Shraddha Routray & Zoya Parwani
Affiliation: Symbiosis School for Liberal Arts, Pune
Symbiosis International (Deemed University)
Correspondence: zoya.parwani@ssla.edu.in

Cite This Source

Routray, S., & Parwani, Z. (2025). Beyond the waves: Understanding PTSD in tsunami survivors from India and Thailand in the wake of the 2004 Indian Ocean tsunami. Confluence: Journal for Interdisciplinary Studies, Volume IX, 25-35.

Abstract

The paper examines the psychological impact of the 2004 Indian Ocean tsunami on residents of Tamil Nadu, India, and southern Thailand. This paper analyses PTSD by comparing two key empirical studies: Risk factors of post-traumatic stress disorder in tsunami survivors of Kanyakumari District, Tamil Nadu, India (Pyari et al., 2012) and Posttraumatic mental health establishment of the tsunami survivors in Thailand (Thavichachart et al., 2009). Despite facing the same challenge, these studies found that different communities and cultures can shape the impact of PTSD.

High rates of PTSD were found in both areas (32.6% in Tamil Nadu and 33.6% in Thailand). The main factors tied to this are being female, having a low income, suffering trauma previously and experiencing bereavement. The Thai study adopted a longitudinal design with a focus on genetic predispositions and coping styles. At the same time, the Indian researchers emphasised matters such as support from services and easy access to counselling.

Both studies note that psychosocial support is crucial. In Thailand, Buddhist monasteries provided important therapy, while in India, those who received more frequent counselling and were pleased with their services experienced less risk of PTSD. Research reveals that avoidant methods and harmful behaviours, such as using drugs, lead to worsened PTSD symptoms.

The paper advocates for culturally grounded, community-based approaches to trauma recovery that consider collective trauma rather than just individual trauma. The results indicate that a multi-dimensional strategy involving social, psychological and cultural approaches should be used to help people in India and Thailand recover from disasters.

Keywords: PTSD, tsunami survivors, psychosocial support, coping strategies, gender vulnerability, disaster mental health, cultural resilience, collective trauma, community-based interventions.

Introduction

In the early hours of 26th December 2004, an underwater earthquake of magnitude 9.0 on the Richter scale wreaked havoc in the Andaman Sea and the Indian Ocean, leading to a Tsunami along the coast of these two water bodies, resulting in widespread devastation and catastrophe. The tsunami, which is categorised as one of the worst in human history, led to massive death and destruction, with more than 300,000 casualties in 12 countries, leaving more than 1 million people homeless and displaced (Pyari et al., 2012).

While numerous studies have examined the physical and socio-economic effects of the tsunami, this paper focuses specifically on the psychological impact of the tsunami in the Kanyakumari district of Tamil Nadu, India and six provinces of the southern part of Thailand, namely, Ranong, Pang-nga, Phuket, Krabi, Trang, and Satoon (Thavichachart et al., 2009). Building on existing research, this paper traces the prevalence and risk factors of PTSD amongst the tsunami survivors and looks at the associated risk factors while also conducting a comparative analysis between the studies to better understand the recurrent patterns or irregularities encountered while understanding PTSD in survivors of natural disasters in the two geographical territories. 

Though a comparative analysis has been conducted between the occurrence of PTSD amongst survivors of the 2004 Tsunami in India and parts of Thailand, it is essential to acknowledge the fact that the only consistent invariant factor is that both regions were impacted by the same natural calamity and all other observations and conclusions that are arrived at are predominantly based on the findings shaped by a range of cultural, infrastructural, and socio-political variables. These factors will be briefly discussed and highlighted in the paper in an attempt to understand their contribution to the findings and the prevalent attitudes and narratives surrounding PTSD in the two geographical regions.

Rationale

This analysis adopts an interdisciplinary approach, drawing on liberal arts perspectives that go beyond the singularities of concepts and phenomena by viewing them in diverse contexts. Similarly, this paper tries to examine a single event- the 2004 Tsunami, by looking at the natural calamity through a diverse lens while trying to understand its contribution to PTSD in the affected population. 

Just as no two human experiences can ever be the same, similarly, human suffering, although caused by the same event, will also remain starkly different when experienced, articulated and recounted. While the two studies manage to reach some sort of consensus and conclusion while examining PTSD in the tsunami survivors, it is particularly significant to examine how these individual experiences that are converted into statistics and data may contribute to certain narratives and perspectives surrounding the variable that is being studied (in this case, PTSD) when this data is viewed as unique and subjective experiences that transcend mere generalisations and conclusions.

