Post-disaster Mental Health Status: A Study of Women from Chooralmala Landslide in Kerala, India

Post-disaster Mental Health Status: A Study of Women from Chooralmala Landslide in Kerala, India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Post-disaster Mental Health Status: A Study of Women from Chooralmala Landslide in Kerala, India Latha Paul, Muhammed Munavvir P K, Suphala S Kotian, Beulah Shekhar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6695309/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The 2024 landslides in Chooralmala, Wayanad, and Kerala had severe psychological impacts, particularly affecting women aged 18–50 years due to trauma, displacement, weakened community bonds, and insufficient mental health support from authorities. Addressing the mental health needs of disaster survivors, especially vulnerable women, is essential for effective rehabilitation and recovery. Understanding their emotional experiences helps in creating targeted psychological interventions. Using a mixed-methods design, the study involved 50 female survivors selected through snowball sampling due to their dispersed relocation. Quantitative assessments were performed via the 1 DASS-21 scale, whereas qualitative narratives from in-depth interviews explored personal emotional experiences. The results revealed high levels of depression (M = 22.04), anxiety (M = 19.24), and stress (M = 20.88). The qualitative findings revealed recurring themes: persistent fear, disrupted sleep, emotional detachment, hopelessness, grief, suicidal ideation, panic responses to environmental triggers, social isolation, and deterioration of mental health due to displacement. This study underscores the urgent necessity for continuous, culturally sensitive, trauma-informed mental health interventions. Recommendations include gender-specific strategies and the integration of community-based mental health services within disaster response frameworks to improve psychological resilience and recovery among female survivors. Depression Anxiety Stress DASS-21 Wayanad landslide Women’s mental health Natural disaster trauma Suicide prevention Crisis intervention 1. Introduction Natural disasters leave lasting scars on the lives they disrupt, often exposing survivors to immense emotional and psychological challenges. Among those survivors most deeply affected are women and children. The devastating landslides in Chooralmala, Wayanad district of Kerala, India on July 30, 2024, claimed over 230 lives and left countless others grappling with profound losses not just of loved ones but of homes, livelihoods, and a sense of stability. Efforts to rebuild their lives have largely focused on physical recovery, financial support, and restoring lost property. However, the invisible wounds and the mental and emotional toll of such a tragedy often remain overlooked. These hidden struggles can profoundly affect survivors’ ability to heal and move forward. Understanding the psychological impact of such disasters is not just necessary; it is essential to ensure that recovery initiatives address the whole person, paving the way for targeted interventions that restore hope and resilience to those most in need. Psychological distress in disaster survivors’ manifests in various forms, including depression, anxiety, and stress, which not only impairs individual well-being but also hinders recovery and resilience. Tools such as the Depression Anxiety Stress Scale ( 1 DASS-21) have gained prominence in assessing these emotional states because of their efficiency, dimensional approach, and cross-cultural applicability. 1.1. Relevance and scope of the study Survivors face significant mental health challenges, including depression, anxiety, and posttraumatic stress disorder ( 2 PTSD), increasing their risk of suicide. Research indicates a disturbing connection between victimization, depression, and suicide attempts among disaster-affected populations (REST, 2024) [1]. Tragically, suicide cases have already been reported among survivors of the recent Wayanad landslide, highlighting a pressing need for comprehensive mental health support and robust financial assistance to help survivors reconstruct their lives meaningfully. In the aftermath of disasters, traffickers and other exploiters also often exploit chaos and vulnerability to coerce survivors into forced labour or sexual exploitation (Reuters, 2024) [2]. Therefore, this study mainly seeks to inform and advocate evidence-based policy recommendations, ensuring that survivors receive timely and appropriate psychosocial care, along with strong financial and community-based support. 1.2. Definitions Stress—The body's response to challenging or threatening situations triggers physiological, psychological, and behavioural changes. Common sources include work stress, marital conflicts, and financial worries. Stress According to Steinberg and Ritzmann (1990) [3], “Stress can be described as either an under load or an overflow of matter, energy, or information input to or output from a living system.” Anxiety- Anxiety According to Spielberger (1983) [4], “Anxiety is defined as the subjective sensations and tension, anxiety, uneasiness, and worry linked with an autonomic nervous system activation.” Barlow (2002) [5] noted that “Anxiety is a state of emotional arousal, worry about perceived threats, cognitions relating specific worries, impaired attention, and physical symptoms such as sweating, muscle tension, heart palpitations, and difficulty breathing. Depression is a psychological condition that is characterized by an ongoing feeling of sadness and an absence of interest. It has an impact on how one feels, thinks, and behaves and can lead to a variety of physical and mental difficulties. It is also known as major depressive disorder or a clinically depressed mood (Association., 2013) [6]. During this time, they are subjected to a variety of stresses, including academic load, familial conflict, and interpersonal coordination, which may result in a variety of psychological issues due to their relatively low tolerance for external pressure or change (Eskin, Ertekin, Harlak et al., 2008) [7]. 