PERTANIKA JOURNAL OF SOCIAL SCIENCES AND HUMANITIES

 

e-ISSN 2231-8534
ISSN 0128-7702

Home / Regular Issue / JSSH Vol. 31 (4) Dec. 2023 / JSSH-8801-2022

 

Determinants of Psychological Problems among Widows Living under the Long Civil Unrest in the Southernmost Provinces of Thailand

Wattana Prohmpetch, Phattrawan Tongkumchum and Rhysa McNeil

Pertanika Journal of Social Science and Humanities, Volume 31, Issue 4, December 2023

DOI: https://doi.org/10.47836/pjssh.31.4.04

Keywords: Civil unrest, psychological problems, widows

Published on: 13 December 2023

People in the deep south region of Thailand have experienced civil unrest since 2004, and widows from the conflict have been severely stressed and faced various psychological problems. This study aims to investigate psychological problems and examine factors affecting the psychological problems among these widows. The psychological problems are post-traumatic stress disorder (PTSD), complicated grief (CG), and depression. The study’s sample consisted of 350 widows who voluntarily participated in the interviews and completed the questionnaires. PTSD symptom scale-interview version assesses post-traumatic stress disorder, and the complicated grief is measured using the inventory of the complicated grief, and the depression is evaluated with the Hamilton rating scale for depression (Thai version). The results indicate that the respondents had a high post-traumatic stress disorder state (M = 21, SD = 13.8), a high complicated grief state (M = 28.56, SD = 19.69), but a low depression state (M = 5.48, SD = 5.70). Thirty-two percent of the samples fulfilled the criteria for post-traumatic stress disorder, 48% for complicated grief, and 26.6% for depression. The factors significantly affecting post-traumatic stress disorder, complicated grief, and depression are low resilience, high external stressors, and the quality of life. However, the results should be interpreted with caution due to the risk of biases of the sensitive nature of the study. Therefore, to better understand the risks and protective factors of post-traumatic stress disorder, complicated grief, and depression of the bereaved widows, significantly different factors should be considered.

  • Alvarez, J., McLean, C., Harris, A. H. S., Rosen, C. S., Ruzek, J. I., & Kimerling, R. (2011). The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program. Journal of Consulting and Clinical Psychology, 79(5), 590-599. https://doi.org/10.1037/a0024466

  • American Psychiatric Association. (2005). Additional conditions that may be focus of clinical attention. In M. R. Liebowitz, D. H. Barlow, J. C. Ballenger, J. Davidson, E. Foa, & A. Fyer (Eds.), Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed., pp. 424-429). American Psychiatric Association.

  • American Psychiatric Association. (2013). Trauma-and stressor-related disorders. In K. A. Phillips (Ed.), Diagnostic and statistical manual of mental disorders: DSM-V (5th ed., pp. 265-280). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596

  • Anton, W. D., & Reed, J. R. (2004). Career development and business: Employee assistance program inventory. Psychological Assessment Resources, Inc.

  • Boelen, P. A., & Prigerson, H. G. (2007). The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults. European Archives of Psychiatry and Clinical Neuroscience, 257(8), 444-452. https://doi.org/10.1007/s00406-007-0744-0

  • Braam, A. W., & Koenig, H. G. (2019). Religion, spirituality and depression in prospective studies: A systematic review. Journal of Affective Disorders, 257, 428-438. https://doi.org/10.1016/j.jad.2019.06.063

  • Britvić, D., Antičević, V., Kaliterna, M., Lušić, L., Beg, A., Brajević-Gizdić, Kudric, M., Stupalo, Z., Krolo, V., & Pivac, N. (2015). Comorbidities with Posttraumatic Stress Disorder (PTSD) among combat veterans: 15 years postwar analysis. International Journal of Clinical and Health Psychology, 15(2), 81-92. https://doi.org/10.1016/j.ijchp.2014.11.002

  • Bryant, R. A., Ekasawin, S., Chakrabhand, S., Suwanmitri, S., Duangchun, O., & Chantaluckwong, T. (2011). A randomized controlled effectiveness trial of cognitive behavior therapy for post-traumatic stress disorder in terrorist-affected people in Thailand. World Psychiatry, 10(3), 205-209. https://doi.org/10.1002/j.2051-5545.2011.tb00058.x

  • Carroll, T. D., McCormick, W. H., Smith, P. N., Isaak, S. L., & Currier, J. M. (2020). PTSD, religious coping, and interpersonal antecedents of suicidal desire among military veterans: An initial examination of moderation models. Psychology of Religion and Spirituality, 12(3), 304-310. https://doi.org/10.1037/rel0000270

