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Procedia - Social and Behavioral Sciences 234 (2016) 125 – 134

ASEAN-Turkey ASLI (Annual Serial Landmark International) Conferences on Quality of Life 2016
AMER International Conference on Quality of Life, AicQoL2016Medan
25 – 27 February 2016, Medan, Indonesia

Posttraumatic Stress Disorder and Quality of Life Among Flood
Disaster Victims
Ahmad Zaidin Othman, Akehsan Dahlan*, Siti Norfaizah Borhani, Halil Rusdi
Occupational Performance and Behaviour Measurement Group (RIG), Occupational Therapy Department, Faculty of Health Sciences / CORE
Management Science, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, 42300 Selangor, Malaysia

Abstract

Flood is a horrible disaster that affects peoples’ life. The disaster affects people in different ways, and many people experience a
posttraumatic stress disorder (PTSD) as a result of changes in daily routine and loss of roles in life. These changes subsequently
affect their quality of life. The aim of this study was to identify the posttraumatic stress disorder amongst flood victims in
Kelantan, Malaysia. One hundred and forty-nine participants participated in this cross-sectional study. The results indicated that
there were a significant difference in PTSD between gender, ethnic groups and age groups amongst participants in the study.
©
© 2015 TheAuthors.
2016 The Authors.Published
Published byby Elsevier
Elsevier Ltd.Ltd.
This is an open access article under the CC BY-NC-ND license
Peer-review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers) and cE-Bs (Centre
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
for Environment-Behaviour
Peer-review Studies,
under responsibility Faculty of Architecture,
of the Association Planning & Surveying,Researchers,
of Malaysian Environment-Behavior Universiti Teknologi
AMER (ABRAMARA, Malaysia.
malaysia)

Keywords: Flood disaster; posttraumatic stress disorder; quality of life; flood victims

1. Introduction

Flood disaster is a frequent occurrence of natural disaster in Malaysia. In December 2014, a severe flood
occurred in several states located on the east coast of Malaysia (i.e. Kelantan, Terengganu, and Pahang). Many were
forced to evacuate their homes to sheltered locations that were situated on higher grounds. Being placed in sheltered
locations with unfamiliar people may cause invasion of personal space and privacy, which Gharaei and Rafieian

* Corresponding author. Tel.: +603-32584380; fax: +603-32584599.
E-mail address: akehsan@salam.uitm.edu.my

1877-0428 © 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the Association of Malaysian Environment-Behavior Researchers, AMER (ABRA malaysia)
doi:10.1016/j.sbspro.2016.10.227

