International Journal of Social Science and Humanity, Vol. 3, No.

6, November 2013

Relating Stress, Anxiety and Depression among Flood

Victims’Quality of Life in Malaysia: A Theoretical
Perspective
Johana Johari and Najib Ahmad Marzuki

area in Malaysia. Monsoon flood normally affects the states

Abstract—Flood disaster is one of the events that have an of Johor, Terengganu, Pahang, Sabah dan Sarawak.
impact on the lives of the individuals involved in Malaysia. Nevertheless, other states such as Perlis, Kedah, Pulau
Destruction and loss make a person feels depressed besides Pinang, Perak, Selangor, Negeri Sembilan, Melaka and
being worried. Even worse when the victims become depressed Wilayah Persekutuan Kuala Lumpur did experience flash
as a result of the incident. Flood events can be seen as a threat to floods[1]. Even worse, in 2010, these flash floodshave turned
the well-being of individuals both physically and emotionally.
This article will discuss how stress, anxiety and depression are
into a nightmare when it became a natural disaster and
relatedtothe quality of life and well-being of flood victims. The affected areas that had never suffered flooding before. The
discussion is based on the Stressful Life EventsTheory, Freud’s total number of flood victims can be seen in Table I [4].
Anxiety Theory, Beck's Cognitive Theory of Depression and the
Quality of Life Conceptual Model. TABLE I: TOTAL NUMBER OF VICTIMS
State Number Number Number Death
of relief of of Cases
Index Terms—Flood, stress life events, freudanxiety theory, centres families victims
beck cognitive theory of depression, conceptual model quality of
life. Perlis 57 2,921 15,261 0
Kedah 202 15,257 64,924 6
Kelantan 45 1,622 5,311 3
I. INTRODUCTION Terengganu 84 1,499 6,061 0
Johor 376 30,276 116,660 6
Flooding in Malaysia has various impacts on the affected Melaka 32 2,325 9,089 1
population in terms of damage to property, destruction of Negeri Sembilan 27 715 3,083 0
property and loss of life. In general, the average rainfall for Pahang 45 961 4,650 0
all the states in Malaysia is 2,500 mm a year [1]. This has put Sabah 20 903 3,389 5
Malaysia as one of the countries with the heaviest rainfall in Sarawak 18 615 2,949 0
the world. Flood disaster has created sufferings, pain and Total 906 57,094 231,377 21
agony among the victims. Source: National Security Council, 2011
In relation to this, stress and anxiety have been recognized
as factors that could lead to depression and this will affect the Effects suffered by each victim in Malaysia are different
quality of life of those involved. With the growing number of depending on the experiences during the flood. Victims are
victims each year, much needs to be done in order to ensure still faced with the risk of flooding in the future. The question
quality health and well-being. Victims are regularly plagued arises in terms of the feelings experienced by the victims is do
by flooding that has happened before. This gives rise to stress they suffer from stress, anxiety and depression when thinking
and anxiety among flood victims. Residents expressed about the recurrent risks? Any daily activities arecertainly
concern and pressure on natural eventsaftera long period of affected if the unforeseen incident occurs again. The
heavy rain. As a consequence, their daily lives are always in a psychological and physiological effects and change will be
state of alert. Hence, they are worried of repeated flooding experienced by those who are dealing with stress [5].
[2]. When a person is faced with stress and anxiety, their
With a total number of 189 river systems (1,800 small quality of life will be affected.According to Ferran[6],one’s
rivers altogether) spanning across 57,300 kilometres, many well-being or quality of life is geared towards how a person
low terrain areas are affected by serious flooding. In general, can live a normal and quiet life, capabilitiesto lead to a more
flood can be categorised under three categories, namely flash meaningful social life, joy and satisfaction, and achieve
flood, monsoon flood and tropical flood. However, in physical and mental ability.
Malaysia, the most suffered flood is the monsoon flood Based on the above discussion, the objective of this paper
caused by the effect of continent location and sea water is to discuss the possible theoretical perspective via model
level[3]. Areas that are affected by serious flooding span integration for the purpose of conducting a research on flood
across 29,800 kilometres, which is about 9 percent of the total management relief.

Manuscript received May 25, 2013; revised August 1, 2013. This work
was supported in part by the Ministry of Higher Education Malaysia under II. CONCEPTUAL DEFINITION
the Long-Term Research Grant Scheme
(LRGS/b-u/2012/UUM/Communication Technology and Information). A. Stress, Anxiety and Depression
Johana Johariand Najib Ahmad Marzuki arewith the School of Social Selye (1968) mentioned that the stress tradition
Development, Universiti Utara Malaysia, 06010 Sintok, Kedah, Malaysia.
(e-mail: [email protected]; [email protected]). encompasses a diffuse and multifaceted array of psychic,

