Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy

Objective: To study the relationship of post-traumatic stress disorder (PTSD) to severity of the disaster experience. Method: A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS-Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest. Results: PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4-0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4-0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5-0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest Level of loss 4.1 [95% CI 2.3-7.5]). Conclusion: Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.