title: Risk factors of post-traumatic stress disorder in tsunami survivors of Kanyakumari District, Tamil Nadu, India.
abstract: BACKGROUND
  In this study, we assessed the relation of possible risk factors with post-traumatic stress disorder (PTSD) in the survivors of December 2004 tsunami in Kanyakumari district.
  
  
  METHODS
  We identified cases (n=158) and controls (n=141) by screening a random sample of 485 tsunami survivors from June 2005 to October 2005 using a validated tool, "Impact of events scale-revised (IES-R)," for symptoms suggestive of PTSD. Subjects whose score was equal to or above the 70(th) percentile (total score 48) were cases and those who had score below or equal to 30(th) percentile (total score 33) were controls. Analysis was done using statistical package for the social sciences to find the risk factors of PTSD among various pre-disaster, within-disaster and post-disaster factors.
  
  
  RESULTS
  Multivariate analysis showed that PTSD was related to female gender [odds ratio (OR) 6.35, 95% confidence interval (CI) 3.26-12.39], age 40 years and above (OR 2.38, 95% CI 1.23-4.63), injury to self (OR 2.97, 95% CI 1.55-5.67), injury to family members (OR 2.09, 95% CI 1.05-4.15), residence in urban area (area of maximum destruction) (OR 3.37, 95% CI 1.35-8.41) and death of close relatives (OR 3.83, 95% CI 1.91-7.68). Absence of fear of recurrence of tsunami (OR 0.32, 95% CI 0.17-0.60), satisfaction of services received (OR 0.57, 95% CI 0.36-0.92) and counseling services received more than three times (OR 0.45, 95% CI 0.26-0.78) had protective effect against PTSD.
  
  
  CONCLUSIONS
  There is an association of pre-disaster, within-disaster and post-disaster factors with PTSD, which demands specific interventions at all phases of disaster, with a special focus on vulnerable groups.
authors.affiliation: Assistant Director, Kerala Health Services, Thiruvananthapuram, Kerala, India. ttpyari@gmail.com
authors.forename: T T
authors.initials: TT
authors.lastname: Pyari
authors.forename: Raman V
authors.initials: RV
authors.lastname: Kutty
authors.forename: P S
authors.initials: PS
authors.lastname: Sarma