REPORT PRESENTATION

Presented by: Sunita Khadka

B.Sc in nursing 4th year
12th Batch
KUSMS
Roll no: 13

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 RESEARCH TOPIC

Prevalence of Post Traumatic Stress Disorder( PTSD)

and its Associated Risk Factors among the
Survivors of 2015 Nepal Earthquake in
Lisankhu Thulopakhar,
Sindhupalchok

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 BACKGROUND (1/2)
• Nepal is situated in between the converging Indian Plate and
Tibetan plate, which is one of the reasons for geological
disasters like earthquakes and landslides in Nepal

• Globally, Nepal ranks 11th in terms of its relative vulnerability to

earthquakes (Maplecroft 2011, BCPR 2004 cited in MoHA
2015).

• Natural disasters such as an earthquake can not only lead to

economic losses, physical injuries, and deaths, but they can also
cause serious mental health problems. .1

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 BACKGROUND (2/2)
• Among all the mental problems posttraumatic stress disorder
(PTSD) is a common problem among victims of natural
disasters both in Western countries and Asian countries. .1
• The prevalence of PTSD differs according to the time frame,
study in Japan 14 months after the earthquake shows PTSD
prevalence of 33% and for the Morocco earthquake 10% of
survivors developed posttraumatic stress symptoms 40 years
after the earthquake and a study about the Taiwan 9.21
earthquake, the PTSD rate was 20.9% among survivors 2
years after the earthquake. 2,3

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 RATIONALE (1/2)

• Sindhupalchok is one of the worst-affected districts as the

highest magnitude (6.7) aftershock took place in
Sindhupalchok district 17km south of Kodari (USGS 2015).
As of 7 May, 3057 people were dead and 860 are injured.

• As disaster is totally unpredictable that may cause loss of life

and it may affect physically as well as mentally . Physical
injury can be treatable as it can be viewed externally but
mental injury is being ignored as it cannot be viewed
externally.

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 RATIONALE(2/2)

•And Sindhupalchok district being one of the most affected

district people residing there are at higher risk of developing
unique stresses and problems that deserve them to be
investigated and find the solution. Since , there is no any
published research looking at the post-traumatic stress
disorder aftermath of an earthquake in general population of
Sindhupalchok district, Nepal. Thus, this study aimed to find
out the prevalence of post-traumatic stress disorders among
the survivors of 2015 Nepal Earthquake.

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 RESEARCH OBJECTIVES (1/1)
General Objective:
• To assess the prevalence of PTSD among the survivors of
2015 Nepal Earthquake in Sindhupalchok, District.
 
Specific Objective
• To find out the prevalence of PTSD among earthquake
survivors.
• To determine the association between PTSD and demographic
variables.
• To identify the association between PTSD and earthquake
related variables.
• To assess perceived social support and it’s relation with PTSD.

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 Methods/Methodology
• Study design
Quantitative, analytical cross sectional study
• Study site
Lisankhu Thulopakhar Rural Municipality ward no.6
• Target population
Earthquake survivors of 2015 Nepal Earthquake residing in
Lisankhu Sindhupalchok District.
• Sample population
All the earthquake survivors of 2015 Nepal Earthquake above
18-65 years of age and who met the inclusion criteria.

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 Selection Criteria
a. Inclusion criteria
• Respondents who were within 18 - 65 age group.

• Without language disorders (a communication disorder such as

deviant articulation, fluency, voice, and/or comprehension
and/or expression of language, spoken or written) and clear
conscious (state or quality of awareness, or being aware of an
external object or something within oneself)

• Those who had experienced the Nepal earthquake on April 2015

and residence of Lisankhu Thulopakhar Rural Municipality.

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b. Exclusion criteria
• Those people who were already identified and recorded in
health facility as a mental retardation, dementia, or any
other major psychosis (e.g., schizophrenia, major
depressive disorders) and those who have used medicines
or are under medication.

• If the respondents weren’t able to answer the question.

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 SAMPLING METHOD AND SAMPLE SIZE(1/2)

 Sampling method
• Among 9 Rural Municipality, 1 rural municipality was
selected through purposive sampling method.
• From the selected rural municipality one ward was selected
again through purposive sampling method.
• Finally, from the selected ward each household was selected
through systematic random sampling method.

