Indian Journal of Social Psychiatry

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 38  |  Issue : 2  |  Page : 168--175

Influence of sociodemographic variables on psychological impact and resilience among children living in multi hazard Region


Aasim Ur Rehman Ganie, Christy Jayakumar, Sekar Kasi 
 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Christy Jayakumar
Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
India

Abstract

Background: Disasters have a great and lasting impact on children physically and psychologically because of their particular physiological and social developmental stage. Disasters are recognized as potential risk for the overall development of children, and children exposed to disasters require some abilities or protective factors which serve as a shield to buffer the risk. The present study was aimed at studying the role of sociodemographic factors on psychological impact and resilience among children exposed to disasters. Materials and Methods: A cross-sectional descriptive research design was used to accomplish the study. The study included 100 out of 502 children, 25 each from four schools from four villages selected randomly of four zones of district Anantnag using multi-stage sampling and systematic sampling. The Children Revised Impact of Events Scale-13 and Connor–Davidson Resilience Scale-25 were used to assess the posttraumatic symptoms and resilience among the children. Results: The results showed that children had mild-to-moderate level of posttraumatic symptoms, and majority of the children had intermediate to high resilience. This study provided interesting results that female children were found high on resilience and low on posttraumatic symptoms, which is not usual. Significant differences were found between resilience and gender, education, socioeconomic status, income, and domicile as well. Similarly, differences were found between posttraumatic symptoms and displacement, family type, domicile, and education. Conclusion: Flood disasters increase the psychological vulnerability for children. To prevent the potential risks, children need protective factors. The present study highlighted that psychological resilience can be improved by looking and improving the sociodemographic factors and making promising ways of establishing resilience-building strategies to regain the spirit of children and families at individual and community level.



How to cite this article:
Rehman Ganie AU, Jayakumar C, Kasi S. Influence of sociodemographic variables on psychological impact and resilience among children living in multi hazard Region.Indian J Soc Psychiatry 2022;38:168-175


How to cite this URL:
Rehman Ganie AU, Jayakumar C, Kasi S. Influence of sociodemographic variables on psychological impact and resilience among children living in multi hazard Region. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Sep 30 ];38:168-175
Available from: https://www.indjsp.org/text.asp?2022/38/2/168/346570


Full Text



 Introduction



John Stuart Mill back in 1852 said in his book Principles of Political Economy that the great rapidity with which countries recover from a state of devastation; the disappearance, in a short time, of all traces of the mischiefs done by earthquakes, floods, hurricanes, and the ravages of war. An enemy lay waste a country by fire and sword, and destroys or carries away nearly all the moveable wealth existing in it: All the inhabitants are ruined, and yet in a few years after, everything is much as it was before.[1] Disasters are gruesome tragedies which cause huge loss of life, property, and infrastructure, and which leave their mark even after years of their occurrence. Every society throughout time have experienced their share of disasters including natural and human-made disasters and bring other consequences such as mental and physical issues among survivors which indirectly increase the burden on the global health-care system.[2] Children are familiar icons of disasters and the most affected group and are vulnerable to physical and psychological effects because of their social and physiological development. Among children, posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms are the most commonly found mental health outcomes after a disaster.[3] Children after witnessing the traumatic event may develop intrusive, avoidance, and arousal manifestations; social withdrawal; constriction of play; poor social skills; irrational thoughts; flashbacks; nightmares; sleep disturbances; etc.. Some children start believing that there are certain signs which predict a traumatic event and if they are alert, they can detect these signs (omen formation).[4] However, to overcome this, children need some shield which can protect them from the effects of disasters. Multiple factors such as social support, higher income level, education, and gender contribute to the children's ability to be resilient throughout the process. Extensive literature on children and adolescents in disasters have found that there are various factors that predict better outcomes (promotive), factors associated with positive adaptation (protective or compensatory) that minimizes the effects of the adversities.[5]

The State of Jammu and Kashmir due to its distinct topography and unique geo-climatic conditions has been experiencing natural as well as human-made disasters which have a prolonged impact on the people of the state. After the partition of India in 1947, the province of Kashmir experienced constant political instability and ongoing conflict.[6] The situation created by frequent disasters and political issues has affected the mental health of the people, and this prevailing situation in the region has contributed to mental health issues among adults. Recent survey has found that in the Kashmir Valley 45% of adults suffer from mental distress, with probable depression among 41% of adults, anxiety 26% and 19% of adult population with probable PTSD.[7] The State of Jammu and Kashmir witnessed a devastating flood on September 7, 2014. Anantnag, one of the districts in the southern part of Kashmir, was worst affected by floods, with 56 villages and 18 hamlets being got worst affected, causing damage to 1500 houses, and nearly 150 schools were also damaged, particularly those situated in areas near to the rivers, affecting thousands of people particularly children. The aim of the study was to understand the role of sociodemographic factors in influencing the psychological reactions of children as a consequence of their exposure to floods and their role in promoting their coping and resilience toward the adversities.

