|Year : 2012 | Volume
| Issue : 1 | Page : 61-63
Psychiatric morbidity in school children who suffered a stampede
Manjeet S Bhatia, Shruti Srivastava, Anurag Jhanjee
Department of Psychiatry, University College of Medical Sciences and Guru Tegh, Bahadur Hospital, Dilshad Garden, Delhi University, Delhi, India
|Date of Web Publication||22-Apr-2013|
Manjeet S Bhatia
Department of Psychiatry, D 1, Naraina Vihar, New Delhi 110 028
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Stampede is described as a sudden movement of a mass of people in response to a particular circumstance or stimulus. Human stampedes are quite often reported from crowded places like places of worship, sporting events, political rallies, etc. There are reports of development of posttraumatic stress disorder, depressive and anxiety symptoms in children and adolescents subsequent to both natural and man-made disasters. The present tragedy struck in a Government Secondary School in Delhi on September 9, 2009. The study describes the long-term psychiatric morbidity in children following stampede. Materials and Methods: The study was conducted by the department of psychiatry of a tertiary care hospital. A total of 38 children (all adolescent girls) were registered at the casualty of the hospital and 1 absconded, 5 were brought dead. A total of 32 children were included in the study. After first assessment in the casualty, subsequent assessments at 8 weeks and 6 months were done using semi-structured performa, GHQ and Child's reaction to traumatic event scale (CRTES-Revised). Data was analyzed using SPSS version 17. Results: The age-group of the children were 12-20 years(mean 14.3), all girls, studying in grades - VII to X Eight weeks follow up GHQ score was high in 27 (87%). On CRTESQ-R scale, 22 children were in high distress group (71%). Twenty-two children had symptoms of PTSD and five were in moderate distress group. Eleven children also had a comorbid diagnosis of depressive disorder, six had phobic disorder and generalized anxiety disorder. There were statistically significant differences in mean GHQ scores at baseline and at 6 months follow up. There was also significant decrease in CRTESQ-R scale scores between baseline and 6 months. Conclusion: The children who were victims of stampede warrant the need for long-term intervention.
Keywords: Psychiatric morbidity, stampede, children
|How to cite this article:|
Bhatia MS, Srivastava S, Jhanjee A. Psychiatric morbidity in school children who suffered a stampede. Ind Psychiatry J 2012;21:61-3
Stampede is described as a sudden movement of a mass of people in response to a particular circumstance or stimulus. Human stampedes are quite often reported from crowded places like places of worship, sporting events, political rallies, etc., Most of the cases of stampede events were preceded by rumors that lead to mass panic. Sometimes deaths have been reported from stampede primarily from compressive asphyxiation.
In one of the incidents in China on December 8, 2009, eight school students were killed and 26 were injured in the incident. It occurred when all the students tried to use the same staircase because it was raining heavily outside and that exit was closest to the school dormitories. 
There are reports of development of posttraumatic stress disorder (PTSD), depressive and anxiety symptoms in children and adolescents subsequent to both natural ,, and man-made disasters. ,, A study for PTSD symptoms in children exposed to the World Trade Centre Disaster in 2001 was associated with an elevated PTSD risk as well as functional impairment. 
The present tragedy struck in a Government Secondary School in Delhi on September 9, 2009. Five girl students were killed and at least 34 were injured in the stampede. The victims were mostly from 7 to 10 th standard, and had come to the school in pouring rain for their midterm examination. According to the report submitted by the police, a rumor about electric current leaking into the rainwater accumulated in the school compound triggered the stampede. The stampede took place while they were trying to make their way up and down a staircase. To the best of our knowledge, there is no published literature on long-term psychiatric morbidity in children and adolescents following stampede.