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 SAMPLING METHOD AND SAMPLE
SIZE(2/2)
• Total household was identified among the selected wards and
kth value was determined by using the following formula:
• For kth interval
K= Total number of houses in selected ward
Sample size (n)
=650/256
=2.5
~3
 Sample size
 256 participants

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 Data Collection Tools/Measures

 Data Collection Tools

 Structured and semi structured questionnaire was used .
 The questionnaire consists of 4 parts:
• Part I: Socio demographic variables
• Part II: Earthquake related variables
• Part III: PTSD checklist –Civillian Version (PCL-C)
• Part IV: Oslow Social Support Scale

 Data Collection Method

• The data was collected through Face to face interview method.

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 Validation of the Tool
 Standard tool was adopted and was freely available in the
website.

 The content validity of the research instrument was maintained

by:
• Literature review
• Consulting to the advisor
• Consulting to the subject expertise

 Pretesting was done among 25 respondents .

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 DATA ANALYSIS

 Software for data analysis

 Statistical Package for Social Science (SPSS) Version 25 was
used for the data analysis.

 Statistical tests 
 Descriptive statistics (frequency and percentage) was applied.
 Inferential statistics (Chi square test) was applied

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 RESULTS OF THE STUDY
• Socio-demographic information of the respondents
• Earthquake related variables
• Prevalence of Post Traumatic Stress Disorder
• Social Support Among the respondents
• Association between PTSD and socio demographic variables
• Association between PTSD and earthquake related variables
• Association between PTSD and social support.

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Table 1.1.Socio Demographic Information of the Respondents

n=256
Characteristics Frequency(f) Percentage(%)
Age
18-35 74 28.9
36-55 104 40.6
>55 78 30.5
Sex
Female 167 65.2
Male 89 34.8
Religion
Hindu 168 65.6
Buddhist 46 18.0
Christain 42 16.4

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Table 1.2.Socio Demographic Information of the Respondents

n=256
Characteristics Frequency(f) Percentage(%)
Educational status
Illiterate 55 21.5
Literate 201 78.5
Educational level (n =201)

Informal education 90 35.2

47 18.4
Primary level 49 19.1
Secondary level 15 5.9
Higher secondary or above

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Table 1.3. Socio Demographic Information of the Respondents

n=256
Characteristics Frequency(f) Percentage(%)

Occupation
Agriculture 216 84.4
Service 39 15.2
Business 1 0.4

Marital status
Unmarried 24 9.4
Married 232 90.6

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 Table 2.1. Earthquake Related Variables
n=256
Experience of Yes, f (%) No , f (%)
earthquake

Got buried 6 (2.3) 250(97.7)

Got injured 23 (9.0) 233(91.0)
Physically disable - 256(100)
Loss of family member 3(1.2) 253(98.8)
Loss of relatives 50(19.5) 206(80.5)
Physically disable 15(5.9) 241(94.1)
within family
Physically disable 15(5.9) 241(94.1)
within relatives

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 Table 2.2. Earthquake Related Variables
n=256

Characteristics Yes, f (%) No , f (%)

Self witnessed
Others buried 72(28.1) 184(71.9)
Others injured 100(39.1) 156(60.9)
Death 39(15.2) 217(84.8)
House and property 242(94.5) 14(5.5)
damage
If yes then, (n=242)
Very low 37(15.3)
Medium 116(47.9)
Very high 89(36.8)

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 Table 3.1. Frequency of Different PTSD Symptoms among the
Respondents
n=256
Cluster of symptoms Asymptomatic Symptomatic
f(%) f(%)
B- group Intrusive re- 14( 5.5) 242( 94.5)
experiencing (at least
one required)
 Recurrent and 62(24.2) 194(75.8)
intrusive distressing
recollection
 Recurrent distressing 118(46.1) 138(53.9)
dreams
 Acting or felling at 66(25.8) 190(74.2)
least events recurring
 Intense psychological 49(19.1) 207(80.9)
distress to cues
 Physiological 115(44.9) 141(55.1)
reactivity to cues

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 Table 3.2. Frequency of Different PTSD Symptoms Among the Respondents
n=256

Cluster of symptoms Asymptomatic Symptomatic

f(%) f(%)
C-group Avoidance and 142(55.5) 114(44.5)
Numbing (at least three
required)
 Avoidance of thoughts, 142(55.5) 114(44.5)
feelings and conversations
 Avoidance of reminder 115(44.9) 141(55.1)
 Psychogenic Amnesia 162(63.3) 94(36.7)
 Markedly diminished interest 158(61.7) 98(38.3)
in significant activities
 Detachment or estrangement 169(66) 87(34.0)

