PROJECT TOPIC- ROLE OF INTENSITY OF EVENT, DISTRESS DISCLOSURE AND RESILIENCE IN POSTTRAUMATIC STRESS DISORDER AMONG FLOOD VICTIMS IN EBONYI STATE
1.1 Background to the Study
Natural disaster in recent years has become a menace to human life. Many people are now drawing their attention on the after effect of flooding especially on mental health. Different kinds of natural disasters occur in different parts of the globe. Flooding has been the commonest disaster in developing countries, including Nigeria (Odufuwa, Adedeji, Oladesu, & Bongea, 2012). In 2012 alone, 106 million people were affected by disasters. But following long-term trends, the largest number of people were affected by flood (Fersis, Petz,& Stark,2013).
It was estimated that within 200 and 2009, flooding affected approximately 949 people worldwide. A greater majority of 900 million lived in countries of medium human development (International Federation of Red Cross Society, IFRC, 2010). During the rainy season, this menace is mostly the talk of the day in most of the countries all over the world and most recently in Nigeria (Akanin & Bilesanmi, 2011; Taiwo, 2011). Recent flood and its consequences all over the world are becoming too frequent and treat to sustainable development in human settlement (Aderogba, 2012). Thus floods are posing concern for researchers and government (Aderogba, 2012).
Nigeria is made up of 36 states and 14 out of these states experience heavy flooding beginning from the month of July, 2012 up till October 2012 when those water dried up. Within the 14 states of Nigeria that witnessed the flood (e.g., Ebonyi, Anambra, Bayelsa, Benue, Cross River, Lagos et.c), 95 LGAs were affected which are within the River Niger and River Benue basins. Within those months, severe flooding ravaged Nigeria and caused serious damage to various sectors of Nigeria economy.
This flood came as a result of excessive rainfall as well as water release from the Lagdo reservoir in the Republic of Cameroun. It washed away farmlands, settlement and her critical infrastructure such as road, bridges, communication and power installations (Muhammad, 2012). Olajuyigbe, Rotowa & Durojaye (2012) stated that flood disaster has occurred in some part of the country in previous years including Ibadan in 1985,1987 and 1990; Osogbo in 1992,1996 and 2002; Y0be in 2000 and Akure in 1996, 2000, 2002,2004 and 2006. Other cities like Lagos, Port Harcourt Calabar, Uyo and Warri have also experienced flood disaster some years ago.
Flood is a large amount of water covering an area that is usually dry (Horny, 2000). Olajuyigbe, Rotowa and Durojaye (2012) stated that flood is an over flow of a large amount of water over dry land. Nwafor (2006) opined that flood is a natural hazard like drought desertification which occurs as an extreme hydrological (run off) event. According to Abam (2006), flood is a large volume of water which arrives at and occupies the stream channel and its flood plain in a time too short to prevent damage to economic activities including homes.
Sources of flood water can rise from the sea (in the form of storm surge or coastal degradation), and from glacier melt, snowmelt, rainfall and/or from failure of man-made water containment system, such as dams reservoirs and pumping system (Ugwu & Ugwu, 2013). Ologunorisa (2004) stated that coastal flooding, river flooding and urban flooding are the three forms of flooding that occur in Nigeria. Coastal flooding, according to him, occurs in the low-lying belt of mangrove and fresh water swamps along the coast.
River flooding on the other hand occur in the flood plains of the larger rivers, while sudden, short-lived flash floods are associated with rivers in the inland areas where sudden heavy rains can change them into destructive torrents within a short period (Folorunsho & Awosika, 2001; Ologunorisa, 2004). Urban flooding occurs in towns where little or no provisions has been made for drainage, or where exciting drainage has been blocked with refuses, wastages and eroded soil sediments (Folorunsho & Awosika, 2001; Ologunorisa, 2004). Urban flood is experienced in all parts of the world but mostly more hazardous in the developing countries due to poor developmental planning (Olajuyigbe, Rotowa, & Durojaye, 2012).
Odemerho (2004) and Nwafor (2006) identified 12 cause of urban flooding which include: surcharges in water level due to natural or man-made construction on flood path, sudden dam failure, inappropriate land use, mudflow, inadequate drainage capacity to cope with urbanization, excess encroachment in flood ways, ice jam, rapid snow fall, deforestation of catchment basins, reclamation, construction sites and solid waste.