 Materials and Methods



Study area

Four disaster-affected zones of district Anantnag of Kashmir valley were selected for the study. The villages in these four zones were severely affected by the 2014 floods as most of the villages are situated on the bank of river Jhelum and Lidder; water of the river Jhelum is considered as elixir in the Kashmir valley.[8] The total population of children in Anantnag district in the age group of 0–18 years is nearly 5 lakhs.[9] Children studying in schools in disaster-affected zones of the Anantnag district were considered the population of the study. The population framework was based on the records maintained by the Department of Education and the District Disaster Management Plan of Anantnag district.[10]

Sample selection and instruments

District Anantnag has a total of 394 villages, out of which 188 villages got affected due to the floods in 2014.[10] The sample design of this study was multi-stage sampling, wherein at the first level, four zones of the district were stratified based on records as per the District Disaster Management Authority (DDMA).[10] At the second stage, four villages were selected based on the data from DDMA on a random basis within these zones by using simple random sampling. At the third level, from the selected villages, those schools (4 schools out of 12 schools from the four selected villages) affected by disasters were selected randomly. At the fourth level, from the four selected schools, 100 participants out of the total 502 students who met the inclusion criteria (such as [i] age from 14 to 18 years, [ii] should have been exposed to disaster, [iii] absence of any mental and developmental disorder, and [iv] permission from parents or guardians) were selected by using systematic sampling tech nique based on the school/class registers available from the selected schools. A total of 100 samples with 25 samples from each zone in the age group of 14–18 years from class 8th to 10th were taken for the study.

Consent and ethical approval

Written informed consent and assent information forms were given to the participants 4 days before the final collection to make them able to understand the process and the purpose of the data collection process. Permission was also taken from the educational institutions prior to the study. A descriptive study design was engaged in the study. The study was approved by the institute's Ethics Committee at NIMHANS under the approval number NIMH/DO/IEC (BEH. Sc. DIV)/2018. This study highly considers the participants' anonymity and confidentiality. All information was de-identified by assigning a unique code number and the security of the data was maintained by using computer password protection.

Data collection

Data collection was carried out in the respective schools after taking permission from the school heads. In each zone, the participants were divided into two groups to make them to think properly without any disturbances and were provided the questionnaires and measurement tools. The data collection process continued for 90 min and the participants were informed about the purpose of the study and how they can answer the measurement tools based on their perception and experience during the disaster. A total of 100 questionnaires were collected from the participants for the final analysis.

Measurement tools

Sociodemographic data sheet

Researchers developed a sociodemographic data sheet to maintain the details of the participants. This was prepared to get information about the biodata of the participants, participants' disaster-related experiences, men or material loss, property and livelihood loss, injuries, and displacement due to floods.

Resilience

The Connor–Davidson Resilience Scale (CD-RISC) developed by Connor and Davidson[11] that assesses the ability to cope with stress and adversity was used to measure the resilience among the participants. The scale shows level of agreement using a 5-point Likert scale from strongly disagree (0) to strongly agree (4). The total score is achieved by adding up all responses, and ranges from 0 to 100, with higher scores reflecting greater resilience. The permission for using this scale was taken from the authors in advance of the study. This scale is fit to measure the resilience among the young population.

Impact of events

The 13-item Children's Revised Impact of Event Scale (CRIES-13)[12] was used in this study to screen children for posttraumatic symptoms. It includes four items measuring intrusion, four items measuring avoidance, and five new items measuring arousal. Each item is rated on a 4-point scale with no reversed items. The total score indicates the severity of a child's posttraumatic stress reactions with a range from 0 to 65.

Data analysis

The statistical analysis was conducted using SPSS (SPSS for Windows, Version 22.0, IBM Corp., Armonk, NY, USA). Descriptive statistics such as means and standard deviations were calculated for analysis of resilience and impact of children. Independent t-test was used to compute the differences between the sociodemographic factors and experiences of disaster with related to resilience and impact.

