Earthquake and Tsunami

Reports of consultants

Duty Travel Report to Maldives - Dr. Vijay Chandra and Dr. Rajesh Pandav - Feb 24, 2005 - March 11, 2005

DUTY TRAVEL REPORT TO MALDIVES

Dr. Vijay Chandra and Dr. Rajesh Pandav

(Feb 24, 2005 – March 11, 2005)

Annex 1 DATE: __ __ /__ __ /__ __ ID NO. __ __ __ __ __ __ __

PSYCHOSOCIAL SUPPORT NEEDS ASSESSMENT IN THE COMMUNITY

MALDIVES

INFORMATION FOR ADULTS

Name
Age
Sex
Current address

I know you have experienced a major disaster. I am here to enquire about your welfare and to see how we can help you. I work for the Ministry of Health and we are contacting each and every affected person. I am going to ask you some questions. Please answer whatever you wish to answer. All responses are confidential.

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Turn over and administer the GHQ questions 1 to 12: TOTAL GHQ-12 SCORE: ____

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13. Have you ever been told that you have a major neuropsychiatric illness such as psychosis, depression or epilepsy Yes / No

My next three questions are a little sensitive. Please do not be offended and respond frankly.

14. Because of the severe stress you have undergone, have you considered suicide as a way out of your suffering? Yes / No

15. Because of the severe stress you have undergone, have you become violent? Yes / No

16. Because of the sever stress you have undergone, have you started taking Yes/No

excessive amounts of sedatives or other drugs?

Community level worker observations:

17. Is the person severely dysfunctional (remaining islolated and inactive,

extremely poor self care, loss of responsibility for self and others) Yes / No

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SCORING and ACTION TO BE TAKEN BY Community Level Worker (CLW)

If GHQ-12 score is 0 or 1,no specific psychosocial intervention is needed.

If total GHQ 12 score is between 2 and 6, provide psychosocial first aid.

If total GHQ-12 score is 7 or more refer to a counselor/physician for evaluation and management.

In addition, if any of the questions 13 to 17 are answered ‘YES’, refer to a counselor/physician for evaluation and treatment.

Name of CLW:_________________________________

GHQ 12: These questions deal with how you are feeling NOW

No.	Question	Response				Score
1	Been able to concentrate on whatever you’re doing?	Better than normal	Like normal	Less than normal	Much less than normal
2	Lost much sleep over worry?	Not at all	Not more than normal	More than normal	Much more than normal
3	Felt that you are playing a useful part in things?	More than normal	Like normal	Less than normal	Much less than normal
4	Felt capable of making decisions about things?	More than normal	Like normal	Less than normal	Much less than normal
5	Felt constantly under strain?	Not at all	Not more than normal	More than normal	Much more than normal
6	Felt you could overcome your difficulties?	Not at all	Not more than normal	More than normal	Much more than normal
7	Been able to enjoy your normal day-to-day activities?	More than normal	Not more than normal	Less than normal	Much less than normal
8	Been able to face up to your problems?	More than normal	Like normal	Less than normal	Much less than normal
9	Been feeling unhappy and depressed?	Not at all	Not more than normal	More than normal	Much more than normal
10	Been losing confidence in yourself?	Not at all	Not more than normal	More than normal	Much more than normal
11	Been thinking of yourself as a worthless person?	Not at all	Less than normal	More than normal	Much more than normal
12	Been feeling reasonably happy, all things considered?	More than normal	Like normal	Less than normal	Much less than normal

Instructions for completing the needs assessment instrument.

1. For GHQ-12 read the question then read all four responses and ask them to select one and circle the response.

2. For GHQ-12 if the person refuses to answer a question and make a note in the margin and leave the response blank.

3. For Q13 ot Q17 if refuses to answer, note in the margin and do not press the point further.

4. Coding of GHQ-12: If either of column 3 or 4 is circled then Score = 1, else score 0.

PSYCHOSOCIAL NEEDS ASSESSMENT :

PRE-TESTING OF QUESTIONNAIRE

Introduction

The English version of the questionnaire was first translated by Ms. Zenia Aminath into Dhivehi. The translation was discussed with a team from the Psychosocial Unit of the National Disaster Management Centre including Mr. Hamid and five counselors. The questions were back translated to English and found to be appropriate.

