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Disaster and Posttraumatic Distress
UNIVERSITY OF GHANA, LEGON
DEPARTMENT OF PSYCHOLOGY
DISASTER AND POSTTRAUMATIC ADAPTATION: RISK AND
PROTECTIVE FACTORS
BY
EMMANUEL DZIWORNU
(10210274)
THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA,
LEGON IN PARTIAL FULFILLMENT OF THE REQUIREMENT
FOR THE AWARD OF DOCTOR OF PHILOSOPHY (PHD) DEGREE
IN PSYCHOLOGY
JULY, 2019
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DECLARATION
I declare that this is an original research conducted by me and has never been submitted to
any other institution for any award. All sources cited in this research are duly acknowledged.
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ACKNOWLEDGEMENT
It has been the grace of the Almighty God since day one of my PhD journey. He (God)
deserves the praise. There are many other people who also deserve my gratitude for this
journey. First thank goes to my supervisors. They have been diligent and nurturing in
guiding me to the end of this project. Dr. Anum has been so supportive. In my despair, he
always opened his arms to embrace and soothe me. God bless you Doc. Prof. Akotia has
been the mother on my team. I remember her heart-warming words; ‘Emmanuel you can
finish this’. These postures reminded me all the time that I must deliver as expected of me.
Prof. Osafo was fantastic in his assistance. Even with his busy schedules as the Head of
Department, he made time for me when the need arises. He offered his out-of-office hours
and his computer to help me make progress with my project. These three faculty have made
the best supervisory committee for my life. I am grateful to you all.
I must thank my wife, Enyonam A. Adzato for her support, encouragement, patience and
endurance. I took all the money and time away from home to school. She made me
understand the worth of a woman and a spouse. God richly bless you dear. My children
always missed me. When they happen to be awake before I return from school to the house,
they screamed as though I had returned from a 4year trip. All their years so far have been
within my PHD journey. Guys, when you grow you will understand. Thank you all.
I also express my gratitude to my siblings, parents and friends. My colleagues, Mary and
Charlotte and the ‘runaway’ Lily, God bless you all. We have been the real survivors. My
junior colleagues, Francis, Paapa Yaw, May, Stella, Seth, Bea and senior colleagues, Prof.
Oppong, Drs. ABC, Dickson, Aful, Judith and Coleman, thank you all.
I am grateful to the entire faculty of the department of Psychology, University of Ghana,
Legon for the support everyone offered me through this journey. Finally, I thank all my
participants and research assistants for their time during my data collection.
God bless everyone.
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Disaster and Posttraumatic Distress
DEDICATION
Dedicated to my Wife and Children. God bless you all.
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ABSTRACT
This research investigated the role of risk and protective factors in how disaster victims
adapt to the impacts of the adversity. This adaptation was examined at two levels:
posttraumatic distress (PTD) and posttraumatic growth (PTG). Four risk factors and five
protective factors were examined. The concurrent nexted mixed methods approach with 336
sample from the population of 3rd June 2015 flood/fire disaster victims in Accra was used;
13 of which participated in both quantitative and qualitative studies.
The quantitative study used standardised measures of PTG, PTSD, and general distress
(using the global severity index of the symptoms checklist) as outcome variables, social
support, religiosity, resilience, belief in just world, and self-efficacy (protective factors) as
moderating variables, and neuroticism, assumptive world, previous traumatic history and
independent self-construal (risk factors) as predictors. Five hypotheses were tested using
hierarchical multiple regression and Pearson correlations. The results indicate that risk
factors namely neuroticism, and previous traumatic history significantly predict PTD
(general psychological distress and PTSD). It was also found that protective factors namely
social support, belief in just world, resilience, and religiosity significantly predict PTG.
Again, it was found that protective factors significantly moderate the relationship between
risk factors and psychological distress. Finally, the quantitative study also found that social
support, self-efficacy, belief in just world, resilience and religiosity are negatively and
significantly correlated with PTD (psychological distress and PTSD), and there is rather a
significant positive correlation between PTG and PTD.
The qualitative study used the phenomenological approach with thematic analysis to
answered three research questions. It was found that victims perceive the causes of the
disaster to include engineering failures and anti-environmental behaviours. Their
experiences include loss and biographical disruption such as disfigurement, death and loss
of property, and psychological impacts such as anxiety, and mood problems. Participants’
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Disaster and Posttraumatic Distress
adjustment experiences involve societal and family level interventions, spiritual support and
post disaster vulnerability.
It was concluded that indeed disaster victims suffer distress with risk factors exacerbating
it. However, victims also experience growth following the disaster and this is facilitated by
protective factors. The implications of the findings regarding clinical practice, policy,
disaster management, research and theory are discussed.
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TABLE OF CONTENTS
DECLARATION ................................................................................................................... i
ACKNOWLEDGEMENT ..................................................................................................... i
DEDICATION ..................................................................................................................... iii
ABSTRACT ........................................................................................................................ iv
TABLE OF CONTENTS .................................................................................................... vi
LIST OF TABLES ............................................................................................................... ix
LIST OF FIGURES .............................................................................................................. x
LIST OF ABREVIATIONS ................................................................................................ xi
CHAPTER ONE ................................................................................................................... 1
INTRODUCTION ................................................................................................................ 1
1.1 Background to the Study ............................................................................................. 1
1.1.1 Nature and Types of Disasters .............................................................................. 2
1.1.2 Disaster and Posttraumatic Distress ..................................................................... 4
1.1.3 Risk Factors for Posttraumatic Distress ............................................................... 5
1.1.4 Disaster and Posttraumatic Growth (PTG) ........................................................... 7
1.1.5 Protective Factors promoting Post traumatic Growth .......................................... 8
1.2 Statement of the Problem .......................................................................................... 11
1.3 Aims of the Study ..................................................................................................... 12
1.4 Rationale for the Study ............................................................................................. 13
1.5 Significance of the study ........................................................................................... 14
1.6 Organization of the Thesis ........................................................................................ 14
CHAPTER TWO ................................................................................................................ 16
LITERATURE REVIEW ................................................................................................... 16
2.0 Introduction ............................................................................................................... 16
2.1 Theoretical Framework ............................................................................................. 16
2.1.1 Posttraumatic Distress Theory ............................................................................ 16
2.1.2 Posttraumatic Growth Theory ............................................................................ 20
2.2 Review of Related Studies ........................................................................................ 23
2.2.1 The Negative Impact of Disaster ........................................................................ 23
2.2.2 Disasters and Posttraumatic Distress .................................................................. 29
2.2.3 Risk Factors for Post Disaster Distress .............................................................. 32
2.2.4 Disaster and Positive Outcome ........................................................................... 37
2.2.5 Factors promoting Positive Disaster Outcomes / PTG ....................................... 38
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2.2.6 Relationship between Posttraumatic Distress (PTD) and Posttraumatic Growth
(PTG) ........................................................................................................................... 49
2.2.7 Summary of Review of Related Studies ............................................................. 51
2.3 Conceptual Framework ............................................................................................. 51
2.4 Statement of Hypotheses for the Quantitative Study ................................................ 53
2.5 Definition of Terms ................................................................................................... 53
2.6 Research Questions for the Qualitative Study .......................................................... 54
CHAPTER THREE ............................................................................................................ 55
METHODOLOGY ............................................................................................................. 55
3.0 Introduction ............................................................................................................... 55
3.1 Research Approach ................................................................................................... 55
3.1 Philosophical Basis of the Research Approach ..................................................... 56
3.2 Research Design ........................................................................................................ 57
3.2.1 The Concurrent Embedded Mixed Method Design ........................................... 57
3.3 Research Setting ........................................................................................................ 59
3.4 Study Population ....................................................................................................... 61
3.5 General Data Collection Procedure ........................................................................... 61
3.6 Inclusion and Exclusion Criteria ............................................................................... 62
3.7 Ethical considerations ............................................................................................... 62
3.8 Quantitative Methodology ........................................................................................ 64
3.8.1 Design ................................................................................................................. 64
3.8.2 Sample ................................................................................................................ 64
3.8.3 Sampling method ................................................................................................ 66
3.8.4 Instrument ........................................................................................................... 67
3.8.5 Outcome Variable Measures .............................................................................. 71
3.8.6 Moderating variables .......................................................................................... 74
3.8.7 Pilot Study .......................................................................................................... 76
3.8.8 Procedure for Quantitative Study ....................................................................... 77
3.9 Qualitative Methodology .......................................................................................... 78
3.9.1 Approach – Phenomenology .............................................................................. 78
3.9.2 Sample and Sampling Technique ....................................................................... 79
3.9.3 Data collection Material ..................................................................................... 80
3.9.4 Pilot Study .......................................................................................................... 80
3.9.5 Data Collection Procedure .................................................................................. 81
3.9.6 Data Processing and Analysis ............................................................................ 81
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3.9.7 Rigor and Credibility of Data and Result ........................................................... 82
CHAPTER FOUR .............................................................................................................. 84
RESULTS ........................................................................................................................... 84
4.0 Introduction ............................................................................................................... 84
4.1 Quantitative Findings ................................................................................................ 84
4.1.1 Data Analysis/Analytic Plan .............................................................................. 84
4.1.2 Preliminary Analysis .......................................................................................... 85
4.1.3 Descriptive analysis: Mean, Normality and Reliability ..................................... 90
4.1.4 Correlation Matrix .............................................................................................. 93
4.1.5 Hypotheses Testing ............................................................................................ 95
4.1.6 Summary of Qualitative Findings .................................................................... 107
4.1.7 Additional Findings .......................................................................................... 108
4.2 Qualitative Results .................................................................................................. 108
Summary of Qualitative Findings ............................................................................. 125
CHAPTER FIVE .............................................................................................................. 126
DISCUSSION ................................................................................................................... 126
5.0 Introduction ............................................................................................................. 126
5.1 Summary of the Study............................................................................................. 145
5.1.1 Point of Convergence: Quantitative and Qualitative Findings ......................... 147
5.1.2 Point of Divergence: Study one and Study Two .............................................. 148
5.2 Contributions of the study ....................................................................................... 148
5.2.1 Contribution to Knowledge .............................................................................. 149
5.2.2 Contributions to Research ................................................................................ 149
5.2.3 Theoretical Contributions and Implications ..................................................... 150
5.3 Practical Implications .............................................................................................. 151
5.3.1 Implications for Clinical Practice ..................................................................... 151
5.3.2 Policy Implications ........................................................................................... 152
5.3.3 Implications for Disaster Management in Ghana ............................................. 153
5.4 Limitations of the Study .......................................................................................... 153
5.5 Recommendations for Future Research .................................................................. 154
5.6 Conclusions ............................................................................................................. 154
REFERENCES ................................................................................................................. 156
APPENDICES .................................................................................................................. 184
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LIST OF TABLES
Table 1.1: Some Disasters Recorded in Ghana over the Years ............................................ 3
Table 3.1: Instruments used for Quantitative study and Cronbach’s alphas ...................... 76
Table 3.2: Demographic Information of Participants ......................................................... 80
Table 4.1: Demographic Characteristics of Respondents ................................................... 87
Table 4.2: Exploratory Factor Analysis of Big Five Personality Scale ............................. 90
Table 4.3: Test of Normality, Reliability, Means and Standard Deviation ........................ 92
Table 4.4: Correlation Matrix showing the ationship between Study Variables ................ 94
Table 4.5: Hierarchical Multiple Linear Regression showing how Risk Factors predict
General Psychological Distress ........................................................................ 97
Table 4.6: Hierarchical Multiple Linear Regression showing how Risk Factors predict
PTSD................................................................................................................. 98
Table 4.7: Hierarchical Multiple Linear Regression showing how Protective Factors
predict PTG ..................................................................................................... 100
Table 4.8: Hierarchical Multiple Linear Regression showing the moderating effect of
Social Support, Self-esteem, Belief in Just World Resilience, and Religiosity
on the Relationship between Risk Factors (Assumptive World, Independent
Self-construal and Previous Traumatic History) and General Distress. .... Error!
Bookmark not defined.
Table 4. 9: Hierarchical Multiple Linear Regression showing the moderating effect of
Social Support, Self-esteem, Belief in Just World Resilience, and Religiosity
on the Relationship between Risk Factors (Assumptive World, Independent
Self-construal and Previous Traumatic History) and PTSD ........................... 105
Table 4.10: Summary of Themes, Subthemes and Supporting Quotes ............................ 110
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LIST OF FIGURES
Fig. 2.1: Organismic valuing theory of growth following adversity. Adapted from Joseph
& Linley, 2005 .................................................................................................. 22
Fig. 2.2: Conceptual framework ......................................................................................... 52
Fig. 3. 1: Concurrent Triangulation Design showing the process of integrating the two
methods (Quan + Qual)adapted from Creswell and Zhang (2009) .................. 59
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LIST OF ABREVIATIONS
ADHD – Attention Deficit Hyperactivity Disorder
AMA - Accra Metropolitan Assembly
APA - American Psychological Association
ATM – Automated Teller Machine
BA – Brong Ahafo Region
CR- Central Region
CSM - Cerebro-spinal Meningitis
DSM- Diagnostic Statistical Manual
EM-DAT - Emergency Events Database
EPT – Emotional Processing Theory
GA – Greater Accra
GDP – Gross Domestic Product
HSCT - Hematopoietic Stem Cell Transplant
KMO - Kaiser-Meyer-Olkin
MSPSS - Multidimensional Scale of Perceived Social Support
NADMO – National Disaster Management Organisation
NR - Northern Region
OV – Organismic Valuing
PCA- Principal Component Analysis
PCL-C - PTSD Checklist-Civilian
PLWH – People Living With HIV
PTA – Parents Teachers Association
PTD – Post Traumatic Distress
PTG – Post Traumatic Growth
PTGI - Posttraumatic Growth Inventory
PTSD – Post Traumatic Stress Disorder
PTSS - Posttraumatic Stress Symptoms
SCL-90-R - The Symptoms Checklist-90-Revised
SPSS - Statistical Package for the Social Sciences
UER – Upper East Region
UWR – Upper West Region
VR – Volta Region
WAS - The World Assumptions Scale
WHO – World Health Organisation
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CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The short to long term consequences of disaster are usually dire and these have been
documented copiously in the literature (see for example, Shultz, Neria, Allen, & Espinel,
2013; Walker-springett, Butler, & Adger, 2017). These consequences are physical
(Paidakaki, 2012) or psychological ( Hussain, Weisaeth, & Heir, 2011). According to the
DSM 5, individuals who survive disasters may experience symptoms such as flashbacks,
nightmares, hypervigilance, sleep and memory problems among others (American
Psychiatric Association, 2013b). Of particular interest are the long-term consequences
because these may be debilitating and normally disrupt affected individuals’ occupational
and social lives.
Disasters may have both negative and positive outcomes. Researches however, focus largely
on the negative outcomes. The implication is that there is little focus on positive outcomes
of disaster and there is equally little focus on personal and environmental factors that
mitigate negative consequences or factors that promote positive outcomes of disaster. For
example, a disaster victim may not develop depression but could rather develop a deeper
sense and appreciation for life (Klasen et al., 2017). This is because several factors influence
psychological outcomes of disasters in victims (Park, 2010). For example, Garcia, Cova,
Rincon, and Vazquez (2015) maintained that when people brood over their adversities, they
tend to develop negative emotions and negative outcomes compared to those who use
deliberate active coping leading to posttraumatic growth. Again, while some personality
factors such as neuroticism are found to influence the negative impacts of disasters (Barlow
et al., 2015), mental toughness promotes positive outcomes among victims (Hardy, Bell, &
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Beattie, 2014). In this study, the primary objective is to examine some of the unexplored
medium to long term consequences of disaster, focusing on risk and protective factors.
1.1.1 Nature and Types of Disasters
Disaster is a traumatic event many people experience in their life time (Bonanno & Mancini,
2015). It is any event that occurs unexpectedly, causes social disruption and threat to human
life/survival (Lindell, 2013). According to the World Health Organisation (WHO, 2000),
disasters disrupt the normal conditions of existence and cause a level of suffering that
exceeds the capacity of adjustment of the affected community. Disasters are broadly
categorized under natural and man-made. There have been several disaster occurrences in
Ghana, both natural and man-made, chief among which is flooding (Asumadu-Sarkodie,
Owusu, & Rufangura, 2015) as shown in the Table 1 below. The reasons for these are not
farfetched. Typically, people build in water ways blocking free flow storm waters. There is
also the problem of inadequate drainage in some communities particularly overcrowded
inner cities. Finally, people deposit garbage into the already narrow drainage systems further
clogging the drains causing flooding when it rains. In 2015, the deadliest of these flood
disasters occurred in Ghana with a fire explosion at a fuel filling station in Accra, claiming
over 150 lives (Asumadu-Sarkodie et al., 2015). Similarly, other disasters in Ghana claimed
several lives and destroyed properties.
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Table 1.1:
Some Disasters Recorded in Ghana over the Years
Date Disaster Area affected Impact
June, 2018 Flood Accra, Kumasi 3 deaths, thousands displaced in
Kumasi
July, 2017 Flood Tamale 3 deaths, destruction of farm
lands, several people displaced
October, Gas Accra (Atomic 7 deaths, Several people burnt,
2017 explosion Junction) properties damages
May, 2017 Gas Takoradi Over 100 people suffer burns,
explosion properties damaged
December, Gas La, Accra 5 deaths, scores injured,
2016 explosion properties damaged
June, 2015 Flood/fire Accra (Circle) Over 150 deaths, several people
disfigured, thousands displaced,
properties damaged
2014 Cholera GR and other four 243 deaths, 28,975 cases
regions
November, Melcom Accra 14 deaths
2012 Building
collapse
2011 Flood Accra 43,087 affect, 15 deaths
2007 Flood UER, UWR, NR 307,127 affected, 41 deaths
1997 Flood UER, UWR, NR, Over 300,000 affected
BA, VR
1997 CSM UER, UWR, NR 1,356 deaths
1997 Cholera GA, CR 117 deaths
CSM: Cerebro-spinal Meningitis, UER: Upper East Region, UWR: Upper West Region,
NR: Northern Region, BA: Brong Ahafo Region, VR: Volta Region, GA: Greater Accra
Region, CR: Central Region.
The nature of disaster determines the impact it presents. The nature of the disaster may
include the severity, duration and the location. Severe forms of disasters have wider physical
effects. They affect public health infrastructure, threaten access to health care services and
displace populations. Also, disasters that occur in densely populated locations such as
regional capitals including Accra, Kumasi, and Takoradi tend to affect many lives. This
results in more deaths and more survivors who may have to deal with the after effects.
Therefore, with the psychological impacts of disasters, the figures represented in the table
above shows that over the years several Ghanaians were psychologically traumatised as a
result of disaster experiences.
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1.1.2 Disaster and Posttraumatic Distress
Disaster victims experience two kinds of effects: they experience distress (Carroll, Morbey,
Balogh, & Araoz, 2009; Jones, Ribbe, Cunningham, Weddle, & Langley, 2002) or they
experience growth (Klasen et al., 2017; Nuttman-shwartz, Dekel, & Tuval-mashiach, 2011).
Sometimes, victims may experience distress then growth (Maitlis, 2012).
Apart from the conspicuous physical effects such as death, disease outbreaks, and injuries
(Haqqi, 2006), disasters lead to significant psychological distresses including depression,
anxiety disorders (e.g. posttraumatic stress disorder), cognitive dysfunctions and
hypersensitivity (Böttche, Kuwert, & Knaevelsrud, 2012; Breslau, 2002; Mason, Andrews,
& Upton, 2010a; Tunstall, Tapsell, Green, Floyd, & George, 2006).
According to Haqqi (2006), occurrence of disasters is accompanied by states of disbelief,
disorganisation, agitation, cognitive dysfunction that may include but not limited to memory
difficulties, planning and concentration (Haqqi, 2006; Tian, Wong, Li, & Jiang, 2014).
Victims also experience irritability or anger, and anxiety (Panyayong & Pengjantr, 2014;
Tapsell, 2000), apprehension (Ohl & Tapsell, 2000), depression (Haqqi, 2006; Panyayong
& Pengjantr, 2014), helplessness, and guilt (especially survivor guilt) (Erikson, 1976; Lifton
& Olson, 1976). There are behavioural effects such as hypervigilance, hyperactivity, social
withdrawal, self-blame (Haqqi, 2006) and loss of appetite. Some also experience sleep
disturbances, loss of interest in activities and substance abuse (Panyayong & Pengjantr,
2014).
The presentation of posttraumatic reactions varies across culture, age and gender. It has been
reported that among the general populations of Europe, Asia and Africa, the prevalence of
posttraumatic stress disorder is about 0.5 to 1% (American Psychiatric Association, 2013).
In Turkey, Dogan (2011) found among adolescent disaster survivors that over 70%
experience severe levels of various posttraumatic impacts. Victims may experience acute
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effects spanning immediately after the disaster to a few days or weeks. Others may
experience delay onset of effects several months to years after the disaster (American
Psychiatric Association, 2013).
Children suffer significant physical effects of disasters both on a short-term and long-term
basis. For example, when a flood disaster occurs, they suffer from more infections because
they breath larger volume of air. They also require more fluid/water and so become
dehydrated during disasters. School facilities are often destroyed through disasters thereby
disrupting children’s academic activities. Children process emotional trauma differently and
slower leading to further and/or delayed mental health complications (Kousky, 2016; Peek,
2008).
It is possible the posttraumatic distresses may be further aggravated by the physical and
economic challenges that the disaster creates for the victims (Ademola, Adebukola, Adeola,
Cajetan, & Christiana, 2016; Paidakaki, 2012). In addition to these challenges, some other
factors pose as risks that can contribute to an increase in the posttraumatic distress suffered
by individuals (Masten & Reed, 2002). Some of these risk factors are discussed below.
1.1.3 Risk Factors for Posttraumatic Distress
Research suggests that history of previous traumatic experiences is associated with the
experience of PTD (Stevanovic, Franciskovic, & Vermetten, 2016). Previous traumas tend
to make an individual’s resilience resources weak ahead of any future disasters (Janoff-
Bulman, 1992). This also makes the individual vulnerable to negative health impacts in
future life (Mock & Arai, 2011). In a similar vein, childhood traumatic experiences increase
the chances of behaviour problems in one’s adult life by making the individual internalize
(shown in anxiety and depression) and externalise (as in aggression and acting out)
behaviours (Gilbert et al., 2009). It is also established that early childhood traumatic
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experiences are associated with adult psychiatry disorders and psychological distresses
(Greenfield, 2010; Pine & Cohen, 2002).
Personality, in particular Neuroticism, is reported to have implications for the development
of PTD and other ill mental health disorders. For example, people who score high on
neuroticism have higher tendencies for posttraumatic distress (Sveen, Arnberg, Arinell, &
Bergh, 2016). People with neuroticism have the predisposition to experience negative
emotions, such as worry, anxiety, depression, irritability, and vulnerability to psychiatric
disorders (Eysenck & Eysenck, 1964; Yanhui, Wang, Jiang, & Mo, 2016). Thus, when they
are further exposed to traumatic events, they tend to experience a heightened level of these
emotions. There is also an indication that PTD is associated with other personality traits
such as negative emotionality, trait hostility and trait anxiety (Jakši, Brajkovi, Ivezi, Topi,
& Jakovljevi, 2012; Yanhui et al., 2016).
Exposure to disasters often requires that victims resort to support from unaffected
communities. This becomes effective in more collectivistic cultures (Wlodarczyk et al.,
2016). However, independent or individualistic societies or persons risk experiencing
distressing post disaster effects since either they may not ask for support or unaffected
communities may not be willing to support. Self-construal is primarily how people view
themselves in relation to other people at the societal level (Hazel & Shinobu, 1991; Voyer
& Franks, 2014). It is categorized into independent and interdependent. Independent self-
construal is when individuals see themselves as distinct from others in their community.
Interdependent self-construal on the other hand is when the individual sees themselves as
connected to others in their society (Giacomin & Jordan, 2017). People with independent
self-construal tend to receive less support during challenging moments. Such people may
not readily endorse communal coping activities thereby putting them under pressure when
their personal coping strategies are stretched to the limit (Wlodarczyk et al., 2016).
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Identified risk factors tend to exacerbate the severity of PTD (Sandica & Pop, 2016; Young,
2017) with increasing number of risk factors relating to higher severity of PTD (Briere,
Elisha, & Deitrich, 2016; van Loo et al., 2016).
Individual socio-demographic factors such as age, gender and economic status may also
predispose them to higher levels of distress following disasters (Sareen, 2014; Young,
2017). These are often considered pre-disaster risk factors. There are however other factors
that may present during and after the disaster that will contribute significantly to the onset
or severity of PTD (Young, 2017). This may include losses during the disaster, injuries, and
poor social support
There is the need to identify as many risk factors as possible in order to understand why and
how PTD develops and is maintained after a traumatic experience. However, many other
victims of disasters may also stay stronger after the adversity and rather develop
posttraumatic growth (PTG) (Dekel, Solomon, & Ein-Dor, 2012; Klasen et al. (2017).
1.1.4 Disaster and Posttraumatic Growth (PTG)
Inasmuch as disasters largely imply negative outcomes, they sometimes reveal potential,
new beginning and growth (Ramos & Leal, 2013). PTG is conceptualized as a
multidimensional outcome of one’s ability to become open to new possibilities, appreciation
of life in a better way, experiencing enhanced personal strength and spiritual development
and able to relate better to others (Tedeschi & Calhoun, 2004). It is an individual’s ability
to bounce back better than before, feeling a strong sense of renewed characteristics and
strength to face future adversities (Dekel et al., 2012).
Joseph and Linley (2005) opined that people perceive their survival from a disaster as an
opportunity to grow. This growth is facilitated by factors that decrease the chances of the
negative effects whilst strengthening the chances of the positive effects or outcomes and
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they are known as protective factors (Masten & Reed, 2002). However, PTG may not
necessarily replace distresses, or does not prevent distresses (Maitlis, 2012). It is rather a
matter of dealing with the distresses and experiencing the sense of personal growth from the
pains of the adversity.
It has been indicated that the positive aspect of disaster studies has receive limited but
growing attention (Redekop & Clark, 2016; Tedeschi & Calhoun, 2004). This study
concurrently considers the factors associated the development of PTG and those that
influence PTD among disaster victims. Some of the factors associated with PTG to consider
in the current study are social support, intervention, religiosity, belief in just world and self-
efficacy.
1.1.5 Protective Factors promoting Post traumatic Growth
There are both external and personal factors that promote growth among survivors of
disasters. Some of the external factors include social support, professional interventions,
and religiosity. There are also personal factors like an individual’s belief in just world,
resilience and self-efficacy.
Social support is a factor that augments the positive effects of disasters (Platt, Keyes, &
Koenen, 2014). Generally, it has been a strong factor for good health among many
populations (Feeney & Collins, 2015; Kafetsios & Sideridis, 2006; O’Donovan & Hughes,
2008; Uchino, 2009). Social support is the perception of, and the reception of any form of
assistance from one’s relational networks (Kafetsios & Sideridis, 2006). It comes in the
forms of received, perceived and embedded supports (Berkman, Glass, Brissette, & Seeman,
2000).
Berkman and Glass (2000) maintained that social support produces positive stress by
catalysing an individual’s sense of purpose, belonging, security, or self-worth, leading to
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increased motivation for positive self-care (e.g., healthy eating). It promotes and restores
health as well as reduces mortality risk (Sarason, Sarason, & Gurung, 2001). It is therefore
important to establish how support from others plays out among victims of disasters with
regards to its availability and use by victims in augmenting post disaster distress and
facilitating post disaster growth.
Similarly, the professional intervention victims receive after a disaster produces
posttraumatic growth (Raphael & Wilson, 2000). This is due to the support and skills a
therapist or counsellor introduces to the individual to help deal with the negative impact of
the disaster. The therapist helps victims identify adaptive coping strategies, sources of
support and better interpretations for the adversity. By utilizing these, victims tend to better
manage the impact of the disaster, thereby experiencing psychological growth (Linares et
al., 2017).
Religiosity also significantly supports victim’s growth after the experience of trauma (Chan
& Rhodes, 2013). It serves as a source of support for the victim. The individual may fall on
the assistance of members of their congregations in addition to the support they enjoy from
God (Oren & Possick, 2009). Oren and Possick (2009) posit that religiosity is a significant
source of meaning for suffering that helps to lessen the adverse effect of adversity.
A person’s belief in a just world is the belief that people get what they deserve (Lerner &
Miller, 1978) also produces PTG (Mcparland & Knussen, 2010). When people experience
trauma which they consider an injustice to them, those with a strong general belief in just
world will be motivated to adopt strategies to maintain this belief by restoring a sense of
justice in some way (Dalbert, 2001; Furnham, 2003; Janoff-Bulman & Frieze, 1983; Lerner,
1980; Rubin & Peplau, 1975). This will make them give positive interpretations of their
misfortune and thus experience less distress (Bulman & Wortman, 1977; Dalbert, 1996,
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1997). For example, when an individual experiences flood and interpret it as an unfair
treatment by nature to them, then they are more likely to feel distressed.
Self-efficacy is also important in how people perceive and deal with adversities (Zulkosky,
2009). According to Bandura (1982), self-efficacy influences a person’s level of motivation,
thought and actions. Zulkosky (2009) explains that people with high self-efficacy are able
to deal with difficulties compared to low self-efficacy which leads to depression and related
distresses. This means that self-efficacy has a bearing on people’s ability to experience
positive outcome from disasters. It was found among cancer patients by Lotfi-kashani,
Vaziri, Akbari, and Kazemi-zanjani (2014) that self-efficacy contributed strongly to PTG
among the patients. Similarly, Li, Cao, Cao, Wang, and Cui (2012) found among children
with congenital disease who are undergoing surgery that self-efficacy is a predictor for PTG.
Resilience provides strong growth outcomes in victims of disasters (Meyer et al., 2019).
According to the American Psychological Association (APA), (2014), resilience is ‘the
process of adapting well in the face of adversity, trauma, tragedy, threats or significant
sources of stress such as family and relationship problems, serious health problems or
workplace and financial stressors’. It is shown that people who are naturally resilient are
able to better manage stressful situations in general and traumatic events in particular
(Tomaszek, Zdankiewicz-ścigała, Kosson, & Kosieradzki, 2018). It helps the individual to
function beyond an expected level. Thus, resilience helps people to grow better after
traumatic experiences.
Unfortunately, most disaster researches have largely focused on only the
negative/distressing aspect of disasters at the expense of the positive effects. In Africa and
Ghana for example, there is little attention given to disaster research. Meanwhile, in Ghana
flood disaster has become an annual challenge. This leaves many people dead, displaced
and traumatized (Dziwornu & Kugbey, 2015). Thus, it is important to examine both the
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negative and the positive effects of disasters among victims and the factors (risk and
protective) that facilitate these effects.
1.2 Statement of the Problem
Disasters have both short and long-term debilitating outcomes which may be physical and
psychological. The effects of disaster can be exacerbated by risk factors including personal
or socio-demographic factors such as personality, and previous traumatic experience, and
other external factors such as lack of intervention or support. However, research evidence
indicates that the effects of disasters on the individual could be mitigated to a large extent
by certain personal and external factors. Some personal factors include self-efficacy, belief
in just world and resilience. External factors include professional psychological
interventions, social support and religiosity. There is the need for scientific research to
establish the risk and protective factors for disaster victims and to guide and enhance
intervention policies for victims. Regardless of this need, attention has often been focused
on the immediate medical or physical effects of disasters with limited psychological
research and attention.
Similarly, the physical outcomes are immediate and more obvious, and they often receive
immediate and significant resources and attention with little effort on medium to long-term
consequences which are usually psychological in nature. Much the same way, there is
limited research on the long-term consequences suffered by disaster victims both globally
and in Africa including Ghana. There is even less psychological research on the
management and coping with the long-term consequences of disaster. Available anecdotal
evidence on this subject suggests that there is limited or no database on victims (either dead
or alive) in Ghana, neither is there documentation on intervention efforts aimed at mitigating
the long-term effects of disaster. This is in spite of growing evidence that survivors of
disasters usually live with dire effects that disrupt their lives. This creates a huge research
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gab regarding knowledge on the psychological consequences of disaster on victims and how
interventions are determined by such knowledge in Africa especially Ghana.
Globally, studies have explained the negative effects of disasters (Shultz, Neria, Allen, &
Espinel, 2013; Walker-springett, Butler, & Adger, 2017). However, how victims deal with,
manage and/or avoid the challenges after adversity is worth exploring in detail at specific
cultural levels. Studies indicate that inasmuch as several people develop PTD after a disaster
experience, several others rather grow and get stronger after they experience disasters (e.g.
Smith, Joseph, & Nair, 2011; Zamora et al., 2017).
It is important to investigate the factors that promote growth among victims as well as the
factors that trigger distress among victims. In the current study, both protective and risk
factors are investigated concurrently among victims who have not received any professional
psychological interventions. These victims had to struggle on their own to deal with the
negative impacts of the disaster. This will help to understand how individuals navigate the
psychological, physical and social processes to adjust to the effects of disasters. The current
study also employs a mixed methods approach that presents a better opportunity to
understand the factors determining PTD and PTG among victims instead of the single
method approach in most studies.
1.3 Aims of the Study
The study aimed to explore the factors that trigger the development of PTD and the factors
that militate against PTD in order to promote PTG. In this regard, the role of different
protective factors against post disaster distresses and how these factors operate in mitigating
the development of the distress were examined. This study also aimed to establish the forms
and levels of post disaster distresses among the disaster victims. The study also sought to
identify the risk factors associated with the development and maintenance of post disaster
distress among disaster victims. Finally, the study sought to understand the story of disaster
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victims in Ghana. It explained their lived experiences after disaster and how they have
managed to deal with the after effects. These aims are summarized as follows:
1. To understand the lived experiences of victims of disasters in Ghana (how they
survived, their strengths)
2. To identify risk factors for the development and/or maintenance of posttraumatic
distress among disaster victims
3. To identify protective factors for the development of posttraumatic growth
4. To find out the link between posttraumatic distress and posttraumatic growth among
disaster victims
1.4 Rationale for the Study
Insofar as research into disaster needs a drastic effort within the African context, there is the
need to drive this move towards the positive angle. There is the need to explore the strength
and/or resources capable of protecting victims of disasters in order to create a viable support
for them after adversities. Indeed, studies globally have sought answers to the question of
what negative effects disasters cause. However, the manner in which people deal with,
manage and/or avoid these negative challenges after adversity is a matter worth exploring
in detail at specific cultural levels.
It is imperative to develop understanding of the capabilities of people and their quest to
develop from challenges. Thus, in disaster research, there is the need for a positive attention
rather than negative views only. This study therefore seeks to explore the factors that help
victims to better manage or deal with the negative effects of disasters thereby resulting in
posttraumatic growth, in addition to understanding the challenges and the risks for such
challenges among victims within an African context.