 Results



Sociodemographic characteristics of the respondents

The study recruited a total of 100 participants whose age ranged from 14 to 18 years (14.93 ± 0.95 years); 55% of the participants were male, with the largest number of participants (73%) being in the age group of 14–15 years. A large proportion of the participants were from rural areas (73%), and most of the respondents belong to joint families (56%). A majority (67%) of the respondents were from lower socioeconomic families. The results showed that 36% of the respondents got displaced during the floods and took shelter in a temporary shed arranged by some local groups. Around 32% of the respondents' households suffered property loss and 08% of the respondents reported livelihood loss during the floods [Table 1].{Table 1}

Impact of events

Regarding the impact of flood on the children, the participants were assessed by using the CRIES-13 [Table 2]. The children were asked to rate their impact with 13 statements of CRIES-13 using a Likert scale. More than half of the respondents (52%) scored above the cutoff score of CRIES-13, that is, 30 [Figure 1], which indicates that majority of the respondents qualify to have mild-to-moderate posttraumatic symptoms. On the statement of “Do you have waves of strong feelings about it?, 43% of the participants scored higher; about 47% of the respondents scored higher on the avoidance statement of “Do you stay away from reminders of it (e.g., places or situations).” In the same manner, 39% of the respondents scored high on CRIES statement that “Do you try to remove it from your memory.” In addition to that, 35% of the respondents scored high on the feeling that the pictures about it pop still into their mind [Table 2].{Figure 1}{Table 2}

In addition, t-test was used to determine the differences between the results on CRIES-13 and sociodemographic factors. The results showed a significant difference between the total score of CRIES-13 and the domicile of participants (t = 2.167, P < 0.033*), socioeconomic status (SES) (t = 3.080, P < 0.003**), and displacement of respondents (t = −2.028, P < 0.045*). The t-test also revealed significant differences between the sub-scales of intrusion, avoidance, and arousal and sociodemographic factors [Table 3], indicating that sociodemographic factors also influence the psychological health of individuals, particularly children.{Table 3}

The overall impact of the disaster on the children is depicted in [Table 4], which presents the mean scores of sub-scales of intrusion (n = 100) at 10.78 ± 3.94, avoidance at 10.41 ± 4.16, arousal at 9.63 ± 4.52, and the total mean score of CRIES-13 at 30.91 ± 8.63 with the cutoff score of 30 indicating that the respondents have mild-to-moderate posttraumatic symptoms.{Table 4}

Resilience

According to the independent t-test, the results showed that the sociodemographic factors such as gender (t = −2.9, P < 0.004**) [Table 5], domicile (t = −1.9, P < 0.049*), SES (t = 2.4, P < 0.017*), and education (t = −1.9, P < 0.058*) were statistically significant to resilience. Whereas, there were no statistically significant differences between the other sociodemographic factors such as age, family type, family strength, displacement, loss of property and life, and resilience [Table 6]. In addition, the item analysis showed that participants scored very high (64% nearly all the times and 23% very often) on the spiritual statement of When there are no clear solutions to my problems, sometimes fate or God can help. Other statements for which the participants scored high are as follows: 43% reported that they take pride of their achievements and 41% reported that all the time they have strong purpose in their lives. A majority of the respondents (54%) reported often that whenever they are stressed, they have at least one close and secure relationship that helps them in the situations [Table 7]. The overall resilience of children affected by disasters is depicted in [Table 4] which reports the mean score of CD-RISC (n = 100) at 62.76 ± 12.58, indicating that the respondents have moderate resilience.{Table 5}{Table 6}{Table 7}

 Discussion



The current study was designed to examine the influence of sociodemographic factors on the psychological reactions and in promoting coping and resilience of children toward the adversities. In the study, a total of 100 schoolgoing children who were directly affected by the disaster were assessed using CRIES-13 to measure posttraumatic experiences and CD-RISC-25 to measure resilience.

Impact along with sociodemographic variables

This section discusses the psychological impact of floods on child survivors with an extended focus on resilience, which is also the focus of the current study. The findings validate further that the psychological effects among the children can last for 15 months[13] to 6 years.[14] This study also focuses on the sociodemographic factors such as age, gender, domicile, family type, SES, and education level as protective factors and their contribution for the adaptive capacity for building resilience among children during disasters, which is embedded in individuals, families, communities, and cultures.

