CORRELATION BETWEEN PSYCHOSOCIAL STRESSOR AND DEPRESSION AMONG SURVIVORS WHO LIVE IN TEMPORARY SHELTER IN DESA UMBULHARJO KECAMATAN

CANGKRINGAN POST DISASTER MOUNT MERAPI VOLCANIC ERUPTION 2010

By: Celina Azureen Bt Mohd Jefri Chand

Background (1)
25/10/2010 Merapi eruption evacuated, 353 dead >350 000

Most survivor suffer from loss of properties and family members, psychological behavior. Staying at the shelter increase psychosocial stress among survivors Mental health diagnostic test conducted to survivors in Yogyakarta and Klaten, it is found : - 595 people (3,5% from 7223 people) have mental problem - Depression is 4,36% (Magelang District Hospital, 2010) Thus, increase risk for depression

Pictures of the shelter

Background (2)
Work Stress

Respect & Acceptance

Stressful Life Events

Threat to social status

Psychosoc ial Stress

General Stress

Income

Marital Stress

Education

Background (3)
Increase in psychosocial stress depression There is no data about correlation between psychosocial stress and depression during Merapi eruption. Riset Kesehatan Dasar 2007 : incidence of depression in kabupaten Sleman estimated 12% which is highest in Yogyakarta province

Research Question
Is there any correlation between psychosocial stress with depression in the survivor that live at Desa Umbulharjo Kacamatan Cangkringan temporary shelter?

Objectives
The purpose of this study is to find out the correlation between psychosocial stressor with depression in survivor that live in Desa Umbulharjo Kacamatan Cangkringan temporary shelter.

Literature Review (1)

1) Psychosocial Stress
Psychosocial stress refers to a relationship with the environment that the person appraises as significant for his or her well-being and in which the demands tax or exceed available coping resources (Lazarus & Folkman, 1986) Psychosocial risk factors for depression such as low self esteem, obsessional personality, experience of adversity, undesirable recent life events and persisting difficulties.
(Baldwin & Birtwistle, 2002)

Individual response varies towards traumatic event but some can develop into psychopathology
(Yehuda & Bierer, 2005)

2) Depression
Depression is a syndrome that describes a cluster of symptoms which are generally comprised of depressed mood, loss of interest, anxiety, sleep disturbance, loss of appetite, lack of energy and sometimes suicidal thoughts
(DSM-IV, 1994)

Depression has biggest case burden in general population with 11.8% (WHO, 2001) and is the 2nd most common disorder to emerge in the aftermath of a disaster. Depression is approximately twice as common in women as in in men, and the incidences increases with age
(Saddock,2007)

Etiology Biology Genetic Psychosocial

Literature Review (3)

3) Disaster
A disaster is defined as an occurrence where normal conditions of existence are disrupted and the level of suffering exceeds the capacity of hazardaffected community to respond to it (WHO, 2005) Cause total breakdown of everyday functioning with disappearance of social functioning, loss of immediate leadership and insuffiency of the system
(Lopez-Ibor,2005)

It is estimated that 9 months after a disaster the number of depression may have increased (WHO,2005)

Conceptual Framework
Risk factors: Gender Age Marital status Income Loss of family member Heavy Survivor

Psychosocial Stress

Mild

Depression

Depression

Yes

No

Yes

No

Research Design (1)

1) Cross Sectional Study 2) Data is categorized into Level of psychosocial stress Presence of depression 3) Population : Survivor of Mt. Merapi volcanic eruption who live in temporary shelter in Umbolharjo Cangkringan, Sleman Inclusion - Adults aged between 20 to 59 - Willingness to participate Exclusion - Unable to complete the questionnaire - Refuse to participate

Research Design (2)

4) Measurement Personal questionnaire BDI Sn: 80% Sp: 82% cut off > 13 considered depressed
1999)

(Lasa et al,

IPSP score > 17 ; heavy stress (Sudiyanto, 1998) 5) Variable Independent : Level of psychosocial stress Dependent : Depression

Results (1)
Minimum sample size from calculation : 38 Sample collected : 60 Included sample : 47 Excluded sample : 13 3 refuse 7 not staying at shelter 2 blind 1 is 62 years old

Result (2)
Table 1. Distribution of characteristic data of subjects in temporary shelter Desa Umbulharjo in July 2011. Variable Total Age Characteristic <25 26-39 >40 SD SMP SMA Farmer Non farmer Housewife >UMR Sleman <UMR Sleman N 47 3 31 13 30 11 6 15 21 11 13 34 Male 16(34,0%) 1 (33,3%) 9 (29,0%) 6 (46,2%) 11(36,7%) 4 (36,4%) 1 (16,7%) 8 (53,3%) 15(71,4%) 0 (0,0%) 5 (38,5%) 11(32,4%) Female 31(66,0%) 2 (66,7%) 22(71,0%) 7 (53,8%) 19(63,7%) 7 (63,6%) 5 (83,3%) 7 (46,7%) 6 (28,6%) 11(100,0%) 8 (61,5%) 23(67,6%)