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1.5 Significance of the study
Apart from natural disasters, there are other adversities that many people suffer with huge
potential for psychological damage. There are several of such vulnerable groups in society
who could barely understand what they are going through. Therefore, it is important to
capitalize on some core promotive/protective factors that can help with their situation. This
study is a purely positive psychological agenda with the goal of establishing the factors that
matter most in the face of an adversity for growth.
The current study will explore the prevalence and extent of psychological distresses among
victims of disasters in Ghana. Meanwhile, this exploration will be done against the back
drop of which factors could impede the incidence and extent of the distresses. By so doing,
the study will establish clear relationship between various protective factors against post
disaster effects.
Findings of this study will widen understanding of the experiences of disaster victims. It
will provide the grounds for better intervention programmes and support from relevant
stakeholders.
1.6 Organization of the Thesis
This thesis is organized under five (5) chapters using a mixed method (specifically the
concurrent nested mixed methods) approach. In chapter one, the general background of the
study is presented. It also presents the problem statement and objectives of the study. The
chapter also presents the relevance of the study. Chapter two of the study presents the
theoretical basis of the study and review of related studies. Chapter two also contains the
specific hypotheses to be tested by the quantitative component of the study and the research
questions to be answered by the qualitative component of the study. It also presents the
operational definition of terms. In chapter three, the methodology of the study is reported.
This includes the philosophical basis of the study, the study approach and ethical
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considerations. It also presents the procedures for the quantitative and qualitative data
collection and data handling. Chapter four is the results section of the study. It consists of
the findings of both the qualitative and qualitative studies. Chapter five presents the
discussion of the findings of the study, implications of the findings, limitations of the study,
recommendations, and conclusions.
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CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
Disaster research continues to receive theoretical and empirical interest over the years. This
has resulted in a good amount of literature on the subject. There are several theoretical
foundations explaining the impact of disaster among victims. This chapter reviews some
theories that give meaning to both the salutogenic and pathogenic effects of disasters. The
chapter also contains a review of empirical studies on disaster and its impacts across the
world.
2.1 Theoretical Framework
This study is guided by two fundamental perspectives on the effects of traumatic events.
These are the pathogenic perspective and the salutogenic perspective. The pathogenic
perspective identifies that traumatic experiences produce distresses collectively called
posttraumatic distress in this study (Dekel et al., 2012). The salutogenic perspective of
trauma directs attention to the fact that traumatic events produce positive outcomes and
psychological experiences among victims (Dekel et al., 2012). These different views have
received empirical research and theoretically supported some of which are discussed below
in this chapter.
2.1.1 Posttraumatic Distress Theory
The Theory of Shattered Assumption (Janoff-Bulman, 1992)
The Theory of Shattered Assumption is a social cognitive theory developed by Janoff-
Bulman in 1992 which explains the relation between individuals’ beliefs about the world
and their emotional reaction after the experience of trauma (Edmondson et al., 2011). These
beliefs or assumptions afford the individual a sense of control and stability.
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There are three basic assumptions underlying the Theory of Shattered Assumption. The first
assumption is that, the individual believes that the world is predictable or meaningful.
Second, the individual believes the world is just/benevolent. Third, the individual believes
the self is worthy. This gives the individual a sense of purpose of the world where things
are believed to happen for a deserving reason. This also instils a sense of predictability of
the world in the individual. They tend to believe that once one is a good person, s/he is
insulated from negative events. A sense of control over the world emerges where one feels
all will be well through being cautious, and preventive (Hashim, 2016). The second
assumption that the world is benevolent makes an individual believe that the world is full
of goodness and people are mostly well-meaning. The individual perceives others to be
helpful and less harmful (Janoff-Bulman, 1992). The third assumption of the Theory of
Shattered Assumption that the self is worthy accords the individual a good sense of self (i.e.
self-worth). When this belief about the self as positive and moral is held and by staying so
and responding to the world’s goodness and justice, negativity becomes impossibility
(Hashim, 2016).
These assumptions of the theory indicate that people perceive the world and people in it
around them to be reliable and well-meaning. Thus, as much as an individual behaves
rightly, they must not be stricken with adversities. However, these assumptions about the
world and the self can be significantly contradicted and challenged by events in the same
world around the person. Events such as disasters that are unpredictable often possess the
highest potential of thwarting the individual’s assumptions (Hashim, 2016). According to
the theory, the assumption of living in a world that is supposed to be harmless as far as one
behaves appropriately becomes defeated when disasters occur without an individual’s fault.
This shatters the very core beliefs held about the world, thereby producing a feeling of
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helplessness and creating a conflict within one’s beliefs and the realities of the world
(Edmondson et al., 2011).
According to Janoff-Bulman (1992) and Nygaard and Heir (2012), people with high positive
assumptions about the world suffer the greatest distress especially on their first traumatic
encounters. They are however said to recover rather quickly. This is because people with
previous traumatic encounters experience more post traumatic distress because they might
not have recovered fully from the previous effects before a new trauma may occur and not
necessarily because of their assumptive world view (Resick, 2001). Thus, a persons with a
history of traumatic experiences will recover slower than people of first time traumatic
experience.
In effect, according to the Theory of Shattered Assumption, posttraumatic distress (PTD)
such as PTSD emanates from the hopelessness felt due to the distortion and shattering of
one’s original assumptions about the world causing fear, worry, intrusive thoughts and
emotional breakdown.
It is however argued that Janoff-Bulman’s retrospective self-report data in developing the
theory may be problematic and suggested that data could have been a prospective one (Mills,
2010). For this reason Mills (2010) conducted a prospective study and realised that trauma
was not related with peoples assumptions about the world in general.
The Emotional Processing Theory (Foa & Kozak, 1986)
Foa and Kozak (1986) developed the Emotional Processing Theory (EPT) in an attempt to
unify the explanation and treatment of anxiety and related disorders. However, the theory
has been extended to challenges of victims following traumatic experiences.
The main tenet of the theory is that, people develop fear when cognitive networks related to
the fear stimulus get activated and when a meaning of danger or threat is assigned to the
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stimulus. A prolonged fear produces a pathological cognitive structure or schema that
reinforces fear and disruptive behaviours such as avoidance, escape and dissociation.
According to the theory, engaging in such behaviours disallows people from a constant
contact with the fear stimulus so as to disconfirm the ‘danger meaning’ they assign to the
stimulus. The experience of this fear produces physiological arousal in addition to the
disruptive behaviours that represent symptoms of PTD. A wide range of stimulus tends to
activate the fear structure. Therefore, people with anxiety problems such as those occurring
after traumatic experiences tend to view the world as generally dangerous and themselves
as incompetent. The sense of self-incompetence is also promoted when people imagine how
they acted during the trauma. These beliefs further strengthen the pathological cognitive
structure and exacerbate posttraumatic symptoms such as memory fragmentation and
disorganisation.
Like the theory of shattered assumptions, Foa and Kozak (1986) explain that PTD and
associated symptoms are significantly influenced by people’s pre-existing perception about
how safe or unsafe the world is and their personal competency or incompetency. They argue
that, trauma violates an individual’s perception of the safety of the world and strengthens
the belief about self-incompetence.
The theory indicates through the work of Foa and McNally (1996) that through exposure,
usually through prolonged exposure therapy a parallel non-pathological network/structure
is formed. This becomes strengthened over time at the expense of the pathological one. This
suggests that, the pathological structures can be rejuvenated after sometime if an individual
reverts to dreading similar fear stimuli. This therefore explains why anxiety problems such
as PTSD could be developed long after a traumatic experience.
However, Foa and Cahill (2001) explained that people experience ‘natural recovery’ where
people who experience high levels of PTD symptoms immediately after trauma may show
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significant decline in such symptoms over time. According to Foa and Cahill (2001), natural
recovery occurs through constant emotional processing of traumatic memories. This may be
done through the utilisation of support from others and engagement of thoughts and felling
about the trauma. Failure to do so may result in chronic PTD.
2.1.2 Posttraumatic Growth Theory
The Organismic Valuing (OV) Theory of Growth (Joseph & Linley, 2005)
The OV theory is grounded in the original Rogerian concept of organismic valuing process.
According to this theory, trauma victims engage in three possible cognitive processes to
psychologically resolve their traumatic experience including; 1) they assimilate the new
experience and this leads them back to a pre-trauma baseline which disposes them to
retraumatisation, 2) they accommodate the new experience negatively, leading to distress,
and 3) they accommodate the new experience positively and this results in growth because
they have resolved the new experience and have developed a new worldview in light of the
current traumatic experience. This means if a disaster does not kill the individual, then it has
the tendency to make the individual stronger.
The organismic valuing process is a humanistic perspective about how people view life and
what they want from it. It maintains that individuals know what is right for them and that
they will work towards their own good in order to progress (Joseph, 2009; Joseph & Linley,
2006). Owning to its background, this concept posits that people are innately disposed to
seeking actualization, a position that agrees with Abraham Maslow’s idea that confrontation
with tragedies elicits the quest to self-actualise (Maslow, 1955). This suggests that people
are naturally more likely to look for benefits in any circumstance (Sheldon, Jarndt, &
Houser-marko, 2003).
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The Organismic Valuing (OV) Theory of Growth is a fall out from several ancient
ideologies on how human beings have innately longed for growth and to stay stronger so
long as they have life.
According to this theory, when people experience disaster/trauma, they process the trauma
related information to either confirm or disconfirm their own views about the world (Joseph,
2009; Wadey, Podlog, Galli, & Mellalieu, 2015). The OV theory indicates that traumatic
experiences defeat an individual’s perceptions about the world. The individual must
therefore either assimilate or accommodate the current information (Wadey et al., 2015).
However, the tendency to accommodate or assimilate the current traumatic information
depends on the relation between their existing views about the world and the current
traumatic information. This creates an assimilation-accommodation task for the victim
where information about the trauma might have to be integrated into existing memory
(assimilation) or the existing memory adjusted properly to accommodate the new traumatic
information (Joseph & Linley, 2006) (This is depicted in Figure 2.1 below). Since growth
is principally about forming new views about the world, adjusting one’s existing memory
or assumptions about the world to accommodate the new traumatic experience/information
facilitates growth (Joseph & Linley, 2006).
According to Howells and Fletcher (2015), accommodating the current traumatic
information forms the basis for growth because whether positive or negative there is the
formation of a new assumption about the world. However, Joseph and Linley (2006) argued
that the formation of new positive assumptions indicates a move from a pre-disaster state to
a healthy posttraumatic state that promotes growth. The important issue is that the victim’s
perception or assumption has to change (Janoff-Bulman, 1992). For example, for a victim
of a building collapse to develop posttraumatic growth, s/he may have to avoid forcing the
incidence into her existing schema of assumptions like ‘but the world should be fair, why is
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this happening to me’, and rather modify her existing schema to accommodate the new event
such as beginning to think that the world is not predictable, anything can happen at any time
and that there is the need to take precaution and be personally strong.
According to Joseph and Linley (2006), this growth is facilitated by supportive social
environment where the individual may obtain basic human need such as autonomy,
relatedness and competence. Thus, adversities will create the room for new models about
the world and a new sense to exist and pursue actualization (Maslow, 1955). Therefore,
growth after trauma as against distress is a matter of utilizing the traumatic event to facilitate
a renewed sense of self, duty and worth. The factors available against PTD in one’s life must
be duly utilized in order to grow. Therefore, these factors are designated as being protective
against PTD.
Fig. 2.1:
Organismic valuing theory of growth following adversity. Adapted from Joseph &
Linley, 2005
In the figure 2.1 above, an individual’s assumptive view (view about the world) is tempered
with by a traumatic event. This event is then processed by the individual by either
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assimilating or accommodating into the existing schema of views about the world.
Assimilation returns the individual to a pre-trauma state whereas accommodation results in
a new world view. A positive accommodation leads to posttraumatic growth.
2.2 Review of Related Studies
There are several studies on the nature and the impact of disaster. Some of these studies are
reviewed in this section. The literature review is organised to present the impacts of
disasters, posttraumatic distress (PTD) and risk factors, posttraumatic growth (PTG) and
protective factors and the link between PTD and PTG.
2.2.1 The Negative Impact of Disaster
Disasters have commonly affected lives directly or indirectly in areas where they occur. The
number of lives affected by disasters continues to increase year after year (Dolman et al.,
2018; United Nations, 2015; Guha-sapir, Vos, & Below, 2011) as the incidence of disasters
continue to increase. The United Nations’ 2015 disaster analysis indicated that billions of
lives are affected in various ways with serious economic impact over the past decade due to
disasters. Indeed, all these lives affected suffer the effects of disasters in diverse forms.
Communities and economies suffer adversely. Some of these effects are reviewed below.
Physical Impact of Disaster
Several physical, economic and political effects of disasters have been documented. Some
of these effects are direct or indirect, immediate or delayed. Whichever way, they present
significant impact on the individual and the community at large. Ultimately, the survival of
victims in the midst of all these effects of the disaster tends to be grossly affected leading to
post disaster distress.
Du, Fitzgerald, Clark, and Hou (2010) recorded some of the physical impacts of flood
disasters especially to include injuries, disease epidemics, snake bites, and loss of
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infrastructure. In their attempt to investigate the circumstances leading to death during flood
disasters, Jonkman and Kelman (2005) reported that about two-third of the deaths are
through drowning and these are often men and high risk taking individuals. The Emergency
Events Database (EM-DAT) (2015) disaster report shows that floods occur more in Africa
and Asia than in other continents and that the global incidence of floods will increase over
the years. The report indicated that billions of people are adversely affected by weather-
related disasters annually with thousands of lives lost across the world due to floods, storms
and related disasters.
According to a study by Paul, Sharif, and Crawford (2018) based on data from 1959 to 2016
in Texas, fatalities recorded from hydrometeorological disasters over the 58year period
show a consistent increase in statistics. According to their study, the fatalities are twice as
higher among males than in females. They also found that the adult population is the high
risk group. Losing loved ones during disasters increases the psychological impacts of
survivors (Coker et al., 2006; Dewaraja & Kawamura, 2006). The more disasters occur, the
more lives are lost (Coker et al., 2006; Neuner, Schauer, Catani, Ruf, & Elbert, 2007) and
survivors will in turn be affected. Thus, many lives have been lost in Ghana and relations of
these people and many other who witnessed their death may be grossly bedevilled with
mental health complications.
Noe et al. (2016) conducted a descriptive study of the nature of illnesses and injuries the
American Red Cross treated after hurricanes Gustav and Ike. They reported in the study that
the major reason for treatments was pains. Survivors of disasters may suffer varying forms
and degrees of injuries (Lindell & Prater, 2004). In the case of explosions and wildfires,
there are usually burns, bruises, deformations and loss of body parts. Floods may also
present injuries from bottle and stick pricks, bites and broken bones. These loses have
implications for psychological experiences among the victims. Frankenberg et al. (2008)
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found that in a tsunami community in Indonesia, victims who experience injuries tend to
suffer high levels of psychological disruptions.
Disasters affect human nutrition and growth as well. Among children in rural India,
Rodriguez-llanes, Ranjan-dash, Degomme, Mukhopadhyay, and Guha-sapir (2011) found
that in an area affected by flood disaster, the children are significantly stunted than their
non-flooded area cohorts. The EM-DAT (2015) report corroborates this finding that floods
often wash away farms thereby resulting in food shortage and famine.
There has been massive property loss and/or damage due to disasters for decades (Lindell
& Prater, 2004). A direct effect of this is the high level of homelessness that follows the
incidences of disasters (Paidakaki, 2012). Typically, disasters affect buildings, roads,
bridges and commercial centres. This affects livelihoods and people’s mental health
(Frankenberg et al., 2008).
In the general population, natural disasters have been reported to result in several infectious
diseases some of which include malaria, typhoid fever, respiratory infections, viral hepatitis,
and meningitis (Kouadio, Aljunid, Kamigaki, Hammad, & Oshitani, 2012). Vachiramon,
Busaracome, Chongtrakool, and Puavilai (2016) studied 96 victims of flood in Thailand
who presented series of skin infections and found that majority of the victims developed
eczema following the disaster. Other victims had itches and skin macerations in their toes
colonized with various microorganisms. These physical and usually acute conditions further
increase the psychological impacts the victims’ experience.
Because disaster affects human lives and tempers significantly with society and national
assets, they have been deemed to present economic cost or impacts (Ladds, Keating,
Handmer, & Magee, 2017). Ademola, Adebukola, Adeola, Cajetan, and Christiana (2016)
found in a study in Nigeria that disasters significantly affect dwelling units, household assets
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and children’s schooling. Access to utilities such as water and electricity was also heavily
challenged. They found that victims spent huge amounts on the average to replace their
losses with rural folks and males spending more. They therefore recommended an insurance
cover and government support for victims of such disasters. The post disaster expenditure
can produce agony and distress as victims may have to recount their losses and replace them.
Economic effects of Disasters
The economic impact of disasters can be at the individual or national levels. The individuals
affected might have incurred significant financial, and property losses and may have to
spend so much to recover. The lack of personal economic ability could be a source of distress
for the victims. At the national level, a lot would be needed to assist individuals, and
communities affected by the disaster. When the needed national support is not readily
delivered, victims may suffer heightened levels of distress, feeling abandoned, and anxious
of the how to face the future.
Klomp (2016) studied how large-scale disaster can affect the economic growth of countries.
The study used satellite data due to poor data quality on GDP of most economies that record
disasters. It was found that climatic and hydrological disasters reduce the luminosity in
emerging/developing economies and geophysical and meteorological disasters negatively
affect the intensity of light in industrialized economies. The study revealed that the impact
of a disaster depends on the nature (scope and size), the location of the disaster, the financial
status and the quality of political institutions of the country involved. Again, Klomp and
Valckx (2014) performed a meta-analysis of studies that examined the impact of disasters
on economy growth. Following an extensive evaluation they found that there is a negative
impact of natural disasters on economic growth and this tended to increase over time. They
indicated that, this impact is most significant in developing countries.
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Brei, Mohan, and Strobl (2018) studied how disasters especially hurricanes affect the
banking sector in the Eastern Caribbean. In their study, they observed that when hurricanes
occur, there are less investments and high deposit withdrawals from the banks. According
to them, this results in negative funding shock which forces banks to fall on their liquid
assets and that prevent funding for post disaster recovery interventions.
Pfurtscheller (2014) analysed both quantitative and qualitative findings on the regional
losses due to disasters. They revealed that disasters cause a significant reduction in gross
regional products where for example, disruptions in traffic networks result in a decline in
regional economies. Generally, there appears to be consensus in the literature regarding how
detrimental disasters can be to economies. These effects include human losses which
eventually affect manpower, physical infrastructural damages, productivity, and trade.
There are also non-market losses such as damage to historic sites, recreation, relevant
cultural assets, and others that affect the end user in the economy (Cochrane, 2004).
Political effects of Disasters
Disasters also present serious political effects that can further compound the impact on the
individual victim, the country and/or the world at large. In Ghana for example, at the local
assembly levels people express disgust for political leaders because they feel that they have
not done their work. This affects voting, contribution to development and nationalism.
There is a changing trend in findings regarding the political effects of disasters in recent
times. In the past however, disaster analysts/researchers indicated that disaster produce
significant political impact by causing instability, distrust and related outcomes. This has be
attributed to scarcity of basic resources among affected communities after disasters
especially in developing countries (Brancati, 2007). Brancati (2007) studied the impact of
earthquakes on intrastate conflict by examining 185 countries between 1975 and 2002 and
found that disasters increase the probability of conflicts. This probability was indicated to
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be even higher for countries that had pre-existing conflicts, and poor domestic abilities.
Omelicheva (2011) also found that disasters pose marginal conflict threats to states but
added that where there are pre-existing challenges and crises in a particular country, the
impact of disaster politically is easily felt. Thus, disasters may only serve as a catalyst
(Raleigh, 2010).
Xu, Wang, Shen, Ouyang, and Tu (2016) noted that apart from the physical and mental
health challenges associated with disasters, they trigger social conflicts. Fisher (2010) found
in a qualitative study among post-tsunami victims in Sri Lanka that even though there may
be an already existing gender-based violence in the society, violence against women was
exacerbated by the disaster. Berrebi & Ostwald (2018) also reported that between the
periods of 1970 and 2007 across 167 countries, disasters have shown strong link with
terrorism and fatalities. They found that there is an immediate increase in transnational
terrorism following disasters whereas domestic terrorism incidences take longer to occur
because the public may need time to recover and access interventions instituted by
government.
In the United States Institute of Peace Special Report by Tipson (2013), it was documented
that disasters in different parts of the world generated political unrests and disturbed national
peace. It indicated that disasters expose government incompetence and indifferences and
social inequalities, thereby generating political oppositions. For example, the report
revealed that the current state of Bangladesh came into being as a result of poor Western
Pakistan government intervention during a cyclone which hit Eastern Pakistan in 1970. The
report also mentioned that there were uprisings in Arab states following droughts in 2010 in
Russia. This was buttressed by Johnstone and Mazo (2011) that even though threats of such
conflicts were always observed within the Arab states, they became apparent during the time
of the droughts. They described disasters as ‘threat multipliers’ where even though they may
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not by themselves spark conflict, they fuel it. The conflicts that may emanate as a result of
disasters may also further traumatise individuals who may witness them.
It appears that the impact of disasters on political stability often remain subtle. When deeper
search and interrogation is conducted, the true state of affair gets revealed. There seems to
be some level of connection between some forms of political challenges and disasters in
states with frequent disasters across the literature. The instability generated by disasters will
further produce disasters especially man-made ones such as riots, conflicts that will leave
many people traumatized.
In summary, the literature has ample evidence that disasters do not only affect the individual
but families and societies and nations at large. This includes economic impacts such as
scarcity of utilities, consumables and poor GDP (Klomp, 2016; Ladds et al., 2017), political
impact such as rebellious activities and terrorist intentions (Brancati, 2007) and physical
challenges such as destruction of properties, farms and disease epidemics (Du et al., 2010).
These evidences in the literature show the breath of disaster impacts, making it imperative
for an increased interest in disaster research in order to avert the challenges that follow them
among victims and communities at large
2.2.2 Disasters and Posttraumatic Distress
Researchers have broadly pointed out that disaster victims most likely suffer posttraumatic
stress disorder (PTSD) (e.g. Chung & Kim, 2010; Dewaraja & Kawamura, 2006; Mason,
Andrews, & Upton, 2010; Neuner et al., 2007). According to Haqqi (2006), people who
experience disasters exhibit several symptoms including anxiety, restlessness and dizziness.
Griensven et al., (2006) studied the prevalence of the symptoms the PTSD, depression and
anxiety among tsunami victims in southern Thailand. In their multistage, cluster population-
based mental health survey using displaced and non-displaced victims, they found that of
the 371 displaced victims, 12% experienced symptoms of PTSD, 37% experienced anxiety
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symptoms and 30% reported symptoms of depression. For non-displaced victims, out of the
322 participants used, there were 7%, 30% and 21% for PTSD, anxiety and depression
symptoms respectively. This indicates that generally, disaster populations experience more
posttraumatic symptoms compared to their non-disaster counterparts. This point was further
supported by the a study among victims of the September, 9 attack in New York by Person,
Tracy, and Galea (2006) to find the prevalence of depression and related factors six months
after the disaster. They found that 9.4% of the 2700 participants show higher probability of
major depression. Similarly, Hussain, Weisaeth, and Heir (2011) studied a sample of 2004
tsunami victims from Norway 2.5years after the disaster and found that 28.6% of the victims
had developed major depressive disorder among other disorder such as social anxiety
disorder, specific phobia, dysthymic disorder, agoraphobia and PTSD.
Suicadality is an impact of disaster that reflects the strong psychological effects disasters
produce among survivors (Kolves, Kolves, & De Leo, 2013). Orui and Harada (2014) noted
an increase in the suicide rate among females during the first seven months after the 2011
Great East Japan Earthquake. Guo et al. (2017) also found in a cross-sectional survey using
1369 victims that eight years after the Wenchuan earthquake in China, 9.1%, 2.9% and 3.3%
of the participants reported suicidal ideation, plan and attempts respectively. This was even
strengthened by experiences of PTSD and depressive symptoms.
Jones, Ribbe, Cunningham, Weddle, and Langley (2002) followed up on fire disaster
victims six weeks after the disaster in the United States of America (USA). They used
standard assessment procedures on victims they classified as high loss and low loss victims
across children, adolescents and their children. Their findings indicated that victims in
general reported PTSD and there was a strong positive correlation between the levels of
PTSD among children and their parents. However, victims with high losses experienced
higher levels of PTSD compared to those with low losses.
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Fang and Chung (2019) studied the relationship between PTSD and psychiatric co-
morbidities among university students in China. It was found in their study that, PTSD is
associated with a significantly rise in psychiatric co-morbidities following disasters. This
association was found to be mediated by cognitive distortions and alexithymia. Gargano,
Li, Millien, Alper, and Brackbill (2019) reported that disaster present long-term
psychological effect for victims. In their study, they examined the role of a previous disaster
(Hurricane Sandy) in the development of PTSD symptoms among 9/11 disaster. It was
found that the previous disaster significantly predicted PTSD in victims of current disaster.
Again, Tapsell (2000) qualitatively studied impact of flood on victims of the 1998 flood
disaster in the United Kingdom (UK) two years after the disaster. Prominently, their study
found that victim expressed anxiety about future flooding. Victims also reported loss of
confidence (distrust) in authorities responsible for handling such events of disaster. From
the foregoing, the literature suggest that people who experience trauma either from natural
or man-made disasters are predisposed to psychological distresses by virtue of their
exposure to the trauma. This fact is not limited to a certain category of victims. Regardless
of protective factors, disasters pose posttraumatic challenges for victims.
The above findings concur with Mason, Andrews, and Upton (2010) who assessed flood
victims in the UK and found symptoms of PTSD, Depression and anxiety. Their study also
reported poor coping strategies among victims who typically used detached, avoidant and
rational coping styles.
Neria, Nandi, and Galea (2008) conducted a systematic review of 284 studies published on
disaster and PTSD. Their study identified three kinds of disaster namely natural disasters,
technological disasters and man-made disasters. They found that PTSD is there is a
substantial burden of PTSD among victims of both man-made and natural disasters across
the globe since 1980. Similarly, Dogan (2011) found among adolescents 13 months after an
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earthquake in Turkey in 1999 that 76% of the victims experienced moderate to severe levels
of PTSD symptoms. They also observed that adolescent victims showed an increase in
behavior problems.
Also, Wilson-Genderson, Heid, and Pruchno (2018) reported that different types of disasters
produce psychological distresses among victims. They however realised that an individual’s
emotional reactions during the disaster affects the level of distress that is experienced. This
means that there are some factors that are risk agents for the development or exacerbation
of posttraumatic distresses.
The negative impacts of disaster have been well documented. However, most of these
studies reviewed above used quantitative methods only. This means that very detailed
information that could be obtained through qualitative approaches is often lost in the study
of disaster and impacts they have on victims. There is the need to investigate the adaptation
processes among disaster victims using in-depth qualitative interview/approaches in order
to establish detailed understanding of the factors. Meanwhile, there are several factors that
influence the development and maintenance of the distress levels among the victims. Some
of these factors are reviewed below.
2.2.3 Risk Factors for Post Disaster Distress
In a review conducted by Neria et al. (2008), they found that several factors are related to
posttraumatic distress among survivors of disasters. They found such factors as lack of
social support, severity of loss in the disaster, dear death experiences in the disaster, injuries
and witnessing deaths in the disaster. Indeed, as indicated above that that social support
significantly predicts PTG, it is understandable that Neria et al. (2008) reported that a lack
is social support influences the level of post disaster distress.
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One prominent risk factor for PTD is the victim’s previous traumatic history (Benjet,
Borges, & Medina-mora, 2010; Breslau, 2002). Seng et al. (2013) conducted a prospective
study comparing a group of mothers maltreated in childhood with a non-maltreated in
childhood group to ascertain their level of PTSD, postpartum depression and wellbeing.
They observed that women who were maltreated in their childhood experienced more
PTSD, depression and poor wellbeing in their adulthood compared to those who were not
maltreated. Studies have suggested that people who experienced trauma in early lifetime
become dependent on substances in adult life (Brady & Back, 2012; Schuck & Spatz, 2001;
Widom, White, Czaja, & Marmorstein, 2007). Such early lifetime experiences are noted by
Enoch (2011) to alter neural networks thereby inducing an enduring psychologically
unattractive behaviours. Enoch (2011) reported that the experience of trauma in the early
years of life results in drinking problems in adolescence and early adulthood. Again
(Kendler et al., 2000) indicated that women who experienced early childhood sexual abuse
are at higher risk of developing psychiatric disorders. Their research using 1411 adult female
twins therefore found that childhood sexual abuse is associated with several adult
psychopathologies including bulimia and alcohol and other drug dependencies (Kendler et
al., 2000).
Anda et al. (2006) studied a sample of 17,337 adults who experienced several early lifetime
adversities such as witnessing domestic violence, abuse and household dysfunction. They
observed that these adults showed increase levels of somatic, affective, aggressive, memory,
substance abuse, affective and sexual problems in their lives. Binelli et al. (2012) as well
found among a sample of 571 Spanish University students in a cross-sectional study that
there is a high positive relationship between family violence experienced in childhood and
social anxiety problems in adulthood. However, their study observed no significant
relationship between other traumatic childhood experiences such as loss of a close relation,
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an emotional, physical or sexual abuse and such social anxiety problems (Binelli et al.,
2012). Similarly, it was found among such early trauma victims that they have smaller social
networks and poorer close relationships (Ford, Clark, & Stansfeld, 2011). These victims
also suffer psychotic disorders and ADHD (Björkenstam, Burström, Vinnerljung, &
Kosidou, 2016).
In a 45 year prospective study, Clark, Caldwell, Power, and Stansfeld (2010) established the
relationship between the experience of previews early childhood adverse events and
psychopathology across the lifespan. They noticed that having adjusted for socioeconomic
factors, childhood traumatic experiences associated with psychopathology such as anxiety,
mood and affective disorders through adolescence, early and mid-adulthood without
attenuation. In this regard, Collishaw et al. (2007) reported in their study that only a few
victims of previews traumatic experiences did not show mental health challenges as a result
of quality adult love relationship, parental care and personality. Their study actually
revealed an increase in psychiatric conditions among adolescents and adults with past
traumatic experiences (Collishaw et al., 2007).
Personality factors play an important role in how individuals adjust to adverse experiences.
Neuroticism has typically been demonstrated to be impactful in the development of
posttraumatic distress among victims of disasters (Breslau & Schultz, 2013; Miller, 2004).
According to Ogle, Siegler, Beckham, and Rubin (2017), the mechanism by which
neuroticism fosters PTD is that it magnifies the centrality availability and the emotionality
of trauma memories. They arrived at this conclusion in their longitudinal study of adults
with traumatic histories or varied intensities. They found that individuals with high
neuroticism scores about three decades apart in young to middle adulthood reported
traumatic memories accompanied by ‘more intense physiological reactions, more frequent
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involuntary rehearsal, and greater perceived centrality to identity in older adulthood’ (Ogle
et al., 2017).
Lundell et al. (2017) observed in a Swedish cohort study of post abortion psychological
adjustment that comparatively, women who experience higher levels of PTSD and related
symptoms scored higher on personality traits related to neuroticism such as somatic trait
anxiety, psychic trait anxiety, stress susceptibility and embitterment. This finding concurs
with Jakši et al. (2012) whose systematic review of the literature reveals that PTD is
positively associated with neuroticism and related personality traits such as negative
emotionality, harm avoidance, novelty-seeking, self-transcendence, trait hostility/anger and
trait anxiety.
Sheikhbardsiri et al. (2015) also reported that among emergency medical service personnel
who frequently face distressing work experiences, most of them that develop PTSD
recorded higher levels of conscientiousness and neuroticism. Breslau and Schultz (2013)
concluded from a prospective study on the role of neuroticism in the development of PTSD
that indeed neuroticism is a major factor in the development of PTSD as a response to
traumatic experiences. This was conducted using a large sample of 1007 participants who
were observed at baseline and followed up on after three, five and ten years later. Their
study found that about 5% of participants who had relative risks of PTSD after traumatic
experiences in the 10year follow up had higher neuroticism baseline scores than the others
(Breslau & Schultz, 2013).
Vujicic and Randelovic (2017) examined the predictive role of personality traits in
depression, anxiety and stress among secondary school students using the five factor
personality traits. They found out that neuroticism was the largest predictor for all of
depression, anxiety and stress among the students
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There have been several taxonomies of personality traits. However, the Big Five has
featured prominently in most trauma studies. Is has also been common to find across the
literature that most of the various classifications are related and have produced similar
findings. From the foregoing, neuroticism appears to be a stronger predictor of PTD among
most traumatised victims.
Cultural factors especially in terms of how relate and see themselves in relation to others
matter in post disaster adjustment among victims. The concept of self-construal, composing
of interdependence and independence has shown some link with post disaster struggles or
adjustment. For example, Mordeno et al. (2016) identified that independent self-construal
is highly related with all the domains of PTSD enumerated by the fifth edition of the
Diagnostic and Statistical Manual (DSM). It has been argued that when people refuse to
express their emotions to their social relations, they tend to experience higher psychological
distress (Nimmagadda & Pallassana, 2000). This was clarified by Mordeno et al. (2016) to
mean that when traumatic experiences are not properly expressed such as avoiding to seek
help or not interacting with other people about the experience meaningfully, it will lead to
elated trauma-related intrusive thoughts, avoidance of reminders and high arousal states.
Jobson and Kearney (2006) established that in cultures where people utilise self-centred
trauma memories, i.e. focusing on themselves on with regards to the traumatic event, they
suffer more posttraumatic challenges compared to those who define their trauma in relation
to others around them. This was demonstrated among Australians and Asians who are
independent and interdependent respectively (Jobson & Kearney, 2006). Jobson and
Kearney (2009) conducted a study to assess the impact of culture on negative cognitive
appraisal among victims of traumatic experiences with and without PTSD. Their study
revealed that victims with PTSD from independent cultures were generally higher on
symptoms such as mental defeat, alienation and change and less control strategies compared
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to those without PTSD. However, in interdependent cultures, there were no differences in
the same symptoms except for alienation for both those with and those without PTSD. This
agrees with their 2008 findings where individuals from independent cultures expressed more
trauma-related cognitive challenges than those from interdependent cultures (Jobson &
Kearney, 2008).
The expression of depression symptoms has also been associated with cultural factors
(Karasz, 2005). Shafi and Shafi (2014) argue that the cultural orientation of an individual
reflects in how symptoms are presented and how the individual appreciates the condition.
These differences have been noted in how different cultures express their depression and
related features in terms of language (Loveys, Torrez, Fine, Moriarty, & Coppersmith,
2018). Similarly, these differences have been shown for other psychological distresses such
as anxiety disorders (Hofmann & Hinton, 2014; Lewis-ferna et al., 2011) and suicide
(Lester, 2008).
2.2.4 Disaster and Positive Outcome
Even though disasters are most likely to produce distresses, there are some positive
outcomes that can result from them. A study by Klasen et al. (2017) provides a significant
insight for an understanding into the positive role of disasters. In their study, Klasen et al.