1.3. Research Objectives To analyse the level of depression among female survivors of natural disasters. To analyse the level of anxiety among female survivors of natural disasters. To analyse the level of stress among female survivors of natural disasters. To explore survivors' personal experiences related to fear, anxiety, and depression. 1.4. Hypotheses of the research There is a significant level of depression among female survivors of natural disasters. There is a significant level of anxiety among female survivors of natural disasters. There is a significant level of stress among female survivors of natural disasters. 1.5. Methodology This study uses a mixed-methods, cross-sectional research design and adopts a snowball sampling approach to reach female survivors of the Chooralmala landslide, as they have been displaced and scattered across different parts of Wayanad. The process began by establishing contact with one survivor, who then connected the researcher to others, gradually expanding the network to include more participants. This method ensures access to those most affected while allowing survivors to share their experiences within a trusted circle. A total of 50 women, aged 18--50 years, were included in the study, ensuring diverse representations across different age groups. To assess their mental health, the Depression Anxiety Stress Scale ( 1 DASS-21) serves as the primary measurement tool. In addition to quantitative assessment, qualitative data were gathered through in-depth interviews and personal narratives, offering deeper insights into the lived experiences of the survivors. The 1 DASS-21 scoring system was used to evaluate depression, anxiety, and stress levels, categorizing them based on established severity criteria. The data were then analysed both quantitatively and qualitatively, allowing for a more comprehensive understanding of the psychological impact of the disaster, the emotional struggles of survivors, and their coping mechanisms. 2. Literature Review The 1 DASS-21 is a widely validated and reliable self-report instrument that evaluates the psychological dimensions of depression, anxiety, and stress. Originally developed by Lovibond & Lovibond (1995) [ 8 ], the scale has been adapted and validated across diverse populations. A study of high school students in disaster-affected areas revealed persistent mental health issues, with significantly higher 1 DASS-21 scores than those reported in nonaffected regions (Bhatia & Kaur, 2024) [ 9 ]. Healthcare workers in disaster-prone regions reported elevated 1 DASS-21 scores and 2 PTSD-like symptoms, indicating the urgent need for mental health interventions to reduce burnout (Samsoor & Stanikzai, 2024) [ 10 ]. Nursing students affected by the Moroccan earthquake presented notable increases in depression, anxiety, and stress levels, emphasizing the importance of targeted post-disaster mental health support (Amane et al., 2024) [ 11 ]. The 1 DASS-21 has been validated as a robust tool with excellent psychometric properties, including strong internal consistency and test-retest reliability. This study aims to explore the mental health status of female survivors of landslides in Wayanad via this scale. 3. About the disaster On July 30, 2024, a series of catastrophic landslides struck Punjirimattom, Mundakkai, Chooralmala, and Vellarimala in Meppadi Panchayat, Vythiri taluk, Wayanad district, Kerala, India. Triggered by intense rainfall, these landslides caused widespread destruction as hillsides collapsed, sending torrents of mud, water, and rocks crashing into residential areas. The disaster led to significant loss of life and property (254 fatalities, 397 injuries and 118 people missing), making it one of the worst natural calamities in India’s recent history (Wikipedia, 2024) [ 12 ]. In the aftermath, rescue and relief operations involving local authorities, national disaster response teams, and volunteers were immediately launched. However, efforts were hindered by continuous heavy rains and the challenging terrain, which made access to affected areas difficult. Many survivors were evacuated to relief camps, where they received food, shelter, and medical assistance. This tragedy has sparked discussions on the need for improved early warning systems and sustainable land-use practices to mitigate the impact of future disasters (Wikipedia, 2024) [ 12 ]. 4. Results and Interpretation 4.1. Demographic profile of the participants The participants in this study included 50 women aged between 18 and 50, reflecting a diverse age group representative of those significantly impacted by landslides in Chooralmala. Most of the participants (45) were married, whereas five were unmarried, emphasizing their varying household responsibilities and caregiving roles, which intensified their difficulties after the disaster. Prior to displacement, these women were involved primarily in occupations related to tourism, daily wage labour at local estates and resorts, or small-scale farming. Chooralmala, being a popular tourist destination, allows many participants to derive their livelihood directly or indirectly from tourism, placing them within a modest economic context. After the landslides, the participants dispersed to various locations throughout Wayanad district, including Meppadi, Mananthavady, Karappuzha, Mundakkai, and Kalpetta. Currently, survivors live in temporary shelters, rented houses, or government-provided accommodations. The family sizes of the participants varied greatly, with several women experiencing profound personal losses, such as the death of their children, spouses, parents, or siblings. These painful losses significantly intensified their emotional distress and economic hardship, highlighting the complex challenges survivors continue to face in their recovery and rebuilding efforts. 