2. psychological. Hoseinifar. and flashbacks of past traumatic events. Furthermore.. however. clean water. affects the quality of life. Eskash. This is in line with a statement by Srivastava. which among other factors. which is supported by the report of University of Colorado Boulder (2001) where disaster created an imbalance in these interactions by creating sudden changes in social networks. Posttraumatic stress disorder (PTSD) is a psychiatric disorder in which an individual experience one or more traumatic events during their lifetime. 2012). the aim of this study was to determine the posttraumatic stress disorder (PTSD) symptoms among flood victims in Kelantan. and would require a tremendous amount of hours spent to clean up and repair their homes. found that most of the victims are afraid that the flood might occur again. disaster gives a tremendous impact on physical.1. lifelines. Settings and participants The study was conducted in Kelantan. as well as. which is a result of mental response towards traumatic events. Sampling Convenience sampling technique was used in determining the impact of flood disaster on the victims’ posttraumatic stress disorder level (Hyperarousal. and Khairudin. However. Mirbeigi.2. hence decreasing quality of life (Zokaeefar. depends on the individuals’ life experience and perception of the events (Nasir et al.”. David and Ramakrishnan (2006). Disruption in basic amenities may affect the victims’ life. (II) able to understand the Malay Language. Dousti. and Avoidance). health.Social and Behavioral Sciences 234 (2016) 125 – 134 (2013). To be included in this study. PTSD. Rezaeinejad & Miri. worry. Besides that. Methodology 2. 2012). Zainah. and Vlahov. trespassing this space would lead to stress. Wok. .. Manaf & Ismail. and experience of flood (Nasir et al. According to Nasir et al. gender. history of flood events and group of ages) and PTSD. (IV) citizen of Malaysia. who experienced the flood disaster that stricken the east coast of Malaysia on December 2014. The objective of the study is to screen the development of PTSD symptoms through the Impact of Event Scale-Revised version (IES-R) assessment. on the psychological effects of the Johor flood in 2006/2007. which would lead to a person experiencing a countless number of symptoms (Heshmati. This is supported by Juarez and Guerra (2010). Intrusion. The 2014 floods event that hit the east coast of Malaysia had caused shortage of food supplies. consisting of both male and female from different races. (2012). The psychological impact of disaster on people. 2015). living in sheltered home and not being able to work has an effect on the disaster victims. 2005). economic. among the various demographic variables of flood victims in Kelantan. where displaced persons are prone to challenges of economic resources. Sedaghatpishe & Shafii. in which. the participants had to meet the following criteria (I) aged 15 years or older. Hence. social and economics on the victims. Malaysia. ethnic. stated that privacy of personal space is a universal need in human. According to Ahmadizadeh et al. Nandi. and communication system (Aisha. A qualitative study conducted by Nasir. 2012. Malaysia. the effects on the disaster victims differ from individual based on age. whether there were differences between the demographic variables (gender. it was found that there is a relationship between psychological wellbeing and disaster among different group of people (including rescue team) who were involved directly in the catastrophe. banking service. “PTSD is characterized by intrusive thoughts. 2. Shookner (1997) explains quality of life as the dynamic interaction between social. hypervigilance and sleep disturbance…. can have lasting effects.. environment and the economic which in turn affecting the victims health and wellbeing. 2010). (III) live in Kelantan and experience the December 2014 flood disaster in Kelantan. aged 15 years old and above. / Procedia . electricity. and aggression. avoidance of reminders of the trauma. nightmares. In recent years. and environmental condition that would shape human and social development.126 Ahmad Zaidin Othman et al. which would exhibit numerous clusters of symptoms (Galea. (2010). 2015). lots of studies have been conducted in determining the relationship between natural disaster and mental as well as physical health. Those involved with high impact incidents or experiencing traumatic events are at greater risk of developing posttraumatic stress disorder (PTSD).

Data had been collected through face to face interview. 2. gender. conducted between researcher and flood victims directly. All participants were explained the aim and objectives of the study and informed consent were obtained and collected from the participants. 1 (A little bit). 2. GFI=0. There are 22 items in IES-R.697). 3 (Quite a bit). Ahmad Zaidin Othman et al. . Bell & Failla.4. discriminant validity. Ethics The study was approved by the Research Ethics Committee of Universiti Teknologi MARA. CFI=0. There is no specific cut-off score for the instruments.6.913.5. Research instruments Data regarding Posttraumatic Stress Disorder (PTSD) was collected using the Impact of Events Scale-Revised (IES-R) developed in 1997.3. gender. eight items for the Avoidance symptoms. ethnic and flood experience or history) with the IES-R scores. 2003). 2014).Social and Behavioral Sciences 234 (2016) 125 – 134 127 There was a total of 149 respondents in this study. The IES-R added six new hyperarousal related items in the instruments as it is one of the major symptom clusters of PTSD (Creamer. Study design Cross-sectional design was used to explore the posttraumatic stress disorder (PTSD) symptoms among flood victims in Kelantan.91 for hyperarousal (Creamer et al.0. 4 (Extremely). as it has high internal consistency for the total scores with Cronbach’s alpha of 0. All of the participants who were willing to participate in the program and fit into the inclusion criteria were chosen.. The three construct of IES-R Malay version have good convergent validity. The original IES only assess the intrusion and avoidance symptom of people with PTSD. 2014).927.96. A translated version (English to Malay). IES-R was used to measure the subjective response towards traumatic events and is not served as a diagnostic tool for PTSD (Christianson & Marren.94 for intrusion. internal reliability and construct validity (Norhayati & Aniza.948. 2012). ethnic and flood experience or history of floods. 0. the same goes to each domain where their Cronbach’s alpha is 0.87 for avoidance. which contains eight items for Intrusion symptoms. Furthermore. Inferential analysis of the study used. Cross- sectional design was chosen as this study was carried out over a short period. and 0. 2012). mean and standard deviation of the socio- demographic data and the score of Impact of Event Scale-Revised (IES-R) Malay version. Scoring is based on 0 (Not at all). It is a valid and reliable measure.079. Malaysia based on their age. (as in Appendix A) was used for this study (Norhayati & Aniza. According to Norhayati and Aniza (2014). but larger score indicates severe symptoms (Christianson & Marren. TLI=0. percentages. and six items for the Hyperarousal symptoms. 2003). / Procedia . 2. 2. It was then followed by post-hoc analysis of the results for multiple comparisons. 2 (Moderately). Data analysis Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. data were collected directly based on individual characteristics that met the inclusion and exclusion criteria. Descriptive analysis was used to determine the frequency. the IES-R Malay version contained ten items compared to the 22 items in the original items and was found that it have acceptable fit (RMSEA=0. SPSS was used to process and analyze the data from the questionnaire that include respondent’s demographic data and score from IES- R. the Independent T-Test (between 2 groups) and one-way ANOVA (more than two groups) to compare the demographic data (include age. x2/df=1.