(2017) identified among former Ugandan child soldiers that despite their severe exposure to
trauma, a good percentage of the victims developed posttraumatic resilience. In this regard,
they showed no symptoms of PTSD, depression and related disorders. They were also less
prone to domestic violence, guilt and revenge. This former child soldiers were reported to
have wanted to support society, work and be responsible.
In the study of people forcibly relocated from their homes in the wake of political activities,
Nuttman-shwartz, Dekel, and Tuval-mashiach (2011) found that victims with the adversity
who exhibited low PTSD exhibited high PTG. This is a signal that when disaster help build
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positive outcomes, the negativity associated with it is low. This emphasizes the need for
building on the factors for resilience and/or growth following adversity. For instance, Bell
and John (2019) observed that when victims of a tragedy use positive spiritual coping, they
gain positive spiritual outcomes and this can build resilience and/or growth.
As part of several findings, Macksoud and Aber (1996) observed in their study of victims
of war that children who were separated from their parents and witnessed violence reported
a more planful lives. They were also found to live a more prosocial life. Their study pointed
these positive outcomes of the tragedy regardless of the fact that some of their participants
reported other adverse outcomes of the trauma.
Lev-wiesel, Goldblatt, Eisikovits, and Admi (2009) studied a group of nurses and social
workers during the second Lebanon-Israel war in 2006. The study found that nurses showed
higher PTG compared to social workers. Interestingly, their study indicated that personal
resources which they termed as potency helped reduced vicarious traumatization among the
participants whereas peri-traumatic dissociation increases PTG.
Clearly, the literature provides the indication that adversity or traumatic events can lead to
growth in some aspects of an individual. This can make the person psychological and
socially better or stronger. This is the crux of the positive psychological argument for this
current research.
2.2.5 Factors promoting Positive Disaster Outcomes / PTG
Several factors influence how disaster victims rise above the negative impact they suffered.
These factors are reviewed under personal/demographic, psychological, and social factors
under this section.
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Personal/demographic factors affecting PTG
It has also been noted that some demographic factors such as gender (Akbar & Witruk,
2016; Vishnevsky et al., 2010), age (Milam, Ritt-olson, & Unger, 2004; Vloet, Vloet, &
Bürger, 2017) and economic abilities (Cormio, Muzzatti, Romito, Mattioli, & Annunziata,
2017; Teodorescu et al., 2012) assist with positive impacts after disaster experiences.
In a meta-analysis of 70 studies by Vishnevsky et al. (2010), they observed that gender has
a small to moderate impact on PTG. Particularly, they observed that females reported more
PTG than males. This relationship was found to be moderated by age. Helgeson, Reynolds,
and Tomich (2006) also conducted a meta-analysis of 87 studies to ascertain among other
things the gender differences in PTG among victims of traumatic experiences. They found
that there is indeed a difference in PTG among males and females with females reporting
higher PTG than males. Similarly, Teixeira, Grac, and Pereira (2013) found in their study
on the factors contributing to PTG among cancer patients that there is a significant gender
difference among the patients in all aspects of PTG. In this view, the literature points to the
fact that as females experience higher levels of PTD after a traumatic experience on one
breadth (Birkeland, Blix, Solberg, & Heir, 2017; Macgregor, Clouser, Mayo, & Galarneau,
2017; Olff, 2017; Olff, Langeland, Draijer, & Gersons, 2007), they also may be
experiencing a higher level of PTG on the other (Jin, Xu, Liu, & Liu, 2014; Teixeira et al.,
2013).
Age is another personal factor that has implication for how people endure the after effects
of adversities particularly in terms of PTG among disaster victims (Xu & Liao, 2011).
According to Patrick and Henrie (2016), there is however a complexity attached to the
attempt to establish how age influences PTG. They point to the fact that as people age, they
experience more adversities that affect their entire life and coping methods. For example,
Lowe, Manove, and Rhodes (2013) assessed the levels of PTD and PTG among hurricane
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victims and observed that older victims experienced higher PTG and higher PTD than their
younger counterparts. On the contrary, Patrick and Henrie (2016), found that among trauma
victim older adults reported less grief than middle adults, however its impact on the level of
PTG was minimal.
However, Milam, Ritt-olson, and Unger (2004) found in a study of PTG among an
adolescent population that age significantly affects how victims grow after the experience
of a disaster. Similarly, Cormio et al. (2017) studied the association between clinical,
demographic variables, social support and PTG among cancer patients in Italy. They found
that age as well as other demographic factors like employment, education significantly
predicted PTG among the patients.
The findings of Cormio et al. (2017) regarding the impact of employment on PTG creates
an impression that socio-economic factors must be important in how disaster victims
progress through the hard after-disaster times. Kunst (2017) also found that most victims
who experienced higher levels of PTD were those who were without employments.
Psychological factors that Promote PTG
There are also a number of psychological factors that predict PTG following traumatic
experience. Some of these factors discussed under this section include self-esteem, self-
efficacy, adaptation, resilience and self-control.
Self-efficacy has been identified to facilitate posttraumatic growth (Mazor, Gelkopf, & Roe,
2018). According to Benight and Bandura (2004), self-efficacy is the central factor that
determines how people feel they can adapt to their environment and situations. It is the belief
in one’s ability or power to gain control and achieve results and this occurs through
motivational, cognitive and decisional processes (Benight & Bandura, 2004). Nygaard and
Heir (2012) posit that self-efficacy is a potent factor for posttraumatic recovery. Thus, it
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creates a sense of self-reliance and control. Their work on a sample of 617 Norwegians
tsunami victims indicated that at least in the short term, self-efficacy is associated with lower
levels of posttraumatic distress (Nygaard & Heir, 2012). This finding correspond with
MacEachron and Gustavsson (2012) who also found among war veterans that self-efficacy
correlated negatively with their PTD levels.
A study by Cieslak et al. (2009) among HIV patients who survived Hurricane Katrina tested
Benight and Bandura's (2004) model that self-efficacy predicts PTG. The results of their
study showed that indeed, an individual’s self-efficacy positively correlated with their PTG.
In a systematic review of the literature on the relationship between self-efficacy and
psychological outcomes, Luszczynska, Benight and Cieslak (2009) found out that most
studies reveal a significant association between self-efficacy and psychological health
where self-efficacy was linked to lower PTSD levels and better somatic health.
It has also been found that resilience, which is one’s ability to sustain a traumatic experience
without experiencing posttraumatic distress (Bonanno, 2004) promotes growth among
traumatic victims. Meanwhile, the theoretical stance on the difference between resilience
and PTG has been confusing with some equating the two constructs (Tedeschi, Calhoun, &
Cann, 2007). Hobfoll et al. (2007) for instance view PTG to be equal or superior to
resilience. But (Westphal & Bonanno, 2007) contend that people are resilient in the face of
traumatic events and that aids their growth following the trauma.
There is a strong association between resilience and PTG within the literature. For example,
Mahdi, Prihadi and Hashim (2014) observed among a sample of university students in Iraq
that resilience has a significant influence on the development of PTG. Waysman,
Schwanwald, and Solomon (2001) also found that hardiness among prisoners of war and
veterans impacted the long term positive and negative changes following traumatic
experiences. Again, Yu et al. (2014) found in their study that certain factors facilitate PTG
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and not much is known about them. Among such factors, they examined the relationship
between social support, positive coping and resilience and PTG and found that all these
factors significantly and positively related with PTG.
Bensimon (2012) found in a study that correlated trait resilience and PTG among individuals
with varied traumatic levels. It was found in that study that there is a significantly associated
between resilience and PTG. Lee et al. (2016) also found among police officers who
experienced traumatic situations that self-resilience help strongly to reduce PTSD
symptoms and increased their levels of PTG. Similarly, Austin, Pathak, and Thompson
(2017) studied the effect of resilience on PTG among emergency medical service
professionals and found that there is a high correlation between their resilience and PTG
and a negative relationship between resilience and secondary traumatic stress.
Mindfulness, a factor related to resilience has also been related to PTG among traumatic
victims. In a study of depression and PTG among Chinese adolescents who experienced
tornado, Xu, Ding, Goh, and An (2018) found that dispositional mindfulness promoted PTG
among the victims. They concluded that mindfulness affords an individual the potential to
adopt adaptive coping against depression after the experience of traumatic events.
Similarly, Garland (2007) reported that mindfulness bolsters adaptation to negative life
experiences through positive reappraisal. This mechanism occurs where the individual
adopts adaptive coping strategies by assigning positive meanings to the event and reframing
the event as benign and well-meaning. This thus helps facilitate wellbeing. Again, Kearney,
Mcdermott, Malte, Martinez, and Simpson (2012) investigated how mindfulness-based
intervention can reduce symptoms of depression and PTSG among veterans and found that
at six months of intervention, participants showed significant improvement in symptoms.
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Some studies however did not find a positive association between resilience and PTG. For
example, Levine, Laufer, Stein, Hamama-Raz, and Solomon (2009) found in their study
among terror and war victims of Israel that even though the two constructs are salutogenic
outcomes of trauma, they are inversely related. Oginska-Bulik and Ogi´nska-Bulik (2016)
also recorded in their study among fire-fighters experiencing job-related trauma that
resilience is negatively related with PTG. This inconsistency may be accounted for by
several factors including characteristics of the disasters studied, differences in cultural
orientation and demographic factors. Clearly, the link between PTG and resilience needs
more exploration due to the mixed findings and understandings put forth within the
literature.
Another psychological factor that promotes PTG among trauma victims is self-esteem. This
is the value of the sense of worth one perceives of him/herself (Holland & Andre, 1994).
The relationship between the self-esteem and PTG has been confirmed by Taku and Britton's
(2017) study among adolescents in the United State of America who experienced some form
of stressful life event. They found that self-esteem positively predicted PTG. Zhou, Wu, and
Zhen (2017) also found in their study of earthquake adolescent victims that even when
victims are well socially supported, it is their self-esteem that helps them to be able to
develop PTG.
Bradley, Schwartz, and Kaslow (2005) indicated that self-esteem serves as a resilience
factor against the negative outcomes of adversities. In their study among low-income
women African decent in America who experienced intimate partner abuse, they found that
self-esteem contributes significantly to PTSD symptoms by mediating the link between
abuse and PTSD (Bradley et al., 2005). Engelkemeyer and Marwit (2008) corroborated the
relationship between PTG and self-esteem in their study finding among grieving parents
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that self-esteem is negatively associated with grief intensity and positively related with
growth scores.
Some personality factors such as conscientiousness, openness have also been found to
determine post disaster growth among victims. For example, Jia, Ying, Zhou, Wu, and Lin
(2015) found among 638 survivors of the 2008 Wenchuan earthquake that there is a
significant direct effect of extraversion on PTG. Also, Karanci et al. (2012) investigated
how personality and posttraumatic stress interacted to affect PTG among accident survivors.
They found that PTG was significantly related to conscientiousness, agreeableness, and
openness to experience and this relationship was found to be moderated by posttraumatic
stress.
Most of the studies examining the role of the psychological factors for post disaster growth
established that the factors play positive role in the development of growth following the
experience of disasters. There however has not been enough understanding on how these
factors also relate to the levels of distress following disaster experience. It becomes
necessary to explore and to establish whether these factors could be counted upon for a
reduction in the level of distress victims of disasters experience.
Social factors influencing PTG
Social support has a huge potential for recovery from traumatic experiences (Han et al.,
2019). According to Rzeszutek (2018), social support positively correlates with PTG.
However, this correlation is mediated by positive affect. This is an important observation in
that an individual’s emotional state may still impact on how support around can help in
times of distress. Bhat and Rangaiah (2015) examined the impact of social support and
conflict exposure on PTG in Kashmir, a cross-sectional study involving 803 college
students. They found that conflict exposure and social support significantly correlated with
PTG among respondents. Lee et al. (2015) investigated the role of social support on PTG
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among American war using a mixed method approach. Their study found that social support
is a high predictor of PTG especially among older veterans and those who obtained the
support from their involvement with peers. Again, Prati and Pietrantoni (2009) conducted a
meta-analytic review examining how social support and some other variables impact PTG.
They found that the literature reported a moderate effect size of social support in PTG.
Many populations experiencing distresses have shown the positive impact of social support.
In the HIV/AIDS population for instance, patients have been shown to benefit immensely
from social support and this has been recorded to associate significantly with PTG. For
example, Rzeszutek, Oniszczenko, and Firla (2017) examined the association between
social support and PTG among persons living with HIV (PLWH) in a one year longitudinal
study using 73 participants. They recorded among other findings that social support is
positively related with PTG among the patients. Similarly, Wei, Li, Tu, Zhao, and Zhao
(2016) found among 790 children aged 6 to 17 years who acquired HIV through mother-to-
child transmission that social support mediated the impact of enacted stigma on PTG and
provided a multiple level protection among the patients.
Among cancer patients, a study conducted by Karanci, and Erkam (2007) using 90 breast
cancer patients revealed that social support is related to higher stress related levels among
patients. A similar finding was obtained in a study by Yi, Zebrack, Kim, and Cousino (2015)
among young cancer patients. They found that children with cancer depicted a level of PTG
that is positively correlated with the social support they enjoy. Nenova, Duhamel, Zemon,
Rini, and Redd (2011) also found among survivors of hematopoietic stem cell transplant
(HSCT) that emotional and instrumental social support are highly associated with the level
of PTG of the survivors. Again, Dirik, and Karanci (2008) established among Rheumatoid
arthritis patients in Turkey that social support correlates significantly with patients overall
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level of PTG and the various domains of PTG such as relationship with others, philosophy
of life, and self-perception.
Religion is another social factor that significantly influences PTG among trauma victims.
Generally, religion has been observed as a strong coping skill used among victims of
disasters (Sipon, Nasrah, Nazli, Abdullah, & Othman, 2014). It serves a significant social
purpose where people tend to fall on the religious groups for needed supports in times of
distress and also derive meaning for their circumstance (Oren & Possick, 2009). According
to Hui and Hui (2009) religiosity promotes several positive aspects of one’s psychological
life. García, Páez-rovira, Zurtia, Martel, and Reyes (2014) observed among the 2010 Chile
earthquake victims that those who use positive religious coping skills have an associated
higher levels of PTG, i.e. religiosity was found to impact PTG significantly. In a similar
regard, García, Páez, Reyes-reyes, and Álvarez (2017) noted in a longitudinal study that
negative religious coping was associated with higher posttraumatic stress levels among a
sample of Chilean trauma victims whereas positive religious coping was associated with
PTG.
Ha (2015) argues that religion plays an important role in the care and mitigation dynamics
of disasters in that it helps to better understand the nature of the disaster. Religious
involvement has provided soothing for women who experience domestic abuse; it is
associated with reduced level of depression and PTSD (Watlington & Murphy, 2006).
Studies have lend support to a positive relationship between religiosity and PTG especially
among people who are traumatised (Shaw, Joseph, & Linley, 2005). For example, in the
study by Taku and Cann (2014) examining religiosity, national background and PTG, it was
found that religiosity, explained as religious affiliation and strength of religious beliefs
strongly predicted PTG among American and Japanese students who had an experience of
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highly stressful life events. Similarly, Rezaei, Forouzi, Roudi Rasht Abadi, and Tirgari
(2017) also conducted a study among cancer patients in Iran to test the relationship between
religiosity and PTG. The results of their study also showed a positive relationship between
religiosity and PTG.
Very much related to the support victims receive from family, friends and religious groups,
interventions received from professionals play a significant role in fostering PTG (Lechner
& Antoni, 2004). There are however varied interventions for traumatic experiences. Each
of these interventions may have their strengths and weaknesses. Xu et al. (2016) reported
on the efficacy of a Chinese Traditional Cultural positive psychological intervention for
PTG among health workers in China. They observed that after the provision of such
intervention to participants, they scored significantly higher on PTG compared to their
baseline scores.
In a systematic review of literature and meta-analysis, Forneris et al. (2013) found that brief
trauma-focused cognitive behavioural therapy effectively helped to reduce PTSD symptoms
compared to supportive counselling. Their study also revealed the efficacy of collaborative
care for PTSD than a usual care. Meanwhile, Benish, Imel, and Wampold (2008) concluded
from their meta-analysis that all psychotherapies for trauma victims especially for PTSD
symptoms are equally effective, ruling out any differences in terms of the efficacy and
preference. But this conclusion has been critiqued by Ehlers et al. (2010) as not being
scientifically rigorous and biased. Ehlers et al. (2010) indicated that several studies stamped
the efficacy of trauma-focused therapies over other therapeutic intervention and
recommended that as first-line treatment for PTSD.
Kline, Cooper, Rytwinksi, and Feeny (2018) also investigated the long-term efficacy of
psychological interventions for post disaster distresses for a minimum of six months through
a meta-analysis. Their analysis included 32 PTSD trials that involved 72 treatment
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conditions. They observed that all active professional psychological interventions yielded
significant long-term efficacy. Similarly, Ehring et al. (2014) conducted a meta-analysis that
particularly focused on studies that evaluated the efficacy of psychological interventions for
PTSD among adults who suffered childhood sexual abuse. Their work recorded that in
general psychological interventions are efficacious for individuals experiencing PTSD due
to childhood sexual abuses. They also identified that trauma-focused therapies more
efficacious than non-trauma-focused therapies similar to the findings of (Ehlers et al.,
2013), whereas individual therapies yielded better results for PTSD than group therapies.
This indicates that individual trauma-focused interventions are most ideal for people who
suffer traumatic experiences.
However, Brady, Warnock-parkes, Barker, and Ehlers (2015) pointed out that there are
patient attributes (Ehlers et al., 2013) or behavioural characteristics that influence the
efficacy of posttraumatic interventions. Brady et al. (2015) investigated whether
behavioural predictors of that account for poor intervention outcomes show early in therapy
sessions. They hypothesised that poor intervention outcomes will be associated with greater
patient perseveration, lower expression of thoughts and feelings and weaker therapeutic
alliance. They also examined the link between treatment outcome and patient behaviours
with therapeutic alliance. This was done by observing and recording 58 patients in therapy
sessions. They found that therapeutic outcomes were negatively affected by perseveration
and less expression of thoughts and feelings and these were found in the initial sessions of
treatment.
Emmerik, Kamphuis, Hulsbosch, and Emmelkamp (2002) also conducted a meta-analysis
on the efficacy of single session debriefing after traumatic experiences and found that this
form of intervention does not work to improve posttraumatic stress symptoms especially in
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the case of critical incident stress debriefing. This means that a ‘one-time snap shot’
intervention or debriefing may not be ideal for disaster victims (Forneris et al., 2013).
2.2.6 Relationship between Posttraumatic Distress (PTD) and Posttraumatic Growth
(PTG)
It may come with some ease to assume that people who suffer higher Posttraumatic Distress
(PTD) will show less Posttraumatic Growth (PTG). The evidence in support for this however,
is scanty and mixed. An extensive review of studies on the relationship between PTD and
PTG by Zoellner and Maercker (2006) reported that indeed both positive and negative
relationships are being uncovered by researchers.
Cadell, Regehr, and Hemsworth (2003) explored the factors that promoted the chances of
PTG through a structural equation modelling. Among various factors, it was observed that
stressors had a significant positive direct effect on PTG. This finding is corroborated by the
assertion by Solomon and Dekel (2007) that the higher the posttraumatic distress, the better
the PTG.
However, some other studies found negative relationship between PTSD and PTG. For
example, Palmer, Graca, and Occhietti (2016) purposed to examine the relationship between
posttraumatic growth (PTG) and symptoms of depression based on their observation that
previous studies revealed a curvilinear relationship between the two variables. Thus, they
sample 269 veterans being treated for PTSD for their study. The study revealed a negative
relationship between PTG and depression among the veterans
In some studies, there has been no relationship between PTD and PTG. In a longitudinal
study by Koutna, Jelinek, Blatny, and Kepak (2017), the predictors of posttraumatic stress
symptoms (PTSS) and posttraumatic growth (PTG) among gender, age, objective factors of
the disease and its treatment, family environment factors and negative emotionality were
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examined. The study which was conducted among children with cancer revealed that there
is no significant relationship between PTSS and PTG.
Sattler et al. (2006) also examined earthquake victims in El Salvador four weeks after the
disaster. Among other aims of their study, the authors attempted to establish the link
between PTG and depression. Using 253 college students who were victims of the disaster,
they found that there is no significant relationship between PTG and depression as well as
with acute stress disorder.
These findings present an unclear state within the literature and so need further investigation
in order to clarify the linkage. There is thus the need to correlate PTG with various
dimensions of posttraumatic distress among victims of trauma in for a better insight into the
relationship.
In all, studies on disaster survivors have been predominantly western leaving what happens
in Africa behind. In Ghana, disaster studies are limited and there are no studies on PTD and
PTG. Cultural difference as far as disaster studies are concerned would require in-depth
scientific studies in the Ghanaian context in order to guide policy and intervention.
In the current study, the major goal was to examine the impact of risk and protective factors
on PTD and PTG among flood disaster victims. Therefore, the relationships among all the
factors were tested using quantitative methods. This provided the opportunity to establish
how the risk and protective factors predicted the PTD and PTG among the victims. The
study also sought to understand the lived experiences of disaster victims. This was done
using the qualitative method through in-depth investigations especially in a setting where
not enough has been recorded on the personal experiences of victims. By this method,
detailed information was gathered on how victims have survived and what resources they
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have personally made use of in their survival. The combined quantitative-qualitative method
therefore helped to triangulate findings in order to establish satisfactory evidence.
2.2.7 Summary of Review of Related Studies
Overall, the literature on disaster has demonstrated that disaster outcomes could be negative
and positive. Negative impacts include physical, economic and political effects. It was
observed in the literature that, the community and national level impacts further exacerbate
the negative impacts experienced by individuals. These impacts are at the individual,
community and national levels. Factors that influence the negative individual level distress
include the experience of traumatic events in the past, neuroticism and independent self-
construal. Positive impacts of disasters include the fact that individuals use the disaster
experience as avenue to grow and be strengthened. Factors promoting the positive outcomes
identified include social support, personal resilience, religiosity, and self-efficacy among
others. As to how distress from the experience of disasters relate to growth or the positive
outcomes of disaster experience has not been clear from the literature. This therefor needs
further exploration.
2.3 Conceptual Framework
Based on the literature review and the variables that emerged, the current study will test the
following framework:
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Fig. 2.2:
Conceptual framework
The above model depicts the relationships between the variables under consideration in the
current study. Under column A are the predictors. These are risk factors of posttraumatic
distress among disaster victims. These include self-construal, assumptive world, early
traumatic experiences and personality. These variables have a direct relationship with PTSD
and general distress (Outcome variable, under column C). Column B has the moderators.
These are the protective factors. These variables moderate the relationship between the
predictors and the outcome variables. However, the moderators also predict directly another
outcome variable (PTG).
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2.4 Statement of Hypotheses for the Quantitative Study
Study one will test the following hypotheses;
1. Risk factors (self-construal, personality, assumptive world, early traumatic
experiences) will negatively predict posttraumatic distresses (PTD) among flood
disaster victims
2. Protective factors (social support, intervention, belief in just world, religiosity, self-
efficacy, resilience) will positively predict posttraumatic growth (PTG) among flood
disaster victims
3. Protective factors will moderate the relationship between risk factors and PTD
among flood disaster victims
4. Protective factors will have a significant negative relationship with PTD among
flood disaster victims
5. There will be a significant relationship between PTG and PTD among flood disaster
victims
2.5 Definition of Terms
Posttraumatic Distress: This includes any psychological or emotional challenges an
individual experiences as a result of an experience or witness of a traumatic event. This
includes PTSD, and general psychological distress measured using the Global Severity
Index of the Symptoms checklist.
Posttraumatic Growth: This is the development of mental/psychological strength as a
result of an experience or witness of a traumatic event.
Risk Factors: Any factor that has the potential of cause distress after a disaster experience.
These include assumptive world, independent self-construal, Neuroticism, and previous
traumatic history.
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Protective Factor: Any factor that has the tendency to promote wellness and sooth against
distress after disaster. These include social support, resilience, self-efficacy, belief in just
world, professional intervention, and religiosity.
2.6 Research Questions for the Qualitative Study
In line with the general objective of this study, the following questions will be answered
by the qualitative aspect of the study.
General research question
What are the lived experiences of the flood disaster victim?
Specific questions
1. What account of the flood disaster do victims have in terms of what they
experienced and how much they recall?
2. What specific psychological effects did victims experience due to the disaster?
3. What personal and collective strategies underscore victims coping abilities over the
years?
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CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter presents the general methodological strategies employed in this study. It
encompasses description of the designs used, paradigmatic considerations, description of
the setting of the study, the ethical matters considered and the procedure employed in the
data collection. The chapter also presents detailed procedures adopted for the quantitative
and qualitative approaches used in the study. This includes sample size and sampling
methods, instruments, and inclusion and exclusion criteria. In order for coherence and
clarity of the presentation, the procedure for the quantitative approach was presented first,
followed by the qualitative approach (Creswell & Zhang (2009).
3.1 Research Approach
The study is conducted using Mixed Method approach. This involves the use of both
quantitative and qualitative methods in the same study (Halcomb & Hickman, 2015;
Schoonenboom & Johnson, 2017). This approach is used to cross-validate and corroborate
findings by obtaining an expanded and robust understanding of the study problem
(Schoonenboom & Johnson, 2017). Practically, both quantitative and qualitative research
designs have their respective disadvantages. However, when the two are used together, they
tend to complement each other, thereby reducing errors that come along with each individual
approach and facilitating rigor (Halcomb & Hickman, 2015). By this, the study
complemented the quantitative findings on the subject matter with the qualitative
information for deeper understanding of findings. It provided the opportunity for a rigorous
examination of the factors influencing post-disaster adaptation and the lived experiences of
disaster victims.
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Since not enough has been done among the population of disaster victims in Ghana, the
mixed method approach adequately helped to explore the subject matter under study.
3.1 Philosophical Basis of the Research Approach
What disaster victims experience post-disaster (ontology) and how to know what they
experience (epistemology) is an important concern in disaster researches. Appropriating
knowledge, source of knowledge and method is deemed necessary for valid outcome in
scientific research. Traditionally, researchers utilised positivist paradigms; an advocate for
a single knowledge or truth about a phenomenon and a quantifiable method of knowing.
However, recent critical paradigms encourage multiple knowledge and approaches to
knowing, owing to the understanding that knowledge is based on individual subjective
experiences. This is often depicted through mixed methods research designs that harbour
two approaches in a single study to address a single problem (Creswell, 2014). Philosophies
such as dialectics, post-modernism, critical realism and pragmatism adhere to such
ideology. The current study is driven by the pragmatic philosophy.
Pragmatism is the philosophy of research that borders on adapting approaches that support
action and allow meaningful interpretation of the problem at hand (Shannon-baker, 2016)
from different relevant viewpoints (Hall, 2013). Ultimately, this study is to arrive at findings
that will inform policy and guide intervention. This can be achieved using an approach that
will work best considering the nature of population and information being pursued. Thus,
the study utilised pragmatism which dictates that research should translate theory into action
and meaning making (Shannon-baker, 2016) by using an approach that ‘works best’
(Creswell, 2014).
In this regard, the current study seeks to understand the challenges and skills that relate to
post disaster adaptation among flood victims; the factors that predispose the victims to the
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experience of psychological distress and factors that could be harnessed to attain some level
of growth following the disaster. Identifying these factors will significantly influence
clinical psychological practice in terms of therapeutic processes and decisions involving
clients who experienced adversity.
Pragmatism consciously allows for the mixing of methods, quantitative and qualitative
methods (Morgan, 2007). Basically the paradigm allows the researcher to use the methods
that will work to arrive at the goal of the study (Creswell, 2014; Halcomb & Hickman,
2015). This helps to obtain better information and understanding of the phenomenon at
stake. In mixing the methods, the researcher decides depending on the goal of the research
to apportion emphasis to the two approaches. For example, if a triangulation mixed method
is being used, then equal attention/emphasis is given to the two methods. But in a nexted or
embedded approach, one method, either the quantitative or the qualitative is given greater
attention over the other method (Creswell & Zhang, 2009).
3.2 Research Design
3.2.1 The Concurrent Embedded Mixed Method Design
The Concurrent Embedded Mixed Method design, otherwise known as the Concurrent
Nested Mixed Method design was used in this study. This design provides the opportunity
for research data for both the quantitative and qualitative to be collected simultaneously
(Halcomb & Hickman, 2015) in a one-phase procedure (Creswell, 2014). With this design,
more attention is given to one data/study whereas the other data plays a supplemental role.
As a mixed method, the design helps to harness the strengths of both methods to answer the
research questions (Creswell, 2014). The design produces data that answer different
research questions that could not have been answered by only one data set. Therefore, one
data set becomes the primary data set and the other plays a supportive role (Creswell &
Zhang, 2009)
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In this study, the quantitative and the qualitative data were collected at the same time. The
data was collected among the same group of participants. However, more emphasis was laid
on the quantitative data. This was to answer the major research questions. Victims of
disasters experience varied levels of psychological distress and growth depending on
individual resources and social support systems. Thus, several factors help promote either
the growth or the distress. The quantitative data was collected to establish the impacts of
such factors (either protective or risk factor) and the general level of either distress or growth
among the victims. Therefore, quantitative methods and tools were used to collect such data
and appropriately analysed to answer the research question at stake. Since the tools used for
the quantitative data collection are of western origin, effort was made to ascertain their
appropriateness through pilot testing ahead of the main data collection procedure.
It was expected that the quantitative data might not have adequately explain all the responses
of the participants. For example, the study sought to record the lived experiences of the
victims. The qualitative was meant to record the exact ordeal they experienced, how they
have managed to survive all this while and the challenges they tried to surmount. Therefore,
the qualitative data was obtained to complement the findings of the quantitative study.
Interviews were conducted and analysed to satisfy this concern. The design and its
implementation are demonstrated in the figure 3.1 below.
Figure 3.1 below is adapted from Creswell and Zhang (2009). According to the authors, this
design is crafted to mix one data up in the methodology for the other data. The two data sets
are collected simultaneously. However, they do not necessarily answer the same research
questions. One tends to complement the other. Therefore in the figure 3.1 below, it is
observed that the qualitative data was obtained in the process of obtaining the quantitative
data. This was necessary in order to understand the lived experiences of the victims. A huge
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data set was obtained for the quantitative study. However, that could not answer the
qualitative question. The results were merged during interpretation.
Fig. 3. 1:
Concurrent Triangulation Design showing the process of integrating the two methods
(Quan + Qual)adapted from Creswell and Zhang (2009)
In the figure 3.1 above, the process adopted in data collection is depicted. Both quantitative
and qualitative were collected simultaneously. Both were given equal weight in the study.
Results obtained were compared and contrasted in order to provide an appropriate
interpretation of the findings.
3.3 Research Setting
This study was conducted in Accra. Accra is historically known to have originated from Ga-
Mashie. This consists of James town and Usher town. These two are all located along the
sea; the Gulf of Guinea. Colonial activities, independence, migration and urbanisation
culminated in an expansion of the city (Karley, 2009). Accra (Accra Metropolitan
Assembly, AMA) which covers a total area of 173 square kilometers is located on Longitude
05°35'N of the Equator and on Latitude 00°06'E of the Greenwich Meridian (Afornorpe,
2016).
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Flood disasters have occurred on an annual basis in Ghana, especially in the capital city of
Accra. According to Karley (2009), flooding in Accra dated back to the 1930s where the
city began to urbanise. The urbanisation resulted in over population, disruptions in town
planning and designs as settlers tended to invade and encroach on lands that would have
been demarcated for water ways. The desire to settle in Accra still persists in present days.
Sanitation and other amenities are affected on daily basis due to the high population.
According to Afornorpe (2016), the geology of Accra is one that disposes the area to
erosions and that leads to flooding. This natural characteristic has further been endangered
by human activities such that the susceptibility of Accra to flood has become very high. The
vegetation and sanitation are poor. Accra usually experiences high rainfalls between May
and October with average rainfall of about 780mm per annum (Afornorpe, 2016).
Flooding in Accra is a perennial problem. The deadliest flood disaster in the current decade
occurred in 2015 on the 3rd of June. Areas affected by that disaster included Malam,
Kaneshie, Alajo, New Town and Kwame Nkrumah Circle. Out of these communities, the
latter was the most hit by the disaster when a petrol filling station exploded and set
surrounding houses, properties and people on fire. This led to over 150 casualties/deaths.
These areas have also experienced several other flood disasters in the past. They are
typically flood prone due to their topography and location. Due to the recurrent disaster in
these areas, the study stands the change of obtaining rich data in order to unearth the study
objectives.
The central business district is located along the coast. However, Accra extends inland with
the closest to the central business district being the Kwame Nkrumah Circle. The Nkrumah
Circle has the popular Odaw river/drain that connects several inland water bodies to the
Atlantic Ocean. Close to this location are such communities as New Town, Alajo, and
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Kaneshie. Closer to Kaneshie is Malam which also serves a passage way for run-over waters
into the sea.
3.4 Study Population
This study used the population of the victims of the 3rd June 2015 flood disasters in Accra.
This was a distinct disaster in Ghana due to the explosion of a fuel filling station at the
Kwame Nkrumah Circle which claimed over 150 lives in the capital city. Specifically, the
population of victims of this disaster in the settings described above (i.e. Kwame Nkrumah
Circle, Kaneshie, Malam, New Town and Alajo) was used. Even though some residents had
to relocate due to the flood, majority who were displaced resettled in the locations, making
them available for the study.
This population has complained about their challenges across the media wave since the
disaster. There was minimal psychological and economic intervention for them. Three years
after the disaster, it is expected that symptoms or sign of distress and growth would be
considerably experienced within the population. This makes the population ideal for the
study. The size of this population is however not known as there is not an exact
documentation on them.
3.5 General Data Collection Procedure
The population for this study is a widely dispersed one. Due to this, some visibility analysis
was done before the start of the data collection. First of all, some stakeholders in the
management of the disaster in 2015 were contacted for direction to possible participants.
These included the National Disaster Management Organisation (NADMO), the Psychiatric
Department of the Korle-Bu Teaching Hospital and the social welfare department. All these
points of contact yielded no significant result. Secondly, a contact was made with a media
organisation that reported the 3rd anniversary of the disaster in Accra. This organisation
linked the researcher up with the Assembly Member of one of the communities that suffered
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the disaster. This paved the way to reach the initial persons for the study. Thirdly, a visit
was paid to the communities to scout for victims who still reside in the localities of the
disaster. Participants were made to sign a consent form. A copy of the consent form was
given to the participant while the researcher kept a copy.