The effects of flooding on economic activities, people’s health, relationships and welfare can be extensive and significant (Stanke, Murray, Amlot, Nurse, & Williams, 2012). It can have alarming effect on mental health and psychosocial well-being. Stanke et. al. (2012) maintained that flood can pose huge social and welfare problems that can continue over extended periods of time as a result of stressors that arise as people try to recover their lives, property and relationships. Bonanno, Galea, Buciarelli and Vlahov, (2006) have examined the relation between health problems and natural disasters and showed that the most frequently reported symptoms among survivors of disaster are mental health problems, such as posttraumatic stress symptoms depression and anxiety.
The DSM-IV-TR (American Psychiatric Asoociation,2000) defined trauma as an extreme stressor involving direct personal experience of an event that involve actual or threatened death or serious injury, or other stressors like natural disasters. Posttraumatic stress disorders (PTSD) on the other hand is characterized by symptoms of re-experiencing aspects of the trauma such as unwanted intrusive images , nightmares, avoidance of internal or external reminders of the trauma and chronic hyper-arousal (American Psychiatric Association, 2000). It is a severe condition that may develop after a person is exposed to one or more traumatic event, such as sexual assault, serious injury or threat of death. The diagnosis may be given when a group of symptoms such as disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyper-arousal ( high levels of anxiety) continue for more than a month after the traumatic event.
According to Diagnostic and statistical Manual of Mental Disorders (American Psychiatric Association, 1980), posttraumatic stress disorder is an anxiety disorder. In the International Classification of Diseases, Injuries, and Causes of Death (ICD-10) (World Health Organisation, 1992), it is classified as a neurotic stress-related and somatoform disorder. Important traumatic events which usually cause posttraumatic stress disorder include war, violent personal assault (e.g. sexual assault, and physical attack), being taken hostage or kidnapped, confinement as a prisoner of war, torture, terrorist attack, or severe car accidents (Javidi & yadollahie, 2012).
The definition of posttraumatic stress disorder describes an anxiety disorder that arises after exposure to an untoward extreme event in which physical harm occurred or was threatened. Unexpected extreme traumatic stressors like war, violent personal assault, kidnapping, torture, severe car accident and terrorist attack, flood, hurricane, wildlife, earthquake to mention but a few can cause posttraumatic stress disorder in adults ( Javidi &Yadollahie, 2012). Predictors of posttraumatic stress disorder symptoms include worries about future terrorist attacks, reduced self confidence and feeling of personal control, guilt/shame and helpless/anger, and low levels of social support (Simeon, Greenberg, & Nelson, 2005).
Kulka, Schlenger & Fairbank (1990), found in the National Vietnam Veterans Readjustment Survey, that people with posttraumatic stress disorder have 99% lifetime co-morbidity. The majority of distressing reaction settle over a matter of weeks or months with a minority developing into a diagnosable psychiatric disorder, such as posttraumatic stress disorder but also others including depression, anxiety disorders and substance misuse. The researcher seeks to explore the predictive roles of intensity of event, distress disclosure and resilience in posttraumatic stress disorder symptoms among flood victims of 2012 in Afikpo North Local Government, Ebonyi State, Nigeria.
Van Der Kolk (1987) was of the view that the probability of the development of posttraumatic stress disorder increases with the intensity of the stressful event. Intensity of traumatic event means the greatness the magnitude or the extremeness of the traumatic event. Strlau & Zawadzki (2005) found that intensity of the traumatic event is the best predictor of the severity of posttraumatic stress disorder symptoms. The DSM-IV-TR (American Psychiatric Association, 2000) specifies that posttraumatic stress disorder’s qualifying event must provoke intense fear, horror or helplessness. Consequently, current diagnostic criteria for posttraumatic stress disorder disqualify any event, however threatening, if the victim did not experience these reactions as the trauma was occurring. This shows that the argument made by McNally(2009) is very important to note.
PROJECT TOPIC- ROLE OF INTENSITY OF EVENT, DISTRESS DISCLOSURE AND RESILIENCE IN POSTTRAUMATIC STRESS DISORDER AMONG FLOOD VICTIMS IN EBONYI STATE
He stated that defining trauma not only by its objective features, but also by the victim’s peri-traumatic emotional reaction, remains controversial because it confounds the response with the stimulus. Apart from this conceptual issue, there remains the empirical issue of foreclosing consideration of peri-traumatic reactions such as anger, guilt, shame, or disgust may elicit symptoms of posttraumatic stress disorder just as fear, horror, or helplessness do (Andrews, Brewin, Rose & Kirk, 2000). Researchers have shown that higher impact trauma is more likely to precipitate a distressing response. Rothbaum & Foa (1993) were of the view that people who live closest to the site of any traumatic event experience higher level of distress than those who live far away from the site. The health impact of trauma may vary with the degree that the traumatic event disrupted a person’s life. This, in other words, means that the intensity of the event has a big role to play in the development of posttraumatic stress disorder.