Low impact respondents were those which their total means score in IES-R was below 1.50. ethnic. Results showed only 2% experienced high impact (n=3).35 . for respondents with 1.128 Ahmad Zaidin Othman et al.0 No 76 51.6 Non-Malay 26 17. age.7 Ethnic Malay 123 82. 98%).5 55 and above 22 14. Socio-demographic characteristics of the participants Demographic Data Frequency Percentage (%) Gender Male 60 40. Results 3.61. (n=146. they were categorized as victims suffering from the high impact of the disaster.26 0.4 Age 15-24 49 32. Demographic information Basic demographic information (gender.18 (0.0 3.2.69 0. and the others show low impact toward the flood disaster events.1 45-54 35 23. and history of flood events) are presented in Table 1.Social and Behavioral Sciences 234 (2016) 125 – 134 3. But. Intrusion scores the highest mean with the value of 1.50 and above in IES-R total means score. avoidance subscale. / Procedia .7 35-44 27 18. and hyperarousal subscale.18 0. Table 2. There is a total of 149 participants (male=60. Table 1.8 History of Flood Events Yes 73 49.41 Hyperarousal 0. The mean total score of IES-R was then categorized into two which are low impact and high impact (Table 3).35) respectively (Table 2).61 Avoidance 0.26 and standard deviation of .9 25-34 16 10. female=89) that met the inclusion and exclusion criteria of the study.1. Mean score decreased involved other subscales include avoidance and hyperarousal with the score 0.69 (0.41) and 0. IES-R mean score for each subscale IES-R Subscale Mean Standard Deviation Intrusion 1.3 Female 89 59. IES-R means score Descriptive analysis for the mean score had been established to determine the mean and standard deviation for each subscale of IES-R include intrusion subscale.

36.73 (0.019.31) 0.011.16). The mean total score for IES-R have a significant difference when compared to gender (p=0.82) compared to male (0. Malay scored higher than non-Malay with 0. and history of flood events Table 4 illustrate the mean differences between male and female for each subscale of IES-R. Female participants had a high mean score when compared to male participants for all subscales (intrusion. However.04).325 (-0. -0.37 (142.155. showed no statistical significant between Malay and non- Malay (p=0. Intrusion subscales when compared to male and female participants showed significant difference (p=0. 95% CI = -0.33) -0. IES-R score on gender.450. 0.62 (147) 0.019 (-0.13 (0. and hyperarousal).86 and 0.25.03). with female had higher mean (0.24.36.Social and Behavioral Sciences 234 (2016) 125 – 134 129 Table 3. 0.52) 1.107) and hyperarousal (p = 0. Comparison between IES-R score and gender Variables Male (n=60) Female (n=89) Mean differences t-stats (df) P value mean (SD) mean (SD) (95% CI) Intrusion 1.40) 0.35 (0.17. on the other hand.11 -1. there was no statistical significance for subscales of avoidance (p = 0.21 (0.23.06) Total 0.32) 0.65) -0.42.30) 0. Comparison between IES-R score and ethnic Variables Malay (n=123) Non-Malay (n=26) Mean differences t-stats (df) P value mean (SD) mean (SD) (95% CI) Intrusion 1.04) Avoidance 0.05 (51.24. the mean score for hyperarousal subscale. ethnic.14 (-0. The mean total score. there was a significant difference for subscales of avoidance (p = 0. avoidance.23 -2.001) between Malay and non- Malay.65 respectively.06 -0.107 (-0.450 (-0.15 (0.22 and 0.011 Table 5 showed the mean differences between ethnic (Malay and non-Malay) for each subscale of IES-R.325).65 (0.42.25 (0.60) 1.42) -0. 95% CI = -0.02) Hyperarousal 0. Table 5.82 (0.62 (0.68).03) -2.43) 0. Impact of Flood Event based on total means score of IES-R Interpretation n (%) Low Impact 146 (98) Impact of Flood Event High Impact 3 (2) 3. There were no significant difference for the intrusion subscale (p = 0.64) -0.004 . 95% CI = -0.76 (147) 0. -0.04).86 (0. / Procedia .3. However.16) Avoidance 0. while. 95% CI = -0. Ahmad Zaidin Othman et al.63) 0.37) -0.99 (147) 0.04 respectively.29) -0.10 -0. 0.58 (147) 0.004) and hyperarousal (p = 0.21 -3.36 (0.68 (0. 0. 0. -0. -0. Table 4. non-Malay scored higher than Malay with 0. The mean score for avoidance subscale.