Education

Occupation

Economy

UMR Sleman = Rp 745,694

Result (3)
Table 2. shows the prevalence of depression and psychosocial stress among sample. Variable N Male Female OR

Depression
Stress

Yes No
Heavy Mild

23 24
34 13

6 (26,1%) 10(41,7%)
11(32,4%) 5 (38,5%)

17(73,9%) 14(58,3%)
23(67,6%) 8 (61,5%) *0,351

*Chi-square test

Result (4)
25 20 23

Number of Subjects

15 11
10 8 5

Male Female

5
0 Heavy

Mild

Figure 1. The distribution of level of stress according to gender

Result (5)
25 20 17 15 11 10 6 5 0 Depression Stress Figure 2. The distribution of depression and heavy stress according to gender Male Female 23

Number of Subjects

Table 2. Correlation between psychosocial stress and depression among the subjects in temporary shelter Desa Umbulharjo, July 2011.
Mean Depression 1,489 Psychosocial 1,277 Stress *Pearson Correlation **Fishers Exact Test Standard Deviation 0,505 0,452 N 47 Statistics * -0,225 P 0,129 **0,112

Table 4. Cross tabulatiuon level of psychosocial stress and depression among the survivors in temporary shelter Desa Umbulharjo, July 2011.
Depression Yes No 19 15 55,9% 44,1% 4 9 30,8% 69,2% 23 24 48,9% 51,1% Total 34 100,0% 13 100,0% 47 100,0%

Stress

Heavy Mild

Count % within stress Count % within stress Count % within stress

Total
*p value for all is 0,112

Discussion (1)
Prevalence of depression in this study is 48,9% , higher than other studies Prevalence of depression for post typhoon Xangsane in Vietnam, 2006 was 5.9% (Amstadter et al., 2009), post Hurricanes season in Florida, 2004 was 6.1% (Acierno et al., 2007) , post Tsunami- affected area in Southern Thailand, 2004 was 51% for (Griensven et al., 2006) The difference due to type of natural disaster, included participants, measurement tools and method chosen. This study is done in temporary shelter, where the subjects are experiencing heavy psychosocial stress

Discussion (2)
Out of 47 subjects, 34 (72,3%) of subjects suffers from heavy psychosocial stress and only 19 (55,9%) had depression Although prevalence is high, there is no significant differences between the variables. OR obtained is 0,351, depression is less likely to occur Not consistent with the theory stressful life events and onset of depression might be associated because such stressful life events directly increase the risk of depression (Kenneth et al., 1999) CI 95% is 0,090-1,365 , thus OR is not significant

Discussion (3)
Negative correlation shows that subject perceive that they have control and are able to react positively and actively towards stressful environment (Dumont, 1998) Inconsistency may be caused by the combined samples of men and women even though there is evidence that the sex difference in depressive symptoms varies with age
(Kessler et al., 1992)

Depression is approximately twice as common in women as in in men, and the incidences increase with age
(Saddock,2007)

Coping as the cognitive and behavioural efforts that allow an individual to tolerate, escape, or minimize the effects of stress (Lazarus & Folkman, 1984)

Gender

Psychosocial stress is not the only factor ! depression is more common in women compared to men
(Saddock,2007, Metin et al.,2004)

incidence of depression increases with age (Saddock,2007, Age

Solomon et al, 2012, Danesh &Landeen,2007, Mirowsky,1992, Shore et al,1986)

low education level have higher tendency for depression Education (Solomon et al,2012, Croat , 2011)
Social low social support increase risk of depression (Solomon et Support al,2012, Burke & Weir,1978, Metin et al,2004)

Social wealthy people were at greater risk than poor people for depression they had lost more than poor people and were less Economy because accustomed to asking for help (Shah, 1985)
low socio-economic status especially when assessed by indices of material standard of living, was consistently associated with a higher prevalence of depression in cross-sectional studies (Lorant et al , 2003)

Conclusion
This study has not been unable to demonstrate the correlation between psychosocial stress and depression in survivor who lives is Desa Umbuharjo Temporary Shelter Kecamatan Cangkringan

Suggestion
Obtaining a larger sample size with equal distribution of demographic data. Expansion of the scope of the study to cover more variables and risk factors that cause depression

Limitation
Study design is cross sectional Time of observation Sample size is too small Previous mental disorders not measured