We have found a high prevalence of suicidal ideations, plans and attempts in adolescents in Muisne, and important differences are distinguished in terms of their frequency between men and women.
Regarding suicide attempts, 15% of adolescents indicated that they attempted suicide (21% of women and 9% of men). These are higher figures in comparison with those reported in other investigations. Most studies report a low percent varying in a range between 4–7% (12). However, a study conducted in India after a cyclone confirms the prevalence of similar suicide attempts such as those found at 12.6% (42). The highest numbers of suicide attempts in the Ecuadorian sample and in the population of India are possibly related to both being regions with high rates of consummate suicide (43), even before the natural disaster suffered by these countries. There could, therefore, be an underlying socio-cultural trend and perception of suicidal behavior that together with an additional stressful event (natural disaster) leads to a high number of attempts.
We found that one third of adolescents have symptoms of PTSD and exceed the cut-off point of the instrument used. This proportion is higher than those reported in the study by Díaz et al (23), which was conducted with adolescents of similar ages in regions affected by a tsunami in Chile (33% compared to 20%). The prevalence of post-traumatic stress is probably related to the severity of the traumatizing event, as Muisne students report a greater degree of physical damage (severe injuries and family losses) and property damage than Chilean adolescents. Therefore, the impact of the disaster may explain a greater impact on the mental health of the students.
Regarding the levels of depression (29%) and anxiety (15%) found, they differ slightly from those reported in the above mentioned study by Díaz et al. (23), with 30% and 14% respectively. Different studies carried out in other regions of the world yield figures comparable to those of Muisne. Thus, three studies that studied the prevalence of depression in groups of adolescents between 6 and 12 months after an earthquake show a prevalence of 31% in Turkey (44) and between 25–37% in China (45,46). Regarding anxiety, the data seem discordant with prevalences of 17% (47) to 40% in China (46), compared to 15% in this study.
Social determinants and their relationship with suicidal tendency, depression, anxiety and post-traumatic stress
Some social determinants such as physical damage or loss of family members, damage to property or other material losses, accommodation in shelters, and economic losses in the family, and their relationship with mental health events were evaluated in the present study.
Although similar percentages to our findings are reported in a study with adolescents in the city of Concepción (Chile) after the telluric movement of 8.8 (23) in regard to economic losses, property damage was much more widespread in the present case (30%) compared to that occured in Chile (14%), as well as physical damages to family members (6–3.3%) and family losses (2.4% in Muisne vs. 1% in the Chilean case).
Only the adolescents who were living longer than nine months in temporal shelters had significantly higher levels of anxiety compared to those living in their own or relatives’ homes. After spending several months in shelters, the risk of developing anxiety disorders is high(48). Uncertainty in young adults generates cronic stress which activates our basic instincts for survival(49). In this situation, the frontal cortex, the amygdala, the hypothalamus and the suprarenal glands are responsible for producing heightened effects in cortisol and adrenaline(50). These are directly linked to physical and cognitive symptoms which lead to anxiety disorders. However, because of constant peer and social support possibly depressive disorders were reduced.
On the other hand, the suicidal tendency of adolescents currently living in shelters was significantly lower than those living in their own home or in the home of relatives. In addition, there are no significant differences between the level of depression and post-traumatic stress when comparing the type of accommodation after the earthquake or at the time in which the study was performed.
These factors can be considered as social determinants that possibly explain the high prevalence of emotional disturbances in our studied population. When measuring the relationship between social determinants and mental health events of adolescents, contradictory results were obtained. On the one hand, this study shows that large economic (or job) losses in the family are associated with higher levels of depression, anxiety and post-traumatic stress; but at the same time, it cannot be demonstrated that there are significantly higher suicidal tendencies in our sample. This result contrasts with that obtained by Kar (51) in a study with those affected by a cyclone in India, where one of the best predictors for high suicidality was job loss and other psychosocial factors. In this sense, the loss of work or business can be considered as a risk factors for a suicidal tendency, only in those directly affected, but not in those indirectly affected, that is the family; however, this rule cannot be extended to high levels of depression, anxiety and PTSD.
There was no statistically significant differences in any of the mental health factors related to housing damage, physical damage and even the death of close relatives. The loss of home, the stay in shelters and the physical damages or even the death of relatives, are associated with mental health events (including the suicidal tendency), but this relationship is not statistically significant except for the young people staying in shelters, in which high levels of anxiety are found. This result partially confirms those described in previous studies in Turkey and Taiwan (52,53) in which the damage or loss of the property was positively related to depression and suicidal ideation.
Our results demonstrated that the levels of depression, anxiety and post-traumatic stress of adolescents whose parents have had a serious economic loss or even job loss, are significantly higher than those who have not suffered economic losses (or those were temporary). Our shows clearly that the suicidal tendency is not higher in students whose families have had greater economic losses, despite the fact that scores on depression, anxiety and post-traumatic stress turn out to be much higher.
On the other hand, it is suggestive that the adolescents who remained until January 2017 in the shelters showed higher levels of post-traumatic stress, depression and anxiety, but at the same time, lower suicidal tendencies than those who continued to live at home. This apparent contradiction is explained in a longitudinal investigation conducted before and after Hurricane Katrina in the United States (54). Although significantly higher prevalence of depression, anxiety and post-traumatic stress were found in the sample after the hurricane, suicidal ideation was lower compared to the measurement taken before the disaster. Additionally, some mediating factors were measured, and it was found that spiritual growth and an improvement in personal relationships (experiences framed during the disaster) probably reduced suicidal ideations (45). In the same line, Yu et al. measured suicidal ideations in adolescents before and after an earthquake in China, with lower prevalence (10.6%) after the event as compared to the initially reported level (19.3%), probably as a result of post-traumatic increase as suggested by these authors.
It is tempting to speculate that the prolonged experience in shelters stimulates the spiritual growth in adolescents, since even being victims of these adverse circumstances and suffering high levels of depression, anxiety and PTSD, the relationship with the other affected and helping volunteers may work as a factor of protection against suicidal ideations and attempts.
In turn, the economic damage or loss of work of parents seems to directly impact family life, affecting hope and favourable perspectives for their future, leading to emotional disturbances and psychological disorders.
High levels of depression, post-traumatic stress and anxiety in high school students in this area, especially in those who have suffered serious economic damage, may also possibly be due to factors inherent to the political and social conditions in this area.
During the reconstruction phase (9 months after the disaster) the population generally goes through a period marked by disappointment and hopelessness, especially if there is a perception that the government is favoring other areas or that reconstruction materials are being distributed unfairly. However, this circumstance has not been addressed in this paper although there are abundant references in the media.