4.2. Quantitative Analysis of Mental Health Status (DASS-21 scores) Depression Levels Table 1. Descriptive Statistics of Depression Scores among Women Survivors Depression Total No. of Participants Mean Standard Deviation 50 22.04 9.02 Source: Author According to Table 1, the descriptive statistics of depression scores among the 50 women who survived the Chooralmala landslide highlight significant psychological distress, particularly evident through their depression scores. According to the Depression Anxiety Stress Scale ( 1 DASS-21), the average depression score among participants was 22.04 ( 3 SD=9.02), indicating that their condition was generally severe. The substantial standard deviation suggests notable differences among individual experiences, indicating varied emotional responses and resilience in coping with the disaster. A closer examination of individual depression scores revealed that several participants reported alarmingly high levels of depression. For example, participants labelled “E” and “Y” both scored a depression level of 42, indicating extremely severe depression. Similarly, participants “G” and “N” had scores of 38, indicating profound emotional distress. Such extreme scores reflect deep feelings of hopelessness, sadness, and a sense of loss and uncertainty regarding their future. Conversely, some participants had relatively lower depression scores. For example, participants “C,” “Q,” and “X” scored only 6, indicating significantly fewer depressive symptoms. This variability underscores that survivors’ mental health experiences differ considerably and are influenced by factors such as personal losses, available support systems, and individual coping mechanisms. These data clearly suggest widespread depressive symptoms among the majority of survivors. Such high levels of depression necessitate immediate, structured psychological interventions and long-term mental health support to assist these women in effectively overcoming their emotional distress and fostering resilience for their future recovery and stability. Anxiety Levels Table 2. Descriptive Statistics of Anxiety Scores among Women Survivors Anxiety Total No. of Participants Mean Standard Deviation 50 19.24 8.29 Source: Author Anxiety emerged as a serious psychological concern among the female survivors of the Chooralmala landslide. According to the Depression Anxiety Stress Scale ( 1 DASS-21), participants' anxiety scores averaged 19.24 ( 3 SD = 8.29), indicating severe anxiety overall. This high mean underscores the profound sense of worry, unease, and emotional insecurity that many survivors continue to experience long after the physical devastation of the disaster. Detailed analysis revealed striking individual differences among the participants. Certain survivors, notably participants “Y” (score = 40) and “N” (score = 38), reported extremely severe anxiety levels. Here, “Y” is associated with high scores for both depression and anxiety. These individuals face extreme consequences in their daily life. These extreme scores reflect ongoing fears and apprehensions about their safety, future stability, and overall ability to cope with daily life after displacement. These women often described experiencing frequent episodes of panic, excessive worries about family safety, and deep uncertainty about their future. However, there were survivors whose anxiety scores were significantly lower, such as participants “V” (score = 2) and “AH” (score = 4), suggesting that anxiety experiences varied substantially on the basis of personal circumstances, resilience, and available support. This disparity in anxiety levels highlights the complexity of survivors' emotional states, emphasizing the need for personalized, sensitive, and contextually informed mental health interventions. Accordingly, the consistently high anxiety levels among most participants clearly indicate that the psychological aftermath of the disaster remains deeply troubling for these women. This underscores the importance of targeted psychological and emotional support initiatives aimed at alleviating anxiety and building resilience among affected communities in Wayanad Stress Levels Table 3. Descriptive Statistics of Stress Scores among Women Survivors Stress Total No. of Participants Mean Standard Deviation 50 20.88 6.57 Source: Author Now, we analyse the aftermath of the Chooralmala landslide, which has deeply affected survivors, and this is profoundly reflected in their stress scores. Among the 50 female participants, the average stress level was 20.88 ( 3 SD = 6.57), indicating significant emotional strain. These figures are more than just numbers; they represent the daily challenges these women face, such as relaxing, persistent nervousness, irritability, and the relentless feeling of being overwhelmed by life's uncertainties since the disaster. Individual scores further illustrate how stress manifests differently among survivors. Participant “Y”, for example, had a remarkably high stress score (42), indicating extreme distress. Such severe stress is typically accompanied by feelings of emotional exhaustion, restlessness, and an inability to cope with daily responsibilities. Similarly, participant “L”, with a score of 32, exemplifies how personal circumstances, including the loss of loved ones or economic instability, contribute significantly to heightened stress levels. However, amid these high levels of distress, there were survivors with relatively lower scores, such as participant “V”, whose stress score was only 6. This contrast highlights the role of individual resilience and support systems that may buffer the psychological impact of traumatic events. This finding suggests that even within the context of shared tragedy, personal experiences of stress vary widely and are shaped by individual coping skills, family support, and socioeconomic conditions. The significant variability in stress scores among participants underscores the critical need for tailored psychosocial interventions. While immediate relief and rebuilding efforts are essential, addressing these persistent stress symptoms through structured psychological support, community-building activities, and emotional care is crucial. These measures can help survivors manage their stress effectively, fostering emotional healing and long-term recovery. An examination of the data clearly revealed that certain participants