104(40.6)
102(39.8)
feelings
 Restricted range of affect 152(59.4)
154(60.2)
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Table 3.3.Frequency of Different PTSD Symptoms among the
Respondents
n=256
Cluster of symptoms Asymptomatic Symptomatic
f(%) f(%)
D- group Hyper 108(42.2) 148(57.8)
arousal (at least two
required) 182(71.1) 74(28.9)
 Sleep difficulty 154(60.2) 102(39.8)
 Irritability or
outburst of anger
 Difficulty 145(56.6) 111(43.4)
concentrating 116(45.3) 140(54.7)
 Hyper-vigilance 112(43.7) 144(56.3)
 Exaggerated startle
response

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31.3%

Asymptomatic
Symptomatic

68.8%

Fig no. 1 Prevalence of PTSD Cases

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 Table 4.Social Support of the Respondents

n= 256
Social Support Frequency (f) Percentage (%)
Poor social support 16 6.3

Moderate social support 158 61.7

Strong social support 82 32.0

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 Table 5.1. Association between PTSD and Socio-Demographic Variables
of the Respondents
n =256
Variables PTSD p value
Asymptomatic Symptomatic
f(%) f(%)
Age
18-35 52(70.3) 22(29.7) 0.368a
36-55 75(72.1) 29(27.9)
>55 49(62.8) 29(37.2)
Sex
Female 106(63.5) 61(36.5) 0.013a
Male 70(78.7) 19(21.3)
Religion
Hindu 115(68.5) 53(31.5) 0.911a
Buddhist 31(67.4) 15(32.6)
Christian 30(71.4) 12(28.6)

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Table 5.2. Association between PTSD and Socio-Demographic
Variables of the Respondents
n =256
Variables PTSD p value
Asymptomatic Symptomatic
f(%) f(%)
Educational
status
Illiterate 38(69.1) 17(30.9) 0.951a
Literate 138(68.7) 63(31.3)
Educational level
Informal 59(65.2) 31(34.8) 0.007b
Primary level 28(59.6) 19(40.4)
Secondary level 43(87.8) 6(12.2)
Higher secondary 8(53.3) 7(46.7)
or above

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Table 5.3.Association between PTSD and Socio-Demographic
Variables of the Respondents
n =256
Variables PTSD p value
Asymptomatic Symptomatic
f(%) f(%)
Occupation
Agriculture 145(67.1) 71(32.9) 0.550b
Service 29(76.3) 9(23.1)
Business 1(100.0) -
Marital status
Unmarried 19(79.2) 5(20.8) 0.247a
Married 157(67.7) 75(32.3)

a=Pearson Chi -Square

b=Fisher’s Exact Test

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 Table 6.1. Association between PTSD and Earthquake
Related Variables of the Respondents
n=256
Experience of PTSD p value
earthquake Asymptomatic Symptomatic
f(%) f(%)

Got buried
Yes 2(33.3) 4(66.7) 0.078b
174(69.6) 76(30.4)
No
12(52.2) 11(47.8) 0.072a
Injury to yourself 164(70.4) 69(29.6)
Yes

No

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 Table 6.2. Association between PTSD and Earthquake
Related Variables of the Respondents

n=256
Experience of PTSD p value
earthquake Asymptomatic Symptomatic
f(%) f(%)

Loss of family
member 1(33.3) 2(66.7) 0.231b
Yes 175(69.2) 78(30.8)
No
Loss of relatives 30(60.0) 20(40.0) 0.137a
Yes 146(70.9) 60(29.1)
No

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Table 6.3.Association between PTSD and Earthquake Related
Variables of the Respondents
n=256
Experience of PTSD p value
earthquake Asymptomatic Symptomatic
f(%) f(%)

Physically
disable within
family 9(60.0) 6(40.0) 0.566b
Yes 167(69.3) 74(30.7)
No      
Physically      
disable within 11(73.3) 4(26.7)  0.782b
relatives 165(68.5) 76(31.5)
Yes

No
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Table 6.4.Association between PTSD and Earthquake Related
Variables of the Respondents
n=256
Self witnessed PTSD p value
Asymptomatic Symptomatic
f(%) f(%)
Others buried
Yes 52(72.2) 20(27.8) 0.453a
No 124(67.4) 60(32.6)
Others injured
Yes 67(67.0) 33(33.0) 0.629a
No 109(69.9) 47(30.1)
Death
Yes 28(71.8) 11(28.2) 0.656a
No 148( 68.2) 69(31.8)