3.6 Inclusion and Exclusion Criteria
Participants selected for this study were expected to meet certain criteria. Meanwhile, some
of the participants met the criteria but were disqualified due to the exclusion criteria they
met. The criteria for inclusion and exclusion are as follows:
To qualify to participate in this study, an individual must:
• Be a victim of the 2015 flood disaster in Accra in Kwame Nkrumah Circle, Alajo,
Kaneshie, Malam and New Town
• Be 18 years and above since most people under 18 years might have been at school
during the data collection period
• Be in Accra at the time of the study
An individual is not qualified to participate in the study if:
• He/she is currently on admission/treatment for any chronic or terminal illness not
caused by the disaster
• Currently suffers significant memory loss
• Suffers a significant psychiatric condition
3.7 Ethical considerations
Before data collection, an ethical approval was obtained from the Ethics Committee for
Humanities of the University of Ghana, Legon. The study strictly adhered to the
recommendations of the committee. The researcher also observed the American
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Psychological Association (APA) ethical considerations for using human participants in a
research.
Confidentiality was observed by excluding the names and possible identifiers of the
respondents in the study. Their responses were also used for the study only. The data
obtained has not been exposed to any other person apart from those involved in the study
namely the researcher and supervisors. Also, due to the large volume of the questionnaire
and interviews, it was envisaged that participants would be tired before the end of their
responses. Thus, breaks were allowed for participants to relax and finish up after a few
minutes. Similarly, participants who needed more time to complete the questionnaire were
allowed to take it home and return it a week after. No inducement was used to attract
participants. A five Ghana Cedis (GHC 5, approximately one Dollar ($1)) airtime recharge
card was however given to each participant for their participation.
Emotional reactions were anticipated. This is because of the nature of information being
elicited from the participants. Therefore, arrangement was made with clinical psychologists
and community psychiatric nurses in the communities to attend to participants who
exhibited emotional difficulties. In all, three participants demonstrated high emotional
challenges. Upon assessment by the professionals, a referral was made to the Pantang
Psychiatric Hospital for further evaluation and assistance. The researcher made a follow up
and obtained information that the participants were admitted but they all absconded a day
after.
Freedom to decline or withdraw participation was also duly observed. In this regard, victims
who were located and approached for possible participation and they declined to
participation were not forced into participation. Over all, two (2) individuals declined to
participate in the study. Reason given was that they have spoken to several
researchers/journalists who promised that their concerns will be addressed but to no avail.
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They indicated that if this will not bring them any compensation from the government, then
they are not interested in participating. Indeed, this concern was raised by several other
participants who were still willing to participate. It appeared that journalists have engaged
the victims on countless occasions. However, their concerns have not received any
government/national attention. Participants were informed that this study is for academic
purposes and not for journalistic or governmental purposes. They were also informed that
the findings of the study can inform national policy and treatment models for such victims
but not to necessarily obtain government reliefs or compensations for them. This helped
prevent high expectations from the participants. It also helped to obtain dispassionate
responses from them.
3.8 Quantitative Methodology
3.8.1 Design
The quantitative study used the cross-sectional survey design. This is a design that allows
for a one time data collection on the opinions of participants on the subject under
investigation particularly through the use of questionnaires (Sedgwick, 2014). Using this
design, the researcher ensures that data is collected across the various segments of the
population. The data collection is done within a limited period of time. In this study
therefore, data was collected among a sample of flood victims within a short period of time
on their opinions on how they have adapted after the experience of the 3rd June, 2015 flood
disaster.
3.8.2 Sample
Sample size is a significant factor in the power of a study or the authenticity of research
findings (Hazra & Gogtay, 2016; Malone, Nicholl, & Coyne, 2016). According to Kelly,
Webster, and Craig( 2010), too small or too large sample size must be avoided by getting a
balance between the two. Too small sample size will result in inconclusive findings,
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typically resulting in type II error where the study will be deemed not to have sufficient
power to detect the intended effect. On the other hand too large sample will lead to more
precise than necessary outcomes and a waste of resources (Kelly et al., 2010). Accordingly,
a sufficient enough sample size must be determined for every study.
To obtain an adequate sample size in order to avoid these errors, some factors needed to be
considered. One of such factors is the statistical power of the study (Malone et al., 2016).
The statistical power of a study is the ability of the study to appropriately reject the null
hypothesis when the alternative hypothesis is true. In other words, it is when the study can
detect a difference if one exists (Suresh & Chandrashekara, 2012). According to Suresh and
Chandrashekara (2012) and Cohen (1988), a statistical power of 80% is ideal for a study
and this is proportional to sample size. The current study used a statistical power of 95%.
Another factor to consider in determining sample size is the significance level of the study.
This is the probability that a type I error will be committed (Kelly et al., 2010). This is often
represented by p-value or ‘α’. Conventionally in the social sciences, the significance level
is set at .05 (Kelly et al., 2010). This means that there is only 5 out of 100 chances of a type
I error to be committed.
The effect size is also important in sample size determination. This is the size of relationship
that is expected in the study. This can be a large, medium or small one (Field, 2009). A
medium effect size is used in this study because this is easily noticeable (Cohen 1988). Other
factors to consider include the statistical tests to use and the number of predictors. In order
to obtain a medium effect size (.15 for regression analysis) with high statistical power,
significance level of .05 and 10 predictors, a minimum of 150 sample size is required
(Cohen, 1988; Field, 2009). Calculating for this using a G-Power software produces a
sample size of 172.
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In this study, the Multiple Linear Regression was used with ten (10) predictors. A sample
size of 400 was proposed for the study in order to avert the effect of attrition, non-completion
and related unforeseen challenges that participants may present to the study. In all 336
participants were realized for the study, representing a response rate of 84%. This is a about
double the minimum sample size required, making it adequate enough for the study.
3.8.3 Sampling method
Selection of the sample for the study was done using the snowball sampling technique. As
much as the size of the sample is important, the method used in gaining the sample is also
important (Martínez-mesa, González-chica, Duquia, Bonamigo, & Bastos, 2016). There are
several techniques to sample participants for a study; grouped under probability and non-
probability sampling techniques (Naderifar, Goli, & Ghaljaie, 2017). However, some factors
determine which technique will be most appropriate for a given study. For instance, if the
study is an experiment with a sample frame available, the researcher may use a probability
sampling method such as simple or systematic random sampling. In cases where the
population is a closeted or hidden one, a non-probability sampling such as snowball
sampling may be used (Naderifar et al., 2017; Sadler, Lee, Lim, & Fullerton, 2010). In the
current study, the snowball sampling technique was used.
Snowball sampling is often used when a particular population is not easy to access for which
reason the researcher must identify some initial participant(s) and use them as links to
subsequent participants (Martínez-mesa, González-chica, Duquia, Bonamigo, & Bastos,
2016; Dragan & Isaic-Maniu, 2013). This could be done either in qualitative studies (e.g.
Graham et al., 2003; Veitch, Bagley, Ball, & Salmon, 2006) or in quantitative studies (e.g.
Sadler, Lee, Lim, & Fullerton, 2010; Etter & Perneger, 2000). This sampling technique is
suitable for the current study because the population of flood victims in Accra is not well
delimited. Available data on the population such as sample frame, location and contact
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information are rare. Some victims had relocated or changed their address or contact
numbers. However, when one or two of these victims were identified, they assisted in
providing information on other victims. This is because they had formed a group intended
to push their needs to government and they easily identify themselves. This is the crux of
snowballing where hard-to-find participants are identified based on the recommendation or
network of initial participants (Sadler et al., 2010). That is, one participant leads to another
participant (Rankin & Bhopal, 2001).
Therefore, in order to select the participants for this study, communities in focus were visited
and enquiries were made from residents about who experienced the 2015 flood until the first
person was identified. This first person helped with further information on how to get some
few other participants. These few others also led the researcher to further participants until
the sample size was reached.
3.8.4 Instrument
The study materials used in the quantitative study include standardized questionnaires for
measuring the respective quantitative variables. The variables measured and the
questionnaires used are described below under predictors, outcome variables, and
moderating variables as follows:
Predictor measures
Predictors are factors or variables that are deemed to be the bases of the outcomes of a study.
In other words, they are the variables that are manipulated for their effect to be observed or
measured in the outcome/dependent variables (Flannelly, Flannelly, & Jankowski, 2014).
They are also called the independent variables. In this study, there are four predictor
variables. These include personality, assumptive worldview, self-construal and early
traumatic experiences.
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Assumptive worldview
The World Assumptions Scale (WAS). This scale was developed by Janoff-Bulman (1989).
It is a 32-item self-report scale that examines an individual’s cognitive schema about
themselves and the world. It taps into three primary domains of assumptions: perceived
benevolence of the world, meaningfulness of the world, worthiness of the self (Janoff-
Bulman, 1989).
This scale measures world assumption along 8 levels (subscales). These are; the
benevolence of the world (BW), benevolence of people (BP), justice (J), controllability (C),
randomness (R), self-worth (SW), self-controllability (SC), and luck (L). It is a 6-point likert
scale with responses ranging from 1=strongly disagree to 6=strongly agree. Sample items
include ‘Misfortune is least likely to strike worthy, decent people’, and ‘I almost always
make an effort to prevent bad things from happening to me’. The scale has reliability of
Cronbach alpha ranging from .60 to .75 (Janoff-Bulman, 1989).
Self-construal
The Self-Construal Scale: This is a 24-item scale developed by Singelis in 1994 to measure
a person’s independent and interdependent dispositions. It therefore has two subscales. Both
subscales have 12-items each. The scale is a self-report scale rated using a 7-point likert
scale ranging from1=strongly disagree to 7=strongly agree. Sample items include ‘I have
respect for the authority figures with whom I interact (Interdependence); I’d rather say ‘No’
directly than risk being misunderstood’ (Independence).
Reliability of the scale was reported to be between Cronbach alpha of .69 and .73 (Singelis,
1994). Items for the interdependent subscale are 3,4,5,6,9,12,13,15,17,19, 21, and 23
whereas items for the independent subscale include 1,2,7,8,10,11,14,16,18,20,22, and 24.
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Personality
The Big Five Personality Inventory: Personality was measured using the Big Five
Personality Inventory developed by Goldberg (1992). It has 50 items with five (5) subscales
namely extraversion, agreeableness, conscientiousness, neuroticism, and openness. Each
subscale has 10 items. The scale rates responses on a 5-point likert scale ranging from 1=not
at all accurate to 5= extremely accurate. According to Sveen et al. (2016), the scale has the
following reliability values; 0.82 for extraversion, 0.73 for agreeableness, 0.74 for
conscientiousness, 0.80 for neuroticism, and 0.80 for openness. Sample items are ‘I get
stressed out easily’ and ‘I have a soft heart’. The scale is scored by summing up component
items to obtain total score for each subscale. However, items numbered 2, 4, 6, 8, 10, 12,
14, 16, 18, 20, 22, 24, 26, 28, 29, 30, 32, 34, 36, 38, 39, 44, 46, 49 are reverse scored.
Items for the respective subscales are Extraversion: 1, 6, 11, 16, 21, 26, 31, 36, 41, 46,
Agreeableness: 2, 7, 12, 17, 22, 27, 32, 37, 42, 47, Neuroticism: 4, 9, 14, 19, 24, 29, 34, 39,
44, 49, Conscientiousness: 3, 8, 13, 18, 23, 28, 33, 38, 43, 48, and Openness: 5, 10, 15, 20,
25, 30, 35, 40, 45, 50.
Early traumatic experiences
The Trauma History Questionnaire: This scale was used to assess past traumatic
experiences of participants. It is a 24-item questionnaire with yeas or no responses
developed by Green (1996). The questions are divided into three (3) traumatic areas namely
crime experiences (e.g. robbery), general disaster and trauma questions (e.g. injury,
witnessing death), and questions about physical and sexual experiences (spanking or
beating, rape/defilement). Participants are to indicate whether they had ever experienced
the traumatic event or not. In addition to that, participants are required to provide the age or
approximate age at which the experience happened as well as the number of times such an
event was experienced. There is one ‘other’ item in the questionnaire that allows participants
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to indicate any personal traumatic event or experience that might have been omitted in the
questionnaire. Participants are to respond with details like they did for the other 23 items.
Response on this ‘other’ item is usually used at the researcher’s discretion depending on the
information provided. It may also be grouped under any of the domains that it is related to.
Sample items are ‘Has anyone ever attempted to or succeed in breaking into your home
while you were there?’, ‘Have you ever experienced a “man-made” disaster such as a train
crash, building collapse, bank robbery, fire, etc., where you felt you or your loved ones were
in danger of death or injury? (If yes, please specify below)’, and ‘Has anyone ever made
you have intercourse or oral or anal sex against your will? (If yes, please indicate nature of
relationship with person [e.g., stranger, friend, relative, parent, sibling] below)’ or ‘Has
anyone in your family ever beaten, spanked, or pushed you hard enough to cause injury?’
for the crime experiences, general disaster and trauma questions, and questions about
physical and sexual experiences respectively.
The questionnaire was scored by counting the number of events endorsed under each
subtype of traumatic experience. A total score was obtained by adding all the responses.
More items endorsed mean high traumatic history. Hooper, Stockton, Krupnick, and Green
(2011) reported that the scale has an interrater reliability for the various trauma categories
as present in at least 20% of respondents showing kappas in the excellent category, ranging
from .76 for sexual assault to 1.00.
Items for the crime experiences are the first four (4), the general disaster and trauma items
are items 5 to 17, questions about physical and sexual experiences are from 18 to 23, and
the last item (item 24) is for ‘other’.
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3.8.5 Outcome Variable Measures
Psychological distress
The Symptoms Checklist-90-Revised (SCL-90-R): This scale was developed by Derogatis
(1975). It is a 90-item five likert-point scale with nine dimensions of primary psychological
symptoms or distresses and three global indices of pathology (Derogatis, Rickelst, & Rock,
1976). Responses range from 0=not at all to 4=extremely. The global indices of pathology
include Global Severity Index (GSI) which is the combination of information on the number
of symptoms and distress intensity, the Positive Symptom Distress Index (PSDI) which is
about the intensity of distress, and the Positive Symptom Total (PST) which is the only
about the number of symptoms (Derogatis et al., 1976).
The nine primary dimensions include somatization, obsessive–compulsive, interpersonal
sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and
psychoticism.
The Somatization (SOM) subscale measures distress or discomfort that arises from
perceptions of bodily dysfunction. The Obsessive-Compulsion (O-C) subscale measure is
on thoughts, impulses, and actions that are experienced as irresistible by the individual but
are unwanted in nature. The Interpersonal Sensitivity (INS) subscale measures a person’s
feelings of personal inadequacy and inferiority in comparison with others. It also includes
the feelings of self-discomfort, self-deprecation and uneasiness as experienced by people
during interpersonal interactions. The Depression (DEP) subscale measures dysphoric
mood, affect, lack of motivation, loss of energy, feelings of hopelessness, and suicidal
thoughts. The Anxiety (ANX) subscale measures symptoms such as nervousness, tension,
and trembling as well as feelings of terror and panic. The Hostility (HOS) subscale measures
thoughts, feelings, or actions such as aggression, irritability, rage and resentment
characteristic of the negative affect state of anger. The Phobic Anxiety (PHO) subscale
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measures persistent fear response to a specific place, object or situation that is irrational.
Paranoid ideation (PAR) is a disordered mode of thinking, projective thinking, hostility,
suspiciousness, grandiosity, centrality, fear of loss of autonomy, and delusions.
Psychoticism (PSY) is a continuous dimension of human experience, providing a continuum
from mild interpersonal alienation to dramatic evidence of psychosis. Items include
withdrawal, isolation, and schizoid lifestyle as well as first-rank schizophrenia symptoms
such as hallucinations and thought-broadcasting.
The scale is scored by adding up the respective items measuring the various subscales and
the result is divided by the total number of items for each subscale to obtain the score for
the dimensions represented. A Global Severity Index (GSI), which is the average score of
the 90 items of the scale, suggesting the best single indicator of the current level of the
distress is also obtained by adding up the entire items divide by 90. The Symptom Total
(PST) is scored by adding up the number of symptoms the respondent complained of, that
is the number of items rated higher than zero. The Positive Symptom Distress Index (PSDI)
is the average of the rating from 1 to 4 (the non-zero ratings) for the symptoms that were
complained of.
This scale demonstrates a strong internal reliability of Cronbach’s coefficient alpha for each
of the nine subscales ranging from .77 to .90 (Derogatis et al., 1976). Sample items include
‘Feeling afraid in open spaces or on the streets’ and ‘Feeling no interest in things’.
Items for the primary dimensions include the following: Somatisation 1, 4, 12, 27, 40, 42,
48, 49, 52, 53, 56, 58, Obsessive-Compulsion 3, 9, 10, 28, 38, 45, 46, 51,55, 65,
Interpersonal sensitivity 6, 21, 34, 36, 37, 41, 61,69, 73, Depression 5, 14, 15, 20, 22, 26,
29, 30, 31, 32, 54, 71, 79, Anxiety 2, 17, 23, 33, 39, 57, 72, 78, 80, 86, Hostility 11, 24, 63,
67, 74, 81, Phobic anxiety 13, 25, 47, 50, 70, 75, 82, Paranoid ideation 8, i8, 43, 68, 76, 83,
and Psychoticism 7, 16, 35, 62, 77, 84, 85, 87, 88, 90.
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PTSD
The PTSD Checklist-Civilian version (PCL-C) The PCL-C is a standardized five point likert
self-report rating scale for PTSD comprising 17 items that correspond to the key symptoms
of PTSD. It was developed by Weathers, Litz, Huska and Keane (1993) to assess PTSD.
Two versions of the PCL exist: the PCL-M is specific to PTSD caused by military
experiences and the PCL-C is applied generally to any traumatic event. The PCL can be
easily modified to fit specific time frames or events. For example, instead of asking about
“the past month,” questions may ask about “the past week” or be modified to focus on events
specific to a deployment. Sample items include ‘Suddenly acting or feeling as if the flood
disaster were happening again (as if you were reliving it)?’, and Avoid activities or
situations because they remind you of the flood disaster?’. The scale has been reported to
have a strong reliability of psychometric properties of Cronbach’s alpha coefficient of 0.94
(Ruggiero, Ben, Scotti, and Rabalais, 2003). Scoring of the scale is by adding up responses
on all 17 items on the scale to get a single total score.
Post Traumatic Growth
Posttraumatic Growth Inventory (PTGI): The PTGI is a self-report inventory developed by
Tedeschi and Calhoun (1996). It measures the positive or salutogenic impact/growth
following traumatic experiences. The scale has 21-items than can be grouped under five (5)
subscales namely; growth relating to others (improved interpersonal relations), new
possibilities (changes in aspirations and goals), personal strength (increased inner strength),
spiritual change (increased spirituality), and appreciation of life (greater appreciation).
The scale has a 6-point likert rating ranging from 0 (I didn't experience this change) to 5 (I
experienced this change to a very great extent). Sample items of include ‘Knowing that I
can count on people in times of trouble’, and ‘New opportunities are available which
wouldn’t have been otherwise’. An overall growth score could be obtained by computing
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the mean of all of the responses on the 21 items. The scale has a good reliability of Cronbach
alpha = .93 (Nuttman-shwartz et al., 2011).
3.8.6 Moderating variables
Social support
Multidimensional Scale of Perceived Social Support (MSPSS): This is a 7-point likert scale
developed by Zimet, Dahlem, Zimet and Farley (1988) to measure social support at three
(3) levels namely, support from family, friends and significant others. Responses range from
strongly disagree (1) to strongly agree (7). It is a 12-item scale with 4-items per subscale.
Apart from obtaining a score for each subscale by adding up the items relating to the
individual items, a total social support score can be obtained by adding up all the 12 items.
Sample items are ‘There is a special person who is around when I am in need’, ‘I get the
emotional help and support I need from my family’ and ‘I have friends with whom I can
share my joys and sorrows’ for the friend, family and significant others subscales.
Reliability of the total scale has been reported to be Cronbach’s coefficient alpha = .93
whereas the subscales (family, friends and significant others) demonstrated reliabilities of
.91, .89, and .91 respectively (Canty-Mitchell & Zimet, 2000). Items for the Friend subscale
are 6, 7, 9, and 12. Items for the Family subscale include 3, 4, 8, and 11. Items for the
significant others subscale include 1, 2, 5, and 10.
Self-efficacy
General self-efficacy scale: This scale was developed by Jerusalem and Schwarzer in 1981.
It has also been translated and used in other languages and populations. It measures self-
efficacy on a 4-point likert scale with responses ranging from 1-not at all true to 4-exactly
true. The scale has 10 items of which are such items as ‘I can always manage to solve
difficult problems if I try hard enough’, and ‘I can usually handle whatever comes my way’.
The scale has an internal consistency ranging between .76 and .90 (Schwarzer & Jerusalem,
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1995). Luszczynska, Estatal, and Rica (2005) also reported that the scale recorded good
reliability across several populations typically with Cronbach’s alphas between .79 and .90.
Scoring is done by adding up the responses on all 10 items to obtain a total self-efficacy
score.
Belief in just world
Global Belief in Just World: This was used to measure the general belief that people deserve
what they get and get what they deserve. It was developed by Lipkus (1991). It is a 7-item
likert scale with ratings from 1=strongly disagree to 6=strongly agree. Example of the items
include: ‘I feel that people get what they are entitled to have’, and ‘I basically feel that the
world is a fair place’. Reliability of the scale has been reported to be .83 (Lipkus, 1991).
Resilience
Wagnild and Young’s Resilience Scale: The resilience scale has 25 items as its full version.
The scale also has a short version consisting of 14 items. The current study however used
the full version. It was developed by Wagnild and Young (1993). This is a self-administered
scale rated on a 7-point likert scale ranging from 1=strongly disagree to 7=strongly agree.
The developers reported a reliability of alpha = .91 (Wagnild & Young, 1993). A study in
Nigeria by Oladipo and Idemudia (2015) reported a reliability of alpha = .86. Sample items
include ‘I can be on my own if I have to’, and ‘I have enough energy to do what I have to
do’.
Religiosity
Santa Clara Strength of Religious Faith Questionnaire: This is a 10-item scale developed
by Plante and Boccaccini (1997). It is a 4-point likert scale that measures an individual’s
level of religious faith. Responses on the scale range from 1=strongly disagree to 4=strongly
agree. Sample items include ‘I look to my faith as providing meaning and purpose in my
life’, and ‘I look to my faith as a source of inspiration’. Reliability of the scale is reported
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to be Cronbach alpha=.95 (Plante & Boccaccini, 1997). Scoring of the scale is done by
adding up all responses to obtain a total score where higher scores indicate higher religious
faith.
Materials used in this study are summarized in the table 3.1 below. They are presented in
the table under predictors, outcome variables, and moderating variables. Their Cronbach’s
alphas as reported in the literature are presented along with those obtained from this study.
Table 3.1:
Instruments used for Quantitative study and Cronbach’s alphas
Construct Scale Developer Developer’s α Pilot
study (α)
Predictors
Personality The Big Five Inventory By Goldberg .82 to .90 .79
(1992).
Assumptive World Assumptions By Janoff-Bulman .60 to .75 .84
world Scale (1989).
Self-construal Self-construal Scale By Singelis (1994). .69 and .73 .88
Past traumatic Trauma History By Green (1996). Not -
experience Questionnaire Applicable
Outcome Variables
Psychological Symptom Checklist By Derogatis, et al. 0.77-0.90 .98
distress (1973).
Posttraumatics PTSD Checklist – Weathers, Litz, 0.94 .90
stress disorder Civilian Version Huska and Keane
(1993).
Posttraumatic Posttraumatic Growth Tedeschi and .93 .92
growth Inventory Calhoun (1996).
Moderators
Social support Multidimensional Zimet, Dahlem, .89-.93 .92
Scale of Perceived Zimet and Farley
Social Support (1988).
Self-efficacy General self-efficacy Jerusalem and .90 .87
scale Schwarzer (1981).
Belief in Just Global Belief in Just Lipkus (1991). .83 .84
World World Scale
Resilience Wagnild and Young’s By Wagnild and .91 .94
Resilience Scale Young (1993).
Religiosity Santa Clara Strength of By Plante and .95 .93
Religious Faith Boccaccini (1997).
Questionnaire
3.8.7 Pilot Study
A pilot study was conducted using 50 participants to ascertain the reliability and
appropriateness of the scale selected for the study. This provided an idea about the
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challenges respondents will face on the main study. It also provided an idea about the
approximate duration of the data collection per participant. Participants use for the pilot
were drawn from the population under study. Reliability analysis was performed and the
results are presented in the last column under pilot study of Table 3.1 above. From the table,
it is observed that the Cronbach’s alpha for the various scales are adequate, indicating good
reliabilities.
3.8.8 Procedure for Quantitative Study
Data in this study was collected using a self-report approach. Questionnaires were
distributed to participants as and when they are identified through the snowball method.
Participants who could speak and write English Language completed the questionnaires on
their own. Participants were given one week to finish responding after which the
questionnaires were retrieved. However, some participants indicated that they may not have
time to respond to the questionnaire in the absence of the researcher, therefore, the
researcher stayed with them till they completed. Enough time was given to allow participant
to relax when tired. Participants who could not read and write were engaged in an interview
form, where the items were explained to them and their responses were captured on the
scales. This took longer time than the time spent by those who could read and write.
Therefore, for those who needed explanations/interpretations, two days on the average were
spent with them. Two assistants with a bachelor’s degree in psychology were recruited for
the data collection. These assistants were those conversant with the local languages
dominant in the research setting. Questionnaires that were completed were rejected and
discarded. Data obtained was entered into the Statistical Package for the Social Sciences
(SPSS), cleaned up and analysed.
A pilot study using 50 participants was initially conducted to ascertain the reliability of the
scales used in the study. The outcome of the pilot indicated that, the scales exhibit
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considerably good reliabilities. It also allowed the researcher to ascertain participants’
understanding of the items on the scales and the possible challenges.
3.9 Qualitative Methodology
This section presents the methods used in conducting the qualitative component of this
research. It presents the study design, sample, and the data collection tool, procedure and
how data was analysed. The qualitative component of this research was designed to augment
the findings of the quantitative study.
A qualitative study was considered appropriate because it would provide the opportunity for
victims of disaster to tell their story in detail (Hammarberg, Kirkman, & Lacey, 2016;
Haradhan, 2018). Consequently, it is expected that findings would provide a better insight
into the ordeal that participants go through and make the needed recommendations.
The qualitative study sought to answer the following questions:
What are the lived experiences of the flood disaster victim? Specifically,
1. What account of the flood disaster do victims have in terms of what they
experienced and how much they recall?
2. What specific psychological effects did victims experience due to the disaster?
3. What personal and collective strategies underscore victims’ coping abilities over
the years?
3.9.1 Approach – Phenomenology
The phenomenological design was used for the qualitative part of this study. This was to
provide the basis for the understanding of the experiences of the victims through their own
narratives.
Phenomenology is when participants provide detailed description of their experiences of a
particular situation and the researcher tries to identify the essence of such experiences
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(Creswell, 2014). Creswell (2014) describes phenomenology as both a philosophy and a
method, it makes it possible for an extensive study of a smaller number or participants in
order to establish patterns within the meanings of the experiences of the participants.
Phenomenology thus forms the basis of the qualitative study to help clarify what disaster
victims endure and how they perceive their own experiences.
3.9.2 Sample and Sampling Technique
A sample size of 13 was used for this study. This was made up of victims of the June 12
flood/fire disaster in Accra in 2015. According to Creswell (1998), a sample size of five (5)
to 25 is recommended for a phenomenological study. Richness of information obtained is
rather suggested and there is priority of depth over length (Pietkiewicz & Smith, 2014). In
spite of this, saturation was a major factor in deciding to use the current sample size. This
is when the information being provided by respondents became similar with no new
information being obtained. This prompted the researcher to end after the 13th participant.
Convenient sampling was employed to select 13 participants participate in the qualitative
study. The demographic characteristics of the participants are presented in Table 3.2 below.
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Table 3.2:
Demographic Information of Participants
Participant Age Gender Occupation Disaster Religion
experienced
1 36 Female Health worker/student Flood Christian
2 44 Female Trader Flood/fire Christian
3 38 Female Trader Flood/fire Christian
4 48 Female Trader Flood/fire Christian
5 37 Male Herbalist Flood/fire Christian
6 63 Female Not working Flood/fire Christian
7 60 Male Transport owner / Flood/fire Christian
driver
8 47 Male Drive Flood/fire Christian
9 42 Male Civil servant Flood/fire Christian
10 30 Male Trader Flood/fire Christian
11 67 Female Retired Flood/fire Christian
12 32 Male Civil servant Flood/fire Christian
13 43 Male Teacher Flood/fire Christian
Most of the participants experienced the ‘twin disaster’ except participant one who
experienced only flood. There is a fair gender balance of the participants. All participants
interviewed are Christians.
3.9.3 Data collection Material
A semi-structured interview guide (see Appendix D) was developed for the qualitative
study. Specifically, the interview guide had three sections around three issues namely: an
account of the tragedy/disaster victims encountered, the impact of the tragedy on their lives
(both positive and negative), and how they survived till now (the strengths they relied
on/coping).
The guide was reviewed by two independent experts for appropriateness before it was used.
3.9.4 Pilot Study
The interview guide was piloted using four (4) participants. Generally, the essence of the
pilot was to establish the appropriateness of the guide. It was also aimed at addressing any
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conceptual confusion in the wording of questions. Further, it also helped to establish the
average duration the interviews would have lasted during the main study. Through the pilot
study, it was observed that items on the interview guide must be arranged in a certain order
to allow for a good flow of the information provided by participants. It was also clear that
some questions must be put together and some separated in order to capture detailed
information. For example, the impact of the disaster was recategorised under physical,
psychological (with subcategories such as anxiety, emotional, behavior) and positive
impacts.
3.9.5 Data Collection Procedure
Verbal consent was obtained from participants who agreed to participate in this study. Thus,
after the first study, consented participants were engaged for the study two. Their contact
numbers were taken and a meeting was arranged for a later date usually the following day
for the interview. However, five (5) out of the 13 participants were interviewed on the same
day they took part in study one because they preferred it so. Participants decided the time
and venue of the meeting. Except for one participant who opted to be interviewed at home
due to health issues, the interviews were conducted at the participants’ workplaces since
most of them spent the day at the Workplace.
Prior to the interview, participants were informed that the interview would be audio recorded
and transcribed for analysis. Initially, participants thought the recording was meant for the
media so that their plights will reach the government but this was clarified that it was purely
for academic purposes. On the average, interviews lasted for between 45 minutes to one (1)
hour.
3.9.6 Data Processing and Analysis
Data obtained in the interviews were all tape recorded. Each of the tapes was named
distinctively to avoid overlapping information. The tapes were all transcribed verbatim by
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the researcher. Interviews were mainly held in English. However, interviews with
participants who spoke in a local language were transcribed verbatim and translated by a
professional from the Department of Linguistics, University of Ghana, Legon. Transcribed
and translated scripts were reviewed for spellings, punctuations and correctness of the
transcriptions along the audio tape by the researcher for clarity of the information they
contained.
Thematic analysis was used to analyse the data obtained in this study. In doing so, the six
step approach to thematic analysis by Braun and Clarke (2006) was used. The researcher
transcribed the interviews, read and re-read them to familiarise with the data and made notes.
Codes were generated using ATLAS.ti. The codes were then grouped into themes. These
themes and corresponding codes were reviewed by two other independent researchers (a
masters and a PhD holder in Psychology) with considerable experience in qualitative
analysis.
The themes were reviewed in relation to the codes. Sub-themes were developed to match
the relationship between the codes. Finally, names were assigned to each of the themes and
sub-themes. Extracts were taken from the transcripts to illustrate each theme.
3.9.7 Rigor and Credibility of Data and Result
Before the analysis of the data obtained, the researcher and the second coder met and
discussed the scope of the research and data. This gave the two coders an even platform for
the codes to generate from the transcripts. The codes generated were then compared and
fused together.
For the purposes of credibility and trustworthiness, the themes drawn from the codes were
informed by the literature. For example, the themes for distress were greatly informed by
the DSM-5 criteria for PTSD and related disorders, anxiety and mood disorders. The data
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from the quantitative study on the distress, risk and protective factors also supported the
data in the qualitative study.
The transferability of the findings of the qualitative study is in the congruence of the findings
with the literature reported across various settings. The stories of the participants were
queried with probes that helped to unearth details spanning various angles of their
experiences. This makes the findings applicable to similar populations.
To ensure confirmability, data and analysis was scrutinised and peer review. As indicated
above, masters and PhD psychology degree holders peer reviewed the transcripts and codes.
This was followed by an expert qualitative researcher. Also, the six step approach to
thematic analysis by Braun and Clarke (2006) was judiciously followed.
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CHAPTER FOUR
RESULTS
4.0 Introduction
This chapter presents the results of the study. This is presented in two part. The first part
presents the findings of the quantitative study, and the second part presents the findings of
the qualitative study.
4.1 Quantitative Findings
4.1.1 Data Analysis/Analytic Plan
The quantitative data collected was analysed using the SPSS Version 16. The data entry was
done as and when questionnaires were retrieved from participants. This was to avoid
forgetfulness especially about the ambiguity in responses that was typically clarified by
participants when they returned the questionnaires. This also afforded the researcher to
detect and correct wrong entries as there were not too much to enter at a time.
Preliminary analysis was conducted after the data set was complete. This was to obtain
demographic and descriptive results of the data. Exploratory Factor Analysis (EFA) was
also conducted to ascertain the suitability of one of the scales. This also helped to determine
the components of that scale as work with. Inferential analysis involving correlation analysis
and regression were conducted.
To test for predictor and moderator effects in the study, five hypotheses were tested. The
first hypothesis considered how much each predictor variable predicts the individual
outcome variables. This was stated as ‘Risk factors (independent self-construal,
neuroticism, assumptive world, and previous traumatic experiences) will predict
posttraumatic distresses (PTD) (psychological distress, and PTSD) among flood disaster
victims’.
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The second hypothesis tested how the moderator variables predicted PTG and this was
stated as ‘Protective factors (social support, intervention, belief in just world, religiosity,
self-efficacy, and resilience) will predict posttraumatic growth (PTG) among flood disaster
victims’. The third hypothesis tests for how protective factors (moderators) moderate the
relationship between to predictors and the outcome variables. This was stated as ‘protective
factors will moderate the relationship between risk factors and PTD among flood disaster
victims’.
Therefore, hypotheses 1, 2 and 3 were tested using a Hierarchical Multiple Linear
Regression. This was used to test for the predictive effect of the risk and protective factors
in the study (hypothesis 1 and 2) and to test for the moderation effect of the moderators in
the study (hypothesis 3). In testing these hypotheses, demographic factors namely age,
number of years in residence, education, marital status and employment status were held
constant.
The fourth hypothesis tests the relationship between protective factors and PTG and the fifth
hypothesis tests the relationship between PTSD and PTG. They were stated as ‘protective
factors will have a significant negative relationship with PTD among flood disaster victims’
and ‘there will be a significant negative relationship between PTG and PTD among flood
disaster victims’ respectively. Thus, hypotheses 4 and 5 were tested using the Pearson
Product Moment Correlation Coefficient (Pearson r) to determine the association between
study variables.
4.1.2 Preliminary Analysis
Preliminary analysis included the bio-data of the research sample, factor analysis,
descriptive statistics and test of normality and reliability, and correlation matrix on the
relationship between study variables.