  • Casey, P., Jabbar, F., O’Leary, E., & Doherty, A. M. (2015). Suicidal behaviours in adjustment disorder and depressive episode. Journal of Affective Disorders, 174, 441-446. https://doi.org/10.1016/j.jad.2014.12.003

  • Charney, M. E., Bui, E., Sager, J. C., Ohye, B. Y., Goetter, E. M., & Simon, N. M. (2018). Complicated grief among military service members and veterans who served after September 11, 2001. Journal of Traumatic Stress, 31(1), 157-162. https://doi.org/10.1002/jts.22254

  • Department of Mental Health. (2005). WHOQOL–BREF–THAI. https://www.dmh.go.th/test/download/view.asp?id=17

  • Department of Mental Health. (2009). Manual for mental health strength in employee crisis program. The Agricultural Cooperative Federation of Thailand Limited.

  • Djelantik, A. M. J., Robinaugh, D. J., & Boelen, P. A. (2022). The course of symptoms in the first 27 months following bereavement: A latent trajectory analysis of prolonged grief, posttraumatic stress, and depression. Psychiatry Research, 311, Article 114472. https://doi.org/10.1016/j.psychres.2022.114472

  • Djelantik, A. M. J., Robinaugh, D. J., Kleber, R. J., Smid, G. E., & Boelen, P. A. (2020). Symptomatology following loss and trauma: Latent class and network analyses of prolonged grief disorder, posttraumatic stress disorder, and depression in a treatment‐seeking trauma‐exposed sample. Depression and Anxiety, 37(1), 26-34. https://doi.org/10.1002/da.22880

  • Edward, K. L. (2005). Resilience: A protector from depression. Journal of the American Psychiatric Nurses Association, 11(4), 241-243. https://doi.org/10.1177/1078390305281177

  • Foa, E. B., & Tolin, D. F. (2000). Comparison of the PTSD symptom scale–interview version and the clinician‐administered PTSD scale. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Studies, 13(2), 181-191. https://doi.org/10.1023/A:1007781909213

  • Ford, J. D., Grasso, D. J., Elhai, J. D., & Courtois, C. A. (2015). Posttraumatic stress disorder: Scientific and professional dimensions. Academic Press.

  • Grafiadeli, R., Glaesmer, H., & Wagner, B. (2022). Loss-related characteristics and symptoms of depression, prolonged grief, and posttraumatic stress following suicide bereavement. International Journal of Environmental Research and Public Health, 19(16), Article 10277. https://doi.org/10.3390/ijerph191610277

  • Hansson, L. (2002). Quality of life in depression and anxiety. International Review of Psychiatry, 14(3), 185-189. https://doi.org/10.1080/09540260220144966

  • He, L., Tang, S., Yu, W., Xu, W., Xie, Q., & Wang, J. (2014). The prevalence, comorbidity and risks of prolonged grief disorder among bereaved Chinese adults. Psychiatry Research, 219(2), 347-352. https://doi.org/10.1016/j.psychres.2014.05.022

  • Hibberd, R., Elwood, L. S., & Galovski, T. E. (2010). Risk and protective factors for posttraumatic stress disorder, prolonged grief, and depression in survivors of the violent death of a loved one. Journal of Loss and Trauma, 15(5), 426-447. https://doi.org/10.1080/15325024.2010.507660

  • Hollander, T. (2016). Ambiguous loss and complicated grief: Understanding the grief of parents of the disappeared in Northern Uganda. Journal of Family Theory & Review, 8(3), 294-307. https://doi.org/10.1111/jftr.12153

  • Horn, S. R., & Feder, A. (2018). Understanding resilience and preventing and treating PTSD. Harvard Review of Psychiatry, 26(3), 158-174. https://doi.org/10.1097/HRP.0000000000000194

  • Hull, A. M., Alexander, D. A., & Klein, S. (2002). Survivors of the Piper Alpha oil platform disaster: Long-term follow-up study. The British Journal of Psychiatry, 181(5), 433-438. https://doi.org/10.1192/bjp.181.5.433

  • Kaewkabthong, H. (2015). Experience of windows from the unrest in Southern border provinces [Unpublished master’s thesis]. Chulalongkorn University.