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 Table 6.5.Association between PTSD and Earthquake
Related Variables of the Respondents

n=242
House and PTSD p value
property Asymptomatic Symptomatic
damage f(%) f(%)

Very low 33(89.2) 4(10.8) 0.001a

Medium 83(71.6) 33(28.4)
Very high 48(53.9) 41(46.1)

a=Pearson Chi -Square

b=Fisher’s Exact Test

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 Table 7.Association between Social Support of the Respondents with PTSD
n =256

PTSD p value
Social support
Asymptomatic Symptomatic
f(%) f(%)
Poor social 9(56.2) 7(43.8)
support 0.067a

Moderate social 103(65.2) 55(34.8)

support
Strong support 64(78.0) 18(22.0)

a=Pearson Chi -Square

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DISCUSSION

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 Table 1. Prevalence of PTSD (1/1)
Characteristics Result of Similar Lower results Higher
the study result results
Post Traumatic 31.3% - • Beichuan Northwestern
Stress (11.2%) and Pakistan
Disorder(PTSD) Jiangyou, (65%) after 3
after 3 years China (2.3%) years (2013)
after 3 years
(2012)
• Beichuan
(9.1%) after 5
years (2015)
•Dhading
(18.5%) after 9
months (2018)

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 Association between Socio-Demographic Variables
and PTSD (1/2)
1) Age
 No any significant association (p-value: 0.235)
 Significantly associated with the study done in Dhading and
Beichuan,China.
2) Gender
 Significantly associated (p-value: 0.013) which is similar to many
other studies conducted in Dhading, Northwestern Pakistan and
China .
 Mostly experienced by female (36.5%)
3) Religion
 No any significant association (p- value: 0.911)
 Significantly associated with the study conducted in Northwestern
Pakistan.

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 Association between Socio-Demographic Variables
and PTSD (2/2)

4) Level of education
 Significantly associated (p-value: 0.007) which is not similar to
any of the previous studies.
 Mostly experienced by the respondents having higher educational
level (46.7%)
5) Occupation
 No any significant association (p-value:0.225)
 In contrast with the study done in Beichuan, China.

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 Association between Earthquake Related
Variables and PTSD
1) Experience of earthquake
 No any significant association
 Loss of family member was significantly associated in a study
conducted in China.

2) House and property damage

 Significant association (p-value:<0.05) which was similar to many
previous studies done in Dhading ,Northwestern Pakistan and many
places of China.

 Mostly experienced by the respondents with high property

damage.

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 CONCLUSION
 This study distinct a high prevalence of PTSD among the
respondents. PTSD remains a common mental health problem
among survivors even after 3 years .

 The associated risk factors for such persistent PTSD included

female gender, educational level and damage to their property.

 Implementing psychological counseling for women, respondents

with higher educational level and those who have high property
damage would be critical in mitigating the long-term risk of
persistent PTSD.

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 RECOMMENDATION
• Various activities and plans for awareness about PTSD can be
conducted among the community health workers by the
Municipality so that they can aware people that PTSD is
manageable and if diagnosed early then it may prevent other
psychiatric co-morbidities.

• Psychological counseling program can be implemented for the

people who are at high risk of PTSD.

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 LIMITATIONS OF THE STUDY

• Since the data was collected at a single point of time, it was

not confirm that PTSD has occurred due to the sole reason of
earthquake.

• Honesty of the respondents cannot be judged.

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 REFERENCES
1) Wang L, Zhang Y, Wang W, Shi Z, Shen J, Li M, Xin Y.
Symptoms of posttraumatic stress disorder among adult
survivors three months after the Sichuan earthquake in China.
Journal of traumatic stress. 2009 Oct;22(5):444-50.
2) Dahal HR, Kumar S, Thapa DK. Prevalence and Risk Factors
of Post-Traumatic Stress Disorders among the Survivors of
2015 Nepal Earthquake, in Dhading, Nepal. Sleep and
Hypnosis. 2018;20(2):128-39.
3) Kadri N, Berrada S, Douab S, Tazi I, Moussaoui D. Post-
traumatic stress disorder in survivors of the Agadir earthquake
(Morocco) in 1960. L'Encephale. 2006;32(2 Pt 1):215-21.

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