Impact of past events and comorbidity of Kuis and PTSD in Bali

Impact of past events and comorbidity of Kuis and PTSD in Bali


Impact of traffic accidents in Indonesia

Qid is a tool used to screen for depression and create a self-report to measure changes in an individual’s life. These Qids contain basic questions about basic issues of a person’s daily life, such as: B. Examine your sleep patterns and duration, concentration, and thoughts about life to see if you have one or more of the disorders. Quis is responsible for measuring the impact of a person’s past events and determining how much that person’s circumstances are influencing them. It is also used to measure the severity of PTSD. These two comorbidities are to analyze the severity of her PTSD using a questionnaire. This links the questions to the individual’s past state. With the help of comorbidities, analysis of PTSD can be carried out more effectively, so that patients can be treated appropriately. The comorbidity of Quis and PTSD affects both mental and physical disorders, allowing researchers to effectively pinpoint the cause of her PTSD (Maccani et al., 2012).

Post-traumatic stress disorder (PTSD) occurs in people who have experienced significant negative events in their lives, such as natural or man-made disasters. Research shows that people who survive catastrophic road accidents show symptoms of post-traumatic stress disorder, and road accidents are said to be the leading cause of post-traumatic stress disorder in the general population . Over the past decade, many accidents resulting in serious injuries and deaths have occurred in Indonesia due to traffic. The most popular mode of transportation in Indonesia is the automobile, which offers unparalleled maneuverability and agility. Although not an accident-prone region, motor vehicle injuries are the main cause of accidents in this region, and the traumatic events that occur after a serious road accident can have both psychological and physical effects. there is. PTSD is the most common disorder affecting survivors of serious accidents.

In Bali, many observations are being made as the general population faces severe PTSD. Balinese people believe that the loss of the soul of a person who suffers from an accident or trauma is a physical, social and mental condition. Due to the shock caused by the accident, the human soul leaves the body and heads to the accident scene. They also believe that accidents are caused by gods or spirits, and some agree that they are caused by physical forces. Avoiding accidents is associated with spirituality, as this belief contradicts the spiritual and physical aspects of life. Spiritual and social effects are addressed through soul restoration rituals, as they are central to the social, spiritual, and psychological healing of accident victims.

Balinese people say that accidents cause loss of soul, which is a dangerous condition, so they will consider all kinds of spiritual rituals to prevent such accidents. 90% of Bali’s population practices Hinduism. They are highly ritualized and highly spiritual. This religion is based on the principle that black magic, spirits and gods are always present in the human world. The people of Balinese embrace this belief and make it a part of their lives. They see road accidents as concrete manifestations of major changes in their lives, and impending road accidents in the Balinese Hindu context may refer to changes in spirituality that give people control. There is. This incident suggests that Balinese people should slow down their worldly activities and participate more in traditional soul-restoration rituals (Wilson & Moran et al., 1998).

Beliefs about PTSD and soul loss in Bali

Western societies have responded to PTSD in beneficial ways, suggesting that they are becoming more aware of the disorder and its effects. They also recognize her PTSD patient’s struggle to seek help. On the contrary, Balinese people have a different perspective on PTSD, as they see it as a spiritual change in a person’s life that can be prevented with the help of spiritual guidance. Western societies are more advanced than Balinese people regarding certain issues such as mental disorders, due to their ability to adapt to mental disorders (Blevins et al., 2015).

Cronbach’s alpha is used in this study because it is a measure of internal consistency and is closely related to the set of items as a group. Scale reliability is included in Cronbach’s alpha, and high values ​​do not require unidimensionality.

The PCL-5: Posttraumatic Stress Disorder Checklist is one of the most widely studied and used assessment tools for PTSD (Weathers, Litz, Herman, Huska, & Keane, 1993; Weathers et al. ., 2013). This scale was recently updated to reflect changes in the DSM-5 PTSD symptom criteria (American Psychiatric Association, 2013).

It is a reliable screening tool for PTSD in community samples (Ashbaugh, Houle-Johnson, Herbert, El-Hage, and Brunet, 2016; Biehn et al., 2013). Although previous versions of his PCL have been studied in various cultural contexts such as China, Sri Lanka, and Chile, his is the only study to validate the new his PCL-5 in a language other than English (French). The only published study (Ashbaugh et al., 2016). ). Currently, there is no known evidence to support validation of PCL-5 in the Balinese population. The PCL-5 was used to assess DSM-5 symptoms of PTSD. It consists of 20 items applicable to PTSD as described in DSM-5 and includes four subscales corresponding to four symptom clusters. The four-factor structure is interpersonal, lifestyle, antisocial, and effective. These are linked internally. It is assessed by psychologists and allows people to assess their own psychotic and antisocial habits (Fodor, et. al.、2015)。

How Western society views PTSD compared to Bali

The diagnosis of PTSD was recently significantly revised in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, American Psychiatric Association, 2013). The most notable change to the PCL-5 was the addition of three new PTSD symptoms: guilt, negative emotions, and reckless or self-destructive behavior. The diagnosis includes 20 symptoms, up from the previous 17 symptoms, categorized into four symptom clusters: intrusions, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity. One consequence of these revisions is that the DSM-5 PTSD symptom assessment instrument needs to be revised. The PTSD Checklist (PCL) is one of the most widely used self-report instruments to assess PTSD symptoms, now in its revised fifth version, each corresponding to a single PTSD symptom. It consists of 20 items (DSM-5 or PCL PTSD Checklist). -5) (Weathers et al., 2013). It has satisfactory psychometric properties and is one of the most widely used measures of PTSD in both research and clinical settings ( McDonald & Calhoun, 2010 ).