consistently presented elevated scores across all three psychological domains: depression, anxiety, and stress. Notably, participants L, M, N, P, R, and Y displayed severe to extremely severe distress across these measures. For example, Participant Y recorded the highest possible scores in all three categories (depression: 42, anxiety: 40, stress: 42), indicating intense and pervasive emotional turmoil. These extreme levels highlight the profound and ongoing psychological struggles these individuals continue to face after the disaster. On the other hand, some participants consistently reported lower scores, reflecting relatively better psychological resilience or coping capabilities. Participants Q, U, V, and AA scored significantly lower in terms of depression, anxiety, and stress. Particularly notable is Participant V, who scored exceptionally low in anxiety and stress (anxiety: 2, stress: 6), suggesting greater resilience or possibly better support mechanisms and coping strategies available to her. These contrasts between consistently high and consistently low scorers underscore the diverse psychological impacts of traumatic experiences and emphasize the importance of targeted, individualized mental health interventions tailored to the varying needs of survivors. 5. Qualitative Analysis of Survivors' Personal Experiences of Stress, Anxiety, and Depression Initially, following the devastating Chooralmala landslide, survivors found solace and temporary comfort in relief camps, sharing mutual support and a collective sense of hope amidst the tragedy. However, as time progressed and they dispersed to various government-provided houses, Govt rented accommodations and other temporary houses scattered across Wayanad, and the survivors began confronting a stark, isolating reality. The once-close community bonds faded, which was replaced by profound loneliness and overwhelming silence that magnified their loss. In this isolation, survivors began deeply reflecting upon their losses, lost homes, cherished possessions, and most painfully, the irreplaceable absence of loved ones. For many, solitude became a harsh reminder of all they had lost, sparking an internal battle against persistent sadness and grief. Memories, both cherished and traumatic, resurfaced vividly during solitary moments, intensifying their emotional distress and making the journey toward recovery seem unattainable. The scattered living conditions drastically altered their psychological well-being. Daily life has become marked by intense fear and anxiety, triggered not only by natural elements such as thunderstorms or rain but also by ordinary sounds, such as passing motorcycles, which are now associated with the trauma of the disaster. Many survivors reported disrupted sleep, frequently waking in panic, and haunted by echoes of past trauma. Each night brought uncertainty; each dawn, a reminder of their struggle to piece together the fragments of their shattered lives. Through their personal narratives, these women openly shared their emotional vulnerability, emphasizing the urgent need for compassionate, consistent mental health support. Their accounts poignantly illustrate the invisible wounds inflicted by disaster, wounds that persist long after visible scars have healed, emphasizing that rebuilding their emotional well-being is as critical as reconstructing their physical homes. 5.1. Thematic analysis of survivors’ narratives To delve deeper into the emotional realities of the women affected by the Chooralmala landslide, a thematic analysis was conducted on the qualitative data collected through personal narratives. While quantitative scores from the 1 DASS-21 scale revealed significant levels of depression, anxiety, and stress, these numbers only scratched the surface of what the survivors were truly experiencing. Through open-ended conversations, the women deeply shared personal reflections about their mental state, fears, losses, and current struggles. The goal of this analysis was to identify recurring emotional and psychological patterns that emerged from their words, capturing the shared pain, resilience, and needs of a community in recovery. These themes not only contextualize the numerical data but also voice the invisible suffering that statistics often overlook. The following themes were developed via a grounded, inductive approach, drawing directly from the survivors' own expressions of trauma, grief, and hope. A thematic analysis of the qualitative data collected from 50 female survivors of the Chooralmala landslide revealed six prominent themes. These themes emerged through a systematic coding of participants' narratives and reflected their ongoing emotional and psychological struggles following displacement. Each theme is discussed below with illustrative quotations and frequency of occurrence to contextualize the findings. Theme 1: Persistent Fear and Sound Sensitivity This theme was reported by 43 out of 50 participants. Many women described experiencing intense fear in response to environmental sounds such as thunderstorms, heavy rainfall, wind, and particularly the loud noise of motorcycles or heavy vehicles. These sounds act as traumatic reminders of the landslide event, often triggering episodes of panic and heightened emotional distress. Several participants mentioned experiencing panic attacks, whereas others described difficulty breathing or a sense of suffocation upon hearing certain sounds. The overwhelming fear, often accompanied by physical symptoms, suggests an enduring trauma response that continues to impact their daily functioning and emotional regulation. I feel fear whenever I hear thunderstorms, heavy winds, or rain. I can’t stand those sounds anymore. I experience intense fear when I hear loud motorcycles or heavy vehicles passing by. Sometimes the sound makes me freeze, and my chest tightens–I feel like I can’t breathe. The recurrence of this theme suggests that environmental triggers remain powerful and emotionally destabilizing for survivors, reflecting ongoing trauma and possibly symptoms of posttraumatic stress. Theme 2: Disrupted Sleep and Night-time Disturbances