Another important phenomenon in this research work is distress disclosure. Distress disclosure is the willingness of a person to disclose distressing personal information to others. By disclosing distressing information, the psychological stress brought about by this information is reduced thereby bringing the individual to a better health condition (Pennebaker, 1997). The counselors and therapists aim at encouraging disclosure from their client in therapeutic settings. Jaffe (1984) was of the view that those who experience particularly traumatic life events regain their sense of self by disclosing what has happened to them or their experiences.
Hook & Andrews (2005) observed that individuals who were low disclosers show more depressive symptom than higher disclosers. This supports Burnard & Morrison (1992) who argued that a greater willingness to disclose is beneficial in the healing process. Individuals who have been diagnosed with posttraumatic stress disorder are often disturbed by traumatic memories, nightmares, unwanted thoughts and painful feeling. They are frequently working to avoid these experiences and the trauma-related situation or cues that occasion them. But being able to disclose such feelings and thoughts help them adapt rationally to the situation. In addition to the symptoms of posttraumatic stress disorder, the painful emotional experience and aftermath of trauma can often lead the traumatized individual view themselves as “damaged” or “broken” in some important ways.
These difficult emotions and thoughts are associated with a variety of behavioral problems, from substance abuse to relationship problems. Individuals who develop posttraumatic stress disorder experience immediate stress that can persist overtime (Hook & Andrews, 2005). Campbell & Renshaw (2013) observed that emotional numbing symptoms of posttraumatic stress disorder are negatively associated with relationship satisfaction in combat veteran and their romantic partners. Many speculate that one mechanism of this association may be distress disclosure by veterans.
Another factor that may affect the development of posttraumatic stress disorder is resilience. Resilience is defined by Clay, Knibbs & Joseph (2009) as the ability to continue to function normally in spite of adversity. Scales Benson, Leffert & Blyth (2000) stated that resilience is overcoming negative events and quickly returning to pre-trauma levels of functioning. Tipson (2013) maintained that humans continue to cope with natural disasters largely as they always have and their capacity to withstand it is generally referred to as resilience.
Bonanno (2008) defined resilience as the ability of adult in otherwise normal circumstances who are exposed to an isolated or partially highly disruptive event, such as the violent life-threatening situation, to maintain relatively stable, levels of psychological and physical functioning. It is the ability to maintain a state or normal equilibrium in the face of extremely unfavorable circumstances. Shalev & Errera (2008) see resilience as the absence of expected bad outcomes and some authors see resilience as the ability of people or things to feel better after something unpleasant such as shock, injury, etc. Ahmed (2007) pointed out that various factors such as believe, attitudes, coping strategies, behaviors and psychological cohesion have been suggested as conveying, protecting or endorsing resilience in the face of trauma. Resilient individuals may show insight, initiative, humor, creativity and independence. It is a dynamic quality.
Certain factors like genetics, neurological factors and childhood development, type of trauma or stressful event, personality characteristics, cognitive style gender, age, ego defense, social support and the host of others were found to be associated with resilience (Agaibi,2003; Fredrickson,2002; Shore, 2003; Southwick, Morgan, Vythilingham, Krysal & Charney, 2004). Some authors feel that resilience is the defense condition because there is evidence that most people who are exposed to loss or potentially traumatic event are resilient (Bonanno, 2004). Most people exposed to a traumatic event experience some level of psychological distress, but only a few develop chronic psychiatric disorders. Some exhibit what has been termed posttraumatic growth (Kilmer & Gil-Rivas, 2010). Thus resilience may buffer posttraumatic stress disorder symptoms.
1.2 Statement of the Problem
The flood disaster that ravaged 24 out of the 36 states in Nigeria in 2012 may have come and gone but its impact remains. Some of the impacts which appear to be neglected in research and public discourse include the psychological impact of the flood to the victims. It is possible that some of the victims are undergoing delayed unset or persistent symptoms of posttraumatic stress disorder, because, posttraumatic stress disorder has been known to pose a very big problem among victims of traumatic events. The research issues of interest to the researcher are:
- Will intensity of event significantly predict posttraumatic stress disorder among flood victims?
- Will distress disclosure significantly predict posttraumatic stress disorder among flood victims?
- Will resilience significantly predict posttraumatic stress disorder among flood victims?
1.3 Objectives of the Study
Posttraumatic stress disorder is an anxiety disclosure that is likely to be affected by a good number of factors. The purpose of this study is to examine whether intensity of event, distress disclosure and resilience will predict posttraumatic stress disorder among flood victims.