title: Lessons from the 2004 Asian tsunami: Nature, prevalence and determinants of prolonged grief disorder among tsunami survivors in South Indian coastal villages.
abstract: BACKGROUND
  Prolonged grief disorder (PGD), previously called complicated grief, is associated with significant distress and long-term disability, and it may complicate assessments for post-traumatic stress disorder (PTSD) after traumatic events.
  
  
  METHODS
  In order to distinguish PGD from PTSD, we conducted a cross-sectional survey among tsunami survivors in five tsunami-affected coastal villages in India, 9 months after the Asian tsunami.
  
  
  RESULTS
  Prevalence of PGD among 643 tsunami survivors was 14.2% (95% confidence interval (CI): 11.5%-16.9%) and among the 351 bereaved survivors was 25.9% (95% CI: 21.3%-30.5%). Spousal bereavement, extensive damage to homes, fewer years of education, and absence of tsunami-related physical injury differentiated those with PGD, after adjusting for potential confounders (p < .05). These factors were distinct from the factors associated with post-traumatic stress symptoms (PTSS) among these survivors. Scores on the avoidance, hyper-arousal and intrusion subscales of the Impact of Events Scale-Revised were significantly lower in those with PGD alone than in those with PTSS or with both disorders.
  
  
  CONCLUSIONS
  Our findings support the validity of PGD in a non-Western post-disaster community and its distinctness from PTSD. They have important public health implications in planning responses to natural disasters and for future revisions of diagnostic classifications.
authors: Department of Psychiatry, Christian Medical College, Vellore, India Department of Biomedicine, Aarhus University, Aarhus, Denmark apr@biomed.au.dk.
authors: Anto P
authors: AP
authors: Rajkumar
authors: Department of Psychiatry, Christian Medical College, Vellore, India University of Adelaide, Adelaide, SA, Australia.
authors: Titus Sp
authors: TS
authors: Mohan
authors: Department of Psychiatry, Christian Medical College, Vellore, India.
authors: Prathap
authors: P
authors: Tharyan
mesh_terms: D000328:Adult; D044466:Asian People; D003430:Cross-Sectional Studies; D004190:Disasters / Q000266:history*; D005260:Female; D006117:Grief; D049674:History, 21st Century; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D017741:Survivors / Q000706:statistics & numerical data*; D057192:Tsunamis / Q000266:history*; D055815:Young Adult
keywords: Grief; disasters; epidemiology; post-traumatic stress disorder; prevalence; regression analysis