A total of 38 participants reported that their sleep has been severely affected since the disaster. Many described waking up suddenly in the middle of the night, drenching in sweat, heart pounding, and gripping due to intense fear. Bad dreams or no dreams at all have become a regular part of their nights, with some recalling vivid nightmares of landslides, cries for help, or collapsing homes. Even those who manage to fall asleep struggle with staying asleep, often jolting awake at the slightest sound and being unable to calm their racing thoughts. This hyperalert state has left them exhausted, both mentally and physically, unable to find the rest they desperately need. I haven’t had good sleep since the disaster, and I often wake up suddenly at night. Even in sleep, I feel like I’m listening for that sound again. It’s exhausting. I wake up sweating, scared, with images in my mind that I can’t erase. This lack of restful sleep has not only impacted their physical health but also aggravated their emotional fatigue, creating a cycle of sleeplessness, fear, and helplessness that continues to haunt them long after the skies are cleared. Theme 3: Emotional Numbness and Disconnection from Life A total of 31 participants expressed a deep sense of emotional detachment and numbness. While they continue to function physically, many shared that they no longer feel truly alive inside. Joy, excitement, and emotional connections to daily life have faded. Being alone and unoccupied often leads them into a spiral of overthinking, sadness, and mental exhaustion. Even though we live, we don’t feel alive anymore. We are going with the flow, but nothing makes us feel present. This theme reflects a survival mechanism, keeping busy to distract from inner pain. Theme 4: Hopelessness and Loss of Motivation This theme appeared in the narratives of 35 participants. Many survivors indicated that they had lost interest in working, setting goals, or planning for the future. Several women mentioned that they engage in small tailoring jobs or occasional work, not for income but simply because they cannot bear to sit idle at home. The disaster not only took away their homes and livelihoods but also eroded their inner drive and sense of purpose. I’ve lost interest in everything after the disaster. There’s no motivation to work or earn anymore. We live without dreams now. The only thing we wish for is a permanent home. I started stitching just so I won’t sit and think too much; it’s not for money anymore. This consistent loss of motivation highlights the psychological paralysis that can follow when survivors face an uncertain future with limited resources and disrupted routines. The work they do is no longer tied to dreams or ambition but has become a tool to simply keep their minds away from memories too heavy to carry in silence. Theme 5: Grief and Sadness Over Irreparable Loss Grief and a deep sense of loss were articulated by 40 participants. Their grief was not limited to material destruction but extended to the emotional trauma of losing homes, close-knit communities, and loved ones. The memory of the disaster lingers in sensory experiences, particularly smell and sound, reinforcing their sense of irreversible loss. We were financially stable, but now we’ve lost everything. The feeling of loss is overwhelming. I still remember the smell of clay from the landslide. This theme underscores the multidimensional nature of loss, material, emotional, and relational, and its lasting impact on survivors' mental health. Theme 6: Suicidal Thoughts and Existential Crisis Although not widespread, 11 participants openly discussed having suicidal thoughts or feeling that life no longer held meaning. These narratives reflected deep emotional exhaustion, identity loss, and existential questioning in the aftermath of overwhelming trauma. What makes this theme even more concerning is the ripple effect it has had on families and communities. Several women shared that even children and young girls have begun expressing a desire to die, overwhelmed by grief and hopelessness. Survivors are often left struggling to comfort and restrain their loved ones, even as they themselves grapple with internal emotional collapse. Sometimes I think about suicide because life feels meaningless without our lost home and community. Two participants also recounted the death of a 20-year-old girl from their neighbourhood who was found hanging, an incident that deeply disturbed many in the survivor community, particularly the younger generation. For those who lost close family, friends, or neighbours in the landslide, the grief continues to haunt them like a shadow that refuses to fade. A few participants shared that the only reason they had not attempted suicide was because their faith strictly prohibits it. They admitted that without this religious restraint, they might have given in to the urge to end their suffering. This reveals how intense the psychological pain is and how religion, while offering strength and structure, is also relied upon as the last thread of emotional control in the absence of formal mental health care. This theme highlights a quiet but serious mental health emergency and underscores the critical need for culturally sensitive, trauma-informed mental health interventions, crisis counselling, and consistent psychological support, especially for vulnerable women and youth navigating this unseen emotional aftermath. 6. Discussion The findings of this study present a deeply human and empirically supported account of the psychological toll faced by female survivors of the Chooralmala landslide. Through the combined use of the 1 DASS-21 scale and in-depth qualitative interviews, research has illuminated both measurable and lived experiences of depression, anxiety, and stress within this vulnerable population. These findings are consistent with, yet extend beyond, the literature, offering new insights and addressing key gaps in the current understanding of post-disaster mental health in gendered contexts. 