Mental health, life functioning and risk factors among people exposed to frequent natural disasters and chronic poverty in Vietnam

BACKGROUND: People living in low- and middle-income countries (LMIC) are at increased risk for exposure to major natural disasters, which places them at increased risk for mental health problems. Evidence is less clear, however, regarding the effects of less severe but more frequent natural disasters, which are likely to increase due to global climate change. AIMS: To examine the mental health and life functioning, and their predictors, of people living in central coastal Vietnam – an area characterised by high risk for natural disasters and poverty. METHOD: One thousand individuals were randomly selected from five provinces in central coastal Vietnam. Individuals were assessed cross-sectionally for exposure to major storms and other traumatic events (Post-traumatic Diagnostic Scale, or PDS), financial stress (Chronic Financial Stress Scale), depression (PHQ-9), anxiety (GAD-7), post-traumatic stress disorder (PTSD) (PDS), somatic syndrome (SCL-90-R), alcohol dependence (ICD-10), self-perceived general physical health (SF-36), and functional impairment (PDS life functioning section); caseness was determined using the various measures’ algorithms. RESULTS: 22.7% of the sample (n=227) met caseness criteria in one or more mental health domains, and 22.1% (n=221) reported moderate to severe functional impairment. Lifetime exposure to typhoons and other major storms was 99% (n=978), with 77% (n=742) reporting traumatic major storm exposure. Moderate to high levels of financial stress were reported by 30% (n=297). Frequency of exposure to major storms was not associated with increased risk for mental health problems but traumatic exposure to a major storm was. Overall, the strongest predictor of mental health problems was financial stress. Number of traumatic typhoons and other major storms in turn were significant predictors (r(2)=0.03) of financial stress. The primary predictor of alcohol dependence was male gender, highlighting the importance of gender roles in development of alcohol abuse in countries like Vietnam. CONCLUSIONS: Individuals living in central coastal Vietnam have elevated rates of PTSD, somatic syndrome, and functional impairment but not depression or anxiety. Financial stress was the strongest predictor of mental health problems. Results suggest the importance of conducting broad assessments when providing mental health support for disaster-impacted communities. Study results suggest that one indirect consequence of predicted global climate change may be increased prevalence of mental health problems in communities such as that assessed in the present study, due to increased risk for traumatic storm-related exposure and through indirect effects on financial stress, but not through a general increased risk for major storms. Such results also indicate that when supporting LMIC communities that have experienced natural disasters, it will be important to consider the broader community context including poverty, in addition to the direct effects of the disaster. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.