According to Thavichachart et al (2009), who referred to the fourth edition of the DSM, PTSD is a psychiatric disorder that results from the experience or witnessing of traumatic or life-threatening events. Symptoms range from re-experiencing the trauma, persistent avoidance of reminders of the event, numbing of responsiveness, and persistent anxiety or hyper-arousal. PTSD is marked by profound psychobiological characteristics that can significantly impair day-to-day functioning and, in some instances, also be life-threatening. For a diagnosis of PTSD, symptoms have to be prevalent for more than one month, causing severe impairment and distress in daily activities. 

Studies show that PTSD is the most predominant following natural disasters, with 81% of investigations from developing countries. However, despite its dominance, a lack of research and data has limited the assistance in developing culturally sensitive strategies to manage the disorder (Pyari et al., 2012). Furthermore, the studies also explore the different risk factors, psychosocial factors and personality traits that make an individual vulnerable towards developing PTSD. These diverse factors and their consequent effects on the study variable give us a more comprehensive and dynamic perspective towards the disorder, which has often been misunderstood and oversimplified. 

PTSD is affected by factors including gender, age, socio-economic status, pre-existing trauma, injury, and bereavement. Both papers look at PTSD through a psychosocial lens, moving away from the purely clinical underpinnings of the disorder. While the Thai study included genetic sampling for future PTSD research, the Indian study highlighted social and infrastructural challenges like service satisfaction and counselling access, especially relevant in developing countries, which can significantly impact the course of the disorder and the subsequent narratives constructed around it.

It is important to note that such narratives and perspectives can have political implications, affecting policy making, disaster response planning and resource allocation. Furthermore, PTSD is often accompanied by mental health disorders like grief, depression, anxiety and substance abuse, which make it necessary to understand the disorder within a more dynamic and relational setting, just as the two papers have attempted to do.

Methodological Approaches

Thavichachart et al. (2009) conducted their research in two phases through community-based surveys in six Thai provinces. Three thousand one hundred thirty-three adult residents participated in the first phase, two to three months after the disaster. The participants filled out self-report material, which included the Davidson Trauma Scale for PTSD symptoms assessment, along with the Beck Depression Inventory for depressive distress evaluation, and the broad-spectrum Symptom Checklist-90, with primary emphasis on the Brief COPE, which assesses fourteen distinct coping strategies. A different personality measure assessed individual preferences between extraversion and neuroticism aspects, while CAPS‐II diagnoses from clinical professionals validated PTSD cases in a subpopulation to ensure their assessment quality.

Two thousand five hundred seventy-three of the original participants underwent a Phase Two assessment using the Composite International Diagnostic Interview (CIDI) to check for chronic PTSD and psychiatric disorders. At the same time, the researchers conducted semi-structured substance abuse assessments. The blood samples gathered during this time announced upcoming genetic methods that the researchers planned to use for psychosocial and biological studies. This design’s longitudinal nature allowed for an in-depth observation of PTSD progression over time and explored various genetic and personality characteristics that lead to acute or chronic conditions.

Pyari, Kutty, and Sarma (2012) conducted their nested case–control research within four villages in Tamil Nadu, Kanyakumari District, at the six-month point. The researchers began by validating the Tamil version of the Impact of Event Scale–Revised (IES-R) with a sensitivity result of .92 and a specificity measure of .67 versus psychiatric interview results. The survey identified 158 “cases” among 485 survivors based on 70th percentile IES-R scores and established 141 “controls” based on 30th percentile IES-R performance. Detailed interviews obtained participant data for demographics and disaster and relief-related information. These interviews recorded demographic information, including age, gender, socioeconomic status, and peri-disaster experiences, specifically personal injuries, loss of family members, and house damage, alongside post-disaster factors such as received counselling sessions, relief satisfaction, and fears about a future tsunami occurrence. The investigators conducted multiple logistic regression analyses to detect the standalone predictive factors of PTSD, which yielded a streamlined assessment of service delivery characteristics together with demographic explanations within their resource-limited context.

Prevalence and Course of PTSD

Both research studies demonstrated a disturbing similarity that one-third of the tsunami survivors showed PTSD symptoms when measured months after the disaster waves died out. The Davidson Trauma Scale results indicated clinical PTSD for 33.6 per cent of Thai participants, while depressive symptoms were present in 14.3 per cent of the sample in Phase One. The combination of PTSD with depression was diagnosed in more than ten per cent of the affected population. A year later, more than 21.6 per cent of the survivors maintained chronic PTSD, while their rates of major depression, panic disorder, and substance use disorders remained elevated.

The Tamil Nadu study matched the findings when 32.6 per cent of its sample group met diagnostic standards for PTSD using IES-R rigorous criteria. The comparable prevalence across both regions suggests that natural disasters can induce similar psychological outcomes across distinct cultural contexts.

