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Validity of the construct of post-traumatic stress disorder in a low-income country: Interview study of women in Gujarat, India

  • Khyati Mehta (a1), Ganpat Vankar (a1) and Vikram Patel (a2)
Summary

The validity of the clinical construct of post-traumatic stress disorder (PTSD) has been questioned in non-Western cultures. This report describes in-depth interviews exploring the experiences of women who were traumatised by the communal riots in Ahmedabad, India, in March 2002. Three specific narratives are presented which describe experiences that closely resemble re-experiencing, avoidance and hyperarousal. Thus, symptoms described as characteristic features of PTSD in biomedical classifications are clearly expressed by the women in our study, and are attributed by them to trauma and grief. We conclude that PTSD may be a relevant clinical construct in the Indian context.

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Copyright
Corresponding author
Dr Vikram Patel, NPHIRU, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Fax: +44(0)207 958 8111; e-maill: vikpat_goa@sancharnet.in
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Declaration of interest

None.

Footnotes
References
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De Jong, J. T. V. M., Komproe, I. H. & Ommeren, M. V. (2003) Common mental disorders in postconflict settings. Lancet, 361, 21282130.
Eisenbruch, M. (1991) From post-traumatic stress disorder to cultural bereavement: diagnosis of southeast Asian refugees. Social Science and Medicine, 33, 673680.
Patel, V. (2000) Culture and mental health consequences of trauma. Indian Journal of Social Work, 61, 619630.
Sharan, P., Chaudhary, G., Kavathekar, S. A., et al (1996) Preliminary report of psychiatric disorders in survivors of a severe earthquake. American Journal of Psychiatry, 153, 556558.
Summerfield, D. (2001) The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ, 322, 9598.
World Health Organization (2002) World Report on Violence and Health: Summary. Geneva: WHO.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Validity of the construct of post-traumatic stress disorder in a low-income country: Interview study of women in Gujarat, India

  • Khyati Mehta (a1), Ganpat Vankar (a1) and Vikram Patel (a2)
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eLetters

PTSD in a low-income country

Rameez Zafar, General Psychiatrist
18 January 2006

I read with interest the report by Mehta et al (2005) in which they have explored the experiences of some women who were traumatised by the communal riots in Ahmadabad, India, in March 2002. The authors have only interviewed women in their report, who in a developing community are traditionally seen as oversensitive and emotionally fragile. In any largescale disaster or other major traumatic events, people are always in need of urgent help and relief. In a country where resources are already limited and where health services are further stretched to limits in these events, the affecteés are even more desperate to get any help or support. Therefore in relief camps, any offer of help or treatment be it is from mental health team, was always going to be welcomed.

Mehta et al used a set of some open ended questions in a unstructurised fashion to elicit the subjective experiences of some women in relief camps. No mention has been made as to how these women were selected, how the interviews were conducted , what diagnostic criteria were used and whether or not any special instruments were used to elicit specific features of PTSD.

Even the introductory comment: “Events like riots may generate strongfeelings & distress” with the offer of counselling and medication to those who were distressed, could be seen as making these women more suggestible which could potentially result in exaggeration of their emotional experiences, thereby causing a bias.

The authors in the end, concluded that the women had sought the help of mental health provider team indicating that they associated their experiences with mental illness. This assumption is quite erroneous. Although some of the symptoms mentioned in the three narratives could be described as core features of PTSD, the methodology used does not provide sound evidence in favour of the validity of the diagnostic category of PTSD in the Indian context.

Mehta, K., Vankar, G., Patel, V. (2005) Validity of Construct of Post Traumatic Stress Disorder in a low income country. Interview study of women in Gujarat, India. British Journal of Psychiatry 187, 585 – 586.

Declaration of interest – None.

R. Zafar, Consultant PsychiatristPeter Hodgkinson CentreGreetwell RoadLincoln LincsLN2 5UA.

Rameez.zafar@lpt.nhs.uk
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Conflict of interest: None Declared

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