This questionnaire was pilot tested in Guraidhoo island on sample of 43 affected adults.

The results are as follows

1. Age

	N	Minimum	Maximum	Mean	Std. Deviation
Age	43	19	90	40.37	18.46

2. Sex

33. GHQ-12 (Third and Fourth Response Column positive)

4. GHQ total (Third and fourth response column positive) histogram

5. GHQ-12 (4th column positive) score

6. GHQ total (fourth response column positive) histogram

7. Comments on cases with GHQ-12 score 7 or more

ID	GHQ0-12 total (3 and 4 column)	GHQ total (4^th column only)	Response to ANY one of questions 13 to17	Comments	Type of psychosocial support needed
38	11	3	No	Needs help to resolve conflict with family which appeared prior to Tsunami, but feels guilty after Tsunami for not being able to help family as he is the eldest in the family	Needs counseling to resolve family dispute
25	8	3	No	At 9.00 am gets a panicky sensation, does not want to go back to work	Needs counselling
26	9	4	Yes to Q15 & 17	Panics a lot around 9.00 am, finishes her work before then, does not want to build house, neighbour says feeling hopeless	Needs counselling
23	7	0	No	Looked withdrawn, answered in monosyllables	Needs counselling
2	9	3	Yes to Q16	Looked withdrawn and slightly depressed	Needs counselling
17	9	4	No	Has lost lot of property, better now, maybe little anxious	No specific intervention now
43	9	0	Yes to Q15	Looses temper, admits he may have resorted to violence	Needs counselling
1	10	6	No	Looks depressed	Needs counselling
36	7	4	Yes to Q13	Known case of epilepsy	See doctor
35	8	1	Yes to Q13	Major neuropsychiatric illness, type unknown	See doctor

8. Subjects with a “YES” response to questions 13 to 17 but with GHQ-12 score below 7

ID	GHQ total (response column 3 or 4 positive)	Comments	Type of psychosocial support needed
20	5	Resorts to verbal abuse, argues and gets very angry, husband disabled, has to do all the work	Needs counselling
18	6	Attempted suicide 5 years ago, has flashbacks, become violent, beating children, thinks she has been depressed for a long time, dysfunctional (probably PTSD)	See doctor
13	4	Taking sedatives. Looks ok, fainted on day, was taken to Male, was seen by psychiatrist	Needs counselling
10	3	Taking sedatives, probably not prescribed	Needs counselling
37	4	Severely dysfunctional, one twin died in Tsunami, not taking care of children and herself in terms of hygiene	See doctor

7. Conclusions

GHQ-12 (response column 3 or 4 positive) 7 or more will identify 23.3% of cases for further support. Five of these subjects were also positive on questions 13 to 17.

In addition, 5 subjects were identified only by Questions No. 13 to 17. Thus, questions 13 to 17 are needed in addition to GHQ-12.

A total of 15 (34.8%) out of 43 subjects were identified as needing additional support. Majority of these subjects need counselling, with a few requiring medical attention.

GHQ1-12 (response column 4 positive) score of 4 or more will miss some cases needing additional support.

8. Recommendations for support to those identified by existing instrument

The capabilities of the Emotional Support Brigade be enhanced with training in simple counseling skills. (e.g. through use of WHO manuals)

Community health workers to be trained in the identification and management of common neuropsychiatric illness using the same material as for physicians.

Community health workers be supported by physicians as needed. Physicians need to be trained. WHO Manual is available.

9. Recommendations for future implementation of the needs assessment instrument

Data management support can be provided by the expert already placed in the MOH for 3 months.

Results of the needs assessment instrument should be evaluated after about 200 questionnaires are complete for any mid course correction of cut-offs for referral or wording of questions.

Data may be analysed stratified on the most affected island vs moderately affected islands vs indirectly affected populations such as those sheltering people who were directly affected.