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Demographic Characteristics of Research Participants
The demographic characteristics of the sample are presented in the Table 4.1. It is shown
that the mean age of the participants for the study is 33.22 (SD=10.47). There are 193
(57.4%) males and 143 (42.6%) females sampled for the study. Majority of the participants
had secondary education [151 (44.9%)]. Those with tertiary education are 96 (28.6%), a
little above those with basic education who were 89 (26.5%). It is also observed that on the
average participants have lived in the location of the disaster for 11.07years (SD=8.70).
The majority of participants are single or widowed (55.7%). This is followed by those
married or cohabiting (33.6%). The least in this category are the divorced or separated
(10.7%). The sample was also made up of more Christians [248 (73.8%)] as against 88
(26.2%) Moslems. Furthermore, most participants (69%) did not receive any form of
assistance/support in the form of relief items or hospital treatment after the disaster.
However, 31% indicated that they were either treated for various injuries, or they had
received some relief items from NADMO/government, Red Cross, private organisations,
and individuals from the general public. Majority of the sample is made up of self-employed
participants [233 (69.3%)]. The rest are those who work for others such as the government
or private companies (14.0%), and students (12.2%).
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Table 4.1:
Demographic Characteristics of Respondents
Characteristic Frequency Percentage Mean Standard
(N) (%) Deviation
Age 33.22 10.47
Duration in settlement 11.07 8.70
Sex
• Male 193 57.4
• Female 143 42.6
Level of Education
• Basic 89 26.5
• Secondary 151 44.9
• Tertiary 86 28.6
Marital status
• Single/widowed 187 55.7
• Married/cohabiting 113 33.6
• Divorced/separated 96 10.7
Religion
• Christian 248 73.8
• Moslem 88 26.2
Support (relief items,
medical treatment) after
disaster
• Yes 104 31
• No 232 69
Occupation
• Student 42 12.2
• Unemployed/retired 15 4.5
• Self-employed 233 69.3
• Work for others 47 14.0
Professional intervention
received
• Medical 11 3.3
• Religious 9 2.7
• None 316 94.0
It is also observed from the table 4.1 above that most of the participants (94%) did not
receive any professional intervention for the traumatic situation they experienced. The
remaining received medical intervention (3.3%) and religious intervention (2.7%). No
participant indicated receiving professional psychological intervention such as counselling
or therapy.
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Exploratory Factor analysis
Exploratory factor analysis was conducted to examine the validity of the Big Five
Personality Scale. This was done because the scale is of western origin and has not been
validated in the Ghanaian context. It was also necessary to do so in order to determine the
subscales of the scale since these subscales were used in the data analysis. Thus, the factor
analysis was conducted to ascertain the factor structure of the scale before being used in the
study.
The Principal Axis Factoring (PCA) with Equamax rotation was used. The Bartlett’s Test
of Sphericity and the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy were
considered. To retain the number of factor components, the Eigenvalue and scree plot were
inspected. It has been argued that the use of the Eigenvalue tends to overestimate the number
of factors to retain (Ruscio & Roche, 2012). Thus, the scree plot was given more attention.
Items with factor loading of .30 or more were retained.
The Big Five Personality Scale
The results indicate that the Bartlett’s Test of Sphericity is significant (x2=4307.00, p=.00)
and a significant KMO test of sampling adequacy is .752. Contrary to the five components
in the original scale, the Eigenvalue of the exploratory factor analysis (EFA) generated 16
factors whereas the scree plot indicated two factors. The 16 factors might be an over
estimation. Thus, the researcher restricted the number of factors to generate to 5 with
minimum factor loadings of .30 retained. The following result presented in the Table 4.2
below is obtained.
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Item Component
1 2 3 4 5
1 I am the life of the party .619 -.041 .113 -.056 .196
2 I feel little concern for others .661 .105 -.169 -.058 .310
3 I am always prepared .589 -.153 .055 .260 .033
4 I get stressed out easily .554 .293 .155 -.037 .111
5 I have a rich vocabulary .480 .106 .172 .193 -.130
6 I don't talk a lot .189 .150 .009 .250 .014
7 I am interested in people .109 .019 .222 .393 .029
8 I leave my belongings around -.068 .127 .039 -.035 .522
9 I am relaxed most of the time .077 -.202 .281 .113 .530
10 I have difficulty understanding abstract
ideas .056 .222 -.034 .204 .474
11 I feel comfortable around people .040 -.130 .033 .431 .250
12 I insult people .033 .401 -.174 -.164 .202
13 I pay attention to details .287 -.006 .111 .511 -.054
14 I worry about things .286 .209 -.085 .389 .115
15 I have a vivid imagination .267 .084 .121 .516 -.142
16 I keep in the background .188 .189 .030 .550 -.036
17 I sympathize with others' feelings -.041 -.049 .250 .473 .142
18 I make a mess of things -.191 .452 -.275 .031 .239
19 I seldom feel blue -.107 .076 .064 -.021 .402
20 I am not interested in abstract ideas .099 .219 .048 .134 .519
21 I start conversations .135 -.105 .089 .370 .490
22 I am not interested in other people's
problems .172 .343 -.006 .025 .395
23 I get chores done right away .032 .033 .181 .514 .135
24 I am easily disturbed .001 .386 .118 .197 .072
25 I have excellent ideas .542 -.099 .467 .212 .002
26 I have little to say .604 .018 .060 .237 .005
27 I have a soft heart .428 -.116 .289 .154 .024
28 I often forget to put things back in their
proper place .149 .242 -.103 .100 .388
29 I get upset easily .099 .474 .136 .063 .129
30 I do not have a good imagination -.008 .507 .106 -.119 .259
31 I talk to a lot of different people at parties .165 .290 .236 -.036 .368
32 I am not really interested in others .061 .451 .168 -.026 .245
33 I like order .160 .068 .649 -.010 .081
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34 I change my mood a lot .215 .400 .142 -.031 -.034
35 I am quick to understand things .400 .169 .142 .255 -.072
36 I don't like to draw attention to myself .278 .111 .083 .221 -.082
37 I take time out for others .302 .022 .053 .476 .213
38 I shirk my duties -.153 .287 -.400 .267 .092
39 I have frequent mood swings .042 .490 .053 .162 .100
40 I use difficult words .057 .589 .004 .036 .146
41 I don't mind being the centre of attention .080 .246 .407 .014 .107
42 I feel others' emotions .113 .172 .590 .068 .062
43 I follow a schedule -.040 .178 .567 .127 .037
44 I get irritated easily -.036 .509 .172 .172 -.157
45 I spend time reflecting on things .167 .241 .357 .320 -.206
46 I am quiet around strangers .204 .277 .288 .220 -.196
47 I make people feel at ease .105 .027 .475 .263 .140
48 I am exacting in my work -.018 .030 .318 .268 .042
49 I often feel blue -.131 .188 -.046 .114 -.208
50 I am full of ideas .109 -.084 .526 .147 .079
Table 4.2:
Exploratory Factor Analysis of Big Five Personality Scale
Five (5) items did not load significantly onto any of the 5 factors generated. These items
include items 6, 36, 38, 46, and 49. Factor 1 has 9 items (items 1, 2, 3, 4, 5, 25, 26, 27, and
35) loading onto it, factor 2 has 10 items (items 12, 18, 24, 29, 30, 32, 34, 39, 40, and 44),
factor 3 has 7 items (items 33, 41, 42, 43, 47, 48, and 50), factor 4 has 10 items (items 7,
11, 13, 14, 15, 16, 17, 23, 37, and 45) and factor 5 has 9 items (items 8, 9, 10, 19, 20, 21,
22, 28, and 31). The factor obtained are therefore named as follows; factor 1=agreeableness,
factor 2= neuroticism, factor 3= conscientiousness, factor 4= openness and factor 5=
Extraversion
4.1.3 Descriptive analysis: Mean, Normality and Reliability
A descriptive analysis was conducted to check for the means and standard deviation of the
various study measures/scales. The analysis also checked for the skewness and kurtosis, and
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the reliabilities (Cronbach’s alphas) of the various measures. The results showed that scores
on all the measures are evenly distributed. Skewness recorded ranged between -.815 and
.701. The kurtosis ranged between -1.483 and 2.809. According to Field (2009) and
Tabachnick and Fidell (2007), normal distribution of scores (skewness and kurtosis) is
assumes if scores fall within +/-2. The measures also recorded adequate reliability
coefficients (above .70) except for three subscales that recorded .65 and above. The results
are presented in Table 4.3 below.
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Table 4.3:
Test of Normality, Reliability, Means and Standard Deviation
Mean Cronbach
Measure (N=336) Std. Dev. Min Max Skewness Kurtosis Alpha
SCL (GSI) 1.22 .85 .00 3.21 -.054 -1.483 .98
• somatization 1.15 .86 .00 3.67 .201 -1.115 .88
• Obsessive- 1.30 .90 .00 3.50 .083 -1.249 .86 compulsive
• Interpersonal
sensitivity 1.32 .94
.00 3.33 .035 -1.367 .85
• Depression 1.25 .88 .00 3.54 .078 -1.220 .88
• Anxiety 1.16 .89 .00 3.40 .190 -1.169 .86
• Hostility 1.16 1.00 .00 3.67 .309 -1.186 .82
• Phobic anxiety 1.13 .95 .00 3.57 .263 -1.192 .83
• Paranoid
ideation 1.29 .94
.00 3.67 .211 -.942 .79
• psychoticism 1.18 .99 .00 3.60 .244 -1.241 .90
Personality 151.00 21.42 45 196 -.47 1.54 .85
• Extraversion 30.45 7.11 9 43 -.38 -.51 .77
• Neuroticism 31.37 6.80 10 46 -.45 .13 .68
• Agreeableness 29.13 6.22 9 54 -.30 .78 .68
• Conscientious
ness 24.72 5.08 7
35 -.63 .39 .71
• Openness 35.33 6.40 10 47 -.73 .13 .65
PTG 75.38 19.56 21.00 113.00 -.600 .368 .90
PTSD 39.49 16.66 17.00 81.00 .078 -1.040 .93
AWS 118.87 19.39 31.00 166.00 -.815 2.809 .83
Self-construal 112.47 23.20 24.00 161.00 -.803 1.310 .88
• Independent .79
self-construal 57.00 12.56 12.00 83.00 -.711 .766
• Dependent
Self-construal 55.47 12.06 12.00 80.00 -.643 .897
.79
Social support 56.05 15.69 12.00 84.00 -.322 .094 .90
Self-efficacy 29.15 5.78 10.00 40.00 -.065 -.407 .80
Belief just world 24.93 7.76 7.00 42.00 -.191 -.392 .80
Resilience 118.31 23.97 25.00 166.00 -.591 1.030 .91
Religiosity 32.30 6.44 10.00 40.00 -.578 -.291 .88
Traumatic history 6.47 5.35 0.00 24.00 .701 -.237 -
SCL (GSI): Symptoms Checklist (Global Severity Index), PTG: Posttraumatic Growth,
PTSD: Posttraumatic Stress Disorder, AWS: Assumptive Worldview Scale
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4.1.4 Correlation Matrix
The correlation matrix presented in table 4.4 below is a Pearson Product Moment
Correlation Coefficient result showing how the various study variables, and some
demographic variables (age, duration of residence in disaster area and previous traumatic
experience) are related.
It is observed from the table that there is a significant positive correlation previous traumatic
history and the outcome variables (distress, PTSG and PTG) (r=.58, p<.01; r=.40, p<.01;
r=.11, p<.05 respectively). There is also a significant negative correlation between
assumptive world and two outcome variables namely distress and PTSD (r=-.25, p<.01; r=-
.37, p<.01 respectively). Agreeableness correlates negatively but not significantly with
distress and PTSD (r=-.09, p>.05; r=-.08, p>.05 respectively). On the other hand,
Neuroticism correlated positively and significantly with distress and PTSD (r=.14, p<.05;
r=.12, p<.05 respectively) There is also a significant negative relationship independent self-
construal and distress, and PTSD (r=-.48, p<.01; r=-.40, p<.01 respectively) and negative
significant relationship between dependent self-construal and distress, and PTSD (r=-.48,
p<.01; r=-.37, p<.01 respectively).
It is observed that, there is a significant negative correlation between the moderating
variables (social support, self-efficacy, belief in just world, resilience, and religiosity) and
two outcome variables (distress and PTG). However, resilience and religiosity correlated
positively and significantly with PTG.
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Table 4.4:
Correlation Matrix showing the relationship between Study Variables
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age 1
Dur. .49** 1
GSI .10 -.09 1
PTG .12* .08 .29** 1
PTSD .18** .01 .82** .30** 1
AW -.04 .00 -.25** .10 -.24** 1
IndSC -.05 .12* -.48** .05 -.40** .33** 1
IntSC -.06 .19** -.46** .08 -.37** .40** .78** 1
Extr -.13* .04 -.39** .04 -.28** .36** .52** .54** 1
Neur -.01 -.12* .14* .04 .12* .09 .01 .04 .17** 1
Agr .08 -.03 -.09 -.07 -.08 .09 .13* .19** .27** .44** 1
Cons .02 .12* -.30** .11 -.27** .32** .29** .32** .40** .25** .27** 1
Opn -.09 .02 -.39** .09 -.32** .27** .46** .46** .50** .20** .31** .42** 1
PTH -.15** -.01 -.47** -.07 -.44** .25** .45** .40** .46** -.02 .17** .26** .35** 1
SS .01 .25** -.36** .08 -.29** .34** .45** .48** .43** -.04 .14* .40** .37** .46** 1
SE -.30** -.14* -.12* .11 -.15** .11* .20** .21** .30** -.02 .03 .05 .14** .29** .26** 1
BJW -.02 .18** -.42** .18** -.36** .35** .45** .47** .47** -.02 .12* .49** .43** .50** .67** .25** 1
Res. -.05 .20** -.46** .13* -.35** .40** .49** .55** .53** -.06 .16** .38** .37** .49** .60** .22** .63** 1
Rel. .10 -.19** -.58** .11* -.40** .23** -.44** -.42** -.39** .06 -.05 -.28** -.31** -.25** -.36** .000 -.34** -.44** 1
*p<.05; **p<.01; n=336
Dur=Duration in residence, GSI= Global severity index PTG= Posttraumatic Growth, PTSD=Posttraumatic stress disorder, AW= Assumptive world,
IndSC= Independent self-construal, IntSD=Interdependent self-construal, Extr=Extraversion, Neur= Neuroticism, Agr= Agreeableness,
Con=Conscientiousness, Opn= Openness, PTH= Previous Traumatic History, SS= Social support, SE= Self-efficacy, BJW=Belief in Just World,
Res=Resilience, Rel=Religiosity
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4.1.5 Hypotheses Testing
Hierarchical multiple regression analyses were conducted to test the first three hypotheses.
Before the regression analysis was conducted, a test for multicollinearity was conducted
using the Variance Inflation Factor (VIF) and Tolerance values. For this assumption to be
met, Tabachnick and Fidell (2006) propose a tolerance value greater than .10 and VIF value
less than 10. The tolerance values in this study ranged between .34 and .85 and the VIF
values ranged between 1.21 and 2.96. This thus satisfies the multicollinearity assumption.
For the first two hypotheses, a two-step regression was conducted. In the step one, the effect
of demographic variables was tested. This also helped to hold such effect constant in order
not to influence the impact of the independent variables. Categorical demographic variables
were held dummy coded. For example, Gender: 1=Male, 0=Female, Education: 1=Basic
education, 0=Others, Employment: 1=No employment, 0=others. In the step two of the
regression, the independent variables were entered. These include the risk and protective
factors.
For the moderation analysis for the hypothesis three, the first two steps described above
were used in addition to a third step where the interaction terms for the independent variables
and the moderating variables were entered. The results are presented according to each
hypothesis below.
Hypothesis one: Testing the effects of Personality, independent self-construal, assumptive
world, and early traumatic experience on General Distress and PTSD
This hypothesis states that risk factors (independent self-construal, personality, assumptive
world, and early traumatic experiences) will predict posttraumatic distresses (PTD) (general
distress and PTSD) among flood disaster victims. A hierarchical multiple linear regression
was used the results are presented in the Tables 4.5 and 4.6.
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From Table 4.5, the overall regression model observed is significant, accounting for 51.2%
variance in general distress (R2=.51, F=16.52, p=.00). Controlling for the effect of
demographic variables in step 1 shows a significant model (R2=.09, F=5.18, p=.00) with age
(β=.17, p<.05), education (β=-.19, p<.01), and duration in residence (β=-.14, p<.05)
significantly affects general distress.
The step 2 also shows a significant model a significant model (ΔR2=.43, F=16.52, p<.01).
It is observed that of all the risk factors being tested in this hypothesis, only neuroticism
(β=.16, p<.01), and early traumatic experience (β=.37, p<.01) contribute significantly to the
total variance in psychological distress. The contributions of independent self-construal and
assumptive world on the other hand are not significant [β=-.06, p>.05; and β=-.07, p>.05
respectively].
In addition, the effect of protective factors on general distress was tested. The results shows
that only social support (β=-.24, p<.01) contributes a significant reduction in the total
variance of general distress. It was also observed that openness contributes a significant
reduction in the total variance of general distress (β=-.12, p<.05). Resilience, self-efficacy,
belief in just world and religiosity did not contribute significantly to the total variance in the
general distress.
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Table 4.5:
Hierarchical Multiple Linear Regression showing how Risk Factors predict General
Psychological Distress
Model B Std. Error β t P
1 (Constant) 1.021 .221 4.618 .000
Age .014 .006 .174 2.480 .014
Gender -.168 .094 -.097 -1.788 .075
Education -.358 .103 -.186 -3.488 .001
Marital Status .104 .105 .061 .997 .320
Employment -.175 .223 -.042 -.784 .434
Duration in residence -.014 .006 -.144 -2.289 .023
2 (Constant) 2.512 .396 6.336 .000
Assumptive world .000 .002 -.011 -.233 .816
Independent Self-construal -.004 .005 -.064 -.935 .351
Dependent Self-construal -.006 .005 -.091 -1.291 .198
Extraversion .006 .007 .048 .845 .399
Neuroticism .021 .006 .166 3.520 .000
Agreeableness -.002 .007 -.017 -.354 .723
Conscientiousness -.015 .008 -.087 -1.730 .085
Openness -.016 .007 -.124 -2.377 .018
Previous Trauma history .060 .008 .374 7.110 .000
Social support -.013 .003 -.243 -4.755 .000
Self-efficacy .010 .009 .065 1.100 .272
Belief in just world .000 .005 -.004 -.084 .933
Resilience -.002 .002 -.047 -.759 .449
Religiosity -.004 .008 -.034 -.555 .579
R2 =.512, F=19.624, p<.00; R2 =.086, F=5.177, p< .001 for step 1; ΔR2=.426, F=16.520,
p< .001 for step2
From the table 4.6 below, below, a significant model was also observed (R2=.37, F=10.87,
p<.01). Step 1 which controlled form demographic variables also produced a significant
model (R2=.07, F=3.83, p<.01) with age (β=.23, p<.01) and gender (β=-.12, p<.05)
significantly contributing to the total variance in PTSD. A significant model is also observed
at step 2 (ΔR2=.31, F=9.24, p<.01). It is observed that two risk factors namely neuroticism
(β=.17, p<.01), and early traumatic experience (β=.23, p<.01), significantly contribute to
the total variance in the PTSD. In addition to these, extraversion significantly contributes to
the total variance in PTSD (β=.13, p<.05).
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The result also shows that social support is the only protective factor (β=-.26, p<.01)
contributes a significant reduction in the total variance of PTSD. Resilience, self-efficacy,
belief in just world and religiosity did not contribute significantly to the total variance in the
PTSD. However, conscientiousness also contributes a significant reduction in the total
variance of PTSD (β=-.13, p<.03).
Table 4.6:
Hierarchical Multiple Linear Regression showing how Risk Factors predict PTSD
Model B Std. Error β t P
1 (Constant) 30.141 4.371 6.896 .000
Age .372 .113 .234 3.291 .001
Gender -4.089 1.855 -.122 -2.205 .028
Education -1.304 2.030 -.035 -.642 .521
Marital Status 1.787 2.067 .053 .864 .388
Employment -3.417 4.412 -.042 -.775 .439
Duration in residence -.160 .122 -.083 -1.316 .189
2 (Constant) 63.245 8.803 7.184 .000
Assumptive world -.051 .045 -.059 -1.138 .256
Independent Self-construal -.133 .103 -.100 -1.293 .197
Dependent Self-construal -.075 .110 -.054 -.681 .496
Extraversion .300 .151 .128 1.982 .048
Neuroticism .424 .131 .173 3.236 .001
Agreeableness -.171 .148 -.064 -1.162 .246
Conscientiousness -.411 .187 -.125 -2.196 .029
Openness -.254 .154 -.097 -1.650 .100
Previous Trauma history .726 .186 .233 3.898 .000
Social support -.279 .062 -.263 -4.531 .000
Self-efficacy .181 .193 .063 .936 .350
Belief in just world -.031 .111 -.015 -.282 .778
Resilience -.037 .049 -.053 -.756 .450
Religiosity .015 .178 .006 .083 .934
R2 =.370, F=10.873 p<.00; R2 =.065, F=3.832, p< .001 for step 1; ΔR2=.305, F=9.243,
p< .001 for step2
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Hypothesis Two: Testing the effects of social support, intervention, belief in just world,
religiosity, self-efficacy, and resilience on PTG
This hypothesis states that Protective factors (social support, intervention, belief in just
world, religiosity, self-efficacy, and resilience) will predict posttraumatic growth (PTG)
among flood disaster victims. To test the hypothesis, demographic factors (age, gender,
number of years in residence, education, marital status and employment) were held constant.
The hypothesis was tested using a hierarchical multiple linear regression. However, in this
study none of the participants reported receiving professional psychological intervention.
Therefore, intervention was excluded from the analysis. The result is presented in the Table
4.7 below.
The results show a significant model accounting for 18.9% variance in PTG (R2=.189,
F=2.70, p=.00). Controlling for the effect of demographic variables in step 1 also shows a
significant model (R2=.09, F=5.53, p=.00) with gender (β=-.12, p<.05), education (β=-.15,
p<.01), and employment (β=-.18, p<.01) significantly affects PTG.
Model 2 is also significant (ΔR2=.10, F=3.67, p<.01) with social support (β=-.21, t=3.36,
p<.01), belief in just world (β=.13, t=.13, p<.05) resilience (β=.21, t=2.74, p<.01) and
religiosity (β=.15, t=1.98, p=.05) contributing significantly to the total variance in the PTG.
Self-efficacy on the other hand does not contribute significantly to the variance in PTG (β=-
.12, t=2.23p>.05).
It is also observed that, no risk factor (neuroticism, previous traumatic history, assumptive
world and independent self-construal) significantly predicts PTG. However, agreeableness
contributes a significant reduction in the total variance of PTG (β=-.12, p<.05).
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Table 4.7:
Hierarchical Multiple Linear Regression showing how Protective Factors predict
PTG
Model B Std. Error β t P
1 (Constant) 77.492 5.057 15.324 .000
Age .028 .131 .015 .215 .830
Gender -4.796 2.146 -.121 -2.235 .026
Education -6.751 2.349 -.153 -2.874 .004
Marital Status -2.190 2.391 -.056 -.916 .360
Employment -17.218 5.104 -.182 -3.373 .001
Duration in residence .250 .141 .111 1.775 .077
2 (Constant) 41.083 11.720 3.505 .001
Assumptive world .027 .060 .027 .460 .646
Independent Self-construal .003 .137 .002 .019 .985
Dependent Self-construal .073 .147 .045 .496 .620
Extraversion .021 .202 .008 .105 .916
Neuroticism .221 .175 .077 1.267 .206
Agreeableness -.392 .196 -.124 -1.994 .047
Conscientiousness .038 .249 .010 .153 .878
Openness .166 .205 .054 .808 .419
Previous Trauma history .464 .248 .127 1.870 .062
Social support -.263 .082 -.211 -3.206 .001
Self-efficacy -.343 .257 -.102 -1.334 .183
Belief in just world .318 .148 .126 2.156 .032
Resilience .172 .065 .211 2.643 .009
Religiosity .463 .237 .153 1.952 .050
R2 =.189, F=2.703 p<.00; R2 =.092, F=5.527, p< .001 for step 1; ΔR2=.097, F=3.671, p<
.001 for step2
Hypothesis Three – Testing the moderating effects of effect of social support, self-efficacy,
belief in just world, resilience and religiosity on the relationship between neuroticism,
previous traumatic history, assumptive world, independent self-construal and general
distress and PTSD
Hypothesis three states that Protective factors will significantly moderate the relationship
between risk factors and PTD among flood disaster victims. It is expected that protective
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factors will weaken the relationship between risk factors and PTD. Thus, the stronger the
protective factor, the weaker the relationship will be.
To test this hypothesis, a hierarchical multiple linear regression using Baron and Kenny’s
moderation analysis method was employed. Baron and Kenny (1986) provided a
comprehensive approach to moderation analysis. In the Baron and Kenny (1986)
moderation approach, there are series of steps. First, the predictor and moderator are centred
(standardized). This is a linear transformation method that eliminates problems associated
with multi-collinearity. This is done by subtracting the mean value for a variable from each
score for that variable (Lingard & Francis, 2006). Secondly, an interaction term is computed
(i.e., predictor X moderator) using the standardized values. In the third step, the outcome
variable is regressed on the predictor, moderator, and their interaction. That is, in the
hierarchical regression analysis, the predictor is entered in the first block, followed by the
moderator in the second block and the interaction term in the third block. If the interaction
effect is significant (i.e., if β of predictor X moderator is significant), then there is a
moderation effect. However, if the interaction term is not significant, then there is no
moderation effect.
Following these steps, the dependent variables were used in separate hierarchical multiple
regressions, first for psychological distress and second for PTSD. They were regressed on
neuroticism, assumptive world, independent self-construal and previous traumatic history
(as predictors) and social support, self-efficacy, belief in just world, resilience and
religiosity (as moderators) in the second block, after controlling for demographic variables
in the first block. The interaction terms were entered in the third block. The results are
presented in tables 4.8 and 4.9 below.
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In the result presented in the Table 4.8 below, a significant model is observed (R2=.62,
F=4.61, p<.01). The step 1 produced a significant model with demographic variables
contributing significantly to the total variance in general psychological distress (R2=.09,
F=4.61, p<.01). Step 2 also produced a significant model with the predictors and moderators
contributing significantly (42.6%) to the total variance in general psychological distress
(ΔR2=.43, F=19.62, p<.01). In this model, neuroticism (β=.17, p<.01), openness (β=-.12,
p<.05), previous traumatic history (β=.37, p<.01) and social support (β=-.24, p<.01)
independently contribute significantly to the total variance in psychological distress.
In step 3, a significant model was observed with a total of 11.6% variance in general
psychological distress (ΔR2=.116, F=12.455, p<.01). The result shows that the interaction
terms between assumptive world and religiosity (β=-.22, p<.01), independent self-construal
and resilience (β=-.20, p<.01), neuroticism and social support (β=-.12, p<.05), neuroticism
and self-efficacy (β=.20, p<.01), and neuroticism and resilience (β=-.18, p<.01) are
significant.
In summary, religiosity moderates the relationship between assumptive world and general
psychological distress, resilience moderates the relationship between independent self-
construal and general psychological distress, social support moderates the relationship
between neuroticism and psychological distress, and self-efficacy and resilience moderate
the relationship between neuroticism and general psychological distress.
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Table 4.8:
Hierarchical Multiple Linear Regression showing the moderating effect of Social Support,
Self-esteem, Belief in Just World Resilience, and Religiosity on the Relationship between
Risk Factors (Assumptive World, Independent Self-construal and Previous Traumatic
History) and General Distress.
Model B Std. Error β t p
1 (Constant) 1.021 .221 4.618 .000
Age .014 .006 .174 2.480 .014
Gender -.168 .094 -.097 -1.788 .075
Education -.358 .103 -.186 -3.488 .001
Marital Status .104 .105 .061 .997 .320
Employment -.175 .223 -.042 -.784 .434
Duration in residence -.014 .006 -.144 -2.289 .023
2 (Constant) 2.512 .396 6.336 .000
Assumptive world .000 .002 -.011 -.233 .816
Independent Self-construal -.004 .005 -.064 -.935 .351
Dependent Self-construal -.006 .005 -.091 -1.291 .198
Extraversion .006 .007 .048 .845 .399
Neuroticism .021 .006 .166 3.520 .000
Agreeableness -.002 .007 -.017 -.354 .723
Conscientiousness -.015 .008 -.087 -1.730 .085
Openness -.016 .007 -.124 -2.377 .018
Previous Trauma history .060 .008 .374 7.110 .000
Social support -.013 .003 -.243 -4.755 .000
Self-efficacy .010 .009 .065 1.100 .272
Belief in just world .000 .005 -.004 -.084 .933
Resilience -.002 .002 -.047 -.759 .449
Religiosity -.004 .008 -.034 -.555 .579
3 (Constant) 3.258 .414 7.864 .000
AW X Social support -.036 .029 -.059 -1.228 .221
AW X Self-efficacy -.021 .060 -.029 -.347 .729
AW X Just world -.030 .034 -.045 -.882 .378
AW X Resilience .033 .053 .053 .621 .535
AW X Religiosity -.142 .040 -.220 -3.545 .000
Trauma history X Social support .111 .058 .116 1.919 .056
Trauma history X Self-efficacy -.043 .057 -.045 -.761 .447
Trauma history X Just world .043 .052 .048 .820 .413
Trauma history X Resilience .121 .062 .122 1.936 .054
Trauma history X Religiosity -.028 .047 -.031 -.591 .555
IndSC X Social support .046 .042 .065 1.103 .271
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IndSC X Self-efficacy .086 .060 .106 1.422 .156
IndSC X Just world -.050 .043 -.068 -1.152 .250
IndSC X Resilience -.133 .044 -.198 -3.051 .002
IndSC X Religiosity .050 .040 .073 1.247 .214
Neuroticism X Social support -.085 .037 -.119 -2.270 .024
Neuroticism X Self-efficacy .149 .051 .201 2.900 .004
Neuroticism X Just world -.025 .034 -.034 -.743 .458
Neuroticism X Resilience -.120 .046 -.179 -2.614 .009
Neuroticism X Religiosity -.002 .052 -.002 -.032 .974
AW= Assumptive world; IndSC= Independent self-construal
R2 =.628, F=4.607, p< .01; R2 =.086, F=5.177, p< .01 for step 1; ΔR2=.426, F=19.624,
p< .01 for step2; ΔR2=.116, F=12.455, p< .001 for step3
The Table 4.9 below presents the results of the moderation effect of the moderating variables
on the relationship between the predictors and PTSD. The regression shows a significant
model (R2=.53, F=5.43, p<.01). In step 1, the effect of the demographic variables were
controlled. This shows a significant model (R2=.065, F=3.83, p<.01). In step 2, a significant
model is observed with a total variance of 30.5% in PTSD (R2=.305, F=10.87, p<.01). The
step 3 also produced a significant model with 17.0% variance in PTSD (ΔR2=.170, F=8.63,
p<.01).
In the model 3, it is observed that social support (β=-.108, p<.05), belief in just world (β=-
.137, p<.05), and religiosity (β=-.202, p<.01) significantly moderates the relationship
between assumptive world and PTSD. It is also observed that the relationship between
previous traumatic history and PTSD is significantly moderated by belief in just world
(β=.153, p<.05). Finally, social support (β=-.181, p<.01) self-efficacy (β=.170, p<.05) and
resilience (β=-.166, p<.05) significantly moderate the relationship between neuroticism and
PTSD.
In summary, social support, belief in just world and religiosity significantly moderate the
relationship between assumptive world and PTSD, belief in just world significantly
moderates the relationship between previous traumatic history and PTSD; and social
support, self-efficacy and resilience significantly moderate the relationship between
neuroticism and PTSD.
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Table 4. 9:
Hierarchical Multiple Linear Regression showing the moderating effect of Social Support,
Self-esteem, Belief in Just World Resilience, and Religiosity on the Relationship between
Risk Factors (Assumptive World, Independent Self-construal and Previous Traumatic
History) and PTSD
Model B Std. Error β t P
1 (Constant) 30.141 4.371 6.896 .000
Age .372 .113 .234 3.291 .001
Gender -4.089 1.855 -.122 -2.205 .028
Education -1.304 2.030 -.035 -.642 .521
Marital Status 1.787 2.067 .053 .864 .388
Employment -3.417 4.412 -.042 -.775 .439
Duration in residence -.160 .122 -.083 -1.316 .189
2 (Constant) 63.245 8.803 7.184 .000
Assumptive world -.051 .045 -.059 -1.138 .256
Independent Self-construal -.133 .103 -.100 -1.293 .197
Dependent Self-construal -.075 .110 -.054 -.681 .496
Extraversion .300 .151 .128 1.982 .048
Neuroticism .424 .131 .173 3.236 .001
Agreeableness -.171 .148 -.064 -1.162 .246
Conscientiousness -.411 .187 -.125 -2.196 .029
Openness -.254 .154 -.097 -1.650 .100
Previous Trauma history .726 .186 .233 3.898 .000
Social support -.279 .062 -.263 -4.531 .000
Self-efficacy .181 .193 .063 .936 .350
Belief in just world -.031 .111 -.015 -.282 .778
Resilience -.037 .049 -.053 -.756 .450
Religiosity .015 .178 .006 .083 .934
3 (Constant) 74.353 9.010 8.252 .000
AW X Social support -1.282 .632 -.108 -2.029 .043
AW X Self-efficacy -.906 1.300 -.064 -.698 .486
AW X Just world -1.757 .733 -.137 -2.397 .017
AW X Resilience 2.022 1.151 .168 1.756 .080
AW X Religiosity -2.543 .869 -.202 -2.925 .004
Trauma history X Social support 2.258 1.254 .121 1.800 .073
Trauma history X Self-efficacy -.187 1.236 -.010 -.152 .880
Trauma history X Just world 2.670 1.134 .153 2.354 .019
Trauma history X Resilience .574 1.356 .030 .424 .672
Trauma history X Religiosity .561 1.033 .032 .543 .587
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IndSC X Social support .087 .909 .006 .096 .924
IndSC X Self-efficacy 2.062 1.314 .130 1.570 .118
IndSC X Just world -1.147 .943 -.080 -1.217 .224
IndSC X Resilience -1.309 .948 -.100 -1.381 .168
IndSC X Religiosity .197 .871 .015 .227 .821
Neuroticism X Social support -2.518 .813 -.181 -3.097 .002
Neuroticism X Self-efficacy 2.467 1.118 .170 2.207 .028
Neuroticism X Just world -.741 .744 -.050 -.997 .320
Neuroticism X Resilience -2.170 .997 -.166 -2.176 .030
Neuroticism X Religiosity .210 1.133 .015 .185 .853
AW= Assumptive world; IndSC= Independent self-construal
R2 =.539, F=5.427, p< .01; R2 =.065, F=3.832, p< .01 for step 1; ΔR2=.305, F=10.873,
p< .01 for step2; ΔR2=.170, F=8.634, p< .001 for step3
Hypothesis Four: Testing the relationship between protective factors (social support,
self-efficacy, belief in just world, resilience and religiosity), and PTD
This hypothesis states that protective factors will have a significant negative relationship
with PTD among flood disaster victims. This was analysed using the Pearson Product
Moment Correlation Coefficient (Pearson r). The result is presented in the correlation matrix
table (Table 4.4 above). The results shows that all five protective factors namely social
support, self-efficacy, belief in just world, resilience and religiosity are negatively and
significantly correlated with psychological distress (r=-.47, p<.01), (r=-.36, p<.01), (r=-.12,
p<.05), (r=-.42, p<.01), (r=-.46, p<.01) respectively and PTSD (r=-.44, p<.01), (r=-.29,
p<.01), (r=-.15, p<.01), (r=-.36, p<.01), (r=-.35, p<.01) respectively. This supports the
hypothesis being tested. However, subjecting these variables regression analysis, it was
observed that only social support significantly contributed to a reduction in the PTG.