6.1 Integration of quantitative and qualitative findings Quantitative data analysis revealed high average scores across all three dimensions: depression (M = 22.04), anxiety (M = 19.24), and stress (M = 20.88), all indicating severe levels of psychological distress. Particularly alarming were the consistently high scores among a subset of participants who scored severely across all domains, suggesting deep emotional trauma that requires urgent intervention. The qualitative data mirrored and enriched these findings, revealing profound themes such as persistent fear, disrupted sleep, emotional numbness, hopelessness, grief, and suicidal ideation. Survivors spoke of panic triggered by natural sounds, nightmares, loneliness, and even witnessing suicide in their community. These narratives added texture to the 1 DASS scores, showing that the trauma experienced is not episodic but woven into the fabric of daily life, especially after forced displacement and community scattering. 6.2 Consistency with the literature The findings of this study are consistent with previous research conducted in similar post disaster contexts. Bhatia & Kour (2024) [ 9 ] reported significantly higher DASS-21 scores among adolescents in disaster-hit regions, confirming that disaster exposure is directly linked to increased psychological distress. Similarly, Elbay et al. (2020) [ 13 ] reported elevated 1 DASS scores and 2 PTSD symptoms among healthcare professionals during the COVID-19 crisis, reinforcing how sustained exposure to stressors leads to burnout and mental decline. The Turkish study by Cambridge University Press (2020) [ 14 ] on pregnant and postpartum women further affirms this, showing that psychosocial health outcomes worsen in disaster settings, especially among women, owing to their compounded vulnerabilities. Our study aligns with these global findings, but it also adds a local and gender-specific dimension within the Indian context, particularly for marginalized women in rural Kerala. 6.3 Addressing the research gaps Despite growing research on disaster-related mental health, three major gaps have been identified in the literature: Lack of gender-focused disaster mental health studies in India - Most Indian studies are generalized or focus on infrastructure and economic loss. Our study specifically captures the emotional landscape of female survivors, providing much-needed data for gender-sensitive policy interventions. Underrepresentation of qualitative experiences - Existing research heavily relies on quantitative tools, with little attention given to how survivors feel, narrate, and internalize trauma. By incorporating rich personal narratives, this study presents a more holistic picture of mental health challenges. Neglect of long-term displacement effects - Most studies focus on immediate relief camp scenarios. Our research highlights how psychological distress increases post-resettlement, when survivors are scattered and isolated, losing the comfort of communal healing that can be briefly provided. This study bridges these gaps by employing a mixed-methods approach in a localized setting, focusing exclusively on women, and exploring the transition from immediate relief to long-term recovery, a phase often ignored in the disaster psychology literature. 6.4 Implications for Policy and Practice This research highlights the urgent need for long-term, trauma-informed mental health care for disaster survivors, especially women and young girls. Intervention models must include the following: Community-based psychological services Mobile counselling units for rural or displaced populations Culturally sensitive therapy that acknowledges religious and social coping mechanisms Economic and housing stability as fundamental mental health support Provide job-oriented training and workshops for women. In the absence of readily available psychological services, it is crucial to equip local health workers with mental health first aid training and establish peer-led emotional support groups within affected communities. Several participants in this study reported that their emotional distress peaks during the night, especially when they are alone, or when it starts raining, as these moments serve as haunting reminders of their traumatic experiences. For many, these are the hours when fear, grief, and panic spiral uncontrollably, with no one turning to. As such, mental health professionals must be available around the clock, particularly during evenings and early mornings, to provide timely intervention. Crisis helplines, mobile counselling units, and local volunteers trained in trauma-informed care can play a transformative role in bridging this critical gap. From a criminological standpoint, the urgency becomes even more pronounced. According to the routine activity theory proposed by Cohen and Felson (1979) [ 15 ], crime occurs when a motivated offender, a suitable target, and the absence of a capable guardian intersect. In the current scenario, displaced women, some of whom are living in isolated, unstable conditions without some, are mentally‒physically weak, have consistent protection, and fulfil all the criteria of potential victimization. Survivors’ emotional vulnerability, economic insecurity, and physical isolation place them at elevated risk of becoming targets of human trafficking, sexual exploitation, theft, or even organ trafficking. Without strong social safety nets or psychological resilience, many of these women lack what the theory describes as a 'capable guardian', whether in the form of community, law enforcement, or institutional support. Thus, mental health care is not just a matter of emotional healing; it is a crucial line of defence against future victimization and criminal exploitation. 