Regarding the findings of the study, the mean score of CRIES-13 was 30.91, which suggests the presence of mild-to-moderate posttraumatic symptoms among the children. The intrusive symptoms among the children were found more as compared to avoidance and arousal with a mean score of 10.87. Half of the population (52%) scored above the cutoff score of 30 on CRIES-13, depicting that posttraumatic symptoms are still present among the children after the flood. Children living in Jammu and Kashmir have witnessed violent traumatic events and are vulnerable to develop PTS symptoms more often. Children living in Jammu and Kashmir develop higher levels of post-traumatic symptoms post flood disaster,[15] which adds that psychological vulnerability is more among these children. These findings concur with that of the early reports that 33% of the people especially children living in Jammu and Kashmir have lifetime prevalence of any traumatic experience.[16],[17]

In addition, sociodemographic characteristics such as domicile, SES, strength of family, and gender showed a significant difference with the impact of floods. In the current study Posttraumatic symptoms were found more among children from rural areas than urban areas and this is in consistent with previous research that increased incidence and occurrence of mental health issues in rural population is because of wide spectrum of psychosocial and socioeconomic factors including the general rural disadvantage and risk of long distances and remoteness of the areas.[18] Respondents with lower income were found to have significantly higher CRIES score. There is a strong association between the mental health issues and socioeconomic condition, and studies[19],[20] have found it as an important predictor of physical and mental health conditions both in pre- and post-disaster periods. This study supports this finding as there was a significant difference between low SES and PTS symptoms. Family strength was also found as a factor to determine the impact of disaster, with low family size depicting higher posttraumatic symptoms. This is in consistent with the findings that families can engage the children in planning and in preparedness activities that focus on the children's reactions to disasters, prioritizing the reunification of family's aftermath of an event.[21]

In contrast, this study found higher posttraumatic symptoms among male as compared to female children. In general, literature suggests that females report higher levels of PTSD symptoms compared to males,[22],[23],[24] and and the reason for higher posttraumatic symptoms among males in the current study could be different sociocultural and political factors contributing to mental distress among males in this region. Male children in this region witness higher number of traumatic events as compared to female children who remain mostly indoor in their houses. The schoolgoing boys help their parents in their work and business, often travel to different places such as markets, and get exposed to external environments, which increase their vulnerability, whereas girls mostly remain indoors or do not venture out as often as boys.

Resilience and sociodemographic variables

Literature suggests that when measuring the psychological symptoms of the children, focus should also be made to assess the protective factors which contribute to resilience among children.[25] In this study, resilience was measured by using CD-RISC-25-item version scale to assess the factors contributing to their resilience. Various sociocultural factors are expected to be related to the resilience of children living in multi hazardous region. The findings of the current study showed that the total mean score of CD-RISC-25 among the respondents was 62.76, which indicates that children have intermediate level of resilience.

There was a significant difference between the sociodemographic characteristics such as gender, SES, domicile, and education level and resilience among children. This study does not support the fact that girl children have less resilience as compared to male children. Studies have found that good and adequate social support from families, adults, and peers has been found a contributor of high resilience among female children.[26],[27] This study supports the fact that female children in Kashmir receive higher care and support from families and enjoy choices and opportunities that their previous generations would not have dreamed of. Children from urban background and with higher levels of education were found to be more resilient. It denotes that children who have better access to services and have better educational opportunities tend to make use of those factors and prove to be more resilient.

In general, the debate is that resilience is considered the flipside of vulnerability, which implies that highly vulnerable people are less resilient. Interestingly, in the current study, the respondents belonging to lower SES have been found high on resilience. The reason could be vulnerability and resilience have different paths, and, hence, vulnerability does not essentially lead to low resilience. It has been found by studies[28] that people from lower socioeconomic background and marginalized people may share the immediate impacts of the disasters, but might be resilient enough to avoid the long-term consequences of the disasters.

This study has reached its aims, but there are some unavoidable limitations. First, logistic complications arise from the inability to plan in advance due to time limitation, changing conditions in the affected area, and the difficulty of assembling and obtaining data quickly from the children. In addition, the instruments that assessed impact and resilience were not developed in India and and may lack cultural relevance and validity in areas impacted by disasters in other areas.

 Conclusion



The present study aimed to understand the psychological reactions and resilience of children as a consequence of their exposure to the devastating floods of 2014. The study found that sociodemographic and sociocultural variables can determine the psychological impact and resilience among children. The current study shows the importance and benefits of sociodemographic factors in high-risk areas and describes how the factors help in enhancing resilience and minimizing the impact among high-risk populations. However, children and communities to be resilient need some protective net such as Better amenities and opportunities, age-related awareness and education, adequate social support, integration of psychosocial care, preparedness, & disaster risk reduction measures into the policies and curriculum, and this can be accomplished within a range of milieu-based approaches and methods. Therefore, this study suggests the need for exploring and designing sustainable psychological resilience-building strategies at individual and community level.

Acknowledgment

The authors are thankful to the heads of the educational institutes for allowing to carry out this study and for providing all the necessary support during the data collection phase.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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