  • Kersting, A., Brähler, E., Glaesmer, H., & Wagner, B. (2011). Prevalence of complicated grief in a representative population-based sample. Journal of Affective Disorders, 131(1-3), 339-343. https://doi.org/10.1016/j.jad.2010.11.032

  • Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., De Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O., Haro, J.M., Huang, Y., Karam, E.G., Kawakami, N., Lee, S., Lepine, J., Levinson, D., ... Koenen, K. C. (2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), Article 1353383. https://doi.org/10.1080/20008198.2017.1353383

  • King, K. M., & Delgado, H. (2021). Losing a family member to incarceration: Grief and resilience. Journal of Loss and Trauma, 26(5), 436-450. https://doi.org/10.1080/15325024.2020.1816753

  • Komischke-Konnerup, K. B., Zachariae, R., Johannsen, M., Nielsen, L. D., & O’Connor, M. (2021). Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 4, Article 100140. https://doi.org/10.1016/j.jadr.2021.100140

  • Kristensen, P., Weisæth, L., & Heir, T. (2012). Bereavement and mental health after sudden and violent losses: A review. Psychiatry: Interpersonal & Biological Processes, 75(1), 76-97. https://doi.org/10.1521/psyc.2012.75.1.76

  • Kydonieus, A. R. (2016). PTSD as an exacerbating factor of external stressors in law enforcement [Doctoral dissertation, Alliant International University]. ProQuest Dissertations Publishing.

  • Lorant, V., Croux, C., Weich, S., Deliège, D., Mackenbach, J., & Ansseau, M. (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. The British Journal of Psychiatry, 190(4), 293-298. https://doi.org/10.1192/bjp.bp.105.020040

  • Lotrakul, M., Sukanich, P., & Sukying, C. (1996). The reliability and validity of Thai version of Hamilton Rating Scale for depression. Journal of The Psychiatric Association of Thailand, 41(4), 235-246.

  • Maier, A., Riedel-Heller, S. G., Pabst, A., & Luppa, M. (2021). Risk factors and protective factors of depression in older people 65+. A systematic review. PloS One, 16(5), Article e0251326. https://doi.org/10.1371/journal.pone.0251326

  • Mash, H. B. H., Fullerton, C. S., Shear, M. K., & Ursano, R. J. (2014). Complicated grief & depression in young adults: Personality & relationship quality. The Journal of Nervous and Mental Disease, 202(7), 539-543. https://doi.org/10.1097/NMD.0000000000000155

  • Mason, T. M., Tofthagen, C. S., & Buc, H. G. (2020). Complicated grief: Risk factors, protective factors, and interventions. Journal of Social Work in End-of-Life & Palliative Care, 16(2), 151-174. https://doi.org/10.1080/15524256.2020.1745726

  • Matinnia, N., Ghaleiha, A., Jahangard, L., & Farahmand, E. (2018). Psychological risk factors for postnatal depression: A prospective study of Iranian low income primigravidae at health care centres. Pertanika Journal of Social Sciences & Humanities, 26(4), 2555-2569.

  • Melhem, N. M., Day, N., Shear, M. K., Day, R., Reynolds, C. F., & Brent, D. (2004). Predictors of complicated grief among adolescents exposed to a peer’s suicide. Journal of Loss and Trauma, 9(1), 21-34. https://doi.org/10.1080/1532502490255287

  • Mongkol, A., Tangseree, T., Udomratn, P., Huttapanom, W., Chetchotisakd, P., & Chutha, W. (2004). The development and testing of a new Thai Mental Health Indicator (TMHI). Prathammakhant Publisher.

  • Morina, N., Rudari, V., Bleichhardt, G., & Prigerson, H. G. (2010). Prolonged grief disorder, depression, and posttraumatic stress disorder among bereaved Kosovar civilian war survivors: A preliminary investigation. International Journal of Social Psychiatry, 56(3), 288-297. https://doi.org/10.1177/0020764008101638

  • Ngamije, K. S. (2009). Post-traumatic stress disorder among widow survivors of the 1994 Rwandese genocide [Doctoral dissertation, University of Nairobi]. University of Nairobi Research Archive.

  • Park, M., Chang, E. R., & You, S. (2015). Protective role of coping flexibility in PTSD and depressive symptoms following trauma. Personality and Individual Differences, 82(August), 102-106. https://doi.org/10.1016/j.paid.2015.03.007

  • Prasithsirikul, W. (2007). Psychometric properties of WHOQOL-BREF-THAI in patients with HIV/AIDS. Journal of The Psychiatrist Association of Thailand, 90(11), 2449-2460.

  • Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K Raphael, B., Marwit, S., Wortman, C., Neimeyer, R., Bonanno, G., Block, S. D., Kissans, D., Boelen, P., Maercker, A., Litz, B. T., Johnson, J. G., First, M. B., & Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLOS Medicine, 6(8), Article e1000121. https://doi.org/10.1371/journal.pmed.1000121

  • Prigerson, H. G., Maciejewski, P. K., Reynolds III, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., Frank, E., Doman, J., & Miller, M. (1995). Inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1-2), 65-79. https://doi.org/10.1016/0165-1781(95)02757-2

  • Prohmpetch, W., Pungrasamee, S., Sinvutinon, P., & Suwalak, Y. (2015). The effects of global anchoring base on neuro-linguistic programming on post-traumatic stress disorder and complicated grief among widows losing their husband from the civil unrest in Thailand’s southern border provinces. Songklanakarin Journal of Social Sciences and Humanities, 21(1), 247-285.

  • Prohmpetch, W., & Songwathana, P. (2018). Research synthesis of mental remedies for people affected by the civil unrest in the southernmost provinces. Journal of Liberal Arts Prince of Songkla University, 10(1), 352-380.

  • R Core Team. (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing. http://www.R-project.org/

  • Razzak, H. A., Harbi, A., & Ahli, S. (2019). Depression: Prevalence and associated risk factors in the United Arab Emirates. Oman Medical Journal, 34(4), 274-282. https://doi.org/10.5001/omj.2019.56

  • Samuels-Dennis, J., Bailey, A., Killian, K., & Ray, S. L. (2013). The mediating effects of empowerment, interpersonal conflict, and social support on the violence–PTSD process among single mothers. Canadian Journal of Community Mental Health, 32(1), 109-124. https://doi.org/10.7870/cjcmh-2013-009

  • Schaal, S., Jacob, N., Dusingizemungu, J. P., & Elbert, T. (2010). Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors. BMC Psychiatry, 10, Article 55. https://doi.org/10.1186/1471-244X-10-55

  • Schwarzer, R., Bäßler, J., Kwiatek, P., Schröder, K., & Zhang, J. X. (1997). The assessment of optimistic self‐beliefs: Comparison of the German, Spanish, and Chinese versions of the general self‐efficacy scale. Applied Psychology, 46(1), 69-88. https://doi.org/10.1111/j.1464-0597.1997.tb01096.x

  • Songwathana, P., Baltip, K., Prohmpetch, W., & Wichaidit, S. (2017). Remedy experience of women having lost their family members through violence in Thailand’s three southernmost provinces. Thai Journal of Nursing Council, 32(4), 39-54.

  • Southern Border Incident Database Working Group. (2014). Summary of statistics on unrest events in the southern border provinces for the year 2014: The year with the lowest number of incidents in 11 years. Deep South Watch Database. https://deepsouthwatch.org/node/6596

  • Stander, V. A., Thomsen, C. J., & Highfill-McRoy, R. M. (2014). Etiology of depression comorbidity in combat-related PTSD: A review of the literature. Clinical Psychology Review, 34(2), 87-98. https://doi.org/10.1016/j.cpr.2013.12.002

  • Taha, P. H., Taib, N. I., & Sulaiman, H. M. (2021). Posttraumatic stress disorder correlates among internally displaced Yazidi population following Islamic state of Iraq and Syria attacks in Iraq. BMC Psychiatry, 21, Article 290. https://doi.org/10.1186/s12888-021-03299-8

  • ThaiHealth Official. (2017, September 21). Southern children at risk to “mind diseases”!! Thai Health Promotion Foundation. https://www.thaihealth.or.th/?p=255429

  • Treesuwan, H. (2020, February 29). The Southern Border: The more you correct, the more Prayut’s rating falls. Polls show that people in evenly matched areas will see peace in 5 years. BBC News Thailand. https://www.bbc.com/thai/thailand-51686158

  • Williams, J. L., Eddinger, J. R., Rynearson, E. K., & Rheingold, A. A. (2018). Prevalence and correlates of suicidal ideation in a treatment-seeking sample of violent loss survivors. Crisis, 39(5), 377-385. https://doi.org/10.1027/0227-5910/a000520

  • Xue, C., Ge, Y., Tang, B., Liu, Y., Kang, P., Wang, M., & Zhang, L. (2015). A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLOS One, 10(3), Article e0120270. https://doi.org/10.1371/journal.pone.0120270

  • Zisook, S., Simon, N. M., Reynolds III, C. F., Pies, R., Lebowitz, B., Young, I. T., Madowitz, J., & Shear, M. K. (2010). Bereavement, complicated grief, and DSM, part 2: Complicated grief. Journal of Clinical Psychiatry, 71(8), 1097-1098. https://doi.org/10.4088/JCP.10ac06391blu

ISSN 0128-7702

e-ISSN 2231-8534

Article ID

JSSH-8801-2022

Download Full Article PDF

Share this article

Related Articles