7. Conclusion This study explored the mental health status of female survivors of the 2024 Chooralmala landslide in Wayanad through a mixed-methods approach that combines the quantitative power of the 1 DASS-21 scale with the emotional depth of qualitative narratives. The findings compellingly demonstrate that the psychological aftermath of natural disasters extends far beyond immediate physical and economic losses, manifesting in long-term emotional distress, especially among socioeconomically and geographically vulnerable women. Quantitatively, the validated 1 DASS-21 scale revealed high average scores in all three domains—Depression (M = 22.04), Anxiety (M = 19.24), and Stress (M = 20.88)—which fell into the severe range for most participants. These findings confirm all three research hypotheses, validating the presence of significant levels of depression, anxiety, and stress among survivors. More importantly, the qualitative data offered an intimate and textured view of these psychological states. The recurring themes of persistent fear, sleep disturbances, emotional numbness, loss of motivation, and suicidal ideation were drawn directly from the survivors' own voices. These emotional narratives provided not just context but also urgency, revealing the silent epidemic of trauma that unfolded long after the disaster faded from public memory. The study also fills several critical research gaps. It highlights the gender-specific emotional toll of natural disasters within a rural Indian context, employs qualitative inquiry to humanize standardized psychological assessments, and most notably, addresses the neglected phase of post-resettlement trauma, where survivors are scattered across unfamiliar terrains and stripped of their communal coping structures. Furthermore, this research integrates a criminological lens, invoking routine activity theory, to suggest that without capable guardianship, social, institutional, or psychological, emotionally and economically vulnerable women remain at risk of secondary victimization, including human trafficking and exploitation. However, this study is not without its limitations. The sample size was modest (N = 50), and the use of snowball sampling, while contextually necessary, may introduce selection bias and limit the generalizability of the findings. Additionally, the study focused solely on women aged 18–50 years, excluding the experiences of older women, men, and children, who may exhibit different psychological responses. The emotional sensitivity of the interviews may also have led to underreporting or guarded responses despite efforts to create a safe and empathetic space. Future research should expand both geographically and demographically, employing longitudinal methods to assess how trauma evolves over time and how effective mental health interventions can be tailored and implemented in rural disaster-prone areas. Interdisciplinary collaboration with public health, criminology, psychology, and social workers will be essential to address the complex aftermath of climate-induced displacement holistically. In conclusion, this study reinforces the urgent need to move beyond temporary relief models toward sustainable, trauma-informed, and community-rooted mental health care, especially for disaster-affected women. It argues for policy reforms that integrate mental health as a core component of disaster recovery and highlights the value of listening—truly listening to the lived experiences of survivors. Healing begins not just with rehabilitation but also with recognition. This study stands as a call to recognize, respond, and rebuild with empathy, equity, and evidence. Declarations Acknowledgements: We sincerely thank the women survivors of the Chooralmala landslide for their courage in sharing their experiences. We are also grateful to the people of Wayanad for their support and cooperation. Special thanks to Karunya Institute of Technology and Sciences, Srinivas University, and the Government of Kerala for their institutional and logistical support throughout the research process. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Clinical trial registration: Not applicable. Ethics, Consent to Participate, and Consent to Publish: This study did not involve any clinical intervention or experimental treatment. All methods were carried out in accordance with relevant guidelines and regulations of APA and ICMR. Informed verbal consent was obtained from all participants prior to data collection, and their confidentiality and anonymity were strictly maintained. Ethical Approval This study was reviewed and approved by the Institutional Ethics Committee of Karunya Institute of Technology and Sciences, Coimbatore, India (KITS/CR&FS/ECL/2024/09). The Committee under the supervision of Dr. C. Joseph Kennady and Dr. A. Shakunthala waived the need for formal ethical approval, as the study involved non-invasive interviews and posed minimal risk to participants. References REST. (2024). The silent suffering: Suicide risks among trafficking survivors. Retrieved from https://iwantrest.com/blog/the-silent-suffering-suicide-risks-among-trafficking-survivors Reuters. (2024, December 11). Human trafficking rises sharply after dropping during pandemic, UN says. Reuters. https://www.reuters.com/world/human-trafficking-rises-sharply-after-dropping-during-pandemic-un-says-2024-12-11/ Steinberg, A., & Ritzmann, R. F. (1990). A living systems approach to understanding the concept of stress. Behavioral Science, 35(2), 138–146. https://doi.org/10.1002/bs.3830350206 Spielberger, C.D. (1983). Manual for the state-trait anxiety inventory. Palo Alto, C.A: Consulting Psychologists Press. Barlow, D.H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guiford Press. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Eskin, M., Ertekin, K., Harlak, H., & Dereboy, C. (2008). Prevalence of and factors related to depression in high school students. Turk Psikiyatri Dergisi = Turkish Journal of Psychiatry, 19(4), 382–389. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety & Stress Scales (2nd ed.). Sydney: Psychology Foundation. Bhatia, R., & Kour, J. (2024). Studying the psychological distress among high school students in disaster-affected areas. International Journal for Multidisciplinary Research, 6(1), 1–9. https://doi.org/10.36948/ijfmr.2024.v06i01.14193 Samsoor, A. A., & Stanikzai, M. H. (2024). Depression, Anxiety and Stress Symptoms among Afghan Healthcare Workers: A Cross-Sectional Analytical Study. Indian Journal of Occupational and Environmental Medicine, 28(2), 154–158. https://doi.org/10.4103/ijoem.ijoem_34_24 Mounia Amane, Nadia Hachoumi, Rquia Laabidi, Loubna Mazzi, Souad Yakini, Sokaina Loulidi, Siham Jbari, El Hassane Mourid, Samia Boussaa, Mental health of nursing students regarding the Moroccan earthquake: A cross-sectional study, Enfermería Clínica (English Edition), Volume 34, Issue 5,2024, Pages 377-385, ISSN24451479, https://doi.org/10.1016/j.enfcle.2024.09.002 Wikipedia. (2024). 