Posted: December 6th, 2014
PTSD for Tsunami Survivors in Sri Lanka
Read the case study ?The Wave That Brought PTSD to Sri Lanka? and analysis the potential problems of conducting Western evaluations and psychological diagnoses in
non-Western Cultures. Please use these three articles along with three more of your choosing:
Watters, E. (2010). The Wave that Brought PTSD to Sri Lanka.
Responding to the mental health and psychosocial needs of the people of Sri Lanka in disasters.
By: Mahoney, John; Chandra, Vijay; Gambheera, Harrischandra; Silva, Terrence De; Suveendran, T. International Review of Psychiatry. Dec2006, Vol. 18 Issue 6, p593-597
This article is intend
Psychological Assessment 2012, Vol. 24, No. 4, 791-800
© 2012 American Psychological Association 1040-3590/12/$12.00 DOI: 10.1037/a0027564
Are Culturally Specific Measures of Trauma-Related Anxiety and Depression Needed? The Case of Sri Lanka
Nuwan Jayawickreme University of Pennsylvania
Pavel Atanasov University of Pennsylvania
Edna B. Foa University of Pennsylvania
Eranda Jayawickreme Wake Forest University
Michelle A. Goonasekera University of Peradeniya
The hypothesis that psychometric instruments incorporating local idioms of distress predict functional impairment in a non-Western, war-affected population above and
beyond translations of already established instruments was tested. Exploratory factor analysis was conducted on the War-Related Psychological and Behavioral Problems
section of the Penn/RESIST/Peradeniya War Problems Questionnaire (PRPWPQ; N. Jayawickreme, Jayawickreme, Goonasekera, & Foa, 2009), a measure that incorporates local
idioms of distress, using data from 197 individuals living in Northern and Eastern Sri Lanka. Three subscales —Anxiety, Depression, and Negative Perception—were
identified. Regression analyses were conducted to test whether these 3 subscales better predicted functional impairment than the PTSD Symptom Scale–Self Report (PSS;
Foa, Riggs, Dancu, & Rothbaum, 1993) and the Beck Depression Inventory (BDI; Beck & Steer, 1987), both widely used self-report measures of posttraumatic stress
disorder and depression, respectively. Two of the 3 subscales from the PRPWPQ—Anxiety and Depression—were significantly associated with higher rates of functional
impairment after controlling for age, the PSS and the BDI. After the inclusion of PRPWPQ, the PSS and the BDI did not significantly contribute to the final regression
model predicting functional impairment. These findings suggest that the scores of measures with local idioms of distress have incremental validity in non-Western war-
affected populations, predicting functional impairment above and beyond translations of established self-report measures that have been developed in the Western world.
Keywords: PTSD, depression, trauma, culture, idioms of distress
As the 21st century unfolds, mass conflict and displacement continue to devastate the lives of millions (Obermeyer, Murray, & Gakidou, 2008). It is estimated that
there are currently 16 million
refugees and 26 million internally displaced persons in the world, with the majority residing in the resource-impoverished, non-Western world (Batniji, van Ommeren, &
Saracen, 2006; United
This article was published Online First March 19, 2012. Nuwan Jayawickreme, Center for the Treatment and Study of Anxiety, University of Pennsylvania, School of
Medicine, Department of Psychia-try; Eranda Jayawickreme, Department of Psychology, Wake Forest Uni-versity; Pavel Atanasov, Department of Psychology, University of
Penn-sylvania; Michelle A. Goonasekera, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; and Edna B. Foa, Center for the Treatment and Study of
Anxiety, University of Pennsylvania, School of Medicine, Department of Psychiatry. Eranda Jayawickreme was a graduate student at the University of Penn-sylvania when
these data were collected. Michelle A. Goonasekera is now at the Acute Medicine Unit, St. George’s Healthcare NHS Trust, London, England. This article is based in part
on Nuwan Jayawickreme’s doctoral disser-tation in Psychology at the University of Pennsylvania. Portions of this article were presented at the 27th Annual Convention
of the International Society for Traumatic Stress Studies, Baltimore, Maryland, November 2011. The research was supported by a grant from the Asia Foundation awarded
to Eranda Jayawickreme and Nuwan Jayawickreme; an American
791
Psychological Association Dissertation Research Award given by the Sci-ence Directorate of the American Psychological Association to Nuwan Jayawickreme; and funds from
the Positive Psychology Center, University of Pennsylvania, awarded to Eranda Jayawickreme. The authors wish to thank Dianne L. Chambless, Seth J. Gillihan, Carmen P.
McLean, Yevgeniya Ratnovsky, and Alyson K. Zalta for reading drafts of this article and for their thoughtful and helpful suggestions. We also gratefully acknowledge
our colleagues for their many contributions to this study. Martin E. Franklin, Arancha Garcia del Soto, Paul Rozin, Jeanine Guthrie, Gameela Samarasinghe, P. Prabu,
and Nadaraja Balasubramaniam provided valuable advice on the design and implementation of the study. Shawn P. Cahill and Robert J. DeRubeis and his supervision group
both provided valuable advice and reviewed back-translations of the measures. Uditha Dassanayake, M. Mikram, and Siva Thushi translated the measures and organized the
focus group. A. Sara Pooven-dran, Charmila Edirisinghe, and MJ.M.I. Hassan facilitated data collection. Correspondence concerning this article should be addressed to
Nu-wan Jayawickreme, Center for the Treatment and Study of Anxiety, University of Pennsylvania, School of Medicine, Department of Psy-chiatry, Philadelphia, PA 19104.
E-mail: nuwanj @mail.med.upenn.edu
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