that high exposure, lower educational level and middle socioeconomic status significantly predicted the outcome of PTSD. Extreme fear and perceived threat to life during the disaster, death in family, damage to home, or staying in shelters were not significantly associated with PTSD.
  
  
  CONCLUSIONS
  Following natural disaster PTSD is a valid clinical construct in children and adolescents in Indian set up; and though highly prevalent it may be missed without clinical screening. Its manifestation and associated factors resembled those in other cultures.
authors.affiliation: Wolverhampton City Primary Care Trust, Corner House Resource Centre, 300, Dunstall Road, Wolverhampton, WV6 0NZ, UK. nmadhab@yahoo.com
authors.forename: Nilamadhab
authors.initials: N
authors.lastname: Kar
authors.forename: Prasanta K
authors.initials: PK
authors.lastname: Mohapatra
authors.forename: Kailash C
authors.initials: KC
authors.lastname: Nayak
authors.forename: Pratiti
authors.initials: P
authors.lastname: Pattanaik
authors.forename: Sarada P
authors.initials: SP
authors.lastname: Swain
authors.forename: Harish C
authors.initials: HC
authors.lastname: Kar
mesh_terms: D000293:Adolescent; D002648:Child; D003431:Cross-Cultural Comparison; D004190:Disasters; D005195:Family Relations; D005239:Fear; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D008297:Male; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*