| Materials and Methods|| |
The study was conducted by the department of psychiatry of a tertiary care hospital in Delhi. A total of 38 children (all adolescent girls) were registered at the casualty of the hospital and 1 absconded, 5 were brought dead. A total of 32 children were included in the study. Informed consent for administering the questionnaire was taken from the parents/guardians and approval was taken from the Hospital Ethics Committee. After first assessment in the casualty, subsequent assessments at 8 weeks and 6 months were done in the school after seeking permission from the school authorities. The following instruments were used:
- Socio-demographic performa was used to record the age, grade in school, years of education, and other details of the students
- General health questionnaire (GHQ) - 12 items.  GHQ is a 12-item questionnaire, which is scored on a 4-point Likert Scale from 0 (not at all) to 3 (much more than usual) for each item. Scores vary according to study population. Higher scores suggest severe problems and psychological distress
- Child's reaction to traumatic events scale-revised (CRTES-Revised).  This is a 23-item self-report measure designed to assess psychological responses to stressful life events in children aged between 6 and 18 years. The scale was updated to Diagnostic and Statistical Manual-IV edition (DSM IV) and now includes arousal as well as avoidance and intrusion symptoms. The revised CRTES uses a 4-point frequency rating scale: Not at all (0); rarely (1); sometimes (3); and often (5). The analysis determined that a low moderate and high distress are expressed by a score of 0-14, 15-27, and 28 and above. A score of 28 or higher is recommended for a diagnosis of PTSD. The diagnosis of PTSD was independently made according to DSM-IV-TR.
Data was analyzed using SPSS Inc., Chicago, IL, USA version 17. Comparisons were made between GHQ and CRTESQ-R item scores at baseline, 2, and 6 months using General linear model.
| Results|| |
The age-group of the children were 12-20 years (mean 14.3), all girls, studying in grades - VII (7 girls; 22.5%); VIII (4 girls; 12.9%); IX (5 girls; 16.1%), and class X (15 girls; 48.3%). Mean number of years of education was 8.3 years. Eight weeks follow up GHQ score was high in 27 (87%) [Table 1]. On CRTESQ-R scale, 22 children were in high distress group (71%). Twenty-two children had symptoms of PTSD and five were in moderate distress group. Eleven children also had a comorbid diagnosis of depressive disorder, six children had phobic disorder and generalized anxiety disorder. Two children developed full blown PTSD after 6 weeks. These children also reported deterioration in academic performance. There were statistically significant differences in mean GHQ scores at baseline and at 6 months follow up. (P=0.001, F=14.76, df=1). There was also significant decrease in CRTESQ-R scale scores between baseline and 6 months ( P=0.024, F=5.67, df=1) [Table 1].
| Discussion|| |
Stampede is one of the man-made disasters with far-reaching psychiatric implications. In our study, the schoolchildren who were victims of stampede exhibited significant psychiatric morbidity. Majority of the stampede victims were found to have clinically significant scores on GHQ-12 and CRTESQ-R at the time of initial assessment. Subsequent assessments at 6 months revealed statistically significant decrease in mean scores. These results illustrate that the psychiatric morbidity decreases significantly with time. The family members could be involved in treatment process by providing ventilation and strong emotional support to the victims.  Risk factors that may play an important role in the development of PTSD include female gender, age of child, lack of social support, and cognitive capacity. , Our study involved only adolescent female students.
Research on the children exposed to the 09/11/2001 terrorist and its aftermath revealed that around 90% of them experienced symptoms of PTSD and around 6% were described as "deeply upset" 6 months after the event.  In the current study, PTSD was not the most common psychiatric disorder identified in the victims of the stampede, which is consistent with the findings of other studies. , This illustrates the need to avoid the over emphasis on PTSD as there are various other identifiable psychiatric disturbances which merit due attention of mental health professionals in management of disaster affected populations. It is possible that development of PTSD in response to a disaster is highly influenced by cultural differences and Indian population may have actually less PTSD cases after the disasters, as compared with the other populations. ,
Our study had few limitations. The study involved only the victims of stampede and not the witnesses of the stampede. Moreover, the sample size of the study was small and involved only adolescent girls.
The children who were victims of stampede warrant the need for long-term intervention strategies in addition to short-term and immediate interventions. School teachers, parents, and caregivers need to be made aware of various psychological traumas, which, if not dealt with properly, can lead to long-term consequences. Clinicians need to enhance their skills to promote safety and resilience in the school children. There is a need to sensitize mental health professionals toward disaster-preparedness especially tailored for children.
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