56 (0.26) 4.44) Avoidance 0.276 0.14) 0. 95% CI = -0.598 0. 0.49) 1.09.16 (0. -0.04 (0. Table 7.78 Table 7 below was analyzed using the one-way ANOVA. Discussion Findings showed only 2% of flood victims suffered high impact after the disastrous flood events in Kelantan.69) 0.27. -0.001 25-34 16 0.01.Social and Behavioral Sciences 234 (2016) 125 – 134 (-0.32) 0.25) 45-54 35 0.12) 0. 0. 0.38) 0. -0.39 (0. Comparison between IES-R score and history of flood events (have history or no history of flood events) Variables Have history of No history of flood Mean differences t-stats (df) P value flood event (n=73) event (n=76) (95% CI) Mean (SD) Mean (SD) Intrusion 1.71 (0.155 Table 6 illustrated the mean differences in IES-R score based on the history of flood events for each subscale of IES-R.01 (0.06.36) 0.04) -1.48.07.43 (147) 0.78. 0.25 2. There are significant differences for intrusion (p=0.27.713 0.20) 13.37) 0. 0.41) 4.27) 0.001) suggesting that at least one group among the populations were significantly different.10 (-0. 0.31) -0.23. 0. 95% CI= -0.051 0.976 (4) 0. The mean difference between IES-R total scores of victims that have history of flood events and who have no history of flood events are not statistically significant (p=0.82) 0. there were no significant difference for subscales of hyperarousal (p = 0. Subsequent post-hoc analysis (Scheffe procedure) was done and suggested that the total mean of IES-R showed higher means for the age group of 55 and above when compared to other age groups.15) Total 0.09.34.14 -2. The other 98% were classified under low impact.18 (0.06.49) 0. It showed a significant difference (p = 0.22 (0.15).28) -0.48 (-0.01 (0.001 Total 0.44) and avoidance (p=0.62 (0. / Procedia . Table 6. Intrusion scored higher than other .74 (0.12 (110.75 (0.04 0.63 (0.04.004) subscales when compared to history of flood events experienced by the participants.12).77 (0. Comparison of IES-R means score between different ages of group Variables (age) n Mean (SD) F-stats (df) P value Total IES-R 15-24 49 0. 95% CI = 0.31) 55 and above 22 1.015 (-0.04 (-0.07.76 (0. However.84 (0.09. 95% CI = -0.14 (0.004) Hyperarousal 0. 0. When compared to each subscale.33) 0.21 (0.130 Ahmad Zaidin Othman et al.87 (0.07) Hyperarousal 0.19) 35-44 27 0.