Finally, gender differences should be tested according to risk factors. Various studies have demonstrated gender differences in PTSD. Women are approximately twice as likely as men to develop post-traumatic stress disorder after a traumatic event (Breslau et al., 1998; Kessler et al., 1995). A meta-analysis by Tolin and Foa (2006) found that women have a higher risk of developing PTSD despite being exposed to fewer traumatic events than men. We hypothesize that women suffer from PTSD more often than men.

LEC is used to detect traumatic PTSD events. The LEC can be accessed from three sources and includes extended self-reports, standardized self-experiments, and interviews. LEC-5 is linked to PCL-5 and allows self-reporting of 17 items. Self-reports are used to standardize the occurrence of health problems in a reactive life. It is used to show people with PTSD about traumatic events. The LEC is the most widely used self-report instrument to assess potentially traumatic events in adults (Elhai et al., 2005). It is also one of the few scales of its kind whose psychometric properties have already been critically evaluated (Gray et al., 2004).

The Quick Inventory of Depressive Symptoms (QIDS) questionnaire is used to assess the level of depression before or after treatment. Find out the symptoms of depression in a person because it is a 16 point process. The score provides insight into a person’s mental health and is also used to diagnose stages of PTSD. This questionnaire is used to record comorbid psychiatric symptoms in people suffering from post-traumatic stress disorder.

PCL-5 as a reliable screening tool

The greatest trauma for parents is the loss of a child, even more so than the loss of a parent or spouse. The death of a child is a very traumatic event because it is unexpected. It is also against normal custom for the child to bury the parent, as in this case the parent has to bury the child. The loss of a child can cause severe physiological and psychological trauma, including depression, cognitive symptoms, physical symptoms, anxiety, and even PTSD. It persists long after the child’s death and can lead to mental illness and grief disorders. The symptoms of someone who has recently lost a child are similar to those of post-traumatic stress disorder, which is also listed in the DSM-5 (Christiansen, Elklit, and Olff, 2013).

To date, there is a lack of research evaluating the psychometric properties of her PCL-5 in non-Western societies such as Bali. This study pursues several goals. Recent changes in the definition and diagnostic criteria for PTSD create an urgent need for revisions to the instruments available to measure the construct. The first is to evaluate the validity and reliability of her PCL-5 in the Balinese population. Reliability is assessed based on internal consistency and inter-rater reliability. Convergent validity is assessed by combining the PCL-5 with the LEC and QUIDS questionnaires. Furthermore, construct validity is assessed by considering differences according to gender, the nature of the relationship with the deceased, and the occurrence of the accident. This is expected according to previous literature. Finally, we examine the factor structure of the PCL-5 using factor analysis. We expect to find four factors underlying PCL-5. The above analysis was performed on a sample of Balinese people at risk for PTSD.

In this project’s cross-sectional survey, the addresses and names of grieving individuals (n=301) were reported by Udayana University’s administration, insurance companies, and Sangla Hospital, Bali’s largest public hospital. Additionally, applicants were classified as novices using a snowball selection method. Participants were asked to complete a number of questionnaires, including the TGI-SR, QIDS, and LEC. In addition, all participants were asked about some demographic information, details regarding the nature of their relationship with the deceased, their involvement in the accident, and information regarding any mental health conditions the applicant or their family members may be suffering from. it was done. Participants are men and women over the age of 18 who have lost a relative, spouse, or in-law in a traffic accident. Participants who had lost someone more than three years ago and those who were unfamiliar with Indonesian were excluded. Balinese is made up of several sublanguages. To obtain clear documentation, this study was translated into Indonesian language only.

Suggested risk factors for PTSD symptoms

Two bilingual public health physicians interpreted her two questionnaires (TGI-SR and WSAS) from English to Indonesian. They received a translation of her QIDS from the last study conducted in Jakarta (Arjadi, Nauta, Utoya, Bckting, 2017). The translated questionnaire was then subjected to a critical review focusing on understandability, relevance, and cultural appropriateness.

Data were collected by interviewing participants at home. Interviewers were hired based on their ability, commitment to research or field of study, and progress. Final year medicine, psychology, and public health students were able to participate in the project as research assistants. Once selected, I received her three-day training session, which included workshops on research skills and survey administration.