Core Causes and Contributing Factors

These studies share a prime finding that women serve as an essential risk factor for developing post-traumatic stress. The research found that women showed stronger symptoms of posttraumatic stress than men did at every point, even after controlling for other relevant factors. People’s social roles that force women to take care of others during crises, together with their natural exposure to interpersonal trauma, may render them more susceptible to post-disaster psychological distress. The researchers discovered that age, coupled with socioeconomic status, is a vital factor. People in Tamil Nadu who reached the age of forty or older faced triple the risk of developing PTSD because ageing weakens physical resistance, while adding up lifetime stress makes them highly vulnerable. People in households below the Standard of Living Index faced twice the risk of PTSD symptoms because poverty intensifies the mental burden endured through loss and displacement. The Thai study examined property and career losses as factors affecting PTSD severity levels, although it did not directly address income consequences. 

The extent of direct involvement between people and disaster events is critical. Areas in Thailand that received the most substantial wave impact had PTSD rates that were almost four times higher. In contrast, people in India’s city centres showed equivalent PTSD risk patterns because of significant destruction in those locations. Physical injuries coupled with the death of relatives produced double impacts on survivors who faced PTSD symptoms and developed both persistent grief and heightened alertness.

Thavichachart et al. (2009) revealed that childhood trauma before age twelve elevated risk factors by approximately 60 per cent. Evidence matches cumulative‐adversity theories, which state that childhood trauma creates sensitivity to future stressors by breaking the fundamental principles of safe expectations.

Psychological Mediators and Protective Interventions

The Thai study employed a diverse battery of psychometric instruments that highlighted how coping styles, along with personality traits, took centre stage. People who used problem-focused coping strategies through planning and active problem-solving, and emotional support seeking, minimised their symptoms severely. The risk of developing PTSD grew between two and four times for individuals who adopted avoidance strategies such as denial, behavioural disengagement, and self‐blame. Research confirmed that elevated neuroticism acts independently to determine how underlying temperament influences the filtering processes of traumatic memories and related stress responses.

The idea of resilience in India is formed through two main aspects of psychosocial support: quality and support frequency. The PTSD risk decreased by about 55 per cent for survivors who received at least four counselling sessions and found relief services to be satisfactory. Notably, the risk reduction approached 70% after survivors stopped continuously worrying about another tsunami coming. Research findings show that safety restoration and dignity preservation through multiple quality-based interventions must be treated as mandatory therapeutic requirements to help survivors recover.

Economic and Social Impact

The 2004 Indian Ocean tsunami led to widespread devastation across coastal communities and habitats in South and Southeast Asia, leading to profound social and economic consequences. Tamil Nadu was one of the hardest hit states, accounting for 75 per cent of deaths and destruction of entire communities within 1,089 villages and 172,000 houses. In Chennai, the tsunami completely ruined the fishing fleet, leading to the damage of 63,000 boats and 200 square kilometres of agricultural land due to saltwater intrusion (Arseculeratne et al., 2017).

The total damage was estimated to be $575 million, with losses amounting to $649 million. Tamil Nadu made it to the top of the list as the state that bore the highest monetary losses in infrastructure and livelihoods at $815 million, translating into long-term disruptions to local occupations and communities. For example, in the port of Chennai, small-scale fishing industries that were crucial for daily survival and employment were crippled. Lower-income communities, particularly in fishing villages, bore the brunt of the economic consequences with little to no insurance coverage to protect them from such destruction of their livelihood (Arseculeratne et al., 2017). 

In Thailand, on the other hand, the tsunami completely disrupted the once-booming tourism prevalent in provinces like Phuket and Phang Nga. In 2002, tourism contributed to nearly 6 per cent of Thailand’s GDP, and Phuket’s hotel and restaurant sector alone accounted for 42 per cent of the gross provincial product, going well beyond the other provinces in southern Thailand. The tsunami directly affected tourism, leading to a massive decline in the first quarter, severely affecting tourism-driven local economies (Birkland et al., 2006). Apart from its direct impacts on tourism, the tsunami also led to significant consequences for provinces that sustained themselves through small-scale fisheries, shrimp farming, rubber production, and agriculture. Coastal communities, in particular, suffered tremendous losses due to their direct geographical exposure to the tsunami’s force (Birkland et al., 2006).

It is of utmost importance to note that both India and Thailand are countries that stem from collectivist orientations, which focus on awareness of and alignment with social norms, achieving collective goals, engaging in activities related to future objectives that emphasise social relations, and assessing well-being in terms of how these relations are functioning in a context of self-deprecation and humility. It was essential for recovery efforts to acknowledge the collectivist nature of both countries and curate adaptive capacities that stem from such embedded cultural beliefs, emphasising group cohesion, humility, and resilience through mutual support (Paton et al., 2007). Such a collectivist culture is a grand narrative of the different interventions and mitigating strategies that counsellors and government organisations need to take into consideration while constructing plausible ways to manage and address psychological trauma and PTSD among the survivors.