DOI: 10.7763/IJSSH.2013.V3.300 543

 International Journal of Social Science and Humanity, Vol. 3, No. 6, November 2013

somatic, and interpersonal problems that often arise as aspects of life and has been used in a variety of disciplines
responses to the strains of everyday life. There is eustress such as geography, philosophy, medical sciences, social
when it helps us perform better, or distress when it causes sciences, health promotion and advertising [13].
upset or makes us sick. The causes of stress are called Many factors such as physical, spiritual and health state,
stressors or triggers [7]. independence level, social relationship with the environment
The anxiety disorders represent a failure to either elect an and others are influencedby the quality of life[14]. Quality of
adaptive response or to inhibit a maladaptive response given life has also been defined “as the satisfaction of an
a situation. Anxiety is a state of diffuse arousal following the individual’s values, goals and needs through the actualization
perception of a real or imagined threat. This fundamentally of their abilities or lifestyle” [15].
experiential, future-oriented, self-focusing emotion at times Quality of life is assessed with the help of both objective
can be adaptive, as anticipatory problem-solving thoughts are and subjective indicators. In the quality of life research, one
triggered. Anxiety disorders will directly implicates emotion often distinguishes between the subjective and objective
[8], [9]. quality of life. Subjective quality of life is about feeling good
Depression is not the same as a blue mood, which is a and being satisfied with things in general. Objective quality
normal short-term experience of sadness or loss. Depression of life is about fulfilling the society and cultural demands for
is an illness that involves the body, mood, and thoughts. material wealth, social status and physical well-being [16].
Often referred to as the invisible disease, it affects the way a According to Ferrell, quality of life is one’s well-being
person eats and sleeps, the way one feels about oneself, and covering four areas, namely physical, mental, social and
the way one thinks about things. Depression is not a sign of spiritual well-being [17]. Quality of life and well-being are
weakness or a condition that can be willed or wished away. practically interchangeable concepts but may be
People who are depressed cannot merely “pull themselves distinguished by the manner they are measured [18].
together” and get better. Without treatment, symptoms can In this paper quality of life refersto the World Health
last for weeks, months, or years. Appropriate treatment, Organization (WHO) definition [19] in the WHO Quality of
however, can help most people who suffer from depression Life-BREFF (WHOQOL-BREFF)as an individual's
[10], [11]. perception of their position and life in the context of culture
and value systems associated with staying connected with the
TABLE II: SCALE AND FEATURES OF DEPRESSION,ANXIETY AND STRESS goals, expectations, standards and concerns. It covers
Scale Features
physical health, psychological state, level of independence,
Depression Chide
Frustrated, moody, blue social relationships, personal beliefs and relationship with the
Convinced that life has no meaning and environment. The quality of life is not just simply related to
worth health, lifestyle, life satisfaction, mental state and well-being,
Pessimistic about the future
Do not get the pleasure or satisfaction
but is also related to the perception of the individual
Not interested in engaging in any activity assessment of the level of mental health, the psychosocial and
Less initiative other aspects of life. The quality of life also includes physical
Anxiety Worry, panic
and mental health and social well-being.
Shy, not confident
Sweating, dry mouth, shortness of
breath, heart palpitations, sweatiness of the
palms III. THEORY
Worried about performance, the possibility of
losing control The theory which will be discussed and is appropriate to
Stress Over-aroused, tense the study of stress, anxiety, depression and quality of life is
Unable to relax
Sensitive, irritable
the stress life event theory, Freud’s anxiety theory, Beck's
Easily startled cognitive theory of depression and the quality of life
Worried, agitated, restless conceptual model.
Tolerance interrupted or otherwise
affected A. The Stressful Life Events Theory
The Theory of Stressful Live Events was presented by
In this paper definitionsof depression, anxiety and stress Holmes and Rahe[20], and, Holmes and Matsu[21]. They
are based on the Depression Anxiety Stress Scale (DASS) by agree with the opinion that the occurrence of specific
Lovibond and Lovibond [12]. It has been noticed that stress eventsin life can have an impact on individual physical and
makes the person easily offended, becomes angry, loses mental self. Their research aims to formulate specific events
focus on the job and this will have an impact on one's health. in life that cause stress. According to this theory, stress
Concerns about uneasyfeelingsareusually responded as appears to be based on the individual’s experienced incidents
nervous, scared and worried about the effects of where the incident raises coping behavior and adaptive
psychological factors, while depression is a disturbance responses. According to this theory, stress stems from life
resulting in the loss of a sense of happiness and excitement experience which in turn affects and change someone’s life.
about things around. This reaction is caused by a condition or This reflectnegative pressure that can affect the daily life
event that causes a person to feel loss in terms of economic journey.
factor, family, health and social services. The salient features
of the scale are as Table II. B. Freud’s Anxiety Theory
According to Freud in Strongman [22], anxiety is caused
B. Quality of Life
by threats or harassment individuals received. Anxiety is part
Quality of life is a broad concept that incorporates all