Nazli. This is supported by previous research by Telles et al. economic. Ahmad Zaidin Othman et al. concerning peritraumatic and posttraumatic cognitions and behaviors (Tolin and Foa.15).: housing. another factor should be explored in the relationship between religious coping skill with age and education background.155. Relating QoL with other variables can vary. Concerning Quality of Life (QoL). there is a need to restore and regain the social. I get worried and panicked. even though they were placed in a sheltered environment as the shelter management provide the basic needs that would suffice them in performing their usual roles and routines.33) and 0. 95% CI = 0. This is supported further by Shubina (2015). Besides that. A study done by (Waelveerakup. on the other hand.78. Othman. the results only represent Malays regarding the coping technique being used in facing flood disaster. However. Since this study also has more Malay participants compared to non-Malay.82 (0. Owens & Olema. Respondent in his study (Abdullah et al. education. 2013) where women have higher rates of developing PTSD as compared to men.4%. health.04). change in life philosophy). Non-Malay = 2. Abdullah & Othman. as well as. This is supported by studies (Sipon. among PTSD victims was found to have a better quality of life (Baglama & Atak. retirement. and environment situation. 0. safe and healthy environment. Different age groups were found to have significant differences when compared to the total means of IES-R. 2015). recreational opportunities.. 2016). There are several coping technique (emotion focused coping. (2009) found that the people over the age of 60 years old had highest scores for PTSD and depression than other age groups significantly. 2015). 2014).. / Procedia .. Nasrah. problem- focused coping. This is supported by other study done by Nasir et al. 2015).6%) and his findings showed that the respondents have high positive religious coping in dealing with life after disaster. victims who had the trauma of the flood events and were scared of experiencing another flood event. a disruption of a person’s roles and routines would affect their QoL. Posttraumatic growth. cognitive impairment and reduced in social support (Cook. young people and people with low education background have lower religious coping skills. in order to enhance QoL after disaster. for the victims to maintain normal human and social development (Shookner. This is most probably due to the perception of local people. and opportunities for civic engagement). in which they find that a flood is a normal event (Ahmad & Abdurahman.. to have a higher QoL. can be explained in which. and religious coping) that was used by everyone in dealing with the aftermath of disaster (Abdullah et al. 2014.01 (0. which is a positive symptom (adapt to life. Perception.g. found that most subjects had a moderate level of QoL. 0. . 2014). The mean difference between IES-R total scores of Malay and non-Malay was found to be not statistically significant (p=0. employment opportunities. mobility. they are experiencing loss of functional performance that includes increased in health problem. Ssenyonga. older people may face more challenging life post-disaster as they are coping with memories of events that lead to trauma and adapting to the changes in role.41) compared to their younger counterparts. The mean difference between IES-R total scores between victims who have a history of flood events and those who are not was found to have no statistical significance (p=0. 2014). This may relate with the psychological well-being of male and female who responded differently to trauma. Will there be a flood again?” It was found that there was a significant difference between male and female in total means of IES-R. decreased in income. whether their basic needs were met. 2006).23. Female scored higher means compared to male with 0. 95% CI = -0. where the way of thinking and key beliefs influence the perception and interpretation (whether it is positive or negative) of incoming events. Nazli. There are various factors on why PTSD symptoms increase with age. Positive spirituality helps in coping with PTSD and develop resilience among victims. 1997). Victims aged 55 years old and above scored the highest mean 1. Damir & Toadir. According to University of Colorado Boulder (2001). health. depending on the victims’ perception of disaster. According to Cook (2001). a community can pick and choose among the options for improving its quality of life (e. had a significant negative impact on their general quality of life (Van Ootegem & Verhofstadt. they will be affected similarly as those in the affected population. 2015). were mostly Malays (Malay = 97.Social and Behavioral Sciences 234 (2016) 125 – 134 131 subscales that are avoidance and hyperarousal. where victims had flashback memories of the flood disaster events and worried about the recurrence of the flood “…until now whenever it rains.07. 2014. This showed that regardless of whether the participants had experienced flood disaster.68 (0. and Ghani (2014). 2001). Sipon. as according to Radzi.30) respectively. among flood victims in Johor. (2012). Victims used religious coping skill as it is a way people cope with adverse life events where they seek relief and strength as well as engaging in religious activities and reasoned themselves that the event was an act of God (Sipon et al. for them to move forward (Sipon et al. Thus.