Hypothesis Five: Testing the relationship between PTD and PTD
There will be a significant negative relationship between PTG and PTD among flood
disaster victims. This was analysed using the Pearson Product Moment Correlation
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Coefficient (Pearson r). The result is presented correlation matrix table (Table 4.4 above).
The result indicated that there is rather a significant positive correlation between PTG and
PTSD (r=.82, p=.00). There is also a significant positive correlation between PTG and
general psychological distress (r=.29, p=.00). This does not support the hypothesis being
tested. It means an increase in PTG corresponds with a possible increase in PTD and vice
versa.
4.1.6 Summary of Qualitative Findings
The following is a summary of the results of the data analysis presented above:
1. Neuroticism, and previous traumatic history significantly predict general
psychological distress and PTSD.
2. Social support, belief in just world, resilience, and religiosity significantly predict
PTG
3. A.
i. Religiosity significantly moderates the relationship between assumptive
world and psychological distress
ii. Resilience moderates the relationship between independent-self-construal
and psychological distress
iii. Social support significantly moderates the relationship between neuroticism
and psychological distress
iv. Self-efficacy and resilience significantly moderate the relationship between
neuroticism and psychological distress.
B.
i. Social support, belief in just world, and religiosity significantly moderate
the relationship between assumptive world and PTSD
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ii. Belief in just world significantly moderate the relationship between
previous traumatic history and PTSD
iii. Social support, self-efficacy and resilience significantly moderate the
relationship between neuroticism and PTSD
4. Social support, self-efficacy, belief in just world, resilience and religiosity are
negatively and significantly correlated with PTD (psychological distress and PTSD)
5. There is a significant positive correlation between PTG and PTD
4.1.7 Additional Findings
Additional findings from the results include;
• Openness significantly and negatively predicts general psychological distress
• Extraversion significantly and positively predicts PTSD
• Conscientiousness significantly and negatively predicts PTSD
• Agreeableness significantly and negatively predicts PTG
• Social support significantly and positively predicts PTD (general psychological
distress and PTSD)
• Age, education, duration in residence predict PTD
• Gender, education and employment predict PTG
4.2 Qualitative Results
In all, three themes were generated. These include experiences during disaster,
psychological impacts and adjustment factors. Each of these themes have subthemes that
are presented below with corresponding quotes. The themes were carefully named to reflect
the information provided by participants and also to satisfy the research questions to be
answered by the study.
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Table 4.10: Summary of Themes, Subthemes and Supporting Quotes
Theme Subtheme Supporting Quote
Perceived Engineering “…when they were constructing the N1 high way, there was
cause of failures. this big gutter… But immediately they constructed that N1
Disaster they blocked that gutter… the new gutter that they were
constructing was left half way. (P 1, Female, 36years)
Anti- “…Some environs dispose their refuse into the gutters.
environmental …Those in Alajo do not have toilets, so they even throw their
behaviours faecal matters into the gutters.” (P 5, male, 37years)
Experiences Loss and Disfigurement: “…Look at my body. Now I always have to
following Biographical wear long sleeves and a cap to cover myself. People fear
disaster disruption how I look now... (P 8, male, 47years)
Death: “…My elder sister who was 58 years died… Because
of the fire…And my senior brother whose 18 years girl was
also at the down also lost her life”. (P 2, female, 22years)
Loss of property: “…Well, we lost a lot of material things.
Our clothes, cars and many things” (P12, male, 32years)
Psychological Anxiety: “…I always dream about it. It’s like the thing is
impacts happening again. I fear at night because of the dreams. Even
during the day sometimes, I dream about it. When I have the
dream and I wake up then I become disturbed.” (P 8, male,
47years)
Behavioural changes: Currently, I do not sleep so well, I
wake up at 2 am and can’t go back to bed. Whereas I sleep
better outside.” (P 4 female, 48years)
Mood effects: “…My brother, it is tough for me. If not my
wife, hmmm. If it were some women, they would have left
me. I have been crying aaa. I feel really sad.” (P 8, male,
47years)
3. Societal level “…A lot of support for possessions came. NADMO also
Adjustment intervention came. Government gave us GHS 100 for 3 months. They
experiences registered us and gave us and ATM card [Actually an ezwich
card] which we withdrew funds for just 3 months. (P5, male,
37years).
Family level “…my daughter lives at Italy… so my daughter come down
intervention and she came to help me to acquire those things back…
helped me to build my own house where I now live” (P7,
male, 60years).
Spiritual “…at first I was not going to church. It is now that I am
support going. They don’t know anything about my situation. But for
me I go to church now because I know what God has done
for me.” (P 10, male, 30years)
Post disaster “…I think government must do something; they must
vulnerability sympathise with us. If they promise something and they are
not doing it, they should know that we are suffering.” (P 10,
male, 30years)
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Perceived cause of disaster
This subtheme examines the impression participants had about the cause of the disaster.
Participants who happen to be at the point of the disaster had their own beliefs about what
might have resulted in the disaster. From the narratives, it was noted that participants
attributed the disaster to inappropriate town planning and constructions and human
behaviours. Therefore, two subthemes emerged under this theme namely engineering
failures and anti-environmental behaviours.
Engineering failures: This subtheme describes the cause of the disaster participants
attributed to construction or engineering problems. At the time of the disaster, the Kwame
Nkrumah Circle Interchange was under construction. Probably, during the construction,
drainages were temporarily blocked either deliberately or not deliberately by construction
works. Participants indicated that this might have resulted in the flooding. For example, one
participant stated that “…the road was under construction so trip of sand covered the roads,
gutters so the rain came with force and did not get a place to pass. It entered the tank and
uncover the top and the fuel came out” (Participant 2, Female, 44years).
Another participant whose residence is not within the construction zone but was still flooded
supported the idea that engineering failures might account for the disaster. This is because
construction works in her vicinity was done several years before the disaster. She states that
“…when they were constructing the N1 high way, there was this big gutter even though at
first it gets flooded but it was just around the edges, not major flooding. But immediately
they constructed that N1 they blocked that gutter… the new gutter that they were
constructing was left half way. They didn’t do the rest” (Participant 1, Female, 33years)
Some participants also attributed the fire to poor maintenance at the fuel filling station.
Some of them said the following:
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“…what I know is that, first we share wall with the filling station, anytime it rains
they use rubber to cover their machines because of leakage. When it rains the petrol
burst” (Participant 2).
“…my house shares a wall with the filling station. From 5pm the rain was getting
heavier, thus it entered our house to the level of our neck. You could smell petrol in
the water, but since we had 2 vehicles in the yard, I assumed it was from their burst
fuel tanks. However, the smell of fuel was so much that you’ll have to cover your
nose before you could enter my room. I then realised it was from the filling station
and not our vehicles. The smell of fuel was also on me” (Participant 4)
“…the filing station that exploded, the owner didn’t maintain the place. I heard there
were leakages from their fuel reservoir. And then also the authorities that needed to
check all those things must be punished. Ghana we are not serious at all. So this
thing happened and people talk and talked but now it has died off again”
(Participant 12)
Anti-environmental behaviours: This is about negative human behaviours that might have
resulted in the floods and related disasters. Participants attributed the disaster to these
behaviours by indicating that people indiscriminately dispose refuse into the drains. The
refuse choke the drains and prevent the free flow of running water whenever it rains. This
diverts the water into homes and cause flooding. They also stated that some households do
not have toilet facilities and so dispose their feacal matter into the drains. One of the
participants admonished Ghanaian by saying ‘…Ghanaians must learn to protect our own
environment’ (Participant 9, male, 42years).
These are some of the responses participants gave about this:
“…We have a big gutter but you see people throwing rubbish and defecating into it
especially in the morning. So all these things contributed to the flood” (Participant
1, Female, 36years)
“…some from dispose their refuse into the gutters. ... Those who do not have toilets
… even throw their faecal matters into the gutters (Participant 5, male, 37Years).
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Experiences following disaster
This theme describes the impact of the experiences of the participants. These include
experiences both during and after the disaster. Participants experienced physical and
psychological impacts and these are captured under subthemes known as biographical
disruption and psychological impacts.
Biographical disruption: This describes physical or bodily disfigurement or alterations
caused by the disaster to participants. Those who were affected by the fire had some various
degrees of burns. This leaves them with some physical deformities that affect their daily
activities. For example, one participant stated that
“…Look at me body. Now I always have to wear long sleeves and a cap to cover
myself. People fear how I look now. Look at my picture [participant pulls out a
picture of himself before the disasters and he looks really different]. Now look at me.
The difference. Hmmm”. (Participant 8, male, 47 years).
He also indicated that due to his current appearance he has only limited places to go to
because people will laugh at him. For example, he said; “…when my children say their
parents should come to PTA (Parent-Teacher Association), I can’t go again because their
friends will laugh at them.” (Participant 8, male, 47 years).
Other participants who were also burnt in the disaster stated how they are disfigured as
follows;
“…I was also burnt. It wasn’t a small issue, from my head to toe, every part of my
body burnt… I look old at once” (Participant 3, female, 38years).
“…I also feel bad about my skin now. I am not married and now see my skin. I feel
shy.” (Participant 12, male, 32years)
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Another participant indicated that even though she was not burnt, when jumped from a
storey building in an attempt to escape the fire and this got her paralysed after a couple of
weeks. She stated the following;
“…It was after say around 2 weeks then I could see that when I am walking, my
legs wobbles. So I didn’t know anything about spine something. So one morning,
when we woke up we swept the area, and I sat down, I wanted to get up, but I couldn’t
get up… It has disabled me, it cost me my ability to work.” (Participant 6, female,
63years).
This participant also indicated that her current state has rendered her unable to work since
she is not able to walk and move about;
“…I am not able to work. Because it is from this work, I use to gather small, small
money to help these children and now that I am not going. There is no father, I am
the only father and the mother. So I can say it is Jehovah GOD that has sustained
us.” (Participant 6, female, 63years).
Participant 2 stated that she had skin depigmentation due to the fuel that spilled on the
surface of the water. She was not burnt but because she swam through the water, her skin
was affected significantly.
“…The problem I face is that I was not burnt, but when I jumped from the top there
was a container choked there so my side hit the container before it turned me.
Because of the road construction there were a lot of things packed as the rain roll
you the things will be hitting you. See my skin. The colour has changed” (Participant
2, female, 44years).
The words of one participant suggests that there is a level of stigma towards disfigurement
in society. His comment suggests that society needs to appreciate the challenges of people
and support them in which ever small way and that acceptance will help sufferers:
“…Ghanaians must know that there are people in society who are ugly not because
they want it. Let them accept them.” (Participant 8).
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Participants also suffered the loss of their loved ones such as relatives and friends. Some
loss their relations or friends through the fire and others through the flood. Some
participants said the following;
“…My elder sister who was 58 years died… Because of the fire. She was not at the
top, she was down. And my senior brother whose 18 years girl was also at the down
also lost her life” (Participant 2, female, 44years).
“…I have no family members left. The fire killed all of them” (Participant 5, male, 37years).
Some lost their marital partners and were confronted with the difficulty of breaking the
news of the death to the children;
“…Finally, I gathered the courage to go to Circle. She was not there too. My
brother, it was on the 7th day that I found my wife’s body at the mortuary at 37
hospital ooo. I couldn’t cry. I was trying to be strong for my children. We have two
children. They were always asking where their mother was. I was just hoping to see
her at least alive in the hospital and tell them something but finally I have to go and
break the news to them” (Participant 9).
Participants also lost their properties in the disaster. Some lost their homes, clothing, cars,
and shops and other belongings. For some, it was all their live time possession that they
have lost. Due to this, some participants find it difficult to resettle. Some sleep outside
because they are unable to raise funds to rent accommodation. Some who were previously
importers are now selling sachet water.
Some participants who lost properties said;
“…We lost everything. We didn’t pick anything from that house. But you know
people even came and robbed the few things that remained” (Participant 1, female,
36years).
“…I lost all my possessions. My electronic devices, wardrobe, the building even had
cracks” (Participant 5, male, 37years).
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“…Well, we lost a lot of material things. Our clothes, cars and many things”
(Participant 12, male, 32)
For others, the loss of the job appears to have completely redefine their state and they
perceive that they have reduced to nothing:
“…I am into business, I import things. My customer is in Italy and one is in US,
they send me things, mattress, television, fridge and others. I cleared them, I do
supply to my customers in Bogoso, Goaso, Prestea, and Tarkwa… Now I sell pure
water, my ice chest is behind you”. (Participant 2, female, 44years)
Some victims have hard time making a living because their source of livelihood had been
severely affected. For example, some participants said;
“…Since then we have been through hardship. We don’t get money to do
anything” (Participant 3).
Others also indicated;
“…I sleep outside, those are my things. My bags, sponge everything is inside. I
sleep in front of Vienna City.” (Participant 2). Another added; “…it has cost me
my children’s schooling” (Participant 6, female, 63years).
Psychological impacts: This subtheme examines the psychological distress endured by
victims over the years as a result of the disaster they experienced. This captures three
dimensions namely anxiety, behavioural changes, and mood effects.
With regards to anxiety, long after the disaster participants still expressed feelings of
uneasiness and fear about the event and related situations. They reported nightmares and
uncomfortable memories about the event. Some participants expressed anxiety over the
location of the disaster as shown in the following narratives;
“…I stopped going to circle or passing there. I remember one day I was going to
Accra from Achimota, I used 37 instead of circle. It makes my heart beat. But this
year I manage to go there like three times.” (Participant 10, male, 30years)
“…Eeii, I get scared when I see it [i.e. the circle filling station], I panic. After we
were discharged from the hospital I didn’t want to come here. I came and stood at
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an area and decided boldly to come if not the fear will be there forever. So I came
with boldness, courage but sometimes I get frightened with goose bumps.”
(Participant 4, female, 48years).
“…I still use circle to the work and back. When I get there at first it scares me. Right
now, it annoys me.” (Participant 12, male, 32years)
Some participants also indicated that they experience anxiety at specific times such as
towards night, and during rains. “…I get panic, when am sleeping or walking around and
when it’s getting to evening” (Participant 3). Another said “…I am better now but whenever
it rains my fears and anxieties resurges”. (Participant 5, male, 37years)
For others, the anxiety has been globalised or generalised when it rains:
“…When it is about to rain, I remember that day. It often keeps me awake especially
if the rain is falling at night. Aha! And also, I don’t know, when I go upstairs, I
remember the incidence papa. It looks like it is happening again. Fortunately, my
room is downstairs so I avoid the top as much as possible.” (Participant 11, female,
67years).
Some participants expressed his experience of nightmare as follows:
“…I have dreams about it as if it is happening again. Almost every week that
happens to me.” (Participant 12, male, 32years).
“…I always dream about it. It’s like the thing is happening again. I fear at night
because of the dreams. Even during the day sometimes, I dream about it. When I
have the dream and I wake up then I become ‘basaa’ (i.e. disturbed).” (Participant
8, male, 47years)
Behavioural changes include information on some negative changes in the behaviour of
victims following the disaster. This includes changes in sleep, eating and physical activities.
Below are some extracts from their narratives;
“…I can’t sleep. I lie down like that then I open my eyes. I don’t feel fine now”.
(Participant 3, female, 38years) and “…Currently I do not sleep so well, I wake up
at 2 am and can’t go back to bed. Whereas I sleep better outside” (Participant 4,
female, 48years).
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For those experiencing eating related changes:
“…Eating, it is the worst of it all. Sometimes I can be stressed and forget whatever
I am doing. I don’t even feel like eating” (Participant 2, female, 44years), and “…As
for food I can eat a little. When I am eating, I don’t feel its taste, especially when I
remember that I have nowhere to sleep.” (Participant 3, female, 38years).
Nevertheless, some participants indicated that their sleep and eating patterns had not
changed that much. Below are some narratives;
“…As for eating honestly I can eat normal.” (Participant 10, male, 30years), and
“…As for sleeping, I sleep well… No. Me, I dey eat paa oh (i.e. I eat so much) …”
(Participant 6, female, 63years); “…I don’t think my eating has been affected that
much. When I feel hungry and I get the food I can eat. So, I think that it is okay.”
(Participant 11, female, 67years).
With regards to physical activities, some participants reported loss of energy and zeal or
motivation. One participant said the following;
“…I wasn’t enjoying myself and the things I used to do in the past and it also
impacted on my work. Because now even waking up and preparing for work became
a challenge.” (Participant 1, female, 36years).
Mood effects describes the emotional feelings such as sadness, depression, loss of interest
by victims of the disaster and anger. Some said they cried, felt sad and lost interest in
activities. One of the participants responded that “…I wasn’t enjoying myself and the things
I used to do in the past” Participant 1). Largely, these experiences underscore depressive
symptoms among the victims. Below are some other quotes from other participants;
“…My brother, it is tough for me. If not my wife, hmmm. If it were some women,
they would have left me. I have been crying aaa. I feel really sad.” (Participant 8,
male, 47years), and “…I was thinking a lot. I still think but not like last year… I was
getting angry too. The only thing is that I try not to offend the children.” (Participant
9, male, 47years).
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A victim who was physically deformed by the disaster shared how difficult it is for him in
public places. His ordeal affects the children as well as he indicated that the friends of his
children will mock them when he turns up in the children’s school. This is what he said;
“…I can be very sad because my children when they say their parents should come
to PTA I can’t go again because their friends will laugh at them.” (Participant 8,
male, 47years)
He also lamented how the general public add to his pain.
“…It’s not easy my brother. If I go and join a trotro, people don’t want to sit on the
seat with me. Meanwhile I didn’t bring this upon myself. But the thing is that as for
the people they don’t know what happened to me. No, I look very scary. When I see
people’s reaction then I start to cry. I can’t hold the tears. Hmmmm.” (Participant
8, male, 47years)
Adjustment experiences
Victims have endured lots of emotional and physical difficulties as a result of the disaster
over the years. This theme describes the resources that help them to live through the difficult
times. These include how society intervened in order to assist the participants in their
difficult moments. It also explains how families have been of support to participants. There
are however some experiences of vulnerability which might impede how well participants
might have adjusted to the disaster effects. Therefore, there are four subthemes under this
theme namely societal level intervention, family level intervention and spiritual support and
post disaster vulnerability.
Societal level intervention: This describes interventions from society to support participants
during and after the disaster. It was also noted that assistance from unrelated people, public
figures and philanthropists was also helpful to victims. At the time, some political figures,
footballers, and well to do Ghanaians were reported to have donated items and money for
the upkeep of victims. Some also supported victims directly. Although participants’
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responses indicated that these resources were not sufficient, but rather more driven towards
attenuating acute crisis, they provided some initial relief:
“…It was Ken Agyapong who promised to take care of that child .so he asked me to
look for school for him so he paid everything. 11 million old currency…. Mr Osei
Kwame Despite also gave me some money. I used some to sew uniform for the
children among others. I rented a room for 2 years. After the advance expired, I
couldn’t renew it” (Participant 2, female, 44years)
As indicated above, the support received by the above participant lasted only during the
early phase of the crisis, but ceased afterwards.
Some participants were critical of the support they received, casting insinuations of
corruption and inefficient distribution. For example,
“…We even heard that Asamoah Gyan came to donate some money to us. But it was
only one tin of milo and cowbell that we were given to go home.” (Participant 10,
male, 30years)
Some participants also got support from government especially through the NADMO. For
example, one participant said;
“…A lot of support for possessions came. NADMO also came. Government gave us
GHS 100 for 3 months. They registered us and gave us and ATM card [Actually an
ezwich card] which we withdrew funds for just 3 months. From there I did not get
anything again. (Participant 5, male, 37years).
The above also reiterates the insufficiency of the support participants received after the
disaster. This signifies the temporary reliefs offered participants. However, the long term
needs of the participants would not be appreciated by society.
Some participants also received support from friends. For example,
“…My friends have been good. Even though most of them died, the few I have, have
been good to me. I also hassle small, small.” (Participant 10, male, 30years) and
“…Eee as for friends in terms of dresses, clothes they helped but not anymore”
(Participant 2, female, 44years).
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Another participant indicated that things are still hard that she had to fall on friends
sometimes for money and good to sell and pay back later:
“…Sometimes, when I see my friend, I beg for money say GHC10.00 and they give
me. I collect cake from a certain woman and sell then I return the proceeds”
(Participant 3m female, 38years).
Another one also said that the sympathy and emotional support from friends was helpful:
“…There were a lot of friends who sympathised with me and my children. There
were calling and encouraging especially the church people” (Participant 9, male,
42years).
Family level intervention: Participants also reported how helpful family members have
been in the trying moments of their lives. For many of them, relatives came to their aid. In
this case, some participants supported by family members to relocate. Others were re-
established in order to make a living. For example, “…My children try to help me. As I told
you they put up my shop again for me” (Participant 11, female, 67years).
Some participants said their relations who were abroad and heard about their ordeal came
to Ghana to support them:
“…As I said, physically my brother came down and bought the little, little things
that would make us comfortable. (Participant 1, female, 36years)
“…my daughter lives at Italy… so my daughter come down and she came to help
me to acquire those things back… helped me to build my own house where I now
live” (Participant 7, male, 60years).
Another participant also expressed joy about how family members had been supportive;
“…My family was very supportive. They have helped me raise the kids this far. I
don’t really need money or materials from them. They have provided us with
emotional support. They were really there” (Participant 9, male, 42years).
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Spiritual Factors: Some participants also used religious or spiritual coping methods such
as praying and attending church. For example, some participants recounted that;
“…I have become stronger in faith and even now I have learnt a lot. Anytime I look
back to that experience, I know that God had a hand in it.” (Participant 1, female,
36years) and “…I thank God for life. At first, I didn’t mind. Now I am close to God.
It has also made me manage the little I have now.” (Participant 10, male, 30years).
The participant 10 was explicit even that it was the disaster that made him start going to
church as in the following;
“…at first I was not going to church. It is now that I am going. They don’t know
anything about my situation. But for me I go to church now because I know what
God has done for me.” (Participant 10, male, 30years)
For most of the participants, being alive is valuable than the possessions they lost. This gives
them some strength to ride on. They appreciate that a supreme being (God) is the holder of
all lives and that one must be grateful if we have life:
“…I appreciate life now than before. You can just vanish like that, so when we have
a day, we must be grateful. Now I see people do things and I tell myself that they
have not seen anything in life” (Participant 9, male, 42years)
“…It has made me appreciate people a lot. And also, I value life. It is very simple
to die. But God is the one that keeps us alive. I now try to be closer to God”
(Participant 12, male, 32years).
One participant expresses how God has been personal with him. He believes that he is
precious to God and that might have spared his life. “…I am precious to God. Having my
life alone is precious to me. That is my strength…I know God is on my side. There is
always hope once there is life.” (Participant 7, male, 60years). This participant also
implies that life without possessions is sufficient. This must be a strong resource for
coping with disaster effects.
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Post disaster vulnerability: This subtheme describes the factors and situations that expose
victims to negative post disaster effects. They include situations during the disaster and
those afterwards. Some of these vulnerabilities include poor or delayed response by rescue
teams and this may create a sense of helplessness in the face of the disaster. One
participant said that;
“…Then I started calling the police 191 and they weren’t picking. It was ringing and
nobody was picking… So, this thing happened after 9pm, it around 3am that the
military people came. But when they came, me I could see that the water was even
going down.” (Participant 1, female, 36years)
“…We did not have NADMO number. Later we saw the police and fire service, so
we asked them to come to our aid, but they said they are protecting the Bank, so they
cannot come to our side. It was after over an hour before they came to our house.”
(Participant 4, female, 48years).
It also emerged that lack of support from government for some of the victims risks
aggravating their plight. One of the participants was explicit in her submission as follows;
“…What I have to say is a plea. As I speak, I have 4 children and because of this
disaster they all face problems with their schooling. Each of them stays at a different
place but what every parent want is to see her children with her. Now whether they
eat and how they sleep I don’t know. We have heard that World Bank gave money
and Goil too. The government also promised … the president of Benin has brought
us money and NADMO officials confirmed it. What are they waiting for? The money
came because of the disaster. They should just give what belongs to us as a matter
of urgency to help us start something”. (Participant 2, female, 44years).
Other participants also supported this with the following submissions.
“…I think government must do something; they must sympathise with us. If they
promise something and they are not doing it, they should know that we are
suffering.” (Participant10, male, 30years)
“…Not knowing they selected about seventeen people, out of all this people and gave
them 100 million, they brought it to the media and we saw it on the tele. So, we think
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everybody who is affected can have that opportunity. I went there and that is what
they told me I wasn’t burnt and after all I did not die, it was only the burnt ones and
the dead ones that their taking care of. (Participant 6, female, 63years)
“…As for government, God will judge their actions. That is all I can say about them”
(Participant 9, male, 42years)
Another factor that poses risk for victims is lack of professional psychological intervention
for victims. Responding to the question whether they were counselled or seen by a
psychologist/counsellor, participants responded in the negative. Below are some of the
narrative;
“…I didn’t know about that. That time we were all too busy putting the house in
order. There were too many information those days. So, I didn’t know about that.”
(Participant 11, female, 67years).
“…No. I heard there was something like that but at the time they were doing that I
was busy looking for my wife. I told you that it took me 7days to get her body.”
(Participant 9, male, 42years).
“…No. I never had any such support” (Participant 6, female, 63years).
“…Those people [referring to psychologists] are scares. I have not seen one before.
But I know they are there” (Participant 12, male, 32years)
Another situation that exposed the participants to vulnerabilities is seeming neglect by
family relations.
One participant said the following;
“…And later when I broke down, no one. Even the chief, the king that town is my
cousin son, I send him a message looking for help. They told me they will meet the
family and whatever come of it he will let me know. Maybe is today that we are
discussion, is today that he will come. So as for my immediate family which is my
children, they are doing their possible best at least to assist me.” (Participant 6,
female, 63years)
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“…Eeee as for the family we were all there at the time of the disaster. My father is
late, his next of Kin was involved as well as the siblings so who will help who? So,
there is nothing like family support.” (Participant 2, female, 44years)
For one particular participant, she had lost all family members in the disaster (the first-
degree family members). This renders her alone especially because the extended family
members were not part of his life. This is what she said; “…I have no family members left.”
(Participant 4, female, 48years).
Job loss is another risk factor among victims that exposes them to posttraumatic distress.
This is indicated in the following statements;
“…I am worried about my job. What will I do? It has been 3 good years. I keep
living on arms.” (Participant 10, male, 30years)
“…Life now is bad. No money, no job, and this skin. It is very bad now.” (Participant
8, male, 47years)
Summary of Qualitative Findings
In all, the qualitative study reveals the experiences of the victims of the 3rd June disaster in
Accra. It reveals the physical and psychological challenges the victims endured over the
years as a result of the disaster and the factors that underscore how they adjusted either
positively or negatively to the impacts over the years. Their perceived causes of the disaster
include under engineering failures and anti-environmental behaviours. Their experiences
include biographical disruption such as disfigurement, death and loss of property, and
psychological impacts such as anxiety, behavioural changes and mood effects. Participants’
adjustment experiences involve societal level intervention, family level intervention,
spiritual support and post disaster vulnerability.
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CHAPTER FIVE
DISCUSSION
5.0 Introduction
This chapter presents the discussion of the findings of the study by integrating both the
qualitative and quantitative findings. The points of convergence and divergence are also
presented. The chapter also presents the contributions and implications of the findings of
the study to knowledge, research, clinical practice and policy decision. Finally, some
recommendations and conclusions are made.
Link between Risk Factors and PTD
One of the major objectives of the study was to examine how risk factors relate to PTD. To
examine this, neuroticism, assumptive world, previous traumatic experience, and
independent self-construal on PTD were tested. It was found that neuroticism, and previous
traumatic history significantly predict PTD (general psychological distress and PTSD).
Independent self-construal and assumptive world however do not predict PTD. These
factors are discussed in succession. It has been generally established in the literature that
disasters result in distress (e.g., Chung & Kim, 2010; Dewaraja & Kawamura, 2006; Mason,
Andrews, & Upton, 2010; Neuner et al., 2007). However, factors that predispose victims to
distress after disasters are still been investigated. Some of these factors are those found by
this result. These factors are known as risk factors.
Neuroticism: The study found that neuroticism significantly predicts PTD. This means that
a person with neuroticism will more likely experience higher levels of psychological distress
after disaster. The association between high neuroticism and likelihood of PTD has been
reported variously (e.g. Breslau & Schultz, 2013; Ogle et al., 2017; Sveen et al. 2016). Since
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people with this trait are bedevilled with negative emotionality, their coping abilities will
become poor when adversities arise. This may increase their distress level.
Personality traits such as neuroticism are enduring. This means that people with neuroticism
will already have enduring emotional challenges before they encounter the traumatic event.
This is why such people are more at risk of experiencing higher levels of PTD. This must
provide a cue for intervention programmes for victims in order to address the personality
factors that could impact victim’s distress levels.
Previous traumatic history: Previous traumatic history is another factor that significantly
predicted PTD in this study. Many people experience at least one traumatic even in their life
time (Bonanno & Mancini, 2008). According to Mock and Arai (2011), these experiences
make the individual vulnerable to future negative health impacts. This means that in Ghana
and other low- and middle-income countries where disasters are projected to increase, many
more people in the near future will experience more posttraumatic distress.
Previous disaster experiences weaken resilience capacity and expose people to
psychological distress (Greenfield, 2010; Pine & Cohen, 2002). This means that continuous
exposure to trauma tends to break down coping resources. Interventions following trauma
experiences are limited in Ghana and therefore not many people receive the needed post
trauma care. Therefore, people exposed to trauma do not develop resource capacity to deal
with the challenges following the adversity. There is Therefore inadequate or weakened
resources to deal with subsequent. In this regard, more traumatic experiences would tend
to increase distress levels.
The population for this study resides in a setting that has experienced several flood disasters
over the years. Floods have become a perineal disaster in Ghana with Accra experiencing it
every year (Asumadu-Sarkodie et al., 2015). Each year this disaster happens, victims
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become displaced and disorganised. They barely get restored before another disaster
happens. This will significantly affect their ability to deal with the current disaster. Other
traumatic events that people might have experienced in addition to natural disasters include
physical and sexual abuses, road accidents and robberies as seen in the findings of Anda et
al. (2006). In this regard, people who suffer such traumas will equally be susceptible to PTD.
It is therefore imperative that people who report any form of abuse or trauma be taken
through thorough assessment and treatment in order to alleviate the psychological
challenges they may experience. This is because, when this is not done and they are faced
with any tragedy in the future, they may struggle more than the need be due to accumulated
impacts. Some of the impacts include anxiety, depression and aggressive behaviours
(Gilbert et al., 2009).
Further support was obtained from in-depth interviews regarding factors that might risk the
development of PTD. For example, delayed or inefficient support from government such as
delay in rescue operations and inadequate relief items, and seeming neglect by society after
the disaster, lack of professional psychological intervention, and lack of family presence
and support. All these factors collectively indicate that lack of support is associated with
vulnerability to distress.
The qualitative findings revealed that victims expressed the need for support during the
disaster. This support is in terms of rescue and relief. It was reported that rescue team arrived
at the disaster scene late. Also, upon arrival, priority was given to monuments over lives.
This can create a sense of neglect among victims during disasters. Some victims reported
that by the time rescuers arrived, they had managed their way out and most damages had
been already caused. This can leave a permanent memory of insecurity when victims sense
danger later in their lives. One of the ways of calling for help during disasters in Ghana is
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by reaching out to the security services and the NADMO. Some victims said when the
numbers of the police were called, there was no response. The emergency contact number
of the NADMO is barely known by most Ghanaians. There is the need for effort to create
awareness and revamp response processes within this service in the country.
Relief items were not enough for victims after the disaster. A participant reported that she
was told that the items are for only those whom were burnt by the fire. However, there were
victims who were not personally burnt but had their houses burnt. They deserve relief items
too. In terms of hospital care, all victims should be given access to medical care regardless
of the extent of the effects they had. Such medical cares must also be prolonged since some
may have delayed onset of symptoms.
Unfortunately, professional psychological support was not available to victims. This would
have helped victims to better cope with the situation (Kline et al., 2018; Linares et al., 2017).
All participants interviewed said they did not have any psychological intervention. Even
though a support centre was set up immediately after the disaster, the centre seemed far from
the disaster scene. Victims also complained that they had too much information to deal with
at the time so could not access the centre. This has implications for post disaster first aid
interventions especially in terms of setting, information, personnel for the intervention and
general strategy.
Some participants also indicated that family members were not available to support them.
A participant mentioned that his family member cannot be countered on. This sends a signal
of neglect. Regardless of the challenges between family members, adversities present the
opportunity to settle differences. If there are no differences and this neglect is portrayed, it
will further affect the victim’s coping process. These factors underscore the importance of
social support during and after disasters.
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Independent Self-construal: The quantitative result showed that independent self-construal
did not predict PTD in this study. This means that people who view themselves to be distinct
from others in the community, more or less individualistic do not tend to experience any
higher distress levels after the disaster experience. This is contrary to the position of Jobson
and Kearney (2006) that people who are self-centred after disasters suffer more
posttraumatic difficulties. It also contradicts Hafi and Shafi (2014) who opined that cultural
orientations influence how distress symptoms are expressed. The idea is that people who
are not communal are less likely be prepared or able to share their challenges in order to
receive support that is available for their ordeal.
However, when disaster strikes, most communities become concerned and supportive where
the lack of that support may result in distress as indicated earlier. In Ghana, support is high
usually during and a little after the disaster. Goverenment provides support in various ways
especially through the NADMO. Familes set out to support and friends lend helping hands.
These supporte are usually made available to everyone regardless of their cultural
orientation. Nevertheless, to be able to enjoy continuous support from the community may
depend on how related one is to others in the community. This is because, many forget the
victims after a short while. But those who express their concerns get the sympathy and
support they may need. A victims with independent self-construal may not readly seek for
support when even things become difficult. For example, such people may not be able to
seek refuge with friends or neighbours when their house is flooded. They may also not be
able to ask for financial or other material support in order to be relieved of their immediate
effects of the disaster. This not withstanding, the finding shows that it does not affect their
PTD levels in any significant way maybe because they have been able to live separately on
their own.