The PCL-5 is used to measure DSM-5 PTSD (Weathers et al., 2013). This is used to quantify the varying severity of PTSD symptoms across members over time. These items refer to recurrent, disturbing, and unwanted memories of stressful events that occurred at least 1 month ago. The PCL-5 is rated on a 5-point Likert scale (0 = “not at all” to 4 = “extremely”). Total scores range from 0 to 80, with a preliminary cutoff score of 38 recommended to indicate a case of PTSD. The PCL-5 has four subscales that correspond to each symptom cluster in the DSM-5. These are intrusion (5 items), avoidance (2 items), negative changes in cognition and mood (7 items), and changes in arousal and reactivity. (Article 6). Respondents rated how much the issues listed in product descriptions bothered them over the past month.

The LEC is a self-report questionnaire that measures the prevalence of 16 potentially traumatic life events and an additional open category (“Other highly stressful events or experiences”). is asked in five answer categories. LEC has been translated into Balinese. Respondents are asked to indicate whether they have experienced, witnessed, or learned about 17 different traumatic events or other particularly stressful experiences not included in the 17 items. (Gray, 2004). These factors include life events such as natural disasters, physical or sexual assault, serious injury, and wrongful death (homicide or suicide). For each situation, respondents were asked to indicate the type of exposure (i.e., whether they experienced the event directly, witnessed an event or situation involving a close family member or friend, and whether it was related to relevant professional activities. You will be asked to indicate whether the

Date of death (of the victim), relationship between the respondent and/or the registered victim. The gender of the participants was also assessed. Finally, when the accident occurred and whether the participant was directly involved in the accident were examined. Gender differences in PTSD
All analyzes were performed using SPSS Statistical Package version 21. Internal consistency of the PCL-5 was assessed using Cronbach’s alpha coefficient. A Cronbach’s alpha of 0.70 or higher is considered satisfactory (Nunnally, 1978). Inter-rater reliability constructs and convergent validity were assessed using Pearson R correlations.


Ashbaugh, A. R., Houle-Johnson, S., Herbert, C., El-Hage, W., and Brunet, A. (2016). Psychometric validation of the English and French versions of the DSM-5 (PCL-5) Posttraumatic Stress Disorder Checklist. PloS 1, 11(10), e0161645.

Blevins, C. A., Weathers, F.W., Davis, M.T., Witte, T.K., Domino, J.L. (2015). Posttraumatic Stress Disorder Checklist for DSM™5 (PCL™5): Developmental and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489-498.

Breslau, N., Kessler, R.C., Chilcoat, H. D., Schulz, L.R., Davis, G.C., & Andreski, P. (1998). Trauma and Posttraumatic Stress Disorder in the Community: The 1996 Detroit Area Trauma Survey. Archives of General Psychiatry, 55(7), 626-632.

Christiansen, D. M., Erkrit, A., & Orff, M. (2013). A parent who experienced the death of a child: Her PTSD symptoms up to 18 years after the death. General Hospital Psychiatry, 35(6), 605-611.

Elhai, J.D., Gray, M.J., Kashdan, T.B., Franklin, C. L. (2005). What are the most commonly used instruments to assess exposure to traumatic events and posttraumatic effects?: A survey of traumatic stress experts. Journal of Traumatic Stress: Official Publication of the International Society for Traumatic Stress Research, 18(5), 541-545.

Fodor, K. E., Posen, J., Ntaganira, J., Sezibela, V., and Neugebauer, R. (2015). Factor structure of posttraumatic stress disorder symptoms in Rwandans exposed to the 1994 genocide: A confirmatory factor analytic study using the PCL-C. Journal of Anxiety Disorders, 32, 8-16.

Gray, M. J., Ritz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the Life Event Checklist. Review, 11(4), 330-341.

M.A. McCanni, D.L. Delahanty, N. Nugent. R. & Berkowitz, S. J. (2012). Pharmacological secondary prevention of PTSD in adolescents: Challenges and opportunities for progress. Journal of Traumatic Stress, 25(5), 543-550.

McDonald, S. D. & Calhoun, P. S. (2010). Diagnostic accuracy of PTSD checklists: A critical review. Review of Clinical Psychology, 30(8), 976-987.

National Collaborative Center for Mental Health. England. (2005). Post-traumatic stress disorder: Treatment of her PTSD in adults and children in primary and secondary care. Gaskell.

Nunnally, J.C. (1978). Introduction to psychometrics. In the clinical diagnosis of mental disorders (pp. 97–146). Springer, Boston, Massachusetts.

Thorin, D.F., Wolfunski, P., Maltby, N. (2006). Are “obsessive” beliefs unique to obsessive-compulsive disorder?: A comparison of different anxiety disorders. Behavioral Research and Therapy, 44(4), 469-480.

Weathers, F.W., Ritz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993, October). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. At the International Society for the Study of Traumatic Stress Annual Meeting, San Antonio, Texas (No. 462).

Wilson, J.P. & Moran, T. A. (1998). Psychological trauma: Post-traumatic stress disorder and spirituality. Journal of Psychology and Theology, 26(2), 168-178.

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