this study was based on a self-report questionnaire. 12. Manaf. 931–937. (2015). H.. Behaviour Research and Therapy. Bell. Eskandari. Lastly. Future research could include a larger sample. preventive measures and on-going research regarding disaster to be taken as priorities. & Atak. (2015).. 6(3 S2). Understanding the impact of trauma events such as flood disasters and PTSD symptoms development will allow us to focus on preventive management and strategies needed to face another calamity. Therefore. 262–266. Procedia . Procedia - Social and Behavioral Sciences. Procedia-Social and Behavioral Sciences. and they might not be willing to share their actual feeling and experiences during the flood disaster events. A.132 Ahmad Zaidin Othman et al. M. H. instead of longitudinal design. Psychometric properties of the impact of event scale—revised.2015. doi:10. K. Paper presented at The 2015 WEI International Academic Conference Proceedings. social worker..westeastinstitute. Ahmadi. some response may be prone to bias. & Ghani. 1489-1496. References Abdullah. & Ismail. Christianson. A. to see whether or not there is a significant difference in experience and problems faced by flood disaster victims and earthquake disaster victims.. & Marren. S. R. This study provides insight to those involved in disaster management team (clinicians. A longitudinal study should also be conducted to examine the changes in the results after a period. and other health teams) in providing the necessary intervention required.Social and Behavioral Sciences 234 (2016) 125 – 134 There were several limitations in this research. Exploring the use of social media during the 2014 flood in Malaysia. A. The impact of event scale-revised (IES-R). I. Z. (2003).com/wp- content/uploads/2015/04/SALHAH-ABDULLAH2.. Anisi. S. The flood victims might have difficulty remembering the flood events. R. (2015). Also.11. Firstly. W. Stress and religious coping among flood victims in Malaysia. M.. Austria.Social and Behavioral Sciences. R. 1-7 Creamer. Radzi. volunteers. Flood victims from other areas may show different results regarding PTSD development and their impact toward flood disaster..123 Baglama. W. T.. and involve other states that experienced flood so that a better comparison can be build nationwide. University Teknologi MARA (UiTM) for permission to conduct the study and to all participants in the study. Medsurg Nurs. 340. this study was only able to provide small sample size due to time constraint. Wok. M.. S. M..2010. 5. It was found that female and older people are more vulnerable to developing PTSD symptoms in relation to flood disaster. Only then a more resilient community towards disaster can be built. & Abdurahman. 448-454.. . male and young people should also be taken into consideration as they may also contribute to the development of PTSD. this provides opportunity and chances for the flood victims to share and understand their emotions. 321-322. S. Mediterranean Journal of Social Sciences. & Failla. S. recommendation can be made for future study on other natural disasters that struck Malaysia such as earthquake.sbspro. Despite that. Posttraumatic growth and related factors among postoperative breast cancer patients. Kelantan. A.. Nevertheless. Borjali.085 Aisha. (2010). (2001). 211(September). Retrieved from http://www.1016/j. it is necessary that. Conclusion As disaster can be unpredictable at times. S. B. (2012). Sipon. Vienna. doi:10. 41(12). M. I. problem solving and combined therapy in chronic war-related post traumatic stress disorder.. Ahmadizadeh. as well as unable to compare the results with other countries that have been involved with flood disaster. S.. Improvement in quality of life after exposure therapy.. Furthermore. M.. Besides that. Post-traumatic stress disorder in older adults. Future research should consider false memories strategies to be incorporated during data collection. this study only involved flood victims from Kelantan and is unable to provide data that would represent Malaysia. / Procedia .pdf Ahmad. E. cross-sectional study that was chosen. & Teimoori. M. could not tell the changes that might occur to flood victims after a period. Cook. J. 21(5).sbspro. Acknowledgements The authors wish to thank Faculty of Health Sciences. 190. J. J. PTSD Research Quarterly. Falsafinejad. 5(2). convenience sampling method used may lead to bias in the sample chosen. Lastly. (2015).1016/j. rehabilitation specialist. Kelantan Flood 2014: Reflections from Relief Aid Mission to Kampung Kemubu. M. J..07.

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/ Procedia . Malay Version . Impact of Event Scale Revised Version (IES-R).Social and Behavioral Sciences 234 (2016) 125 – 134 Appendix A.134 Ahmad Zaidin Othman et al.