Natural disasters cause immense suffering among affected communities. Most occur in developing countries, which have fewer resources to respond to the resulting traumas and difficulties. As a consequence, most survivors have to rely on their own coping resources and draw from what support remains within family, social networks and the wider community to manage and deal with their losses and consequent emotional distress.
Using in-depth qualitative methods, we set out to investigate the coping strategies adopted by survivors of the 2004 Boxing Day tsunami in Sri Lanka to deal with a range of psychological and social problems.
The setting of this study was the Matara district of southern Sri Lanka, where 19,744 families were affected, 2235 were displaced, and 1342 people died (18). We conducted field work from October 2007 to September 2008 in selected Grama Niladari divisions (the lowest administrative unit in Sri Lanka, usually comprising two to three villages). Ethical approvals were obtained from the ethics committees of King’s College London, UK and the Faculty of Medical Sciences, University of Sri Jayawardanepura, Sri Lanka.
This was primarily a qualitative study, based on individual in-depth interviews with survivors, with researcher observations and secondary official sources providing additional data. In addition, we used two screening tools — the PRIME-MD Patient Health Questionnaire (PHQ-9, 19) and the Composite International Diagnostic Interview (CIDI, 20), Section K — to provide standardized information on the current mental health status of participants.
The study group comprised 21 women and 17 men aged 18–65 years. Among the 38 participants, 36 were Sinhalese and two were Muslim. We could not find any Tamil participant from the study area. Most were Buddhist (34) and two each were Catholic and Muslim. Five participants sustained severe physical injuries during the tsunami and 11 experienced moderate injuries. The study group included 20 individuals who lost one or multiple family members, three of whom never recovered their relatives’ bodies. To some degree almost everyone in the study group had been displaced and experienced loss of property, livelihood or household items. Results from the PHQ and CIDI indicated that five participants were positive for post-traumatic stress disorder and somatoform disorders, and three were positive for major depression, using standard diagnostic criteria. Seven participants reported other depressive and /or anxiety symptoms without meeting criteria for disorder during the time of data collection. Participants described a range of strategies that were adopted at different points following the tsunami to manage and respond to the immediate and lasting emotional trauma and practical devastation they and their communities experienced.