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Assumptive world: Assumptive world did not also predict PTD. Assumptive world is how
people typically expect the world to turn out for them. Typically, disasters defy people’s
expectations and leave them with long-term impacts. However, in this study, assumtive
world did not predict PTD. Thus, it is important note that even if the assumptions people
have about the world tends to be challenged and shattered by disasters, this does not
determine whether they will relive the traumatic experience or suffer other psychological
impacts. Perhaps the relationship between assumptive world and PTD may be enhanced by
other factors.
The theory of shattered assumptions indicates that because people with high positive
assumptions about the world tend to perceive the world to be benevolent, meaningful and
predictable, they get shattered when disaster strikes them (Janoff-Bulman, 1992). Perhaps,
they tend to struggle to come to terms with the realities of the event. Maybe, after they
accept the reality then they tend to accept what actually happened to them.
Perhaps, the attribution of the cause of the disaster may also influence victims’ assumptive
world and subsequent distress level. From the qualitative findings in this study, it was found
that victims attributed the causes of the disaster to engineering failures and anti-
environmental behaviours exhibited by citizens. It was lamented that construction works at
the time precipitated the disaster. In 2015, the Kwame Nkrumah Interchange was upgraded
into a three-layer overheard. This construction took several months to complete. During the
raining season, the water ways in the area got choked and caused flooding. Ideally, path
should have be created for running water ahead of the rains to avoid such tragedies. The
situation became worse because generally, drainage in Accra has been poor. This agrees
with Asumadu-Sarkodie et al. (2015) who reported that Accra has a poor drainage system.
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One participant said the construction works on the N1 high way had blocked a big gutter in
their area.
Some drains in Accra are too small. In some area there are none. Some are also damaged,
creating danger for human existence. In some cases, when it is raining in Accra, commuters
are not able to identify the end of drains. They either walk or drive into the drains when
there is an overflow. Roads get flooded during rains in Accra. In fact, the Kwame Nkrumah
interchange that was constructed around the time of the disaster began to be flooded a year
after commissioning. There is the need for a review of construction activities in the country.
It was reported that fuel reserved in an underground thank leaked onto the surface of the
water. This also raises some engineering concerns. It also reveals poor maintenance culture.
Fuel stations need regular check and maintenance to avoid leakages and explosions.
Anecdotal data reveals that this is a requirement for the renewal of operation license in
Ghana. However, concerns have been raised about how functional this regulation has been
especially following series of similar disasters in the country.
Human behaviour towards the environment is a crucial factor in disaster occurrence.
Negative behaviours endanger human lives by exposing them to dangerous structures in the
environment. There is indiscriminate disposal of refuse especially into drains in Accra.
When it rains, the refuse block drainages leading to poor flow of running water. At the
Kwame Nkrumah Circle where the disaster occurred, most people complained about how
the main drainage that connect water to the sea is chocked by refuse. During the interviews,
a participant indicated that when you see people dispose refuse into the gutter and you
caution them, they insult and ask if the gutter belongs to you. This problem therefore
compounds the already narrower, unmaintained drains that are in the country.
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Some Ghanaian households do not have toilet facilities. For that reason, the drains became
the grounds for dumping their faecal matter. People typically would tie these wastes in black
rubbers and drop them in the drains. These behaviours can clearly be described as anti-
environmental since they tend to deteriorate and endanger lives.
With these evidences in mind, residents may already anticipate disaster especially in the
raining season. This means that their assumptions that the world is meaningful might have
been already challenged. Therefore, they are less likely to feel the shock of having their
assumptive world altered after the disaster, and consequently less impact on their distress
level.
Link between Protective factors and PTG
The second major objective in this study was to examine the effect of protective factors in
PTG. The results indicated that social support, belief in just world, resilience, and religiosity
significantly predict PTG. It was however found that self-efficacy does not predict PTG.
Protective factors are factors that sooth an individual against negative impacts and promote
wellness. As indicated, four out of the five were found to promote PTG among disaster
victims.
Social support: Social support is one of the protective factors that significantly predicted
PTG. However, the result shows that social support is associated with a reduction in PTG.
This means that victims who received more social support are likely to experience less
growth. This is contrary to the popular understanding on the role of social support in PTG,
contradicting the findings of several studies such as Feeney and Collins (2015), Yi et al.
(2015), and Platt et al. (2014). Social support involves assistance from friends, family and
significant others in society. According to Berkman and Glass (2000), these supports from
people around us motivates the individual to adopt positive self-care behaviour and to
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develop a sense of security and self-worth. It is also said to restore health and wellbeing
(Sarason et al., 2001).
Social support systems in Ghana after disasters include government aids, assistance from
friends and families, and support from philanthropist and other well-meaning Ghanaians.
Usually, government assists victims through the NADMO by providing relief items and
supporting with medical care. Ghanaians also support through cash and material donations
to victims. In many communities, the community leaders offer school classrooms and
palaces for displaced victims. Churches and mosques are also released for the same purpose.
Non-Governmental Organisations (NGOs) also provide assistance in disaster periods in
Ghana. Families receive their relations to stay with them, they provide necessary needs and
support victims emotionally. These systems are expected to help victims to recover quickly
and grow from the impact of the adversity as also indicated by Han et al. (2019) and
Oniszczenko, and Firla (2017).
However, rather than experiencing growth, victims with higher social support experience
less growth. People who receive support from others in times of need may tend to feel that
they are a burden on their supporters and as such feel embarrassed. In view of this, Sheikh
(2004) conclude that the role of social support in PTG is unclear.
In the case of the flood victim who has lost his belongings and home, it should be a big deal
to now live with others and practically be cared for. The current population under study have
victims whose homes were destroyed by fire. This means that it would take months for them
to get another descent house for relocation. Perhaps, a person who previously used to be the
source of support for people is not being supported, thus creating a sense of defeat and, pain
and guilt.
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The findings of the qualitative results in this study on the other hand agree with the common
understanding of the role of social support in difficult times where participants reported
social and family level interventions as some of the resource for coping in their hard times.
Social support features prominently in the interventions identified in this study. Both the
societal and family level interventions portray social support as a key resource for the
disaster victims. This corresponds with the literature where social support have been found
as a significant coping resource or protective factor against PTD (e.g., Feeney & Collins,
2015; Han et al., 2019; Sarason et al., 2000). It is also in consonance with the finding in this
study that social support predicted a reduction in PTD.
Societal level intervention received by victims included support from politicians,
philanthropists and sympathisers. It also included government assistance either in cash or in
kind. Usually in Ghana, government offers relief items to victims during disasters. These
include mattress, bucket, food items, water, and cloths. Other well-meaning Ghanaians also
provide items that may be of need to victims. Participants reported that they received such
items from government and sympathisers including money. However, they were also quick
to add that these items especially the money was not sufficient. One participant mentioned
that after renting an accommodation with the money she received for two years, she was not
able to renew the rent because the money was finished and her job was crippled by the
disaster.
It was also indicated that government paid the medical bills of victims who were
hospitalised. At least that would relieve the victims and families of the financial burden that
comes with treatment for injuries during disasters. Again, some Ghanaians also donated
various items to victims while they were at the hospital. People visited them, sympathised
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and prayed with them. This inspires some sense of belonging, collectivism, care and self-
worth among victims (Berkman & Glass, 2000).
However, there is a seeming corruption and political game in times like this. Victims
indicated that government promised them compensations but they never had it. Some also
said donations that were meant for them did not reach them. While some well-meaning
citizens will be willing to help, others are found to be making personal gains at the expense
of victims. There is the need for a protocol in the donation and distribution process during
disasters in order to avoid instances of corruption and personal and political interests.
The availability of support from friends is a significant factor after the experience of
adversity. In fact, this is when to know real friends. Sometimes, families may not have the
support a victim may need. Friends may provide that support either financially or
emotionally. As Oren and Possick (2009) indicated that people may receive support from
friends when they are in need. This support may be received whether the victims have asked
for it or not. This emphasises the need for communal existence which characterises
collectivistic societies.
Family social support during adversities is an invaluable one, augmenting the positive
effects of disasters (Platt et al., 2014). In a typical collectivistic culture like Ghana, family
may typically feel affected when a family member is stricken by an adversity. Support from
family members may come in various forms. In distress, people may receive emotional
support from family members just as they may receive from friends. Some may receive
physical support such as money and clothing. In this study, some participants had their
sources of income re-established by family members while others had houses build by their
family members for them. Seeing relatives showing care when in trouble would be
encouraging and soothing.
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This finding has implication for communal living. People with good connection with family
and friends may tend to be more supported in addition to what they enjoy from government.
Communities must also endeavour to stay cohesive and supportive especially in adverse
times since this will provide relief and growth for victims.
Religiosity: This study also found that religiosity significantly predicts PTG. Religiosity
offers similar support towards growth after disasters as social support (Chan & Rhodes,
2013). It has been argued that religiosity actually provides meaning for suffering and that
lessens the adverse effect of disasters (Oren & Possick, 2009).
Taku and Cann (2014) explained religiosity as one’s religious affiliation and strength of
religious beliefs. This provides people with relationship with God and people in their
religious circle. The people within one’s religious group can be a source of physical,
emotional and spiritual support in times of adversity to victims. They could help with
prayers, money, cloths, food and housing. These activities will serve the same purpose as
social support does as indicated above. Religious leaders may counsel their members who
are traumatised and assist them to receive the necessary interventions. The individual may
also look to God in the trying moments and will perceive that God is on their side. They will
ask for God’s protection and strength to pull through the challenges.
In Ghana, Christian and Islamic groups organise prayers for victims of disasters. They visit
them while they are on admission and offer prayers and donations. It is yet these groups that
provide residence when victims or members are displaced. Their activities depict love and
emotional support that victims need in the face of adversity.
Similarly, from the qualitative results, it was found that victims also utilised spiritual and/or
religious support during these hard times. Some indicated that they now see that God is on
their side. This belief in a higher Being creates a sense of identity and renewal of faith. This
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in turn may create a sense of protection and hope for victims. This is because, a victim may
feel that if God does not allow them to perish in the disaster then he will protect them in
other trying times in life. Participants indicated that they are now closer to God their maker
and try often to be in his presence (that is in Church). This means they may also become
religious and this in turn will be supportive for them (Chan & Rhodes, 2013). One
participant said he now goes to Church and he alone knows why he does so. According to
Ha (2015), this can help victims to understand the disaster better. Watlington and Murphy
(2006) also maintained that being religious facilitates reduction in deppressive symptoms
and PTSD.
Belief in Just World: Belief in just world another protective factor for PTG in this study.
Belief in just world implies that whatever happens is deserving and that there is a reason
and an opportunity from it. In the face of injustice, this belief enables the individual to
restore a sense of justice in order to by assuming that it needed to happen (Dalbert, 2001;
Furnham, 2003). This interpretation of traumatic events tends to lower the negative impact
of the event. This will also afford the individual strength to match forward towards growth
after the adversity.
Indeed, things happen for a reason. It is up to individuals to assign either a positive or
negative reason to the events. When people see opportunity in negativity, they are more
likely to fight harder and stay stronger (Bulman & Wortman, 1977; Dalbert, 1996, 1997).
For example, someone who survives a fire disaster may be thankful to God and see how
much God loves him/her. This will give them a renewed sense of life and purpose to get
closer to God and be more responsible.
Resilience: Resilience was also found to predict PTG in this study. This is supported by
other studies such as Mahdi, Prihadi and Hashim (2014), Yu et al. (2014) and Austin et al.
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(2017) all of which found that resilience produces PTG. People who are resilient would
stand strong when challenges arise. This helps them to navigate the processes required to
defeat the negative impact of the challenge (Tomaszek et al., 2018).
Resilience helps people to cope better, live beyond expectation and function stronger when
challenged. Such people will also expect the best out of adversities. They would look for
opportunities and utilise them for the betterment of their lives. This is the whole process of
adaptation in adverse times (APA, 2014).
Self-efficacy: It was however found that self-efficacy did not predict PTG contrary to the
trend in the literature. Zulkosky (2009) indicated that high self-efficacy helps people to deal
with difficulties and studies such as Lotfi-kashani et al. (2014) and Li et al. (2012) found
that self-efficacy promotes PTG. In the current population of study however, the finding
does not support the previous studies. This means that even if people with high self-efficacy
are able to manage their difficulties, it does not translate into growth after an adversity.
Maybe victims were not able to utilise how efficacious they are towards growth. Perhaps
other factors were relied upon more such as religiosity and social support. It is possible that
when other factors are available and much stronger, people may tend to utilise them more
over others. This defeats the assertion that self-efficacy is a central factor in how people feel
and adapt to their environment as shown by Benight and Bandura (2004). Where support is
available in the community, self-reliance and control does not seem to be most significant.
In the qualitative findings however, victims indicated the use of personal strength to forge
ahead. They engaged in self-encouragement and engagement in actions that will eventually
offer them relief. This resonates with the use of prayers and decisions to work harder to
replace their lost possessions.
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The Moderating Role of Protective Factors on the Link between Risk Factors and PTD
The study also revealed that some protective factors significantly moderate the relationship
between some risk factors and PTD. It was found that religiosity significantly moderated
the relationship between assumptive world and psychological distress, resilience moderates
the relationship between independent-self-construal and psychological distress, social
support significantly moderates the relationship between neuroticism and psychological
distress, and self-efficacy and resilience significantly moderates the relationship between
neuroticism and psychological distress.
Largely, all five protective factors in this study moderated the relationship between risk
factors and PTD. This means the relationship between the protective factors and PTD is
indirect modifying the strength of the relationship between risk factors and PTD. For
example, someone with multiple previous traumatic history may still be better in dealing
with posttraumatic challenges if he is religious and receives the needed attention from his
congregation. Also, if support is available for victims from people around them, the negative
impact of disasters will be minimised regardless of the individual’s personality trait.
In times of adversity, people must utilise factors that are protective against distresses.
Religious bodies and leaders must use their activities to alleviate pain after disasters,
government must adopt the needed relief programme for support victims, and families and
friend must as well be there for victims. Even before disaster, individuals must also develop
their capabilities and resilience levels. People must adopt positive meanings to events and
be prepared for any eventualities. By so doing, the presence of risks and traumatic events
will only produce minimal effect on lives.
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Relationship between Protective Factors and PTD
The fourth major finding of this study is that social support, self-efficacy, belief in just
world, resilience and religiosity are negatively and significantly correlated with PTD
(psychological distress and PTSD). This indicates that people’s experience higher forms of
protective factors is associated with a reduction in the distress levels they experience just as
being argued earlier. Even though this does not imply causation, it indicates that protective
factors serve a soothing role after disaster experiences. It was however found that social
support significantly predicted PTD among the other protective factors. It can be argued that
the chances that distress levels will reduce when protective factors are available is high
among victims (Masten & Reed, 2002).
It is clear so far that disaster victims have the opportunity to grow and experience less
negative impact. It is however relevant to reiterate that growth will not completely replace
or prevent distress after adversity (Maitlis, 2012). However, when a sense of growth or
positivity is acquired even in the wake of frustrations, it will help to deal with the negative
outcomes more adaptively.
Relationship between PTD and PTG
The final objective of the study was to examine the relationship between distress and growth
after disaster experiences. It was found that a significant positive correlation exists between
PTG and PTSD contrary to a negative prediction that was made. Actually, the literature has
presented disagreement on how related PTD and PTG are (Zoellner & Maercker, 2006).
Some findings suggested positive relationship (e.g. Cadell et al., 2003; Solomon & Dekel,
2007). Other studies found negative relationship (e.g. Palmeret al., 2016). The current
finding corroborates other findings that established positive relationship between PTG and
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PTD. This means that higher distress levels correspond with higher growth after disaster
experiences.
Victims that are more distressed tend to utilise more resources to be able to survive the
challenges. They may acknowledge their challenge and seek assitance, or turn to God since
these factor result in PTG. It is often said that until you are in trouble, you would not
appreciate you strength. Therefore, people who are devastated by traumatic event may
appreciate life and see their survival as an opportunity and so will strive for and acomplish
growth. This is the impport of the OV theory that since there is life, there is hope (Joseph &
Linley, 2005).
If the disaster does not kill the individual, it will make them stronger. Victims will surely
wish to bounce back stronger and better than before the disaster. This does not prevent the
memories and pains and fears. However, they could be a conduit for motivation and
growth since it is an innate disposition for everyone to develop so long as there is life
(Sheldon et al., 2003; Maslow, 1955).
The Experiences of Disaster Victims
The experiences of disaster victims are important in whatever is done to support them. By
considering their experiences, interventions can be tailored to benefit victims. The findings
from the qualitative results in this research show significant experiences of victims of the
3rd June, 2015 flood/fire disaster in Accra, Ghana. These experiences will have implication
for clinical, social and political interventions. The findings are discussed in this section.
The experiences of victims of include physical and psychological effects. The physical
effects are described biographical disruption. Biographical disruption describes the presence
of a long term or chronic illness that alters and impedes one’s behaviour. Participants
suffered physical effects ranging from personal injuries through the loss of properties to the
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death of their loved ones. These have left them with significant disruptions impede their
general live and daily functioning. This finding concurs with Du, Fitzgerald, Clark, and Hou
(2010) and Noe et al. (2016). Jonkman and Kelman (2005) also indicated that there are
usually deaths during floods especially through drowning. In the 3rd June disaster in Accra,
many people were drowned, many others were burnt though the fuel station explosion. Thus,
apart from the over 150 lives that were lost through the explosion, there were several other
bodies discovered that were dead through drowning.
Unfortunately, it is predicted that more lives will continue to suffer due to flood disasters in
Africa (EM-DAT, 2015). This is true because in Ghana, subsequent years following the 3rd
June disaster lives were lost again through floods in the capital city. This probability is due
to the anti-environmental behaviours citizens exhibit that precipitates disaster occurrences.
Of course, the drains and engineering mistakes have not change.
During disasters, some populations are more vulnerable ((Paul et al., 2018). These include
children, women and the aged. With the perineal flooding in Ghana, these in the era of
increasing aged population, more of such lives will be affected. This is because the more
disaster that occur, the more lives are affected (Coker et al., 2006; Neuner et al., 2007). This
poses strong national challenge that requires immediate attention.
The disaster has caused permanent physical disability for some victims. Some are unable to
walk, work and socialize. It is reported in the literature that these effects are as a result of
pricks from sticks, bottles and snake bites when victims are struggling to swim off floods
(Lindell & Prater, 2004). In the current disaster under study, participants reported similar
events. One participant indicated that she probably might have hit her hip against a container
that was submerged in the water. Other had their injuries through the fire/explosion.
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Lindell and Prater (2004) reported that natural disasters cause massive property damages or
losses. As a result, victims usually become homeless (Paidakaki, 2012). As the result of this
study showed, some participants reported that they have been sleeping outside in front of
shops for some time now because their houses had been destroyed by the disaster and they
currently are not able to rent a place to stay. Apart from homes, jobs were lost. Victims had
their workshops destroyed completely. People had their goods destroyed and their moneys
burnt up in the explosion. A participant reported that she used to import goods and sell but
now she sells sachet water. The crucial aspect of these effects is that they have significant
implication for psychological health among victims (Frankenberg et al., 2008).
These effects also affect economic activities of the state (Klomp, 2016). Government was
compelled to foot the medical bills of victims who were hospitalised due to the disaster. Till
date, victims still expect and demand from government compensations for their losses.
Immediately after disaster, government also need to reconstruct affected roads, bridges, and
monuments. In Ghana, the NADMO tends to be overstretched during disasters since victims
tend to require relief items beyond expectation. Since many people tend to be affected by
disasters, their jobs and earnings get affected and that translate into poor savings and, poor
GDP and related economic indicators (Brei et al., 2018; Klomp, 2016; Ladds, Keating,
Handmer, & Magee, 2017).
Indeed, victims expressed psychological impacts of the disaster on their lives. The
psychological impacts associated with disasters is extensively demonstrated in the literature.
For the current study, mood disturbances, anxiety related effects and behavioural problems
were reported. These reports are in tune with Haqqi (2006), Griensven et al., (2006) and
Chung and Kim (2010).
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PTD is a major psychological concern among disaster survivors (Hussain et al., 2011). This
includes anxiety, depression, hypersensitivity, and insomnia (American Psychiatric
Association, 2013b). Victims in this study reported most of these distresses. They feel
depressed and cry a lot, they are anxious, unable to sleep, have high interpersonal sensitivity
and poor appetite.
These distresses have implication for suicidality among victims (Guo et al., 2017; Kolves et
al., 2013). Orui and Harada (2014) pointed out that suicidal implications of disasters is high
among females in the whole. Another group that may be of concern in this instance is those
with higher losses during the disaster. Fang and Chung (2019) reported higher psychological
impacts among these group compared to those with fewer losses. For example, a victims
who loses the whole family, house, cars and shop in the disaster will be more
psychologically distressed compared to one who loses only shop. This must be of concern
for policy makers and therapists. In this regard, resources available must be harnessed to
assist such victims in order to deal with their ordeals.
5.1 Summary of the Study
The current study examined the impact of disaster and how this is influenced by risk and
protective factors. The population used for the study is the 3rd June 2015 flood/fire disaster
victims at the Kwame Nkrumah Circle in Accra Ghana. In all, 336 participants participated
in the study. The study used the concurrent mixed method design where the quantitative
study used a cross-sectional design and tested five hypotheses through regression analysis
and the qualitative used phenomenology and answered three research questions through
thematic analysis.
Quantitatively, it was found that risk factors namely neuroticism, independent-self construal
and previous traumatic history significantly predict psychological distress and assumptive
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world, independent self-construal and previous traumatic experience significantly predict
PTSD. It was also found that protective factors namely social support, belief in just world,
resilience, and religiosity significantly predict PTG. The quantitative study found that
religiosity significantly moderates the relationship between assumptive world and
psychological distress, social support significantly moderates the relationship between
previous traumatic history and psychological distress, resilience moderates the relationship
between independent-self-construal and psychological distress, self-efficacy and religiosity
significantly moderates the relationship between neuroticism and psychological distress,
social support and religiosity significantly moderate the relationship between assumptive
world and PTSD, social support, belief in just world, resilience and religiosity significantly
moderate the relationship between previous traumatic history and PTSD, and social support,
self-efficacy and resilience significantly moderate the relationship between neuroticism and
PTSD. Finally, the study one also found that social support, self-efficacy, belief in just
world, resilience and religiosity are negatively and significantly correlated with PTD
(psychological distress and PTSD), and there is rather a significant positive correlation
between PTG and PTD.
Largely, these findings are in consonance with the literature especially on how risk factors
predict PTD and protective factors predict PTG (Ogle et al., 2017; Gilbert et al., 2009). It
was also observed that high levels of distress correspond with high level of growth among
victims of adversities.
The qualitative findings also found that victims perceive the causes of the disaster to include
engineering failures and anti-environmental behaviours. Their experiences include
biographical disruption such as disfigurement, death and loss of property, and psychological
impacts such as anxiety, behavioural changes and mood effects. Participants’ adjustment
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experiences, that is resources that enabled them to deal with the effects of the disaster or
otherwise, involve societal level intervention, family level intervention, spiritual support
and post disaster vulnerability. To a large extent, the findings in study two were found to
be consistent with the literature (e.g. Lindell & Prater, 2004; Frankenberg et al., 2008).
5.1.1 Point of Convergence: Quantitative and Qualitative Findings
The quantitative (study one) and qualitative (study two) studies lend support to each other
in terms of their findings. There are at least two cardinal points at which the two studies
converge. First, study one found that there are some risk factors that have the tendency to
aggravate PTD among disaster victims. For example, people who have experienced other
adversities prior to the current disaster are more likely to be distressed than those who did
not. In the study two, it was evident that people who do not have the needed support after
the disaster were more distressed. They called more on the government for support and feel
abandoned. Study two also added that severity of physical impact can also serve as risk
factor for PTD. These physical impacts includes injuries, both the loss of materials such as
house, car, belongings, and loss of the lives of relations and friends
Secondly, it was observed that those who possess protective factors experienced PTG after
the disaster. Social support as well as religiosity predicted PTG. Victims revealed same in
the study two where most of them narrated how they were supported by friends and families
and significant others. They also recounted their renewal of faith and trust in God and how
they have become committed to church attendance now than before, believing that it was
God who spared their lives.
Also, the two studies lend support to the positive association between PTG and PTD. The
quantitative study produced a significant relationship between the two as well as victims
indicating distress levels and growth in the qualitative study. Victims who said they are
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suffering also mentioned that they have learned to appreciate life and drawn closer to their
maker. They now value friends and have also realised that they must make the best in their
lives so long as there are alive.
5.1.2 Point of Divergence: Study one and Study Two
In as much as the two studies converge on some points, there are two points of divergence
that are worth noting. One of these points of divergence is that self-efficacy did not predict
PTG in the study one. In the study two however, participants utilised their personal strengths
where they indicated that disasters must happen but once they are alive, they must forge on.
This is an indication that victims believe in their ability to strive despite challenges.
Another divergence is that whilst social support provides avenue for growth in study one,
participants saw it as they being burden to families and friends in study two. This means
that even though participants benefited from the support they received from others, they felt
they were not supposed to be relying on others for their needs.
5.2 Contributions of the study
Generally, disaster research has thrived in the developed world leaving behind the
developing countries. Few studies on disaster are available in Africa particularly Ghana.
Meanwhile, the occurrence of disasters is on the rise. Again, it was noticed that a greater
percentage of disaster researches have focused on the pathology that comes with disasters.
The positive outcomes and factors that promote them have gained little attention. This study
therefore attempted to combine the positive and negative outcomes of disasters and factors
that underpin them within the Ghanaian context. The findings therefore contribute to
knowledge and research in several ways some of which are presented below.
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5.2.1 Contribution to Knowledge
How disaster victims cope in Ghana and their ordeal have not been clearly known. The
researcher’s personal conversation with authorities at the NADMO reveals that victims are
not followed up on to ascertain their distress levels and how they are surviving. In fact,
government relief ends a few days after the disaster occurs. This means that victims are
often left to their own fate regardless of whether they have the ability to thrive or not. This
study reveals significant information about what victims go through years after disaster
encounters. Importantly, it was revealed that support for victims is crucial. This means that
government must have a comprehensive programme to see victims to the full length of their
struggle in order to better equip them for life afterwards.
This study is the first of a kind in Ghana to be conducted years after a disaster. It is also the
first to combine both protective and risk factors in a single study in Ghana. This will help
with the understanding of what factors are helpful or otherwise after disasters occur. It also
utilised a mixed method that sheds more light on the subject matter.
Again, the study will help individuals understand what they experience after they encounter
disaster and adopt best approaches to deal with the impacts thereafter. For example, people
may learn from this study that isolation from society and being individualistic does not help
in times of adversity. It provides first-hand information to victims regarding their
expectations in distress so as to be ready for any eventualities.
5.2.2 Contributions to Research
This study has offered support to the literature on how disaster victims cope in various
jurisdictions. Ghana and Africa have produced little information to disaster research over
the years. This study makes a significant addition to the research findings in the literature.
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The study is among the few that have combined both risk and protective factors in a single
study. This makes it possible to compare the findings for an informed understanding.
Adopting the mixed methods is also significant in disaster research as most studies in the
past tend to relied on only one method. The findings from this current method are
complementary and shed more light on the information provided.
The study also added to the findings that PTD and PTG are positively related. The relation
between the two conditions have been illusive over the years and requires further studies to
provide more information. This study supports the position that even when people are
distressed after experiencing adversities, they are able to grow and make meaning of their
experiences and life in general.
5.2.3 Theoretical Contributions and Implications
The salutogenic outcome of disasters is described by the OV theory as an innate tendency
of human beings to grow regardless of challenges. The theory was clear on the fact that
when conducive ground is provided people benefit from adversities. This was supported in
by the findings of the study. People felt they have developed stronger faith and now
appreciate life more than before. These impressions of growth are promoted by protective
factors as found in the study.
The pathogenic effect of disasters has also been supported. This is significant for the theory
of shattered assumptions and the emotional processing theory. For example, when victims
perceived that they have become burden for others, they may further dread the adversity and
effects and become more distressed. This may occur several years after the event in the form
of PTSD, indicating poor assimilation of the event into their existing assumptions.
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The findings of this study could be used to advance the stance of the OV theory in order to
assist victims grow since protection factors may be available but effort must be made to
harness them. Example, victims must make conscious effort to seek assistance, society must
be proactive in supporting victims and government must deliver right and prompt assistance
for victims.
5.3 Practical Implications
5.3.1 Implications for Clinical Practice
These findings reveal some implications for clinical practice especially in Ghana. Firstly, it
was observed that an intervention centre was set up immediately after the disaster.
Participants were supposed to go to the centre for psychological support. In the first place,
victims revealed that at the time the intervention was going on, they were too busy putting
their lives back in order. For example, they needed to figure out where to sleep, how to
benefit from relief aid and for those who lost their relation, they needed to find the bodies.
This means that the timing for interventions must be appropriate in order not to cut off
victims who need the support most. In addition, the location of the intervention centre must
be carefully considered. If it is too far, a victim who lost everything may not be able to travel
to the centre. Intervention centres must be within the closest vicinity in order to attract
victims
Duration of interventions programmes is another significant factor in clinical practice
towards disaster victims. Some victims develop psychological challenges years after the
traumatic event. However, barely a week after the disaster, no intervention activities went
on in Ghana. One participant for example mentioned the inadequate number of
psychologists in Ghana. It is necessary to conduct follow ups on victims, track their
wellbeing over years and place them on the needed support until they are capable of being
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on their own. Mental health first aid and long-term intervention programmes are required
for disaster victims.
Also, hospitals that treat victims must endeavour to make psychological or mental health
support a must for them. Appropriate referrals should be made and follow ups must be
properly conducted. These will safeguard victims and protect them against distresses.
5.3.2 Policy Implications
Policy on disaster management in Ghana is too physical and short-lived. There is little
budget for disaster interventions. Mental health component is missing in the management
of disaster related effects. Government needs to redesign disaster policy in the country. For
instance, there must be a psychiatric and psychological component for disaster related
interventions.
The collection and disbursement of support items from society must be coordinated.
Individuals who wish to support victims must be made aware of points of collect.
Disbursement must be transparent and free of corruption. People usually accuse rescue or
relief workers of diverting relief items and supporting non-affected people. A
comprehensive and implementable programme must be adopted to deal with the situation.
Finally, information dissemination during disasters must be properly controlled. Victims
indicated that there was too much information for them to manage. There must be training
for reporters and community leaders on how they relay information to a population that is
bedevilled with a disaster. This will reduce panic and will create order in how victims are
assisted.
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5.3.3 Implications for Disaster Management in Ghana
Disaster management in Ghana requires more than the provision of relief to victims. There
is the need for sensitisation on the impact of disasters and what victims should expect from
government. The general public must also be informed about the various support systems
available when adversities strike.
Clearly, the current disaster management model being used in Ghana does not resolve the
needs of victims. A comprehensive model must be adopted which will make some critical
service providers an integral part of the decision making and implementation process.
For mental health practitioners, intervention models need to be developed for emergencies.
Practitioners need to be educated on what to expect and to do in such critical times. Ad hoc
programmes for victims may not be enough and may rather distress victims the more.
5.4 Limitations of the Study
There are some limitations associated with the current study. One of these limitations is that
the best design would have been a longitudinal design. This is because, it would have been
beneficial to follow the victims over a long enough period of time to understand the
dynamics of their challenges and how the various factors played out. Since victim may
develop symptoms of distress several years after and some shortly after disaster encounters,
a longitudinal approach would have helped with more information to this effect by providing
baseline data for further comparison.
Also, the study excluded children that is victims below the age of 18. This means that there
is still a population of victims whose information is missing in the knowledge about
experiences after disaster in Ghana. Children form a significant unit of the disaster
population. They are also deemed vulnerable. Therefore, they need to be studied in this
regard.
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Finally, most victims who participated in this study felt they needed to participant in order
that their voices would be heard by government so as to propel authorities to come to their
aid. To some extent, this would have resulted in the exaggeration of some of the responses
provided. Even though it was clearly explained to participants before the start of the study,
there is the tendency that participant would magnify their responses for potential benefit
from authorities.
5.5 Recommendations for Future Research
First, it is recommended that future researches include children in order to understand how
they process and deal with the challenges of disaster experience. In addition to this, future
researches should also identify more groups that are most vulnerable in order to inform
policy decisions regarding disaster management.
Secondly, it is recommended that future studies employ a longitudinal design in order to
ascertain the changes that occur across time among disaster victims. In addition, future
studies could also adopt a cohort design in order to compare victims with non-victims
establish differences in distress levels and factors that influence distress and growth among
the two groups.
Finally, it must be recommended that shorter instruments should be used on such
populations as longer ones tend to stress them and this may affect their responses. Apart
from the length of the instruments, their context-specific validity must be considered as
some items tend to be alien to participants and require replacement.
5.6 Conclusions
In conclusion, this study investigated the role of risk and protective factors in post disaster
adaptation using the mixed method approach. A population of flood/fire disaster victims
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was used with 336 sample selected, 13 of which participated in both the quantitative and
qualitative studies.
The findings of this study show that victims of disasters experience significant impacts, both
physical and psychological, over a long period of time. There are risk factors that may
aggravate their situation for victims. Meanwhile, there are also protective factors that can
be utilised to cope with the effects. Since it was revealed that people who experience distress
after disasters also sometimes experience growth, protective factors that promote growth
must be prioritised for such victims. Unfortunately, there are significant policy and practice
gaps in the management of disaster victims in Ghana. This requires national and clinical
attention to support victims appropriately.
With the right interventions, victims of disasters may experience reduced levels or shorter
durations of distress. This is because, the intervention would use protective factors and
resources and these have proven to a large extent to moderate how risk factors impact on
distress levels. If these interventions are well planned and executed, they help eliminate the
short-lived attention/interest given to disaster victims in the country.
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Zamora, E. R., Yi, J., Akter, J., Kim, J., Warner, E. L., & Kirchhoff, A. C. (2017). ‘Having
cancer was awful but also something good came out’: Post-traumatic growth among
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Zhou, X., Wu, X., & Zhen, R. (2017). Self-esteem and hope mediate the relations between
social support and post-traumatic stress disorder and growth in adolescents following
the Ya ’ an earthquake. Anxiety, Stress, & Coping, 1–14.
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Zulkosky, K. (2009). Self-Efficacy : A Concept Analysis. Nursing Forum, 44(2).
