AReassurance supportive therapy for reducing depression in paraplegic patients due to Bantul earthquake

1. IntroductionThe earthquake that strike on May 27, 2006 in Yogyakarta and Central Java caused many people have disabilities. And estimated that not less than 500 people got spinal cord injury (SCI), 350 of them had paraplegia caused the accident. Paraplegia resulting in an acute disease and sufferers experience a psychological problem. This is due to that paraplegia have is very small cure rate. (Kishi, Robinson & Kosier, 2001).Sharma (2005) stated that the psychological problems that arise in survivor with paraplegia in the form of emotional disorders such as anxiety, depression, fear, anger, hostility and feelings of helplessness. 23% - 30% of patients experience depression predicted paraplegia after a few months and had anxiety for at least two years after being diagnosed paralyzed. Some triggers that cause depression include a fairly long period of rehabilitation, very limited mobility, sores pressure (sores like burning on the surface of the skin due to prolonged pressure on parts of the body have a disability), bladder and bowel tract infections, medical treatment spent a long time and considerable cost, also self-care process that must involve other individuals such as family members or professional caregivers. Symptoms of depression include a greater dependence on others, especially in the aspect of self-care, feel insecure when meeting with others, haunted by a sense of despair, and a desire to commit suicide. This condition is expected to be experienced by people ranging from first year to nine years after the diagnosis of paralysis.Patients with depression generally have an error in perceiving the conditions that they experienced. As a result, become more sensitive to stimuli that are connected with these conditions. Based on the theory proposed Beck regarding negative cognition or depressive triad, depression can occur due to: 1) the emergence of negative cognitions against him were marked by the emergence of self-belief that he or she is worthless, incapable and not expected. Then the individual will interpret negative events caused the failure and inability of self, 2) emergence of a negative outlook on the environment or the outside world. Individuals who are depressed feel that all the bad things happening to them, the world and the environment are not considered sensitive, frustrating and demanding. Furthermore, he will see the world in a pessimistic and cynical, and 3) the emergence of a negative outlook on the future and assume that there will be a change, consider future is hopeless and believe that negative events will continue to occur. Depressed individuals who believe that they are helpless and do not have the power to improve the situation or the future (Beck, 1985).In paraplegic patients survivors of the earthquake, the disaster is experienced as loss of health due to disability, loss of property and loved ones, hope to be able to recover back that has not materialized, and the economy state has not returned to normal, can bring up feelings no luck, feeling very miserable , not precious, which is the crushing poverty, despair resulting in the emergence of psychological problems. This condition will more accumulate with the rehabilitation process that must be followed. In the early stages of rehabilitation is less than a year after the earthquake, the government financing and also borne by the health agencies of foreign aid. But now, most people have to spend their own money to finance the process. This greatly affects the stability of the economy that has not recovered after the earthquake. Accumulation of these problems in the future can lead to emotional distress in patients. Might even have an impact on interpersonal relationships with husbands, children and the environment in which people live.Other factors that also play a role determining the severity of depression in people with paraplegia is pain attacks (Ravenscroft, Ahmed & Burnside, 2000; Budh, Hultling, & Lundeberg, 2005). …