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 International Journal of Social Science and Humanity, Vol. 3, No. 6, November 2013

of the natural instinct for self-safety stemming from

emotional shock and fear of castration. Concerns create a
sense of panic. Reality due to concerns result in bitter
experience that the perception of the environment poses a
threat in dealing with the fear of an environmental condition.
This effect is sometimes able to affect up to a lifetime. Things
that can inspire fear and stress to individuals will cause
concerns in them to deal with the situation [23].
C. Beck’s Cognitive Theory of Depression
Stress and anxiety experienced by the victims can finally Fig. 1. Theory integration model.
create the symptoms of depression. According to Beck [24],
depression is due to the attitude and mindset of private
individuals and the symptoms showing signs of depression V. DISCUSSION
are a result of nonpeaceful thoughts. Those who are Floodsin Malaysia have caused a change in the lives of
depressed are more likely to perceive their future experience those affected. These changes sometimes provide pressure to
as an understanding of the personal and impersonal factors. the flood victims in their daily life. The relationship between
Cognitive structure between the input stimulus and response experienced events and stress affect the victims indirectly.
personality of the beliefs and assumptions relate to an object, Pressure can affect the flood victims’quality of life. Despite
event or environment. They also consider the future of their this,sustained pressure varies with individuals. According to
experience as negative and unrealistic. Depressed attitude is Ralf and Ute [26],although the flood disaster can be predicted
likely to be long-lasting and permanent if not controlled. and detected several days before the incident, it still
They are also in a state of worry and concern. This theory givesshock and pressure to the flood victims, and this is
describes the three negative thinking: man, of himself, the considered as a perception of control (perceived
world and the future as he thinks. Negative thoughts of controllability). Perception of control is considered to be
oneself are how individuals will see themselves in a negative one-dimensional in categorizingstressful life events. This
frame of thought; thinking of oneself as inadequate and disaster could provide pressure and alter the function of the
worthless. This condition will cause the individual to express victim’s daily routines. For children,this disaster affects their
himself or herself physically, mentally, and morally, and will daily routine and can cause negative effects if the routine is
further push himself or herself out of any activity. disrupted [27]. Flood victims also have thepossibilitiesof
dealing with the stress response and ongoing trauma [28].
D. The Quality of Life Conceptual Model
Some flood victims in Malaysia may experience anxiety
Perceived quality of life is closely related to psychological every time there is heavy rain. This is due to the experience of
factors. Negative characteristics such as stress, anxiety and the past, that heavy rain has resulted in flooding which
depression can affect the quality of life of victims. According destroyed crops and livestock, damage to property, loss of a
to the quality of life model built by Zhan [25],the quality of financial equity and also resulted in the loss of life of family
life is defined as a life experience to identify and satisfy members. Their daily lives are always in a state of alert.
nature. The quality of life is affected by a person’s Therefore, they are worried of repeated flooding [2]. The
background, health, and the situation. Symptoms of stress, level of concern over the possibility of floods is experienced
change and adaptation functionality are considered as a by those with lower incomes [29]. Anxiety and depression
medium of communication. among victims are related to losses in the event of flooding
and previous studies showed that if the aid in terms of
counseling and social support aregiven several months after
IV. INTEGRATED MODEL the incident, fear is reduced among the victims [30].
Fig. 1 shows how each theory integrates with each other. There are several limitations of human perception of risks
Through the model, it can be seen how floods become a related to the psychological mechanisms. Floods can cause
trigger to stress experienced by the flood victims in Malaysia. unpleasant feelings of anxiety and lack of sense of security.
The stressful life events theory states that stress emerges as a For this reason every individual’s emotional and
result of events experienced by individuals. Incidents result psychological characteristics affect their perception. This can
in a change which occur in the lives of the victims. Other lead to an effect known as cognitive dissonance where one is
theories integrated are the Freud’s anxiety theory and the confronted with information that affects the integrity of their
cognitive theory of depression in which reality concerns beliefs about the world and cause internal tension.
arising from bitter experience result in the perception that the Persistent concerns among the flood victims in Malaysia
environment poses a threat in dealing with the fear of will lead to depressive behavior. Should any victims
anenvironmental condition, while depression emerges as a experience symptoms of depression, this will lead to negative
result of nonpeaceful thoughts. Those who suffer from stimuli in the self-improvement and consequently, the level
depression have a negative perception of themselves. Beck’s of prosperity enjoyed is decreased [31]. Depression will
cognitive theory of depression integrates with the conceptual cause a drop in the positive emotions of a person [32]. If
model of the quality of life of negativecharacteristics that can someone is experiencing symptoms of depression, it will
affect the quality of life enjoyed by the flood victims in weaken and can lead to more serious mental health problems
Malaysia. and other diseases. According to Beck, the negative thoughts

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experienced by a person as a result of negative assumptions integrated model for flood victims’ quality of life. Hopefully,
on the environment held the loss of a loved one and the same the flood relief management programs and strategies maybe
scene over and over [33]. put forward and utilized by relevant authorities throughout
Flood not only affects the victims physically,but also from Malaysia.
the security perspective as well as places of residence and
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