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APPENDICES
Appendix A: Ethical Clearance
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Appendix B: Consent Form
UNIVERSITY OF GHANA
Official Use only
Protocol number
Ethics Committee for Humanities (ECH)
PROTOCOL CONSENT FORM
Section A- BACKGROUND
INFORMATION
Title of Study: DISASTER AND POSTTRAUMATIC ADAPTATION: RISK AND
PROTECTIVE FACTORS
Student Investigator: Emmanuel Dziwornu
Certified Protocol
Number
Section B– CONSENT TO PARTICIPATE IN
RESEARCH
General Information about Research
This study aims to explore the kinds of protective factors that mitigate against post disaster
psychological challenges among natural disaster victims in Ghana. The study will also
establish the forms and levels of post disaster distresses and the associated risk factors
among disaster victims. You will be required to spend 45minutes of your time to respond to
some questionnaires in English. Participants are required to answer all items on the
questionnaires. There is the allowance for participants to return the completed
questionnaires in within two days. Clarity will be provided if the need be. If selected for the
interview component of the study, participants will be required to spend an extra 30minutes
for a one-on-one interaction/interview with the researcher on the lived experiences of
disaster victims.
Benefits/Risk of the study
This study does not present any direct risks or benefits to participants. However, in terms of risks,
participants may be required to recall some experiences that may be discomforting. In this case,
there is the opportunity to contact the researcher for appropriate referral or assistance. The benefit
from this study may be indirect where findings will inform mental health treatment modules in
Ghana and policy decisions.
Confidentiality
Any and all information obtained from you during the study will be confidential. Your
privacy will be protected at all times. You will not be identified individually in any
way as a result of your participation in this research. By this, you will not be required
to provide your name. Your responses to the questionnaires shall not be made available
to any other person(s) except the results of the written report.
Compensation
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There is no form of compensation for the time spent in this study. However, participants have the
opportunity to inquire about available support for challenges they face as a result of their traumatic
experiences. Participants may also request for the findings of the study by contacting the principal
investigator through the contacts provided below.
Withdrawal from Study
Your participation in this study is entirely voluntary. You may refuse to participate in
this research. Such refusal will not have any negative consequences for you. If you begin
to participate in the research, you may at any time, for any reason, discontinue your
participation without any negative consequences. If your response to the questionnaires is
incomplete, your participation will be revoked.
Contact for Additional Information
Please feel free to ask any questions about anything that seems unclear to you and to
consider this research and consent form carefully before you sign. You may also call the
student researcher (Emmanuel Dziwornu) on 0276090802 or email
emmanuel.dziwornu@yahoo.com for clarifications. If you have any questions about your
rights as a research participant in this study you may contact the Administrator of the Ethics
Committee for Humanities, ISSER, University of Ghana at ech@isser.edu.gh /
ech@ug.edu.gh or 00233- 303-933-866.
Section C- VOLUNTEER AGREEMENT
"I have read or have had someone read all of the above, asked questions, received answers
regarding participation in this study, and am willing to give consent to participate in this study.
I will not have waived any of my rights by signing this consent form. Upon signing this consent
form, I will receive a copy for my personal records."
________________________________________________
Name of Volunteer
_________________________________________________ _______________________
Signature or mark of volunteer Date
If volunteers cannot read the form themselves, a witness must sign here:
I was present while the benefits, risks and procedures were read to the volunteer. All questions
were answered and the volunteer has agreed to take part in the research.
_________________________________________________
Name of witness
________________________________________________ _______________________
Signature of witness Date
I certify that the nature and purpose, the potential benefits, and possible risks associated with
participating in this research have been explained to the above individual.
__________________________________________________
Name of Person who Obtained Consent
_________________________________________ ______________________
Signature of Person Who Obtained Consent Date
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Appendix C: Questionnaire
Bio-Data
1. Please indicate your Gender Male [ ]
Female [ ]
2. Please indicate your highest educational Basic [ ]
achievement/level
Secondary [ ]
Tertiary [ ]
Other (please specify) ___________
3. What is your marital status please? Single [ ]
Married [ ]
Divorced [ ]
Separated [ ]
Cohabiting [ ]
4. What is your religion? Christian [ ]
Islam [ ]
Traditional [ ]
Other (please specify) ___________
5. Please indicate your occupation Please specify ___________
6. Please for how long have you been living in
this community? (please specify duration) ____________________________
7. Did you receive any form of professional Yes [ ]
intervention concerning your disaster
experience?
No [ ]
8. If Yes to question 7 above, please specify
source of intervention ________________________________
9. If Yes to question 7 above, for how long did
you receive the above intervention? ________________________________
10. Could you please provide your age? ________________________________
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Assumptive Worldview Scale (AWS)
Please respond to each of the following statements regarding your general beliefs about
the world according to the following scale:
1-Strongly Disagree 2-Disagree 3-Slightly Disagree 4-Slightly Agree
5-Agree 6-Strongly Agree
1 Misfortune is least likely to strike worthy, decent people. 1 2 3 4 5 6
2 People are naturally unfriendly and unkind. 1 2 3 4 5 6
3 Bad events are distributed to people at random. 1 2 3 4 5 6
4 Human nature is basically good. 1 2 3 4 5 6
5 The good things that happen in this world far outnumber the 1 2 3 4 5 6
bad.
6 The course of our lives is largely determined by chance. 1 2 3 4 5 6
7 Generally, people deserve what they get in this world. 1 2 3 4 5 6
8 I often think I am no good at all. 1 2 3 4 5 6
9 There is more good than evil in the world. 1 2 3 4 5 6
10 I am basically a lucky person. 1 2 3 4 5 6
11 People’s misfortunes result from mistakes that they have made. 1 2 3 4 5 6
12 People don’t really care what happens to the next person. 1 2 3 4 5 6
13 I usually behave in ways that are likely to maximize good 1 2 3 4 5 6
results for me.
14 People will experience good fortune if they themselves are 1 2 3 4 5 6
good.
15 Life is too full of uncertainties that are determined by chance. 1 2 3 4 5 6
16 When I think about it, I consider myself very lucky. 1 2 3 4 5 6
17 I almost always make an effort to prevent bad things from 1 2 3 4 5 6
happening to me.
18 I have a low opinion of myself. 1 2 3 4 5 6
19 By and large, good people get what they deserve in this world. 1 2 3 4 5 6
20 Through our actions we can prevent bad things from happening 1 2 3 4 5 6
to us.
21 Looking at my life, I realize that chance events have worked 1 2 3 4 5 6
out well for me.
22 If people took preventative actions, most misfortune could be 1 2 3 4 5 6
avoided.
23 I take the actions necessary to protect myself from misfortune. 1 2 3 4 5 6
24 In general, life is mostly a gamble. 1 2 3 4 5 6
25 The world is a good place. 1 2 3 4 5 6
26 People are basically kind and helpful. 1 2 3 4 5 6
27 I usually behave so as to bring about the greatest good for me. 1 2 3 4 5 6
28 I am very satisfied with the kind of person I am. 1 2 3 4 5 6
29 When bad things happen, it is typically because people have 1 2 3 4 5 6
not taken the necessary actions to protect themselves.
30 If you look closely enough, you will see that the world is full of 1 2 3 4 5 6
goodness.
31 I have reason to be ashamed of my personal character. 1 2 3 4 5 6
32 I am luckier than most people. 1 2 3 4 5 6
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Self-Construal Scale
This is a questionnaire that measures a variety of feelings and behaviors in various
situations. Listed below are a number of statements. Read each one as if it referred to you.
Beside each statement tick the number that best matches your agreement or disagreement.
Please respond to each statement using the scale below.
1=Strongly Disagree
2=Disagree
3=Somewhat Disagree
4=Don’t Agree or Disagree
5=Agree Somewhat
6=Agree
7=Strongly Agree
1 I enjoy being unique and different from others in many 1 2 3 4 5 6 7
respects
2 I can talk openly with a person who I meet for the first time, 1 2 3 4 5 6 7
even when this person is much older than I am
3 Even when I strongly disagree with group members, I avoid 1 2 3 4 5 6 7
an argument
4 I have respect for the authority figures with whom I interact 1 2 3 4 5 6 7
5 I respect people who are modest about themselves 1 2 3 4 5 6 7
6 I will sacrifice myself interest for the benefit of the group I 1 2 3 4 5 6 7
am in
7 I'd rather say "No" directly, than risk being misunderstood 1 2 3 4 5 6 7
8 Having a lively imagination is important to me 1 2 3 4 5 6 7
9 I should take into consideration my parents' advice when 1 2 3 4 5 6 7
making education/career plans
10 I prefer to be direct and forthright when dealing with people 1 2 3 4 5 6 7
I've just met
11 I am comfortable with being singled out for praise or 1 2 3 4 5 6 7
rewards
12 If my brother or sister fails, I feel responsible 1 2 3 4 5 6 7
13 I often have the feeling that my relationships with others are 1 2 3 4 5 6 7
more important than my own accomplishments
14 Speaking up during a class (or a meeting) is not a problem 1 2 3 4 5 6 7
for me
15 I would offer my seat in a bus to my professor (or my boss) 1 2 3 4 5 6 7
16 I act the same way no matter who I am with 1 2 3 4 5 6 7
17 My happiness depends on the happiness of those around me 1 2 3 4 5 6 7
18 I value being in good health above everything 1 2 3 4 5 6 7
19 I will stay in a group if they need me, even when I am not 1 2 3 4 5 6 7
happy with the group
20 Being able to take care of myself is a primary concern for 1 2 3 4 5 6 7
me
21 It is important to me to respect decisions made by the group 1 2 3 4 5 6 7
22 My personal identity, independent of others, is very 1 2 3 4 5 6 7
important to me
23 It is important for me to maintain harmony within my group 1 2 3 4 5 6 7
24 I act the same way at home that I do at school (or work) 1 2 3 4 5 6 7
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Big Five Personality Scale
Please describe yourself as you generally are now, not as you wish to be in the future.
Describe yourself as you honestly see yourself, in relation to other people you know of the
same sex as you are, and roughly your same age. So that you can describe yourself in an
honest manner, your responses will be kept in absolute confidence. Indicate for each
statement whether it is
1. Very Inaccurate
2. Moderately Inaccurate
3. Neither Accurate Nor Inaccurate
4. Moderately Accurate
5. Very Accurate
1 I am the life of the party 1 2 3 4 5
2 I feel little concern for others 1 2 3 4 5
3 I am always prepared 1 2 3 4 5
4 I get stressed out easily 1 2 3 4 5
5 I have a rich vocabulary 1 2 3 4 5
6 I don't talk a lot 1 2 3 4 5
7 I am interested in people 1 2 3 4 5
8 I leave my belongings around 1 2 3 4 5
9 I am relaxed most of the time 1 2 3 4 5
10 I have difficulty understanding abstract ideas 1 2 3 4 5
11 I feel comfortable around people 1 2 3 4 5
12 I insult people 1 2 3 4 5
13 I pay attention to details 1 2 3 4 5
14 I worry about things 1 2 3 4 5
15 I have a vivid imagination 1 2 3 4 5
16 I keep in the background 1 2 3 4 5
17 I sympathize with others' feelings 1 2 3 4 5
18 I make a mess of things 1 2 3 4 5
19 I seldom feel blue 1 2 3 4 5
20 I am not interested in abstract ideas 1 2 3 4 5
21 I start conversations 1 2 3 4 5
22 I am not interested in other people's problems 1 2 3 4 5
23 I get chores done right away 1 2 3 4 5
24 I am easily disturbed 1 2 3 4 5
25 I have excellent ideas 1 2 3 4 5
26 I have little to say 1 2 3 4 5
27 I have a soft heart 1 2 3 4 5
28 I often forget to put things back in their proper place 1 2 3 4 5
29 I get upset easily 1 2 3 4 5
30 I do not have a good imagination 1 2 3 4 5
31 I talk to a lot of different people at parties 1 2 3 4 5
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32 I am not really interested in others 1 2 3 4 5
33 I like order 1 2 3 4 5
34 I change my mood a lot 1 2 3 4 5
35 I am quick to understand things 1 2 3 4 5
36 I don't like to draw attention to myself 1 2 3 4 5
37 I take time out for others 1 2 3 4 5
38 I shirk my duties 1 2 3 4 5
39 I have frequent mood swings 1 2 3 4 5
40 I use difficult words 1 2 3 4 5
41 I don't mind being the center of attention 1 2 3 4 5
42 I feel others' emotions 1 2 3 4 5
43 I follow a schedule 1 2 3 4 5
44 I get irritated easily 1 2 3 4 5
45 I spend time reflecting on things 1 2 3 4 5
46 I am quiet around strangers 1 2 3 4 5
47 I make people feel at ease 1 2 3 4 5
48 I am exacting in my work 1 2 3 4 5
49 I often feel blue 1 2 3 4 5
50 I am full of ideas 1 2 3 4 5
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Symptom Checklist-90
Below is a list of problems and complaints that people sometimes have. Please read each
one carefully. After you have done so, select one of the numbered descriptors that best
describes HOW MUCH THAT PROBLEM HAS BOTHERED OR DISTRESSED YOU
DURING THE PAST WEEK, INCLUDING TODAY. Circle the number in the space to
the right of the problem and do not skip any items. Use the following key to guide how
you respond:
Circle 0 if your answer is NOT AT ALL
Circle 1 if A LITTLE BIT
Circle 2 if MODERATELY
Circle 3 if QUITE A BIT
Circle 4 if EXTREMELY
Please read the following example before beginning:
Example: In the previous week, how much were you bothered by:
Backaches 0 (1) 2 3 4
In this case, the respondent experienced backaches a little bit (1).
Please proceed with the questionnaire.
How much were you bothered by:
1. Headaches 0 1 2 3 4
2. Nervousness or shakiness inside 0 1 2 3 4
3. Unwanted thoughts, words, or ideas that won't leave your mind 0 1 2 3 4
4. Faintness or dizziness 0 1 2 3 4
5. Loss of sexual interest or pleasure 0 1 2 3 4
6. Feeling critical of others 0 1 2 3 4
7. The idea that someone else can control your thoughts 0 1 2 3 4
8. Feeling others are to blame for most of your troubles 0 1 2 3 4
9. Trouble remembering things 0 1 2 3 4
10. Worried about sloppiness or carelessness 0 1 2 3 4
11. Feeling easily annoyed or irritated 0 1 2 3 4
12. Pains in heart or chest 0 1 2 3 4
13. Feeling afraid in open spaces or on the streets 0 1 2 3 4
14. Feeling low in energy or slowed down 0 1 2 3 4
15. Thoughts of ending your life 0 1 2 3 4
16. Hearing voices that other people do not hear 0 1 2 3 4
17. Trembling 0 1 2 3 4
18. Feeling that most people cannot be trusted 0 1 2 3 4
19. Poor appetite 0 1 2 3 4
20. Crying easily 0 1 2 3 4
21. Feeling shy or uneasy with the opposite sex 0 1 2 3 4
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22. Feeling of being trapped or caught 0 1 2 3 4
23. Suddenly scared for no reason 0 1 2 3 4
24. Temper outbursts that you could not control 0 1 2 3 4
25. Feeling afraid to go out of your house alone 0 1 2 3 4
26. Blaming yourself for things 0 1 2 3 4
27. Pains in lower back 0 1 2 3 4
28. Feeling blocked in getting things done 0 1 2 3 4
29. Feeling lonely 0 1 2 3 4
30. Feeling blue 0 1 2 3 4
31. Worrying too much about things 0 1 2 3 4
32. Feeling no interest in things 0 1 2 3 4
33. Feeling fearful 0 1 2 3 4
34. Your feelings being easily hurt 0 1 2 3 4
35. Other people being aware of your private thoughts 0 1 2 3 4
36. Feeling others do not understand you or are unsympathetic 0 1 2 3 4
37. Feeling that people are unfriendly or dislike you 0 1 2 3 4
38. Having to do things very slowly to insure correctness 0 1 2 3 4
39. Heart pounding or racing 0 1 2 3 4
40. Nausea or upset stomach 0 1 2 3 4
41. Feeling inferior to others 0 1 2 3 4
42. Soreness of your muscles 0 1 2 3 4
43. Feeling that you are watched or talked about by others 0 1 2 3 4
44. Trouble falling asleep 0 1 2 3 4
45. Having to check and double-check what you do 0 1 2 3 4
46. Difficulty making decisions 0 1 2 3 4
47. Feeling afraid to travel on buses, subways, trains 0 1 2 3 4
48. Trouble getting your breath 0 1 2 3 4
49. Hot or cold spells 0 1 2 3 4
Having to avoid certain things, places, or activities because they 0 1 2 3 4
50.
frighten you
51. Your mind going blank 0 1 2 3 4
52. Numbness or tingling in parts of your body 0 1 2 3 4
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53. A lump in your throat 0 1 2 3 4
54. Feeling hopeless about the future 0 1 2 3 4
55. Trouble concentrating 0 1 2 3 4
56. Feeling weak in parts of your body 0 1 2 3 4
57. Feeling tense or keyed up 0 1 2 3 4
58. Heavy feelings in your arms or legs 0 1 2 3 4
59. Thoughts of death or dying 0 1 2 3 4
60. Overeating 0 1 2 3 4
61. Feeling uneasy when people are watching or talking about you 0 1 2 3 4
62. Having thoughts that are not your own 0 1 2 3 4
63. Having urges to beat, injure, or harm someone 0 1 2 3 4
64. Awakening in the early morning 0 1 2 3 4
Having to repeat the same actions such as touching, counting, 0 1 2 3 4
65.
washing
66. Sleep that is restless or disturbed 0 1 2 3 4
67. Having urges to break or smash things 0 1 2 3 4
68. Having ideas or beliefs that others do not share 0 1 2 3 4
69. Feeling very self-conscious with others 0 1 2 3 4
70. Feeling uneasy in crowds, such as shopping or at a movie 0 1 2 3 4
71. Feeling everything is an effort 0 1 2 3 4
72. Spells of terror or panic 0 1 2 3 4
73. Feeling uncomfortable about eating or drinking in public 0 1 2 3 4
74. Getting into frequent arguments 0 1 2 3 4
75. Feeling nervous when you are left alone 0 1 2 3 4
76. Others not giving you proper credit for your achievements 0 1 2 3 4
77. Feeling lonely even when you are with people 0 1 2 3 4
78. Feeling so restless you couldn't sit still 0 1 2 3 4
79. Feelings of worthlessness 0 1 2 3 4
80. Feeling that familiar things are strange or unreal 0 1 2 3 4
81. Shouting or throwing things 0 1 2 3 4
82. Feeling afraid you will faint in public 0 1 2 3 4
83. Feeling that people will take advantage of you if you let them 0 1 2 3 4
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84. Having thoughts about sex that bother you a lot 0 1 2 3 4
85. The idea that you should be punished for your sins 0 1 2 3 4
86. Feeling pushed to get things done 0 1 2 3 4
87. The idea that something serious is wrong with your body 0 1 2 3 4
88. Never feeling close to another person 0 1 2 3 4
89. Feelings of guilt 0 1 2 3 4
90. The idea that something is wrong with your mind 0 1 2 3 4
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Post Traumatic Growth Inventory
Indicate for each of the statements below the degree to which this change occurred in your
life as a result of the flood disaster you experienced, using the following scale:
1 = I did not experience this change as a result of my crisis
2 = I experienced this change to a very small degree as a result of my crisis
3 = I experienced this change to a small degree as a result of my crisis
4 = I experienced this change to a moderate degree as a result of my crisis
5 = I experienced this change to a great degree as a result of my crisis
6 = I experienced this change to a very great degree as a result of my crisis
1. My priorities about what is important in life 1 2 3 4 5 6
2. I’m more likely to try to change things that need changing 1 2 3 4 5 6
3. An appreciation for the value of my own life 1 2 3 4 5 6
4. A feeling of self-reliance 1 2 3 4 5 6
5. A better understanding of spiritual matters 1 2 3 4 5 6
6. Knowing that I can count on people in times of trouble 1 2 3 4 5 6
7. A sense of closeness with others 1 2 3 4 5 6
8. Knowing I can handle difficulties 1 2 3 4 5 6
9. A willingness to express my emotions 1 2 3 4 5 6
10. Being able to accept the way things work out 1 2 3 4 5 6
11. Appreciating each day 1 2 3 4 5 6
12. Having compassion for others 1 2 3 4 5 6
13. I’m able to do better things with my life 1 2 3 4 5 6
14. New opportunities are available which wouldn’t have been 1 2 3 4 5 6
otherwise
15. Putting effort into my relationships 1 2 3 4 5 6
16. I have a stronger religious faith 1 2 3 4 5 6
17. I discovered that I’m stronger than I thought I was 1 2 3 4 5 6
18. I learned a great deal about how wonderful people are 1 2 3 4 5 6
19. I developed new interests 1 2 3 4 5 6
20. I accept needing others 1 2 3 4 5 6
21. I establish a new path for my life 1 2 3 4 5 6
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Posttraumatic Stress Disorder Checklist-Specific
Below is a list of problems and complaints that people sometimes have in response to
stressful life experiences flood as the experience of flood disasters. Please read each one
carefully, circle the number that corresponds how much you have been bothered by that
problem in the last month.
Not at all (1) A little bit (2) Moderately (3) Quite a bit (4) Extremely (5)
1 Repeated, disturbing memories, thoughts, or images of the flood 1 2 3 4 5
disaster?
2 Repeated, disturbing dreams of the flood disaster? 1 2 3 4 5
3 Suddenly acting or feeling as if the flood disaster were 1 2 3 4 5
happening again (as if you were reliving it)?
4 Feeling very upset when something reminded you of the flood 1 2 3 4 5
disaster?
5 Having physical reactions (e.g., heart pounding, trouble 1 2 3 4 5
breathing, or sweating) when something reminded you of the
flood disaster?
6 Avoid thinking about or talking about the flood disaster or avoid 1 2 3 4 5
having feelings related to it?
7 Avoid activities or situations because they remind you of the 1 2 3 4 5
flood disaster?
8 Trouble remembering important parts of the flood disaster? 1 2 3 4 5
9 Loss of interest in things that you used to enjoy? 1 2 3 4 5
10 Feeling distant or cut off from other people? 1 2 3 4 5
11 Feeling emotionally numb or being unable to have loving 1 2 3 4 5
feelings for those close to you?
12 Feeling as if your future will somehow be cut short? 1 2 3 4 5
13 Trouble falling or staying asleep? 1 2 3 4 5
14 Feeling irritable or having angry outbursts? 1 2 3 4 5
15 Having difficulty concentrating? 1 2 3 4 5
16 Being “super alert” or watchful on guard? 1 2 3 4 5
17 Feeling jumpy or easily startled? 1 2 3 4 5
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Multidimensional Scale of Perceived Social Support
We are interested in how you feel about the following statements. Read each statement
carefully. Indicate how you feel about each statement.
Circle the “1” if you Very Strongly Disagree
Circle the “2” if you Strongly Disagree
Circle the “3” if you Mildly Disagree
Circle the “4” if you are Neutral
Circle the “5” if you Mildly Agree
Circle the “6” if you Strongly Agree
Circle the “7” if you Very Strongly Agree
1 There is a special person who is around when I am in need. 1 2 3 4 5 6 7
2 There is a special person with whom I can share my joys 1 2 3 4 5 6 7
and sorrows.
3 My family really tries to help me. 1 2 3 4 5 6 7
4 I get the emotional help and support I need from my 1 2 3 4 5 6 7
family.
5 I have a special person who is a real source of comfort to 1 2 3 4 5 6 7
me.
6 My friends really try to help me. 1 2 3 4 5 6 7
7 I can count on my friends when things go wrong. 1 2 3 4 5 6 7
8 I can talk about my problems with my family. 1 2 3 4 5 6 7
9 I have friends with whom I can share my joys and sorrows. 1 2 3 4 5 6 7
10 There is a special person in my life who cares about my 1 2 3 4 5 6 7
feelings.
11 My family is willing to help me make decisions. 1 2 3 4 5 6 7
12 I can talk about my problems with my friends. 1 2 3 4 5 6 7
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General Self Efficacy Scale
Below are a number of statements describing how you may feel about yourself. Please
respond by using the rating scale below. Be as honest as possible.
1 = Not at all true 2 = Hardly true 3 = Moderately true 4 = Exactly true
1 I can always manage to solve difficult problems if I try hard enough 1 2 3 4
2 If someone opposes me, I can find the means and ways to get what 1 2 3 4
I want
3 It is easy for me to stick to my aims and accomplish my goals 1 2 3 4
4 I am confident that I could deal efficiently with unexpected events 1 2 3 4
5 Thanks to my resourcefulness, I know how to handle unforeseen 1 2 3 4
situations
6 I can solve most problems if I invest the necessary effort 1 2 3 4
7 I can remain calm when facing difficulties because I can rely on my 1 2 3 4
coping abilities
8 When I am confronted with a problem, I can usually find several 1 2 3 4
solutions
9 If I am in trouble, I can usually think of a solution 1 2 3 4
10 I can usually handle whatever comes my way 1 2 3 4
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Global Belief in Just World Scale
The following statements describe how just people think the world is. Please indicate the
extent to which you agree or disagree with the statement using the rating scale below.
1-Strongly Disagree
2-Disagree
3-Slightly Disagree
4-Slightly Agree
5-Agree
6-Strongly Agree
1 I feel that people get what they are entitled to have 1 2 3 4 5 6
2 I feel that a person’s efforts are noticed and rewarded 1 2 3 4 5 6
3 I feel that people earn the rewards and punishments they get 1 2 3 4 5 6
4 I feel that people who meet with misfortune have brought it on 1 2 3 4 5 6
themselves
5 I feel that people get what they deserve 1 2 3 4 5 6
6 I feel that rewards and punishments are fairly given 1 2 3 4 5 6
7 I basically feel that the world is a fair place 1 2 3 4 5 6
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Wagnild and Young’s Resilience Scale
Please read the following statements and indicate the extent to which you agree or
disagree with them using the rating scale provided below
1 = Disagree strongly
2 = Disagree moderately
3 = Disagree a little
4 = Neither agree nor disagree
5 = Agree a little
6 = Agree moderately
7 = Agree strongly
1 When I make plans, I follow through with them. 1 2 3 4 5 6 7
2 I usually manage one way or another 1 2 3 4 5 6 7
3 I am able to depend on myself more than anyone else 1 2 3 4 5 6 7
4 Keeping interested in things is important to me 1 2 3 4 5 6 7
5 I can be on my own if I have to 1 2 3 4 5 6 7
6 I feel proud that I have accomplished things in life 1 2 3 4 5 6 7
7 I usually take things in stride 1 2 3 4 5 6 7
8 I am friends with myself 1 2 3 4 5 6 7
9 I feel that I can handle many things at a time 1 2 3 4 5 6 7
10 I am determined 1 2 3 4 5 6 7
11 I seldom wonder what the point of it all is 1 2 3 4 5 6 7
12 I take things one day at a time 1 2 3 4 5 6 7
13 I can get through difficult times because I’ve experienced difficulty 1 2 3 4 5 6 7
before
14 I have self-discipline 1 2 3 4 5 6 7
15 I keep interested in things 1 2 3 4 5 6 7
16 I can usually find something to laugh about 1 2 3 4 5 6 7
17 My belief in myself gets me through hard times 1 2 3 4 5 6 7
18 In an emergency, I’m someone people can generally rely on 1 2 3 4 5 6 7
19 I can usually look at a situation in a number of ways. 1 2 3 4 5 6 7
20 Sometimes I make myself do things whether I want to or not 1 2 3 4 5 6 7
21 My life has meaning 1 2 3 4 5 6 7
22 I do not dwell on things that I can’t do anything about 1 2 3 4 5 6 7
23 When I’m in a difficult situation, I can usually find my way out of it 1 2 3 4 5 6 7
24 I have enough energy to do what I have to do 1 2 3 4 5 6 7
25 It’s okay if there are people who don’t like me 1 2 3 4 5 6 7
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Santa Clara Strength of Religious Faith Questionnaire
Using the following rating scale, please indicate your degree of agreement or otherwise
with the statements below concerning your religious faith.
1=strongly disagree
2=disagree
3=agree
4=strongly agree
1 My religious faith is extremely important to me. 1 2 3 4
2 I pray daily. 1 2 3 4
3 I look to my faith as a source of inspiration. 1 2 3 4
4 I look to my faith as providing meaning and purpose in my life. 1 2 3 4
5 I consider myself active in my faith or church. 1 2 3 4
6 My faith is an important part of who I am as a person. 1 2 3 4
7 My relationship with God is very important to me. 1 2 3 4
8 I enjoy being around others who share my faith. 1 2 3 4
9 I look to my faith as a source of comfort. 1 2 3 4
10 My faith impacts many of my decisions. 1 2 3 4
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Disaster and Posttraumatic Distress
Trauma History Questionnaire
The following is a series of questions about serious or traumatic life events. The
questionnaire is divided into questions covering crime experiences, general disaster and
trauma questions, and questions about physical and sexual experiences. For each event,
please indicate (circle) whether it happened or not and, if it did, the number of times and
your approximate age when it happened (give your best guess if you are not sure).
If you circled yes,
Crime-Related Events Circle please indicate one Number Approxim
of times ate age(s)
Has anyone ever tried to take something directly
1 from you by using force or the threat of force, such No Yes
as a stick-up or mugging?
2 Has anyone ever attempted to rob you or actually robbed you (i.e., stolen your personal belongings)? No Yes
3 Has anyone ever attempted to or succeeded in breaking into your home when you were not there? No Yes
4 Has anyone ever attempted to or succeed in breaking into your home while you were there? No Yes
If you circled yes,
General Disaster and Trauma Circle please indicate one Number Approxim
of times ate age(s)
Have you ever had a serious accident at work, in a
car, or somewhere else? (If yes, please specify
5 below) No Yes
__________________________________________
________
Have you ever experienced a natural disaster such as
a tornado, hurricane, flood or major earthquake, etc.,
where you felt you or your loved ones were in
6 danger of death or injury? (If yes, please specify No Yes
below)
__________________________________________
________
Have you ever experienced a “man-made” disaster
such as a train crash, building collapse, bank
robbery, fire, etc., where you felt you or your loved
7 ones were in danger of death or injury? (If yes, No Yes
please specify below)
__________________________________________
________
Have you ever been exposed to dangerous
8 chemicals or radioactivity that might threaten your health? No Yes
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Have you ever been in any other situation in which
you were seriously injured? (If yes, please specify
9 below) No Yes
__________________________________________
________
Have you ever been in any other situation in which
you feared you might be killed or seriously injured?
10 (If yes, please specify below) No Yes
__________________________________________
________
Have you ever seen someone seriously injured or
11 killed? (If yes, please specify who below) __________________________________________ No Yes
________
Have you ever seen dead bodies (other than at a
funeral) or had to handle dead bodies for any
12 reason? (If yes, please specify below) No Yes
__________________________________________
________
Have you ever had a close friend or family member
murdered, or killed by a drunk driver? (If yes,
13 please specify relationship [e.g., mother, grandson, etc.] below) No Yes
__________________________________________
_______
Have you ever had a spouse, romantic partner, or
14 child die? (If yes, please specify relationship below) __________________________________________ No Yes
_______
Have you ever had a serious or life-threatening
15 illness? (If yes, please specify below) __________________________________________ No Yes
_______
Have you ever received news of a serious injury,
life-threatening illness, or unexpected death of
16 someone close to you? (If yes, please indicate below) No Yes
__________________________________________
_______
Have you ever had to engage in combat while
in military service in an official or unofficial war
17 zone? (If yes, please indicate where below) No Yes
__________________________________________
_______
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If you circled yes,
please indicate
Physical and Sexual Experiences Circle Approximone Repeated ate age(s)
? and
frequency
Has anyone ever made you have intercourse or oral
or anal sex against your will? (If yes, please
18 indicate nature of relationship with person [e.g., stranger, friend, relative, parent, sibling] below) No Yes
_________________________________________
________
Has anyone ever touched private parts of your
body, or made you touch theirs, under force or
threat? (If yes, please indicate nature of
relationship with person [e.g., stranger, friend,
19 relative, parent, sibling] below) No Yes
_________________________________________
________
Other than incidents mentioned in Questions 18 and
20 19, have there been any other situations in which another person tried to force you to have an No Yes
unwanted sexual contact?
Has anyone, including family members or friends,
21 ever attacked you with a gun, knife, or some other No Yes
weapon?
Has anyone, including family members or friends,
22 ever attacked you without a weapon and seriously No Yes
injured you?
23 Has anyone in your family ever beaten, spanked, or pushed you hard enough to cause injury? No Yes
Have you experienced any other extraordinarily
stressful situation or event that is not covered
24 above? (If yes, please specify below) _________________________________________ No Yes
_________
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Appendix D: Interview guide for Qualitative Study
Greeting
Please, in order that I do not forget any part of our conversation, I will like to record the
interview. Do I have your permission to switch on the recorder please?
[Switch on the recorder]
[Remember to number interview]
As I said earlier, my name is Emmanuel Dziwornu, a student from the University of
Ghana, Legon. I will like to have an interview with you in relation to the same research
you filled the questionnaire for (title: Disaster and Posttraumatic Distress: Risk and
Protective Factors). Please feel free to ask for explanation if something is not clear to you.
Bio-data
Please how old are you?
Are you married or not?
Kindly tell me your level of educational
Please, what job do you do?
Area of interest Guiding Follow ups/prompters
question
Account of the Please tell me • Where were you when it all started?
disaster what you recall • Did you receive any warning signs prior
experienced or remember to the flood? Weather forecast, NADMO
from the 2015 cautions, AMA warning, brief floods?
flood disaster • When you realized that there was flood
what did you do? Called for help,
struggled with it alone, run for your life?
• Who were you with during the flood?
What does this • What do you think explains this disaster?
disaster mean to • Who in your opinion should take a/the
you? blame for it? Self, government,
neighbours?
• Were you expecting it probably because
of the area you live? If you do, which
precautions did you try and why did you
still have to encounter the flood?
Impact of the Please tell me • How did the disaster affect you
disaster on what effects the physically?
victim disaster had on ▪ Injuries
you ▪ Death of relative/friend
▪ Loss of valuables, capital
▪ Loss of job, business,
shop
• How did the disaster affect your
psychological health?
▪ Fear/anxiety, panic
▪ Sadness/depression
▪ Emotional hurt/pain
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▪ Poor sleep
▪ Concentration
▪ Eating problems
▪ Family/marital
problems/divorce
• What would you perceive as positive
from the flood?
▪ become stronger in faith?
▪ see life more positive or
value life now?
▪ think better about life
now?
• How would you compare yourself now
to yourself before the flood?
▪ Financially, health-wise,
interpersonally, spiritually
How client How have you • What personal resources would you say
survived the manage with the helped the most in dealing with the
disaster effects of the impact of the disaster?
experience disaster all this • In what ways were your family members
while? helpful in managing with the disaster?
• What forms of support did you receive
from society (friends, strangers and
neigbours)?
• Did you receive any form of professional
intervention? Pastors/imams,
psychologists/counselors, family elders?
Was it available, accessible, affordable?
• What government aids did you receive?
▪ Was the aid timely,
appropriate, sufficient?
Conclusion What else do you • What more must you do to cope with the
have to say? situation?
• What help do you need currently
regarding the flood?
• What do you know about psychological
support systems in Ghana?
• Do you have any advice for government
and individual citizens about such
disasters?
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