Plausible Ways to Manage and Address PTSD

The research suggests that PTSD, which affects tsunami survivors, creates disruptions in how they view the world as well as symptom-specific issues. The trusted stability of land and life was temporarily disrupted after the sea transformed from a lifeline to a deadly destroyer of communities. In such a case, PTSD represents communal trauma greater than individual symptoms since it requires collective healing.

Based on the findings of the paper, targeted psychosocial interventions such as regular counselling sessions helped mitigate the PTSD symptoms in survivors. Individuals receiving counselling services more than three times had a lower risk of developing PTSD (OR = 0.45), indicating that sustained mental health support proved to be effective in such cases (Pyari et al., 2012). The use of structured screening tools, which are reliable and validated, along with timely identification of PTSD symptoms, can help facilitate early diagnosis and tailored treatment plans. For instance, the Thai study incorporated screening measures within three months of the incident and a follow-up at six months to detect chronic PTSD cases.

Another significant aspect of addressing plausible ways to manage the disorder is community-based mental health support, including religious and cultural practices specific to the geographical regions. In Thailand, for example, the Thai Buddhist monastic order (sangha) served as a key network that immediately mobilised to become central to the recovery efforts of the affected regions. Buddhist monks from Bangkok and other parts of Thailand travelled to the provinces struck by the tsunami to help the local communities. Buddhism also contributed to recovery and the development of resilience in a spiritual and religious capacity by offering spiritual and emotional support during the recovery process. In India, many survivors and victims preferred social and cultural coping strategies and found comfort in religious beliefs and practices rather than submitting to formal mental health services (Falk, 2021).

Such natural disasters are fundamentally social in nature, and other researchers have also depicted that such natural calamities reflect how a society is structured (Schröder, 2015). In many districts of Tamil Nadu, women accounted for 391 out of the total of 537 deaths due to their predetermined social roles carved out by patriarchy, which conditions them to protect their children and family members rather than learning to swim or climb trees to protect themselves in such perilous times (Arseculeratne et al., 2017). Identifying high-risk sections of society, such as women, children, the elderly, and those with physical injuries or bereavement and incorporating PTSD into disaster management policies becomes increasingly important as a measure to address and manage the disorder.

Promoting the use of positive coping mechanisms is another way to mitigate the symptoms of PTSD and effectively manage the disorder. The study conducted by Thavichachart et al. (2009) depicts how coping mechanisms such as alcohol or substance abuse, which were commonly adopted, can exacerbate psychiatric symptoms and hinder recovery. 

Finally, developing countries such as India need to acknowledge the importance of making provisions for disorders such as PTSD at a national level through effective policy-making and infrastructure. Pyari, Kutty, and Sarma (2012) point out that Satisfaction with relief services was a protective factor in India (OR = 0.57) and that mitigating psychological distress is possible through the restoration of trust and a sense of control by establishing strategic and transparent post-disaster relief efforts and policies.

Conclusion

Though these studies investigate the effects of the same natural disaster as experienced by survivors from two different countries, they are different in their scope, methodology, and analysis. Thavichachart et al. (2009) utilised a longitudinal, multi-province design along with very detailed psychological profiling through the various tests. In contrast, Pyari et al. (2012) conducted a nested case-control study focusing on demographic and service-related variables. The Thai study explored coping methods, individual characteristics, and psychiatric disorders to generate psychological and psychiatric understanding. The Indian study’s data focused on variables that could be used in public health actions, including counselling frequency and service satisfaction ratings. The studies agreed on fundamental risk factors, including being female and experiencing direct exposure and loss, and recognising that continuous psychosocial assistance is a protective factor.

Since therapeutic interventions should move past personal cognitive-behavioural practices, they should focus on collective forms of social meaning reconstruction. Group-based narrative therapy allows survivors to combine personal experiences into collective stories, reconnecting the life before and after suffering. Through community-led reinterpretation of their shared experiences, which acknowledges losses while recognising strengths and reaffirms core beliefs, the collective suffering will decrease, and the social bond will be restored after disasters have destroyed it. This invites a broader question: how can collective healing contribute to individual psychological recovery?

References

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Birkland, T. A., Heraba, P., Little, R. G., & Wallace, W. A. (2006, June). The Impact of the December 2004 Indian Ocean Tsunami on Tourism in Thailand. Research Gate. https://www.researchgate.net/publication/237970624_The_Impact_of_the_December_2004_Indian_Ocean_Tsunami_on_Tourism_in_Thailand

Falk, L.M. (2021). Buddhism and Resilience in Post-tsunami Thailand, 22(1), 157-171. Journal of Global Buddhism. https://www.globalbuddhism.org/

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