2024 Wayanad landslides. Retrieved from https://en.wikipedia.org/wiki/2024_Wayanad_landslides Rümeysa Yeni Elbay, Ayşe Kurtulmuş, Selim Arpacıoğlu, Emrah Karadere. (2020). Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Research, 290, 113130. https://doi.org/10.1016/j.psychres.2020.113130 Cambridge University Press. (2020). Determinants of psychosocial health status in pregnant and postpartum women experiencing earthquake in Turkey. Disaster Medicine and Public Health Preparedness. https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/determinants-of-psychosocial-health-status-in-pregnant-and-postpartum-women-experiencing-earthquake-in-turkey/3877A882A5CBEEF500D371B24DD0183B Cohen, L. E., & Felson, M. (1979). Social change and crime rate trends: A routine activity approach. American Sociological Review, 44(4), 588–608. https://doi.org/10.2307/2094589 Footnotes Depression Anxiety Stress Scale= DASS Post-traumatic stress disorder= PTSD Standard Deviation= SD Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Introduction","content":"\u003cp\u003eNatural disasters leave lasting scars on the lives they disrupt, often exposing survivors to immense emotional and psychological challenges. Among those survivors most deeply affected are women and children. The devastating landslides in Chooralmala, \u003c/p\u003e\n\u003cp\u003eWayanad district of Kerala, India on July 30, 2024, claimed over 230 lives and left countless others grappling with profound losses not just of loved ones but of homes, livelihoods, and a sense of stability.\u003c/p\u003e\n\u003cp\u003eEfforts to rebuild their lives have largely focused on physical recovery, financial support, and restoring lost property. However, the invisible wounds and the mental and emotional toll of such a tragedy often remain overlooked. These hidden struggles can profoundly affect survivors\u0026rsquo; ability to heal and move forward. Understanding the psychological impact of such disasters is not just necessary; it is essential to ensure that recovery initiatives address the whole person, paving the way for targeted interventions that restore hope and resilience to those most in need.\u003c/p\u003e\n\u003cp\u003ePsychological distress in disaster survivors\u0026rsquo; manifests in various forms, including depression, anxiety, and stress, which not only impairs individual well-being but also hinders recovery and resilience. Tools such as the Depression Anxiety Stress Scale (\u003csup\u003e1\u003c/sup\u003eDASS-21) have gained prominence in assessing these emotional states because of their efficiency, dimensional approach, and cross-cultural applicability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1. Relevance and scope of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurvivors face significant mental health challenges, including depression, anxiety, and posttraumatic stress disorder (\u003csup\u003e2\u003c/sup\u003ePTSD), increasing their risk of suicide. Research indicates a disturbing connection between victimization, depression, and suicide attempts among disaster-affected populations (REST, 2024) [1]. Tragically, suicide cases have already been reported among survivors of the recent Wayanad landslide, highlighting a pressing need for comprehensive mental health support and robust financial assistance to help survivors reconstruct their lives meaningfully. In the aftermath of disasters, traffickers and other exploiters also often exploit chaos and vulnerability to coerce survivors into forced labour or sexual exploitation (Reuters, 2024) [2]. Therefore, this study mainly seeks to inform and advocate evidence-based policy recommendations, ensuring that survivors receive timely and appropriate psychosocial care, along with strong financial and community-based support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2. Definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStress\u0026mdash;The body\u0026apos;s response to challenging or threatening situations triggers physiological, psychological, and behavioural changes. Common sources include work stress, marital conflicts, and financial worries. Stress According to Steinberg and \u003c/p\u003e\n\u003cp\u003eRitzmann (1990) [3], \u0026ldquo;Stress can be described as either an under load or an overflow of matter, energy, or information input to or output from a living system.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAnxiety- Anxiety According to Spielberger (1983) [4], \u0026ldquo;Anxiety is defined as the subjective sensations and tension, anxiety, uneasiness, and worry linked with an autonomic nervous system activation.\u0026rdquo; Barlow (2002) [5] noted that \u0026ldquo;Anxiety is a state of emotional arousal, worry about perceived threats, cognitions relating specific worries, impaired attention, and physical symptoms such as sweating, muscle tension, heart palpitations, and difficulty breathing.\u003c/p\u003e\n\u003cp\u003eDepression is a psychological condition that is characterized by an ongoing feeling of sadness and an absence of interest. It has an impact on how one feels, thinks, and behaves and can lead to a variety of physical and mental difficulties. It is also known as major depressive disorder or a clinically depressed mood (Association., 2013) [6]. During this time, they are subjected to a variety of stresses, including academic load, familial conflict, and interpersonal coordination, which may result in a variety of psychological issues due to their relatively low tolerance for external pressure or change (Eskin, Ertekin, Harlak et al., 2008) [7].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3. Research Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003col class=\"decimal_type\"\u003e\n\u003cli\u003eTo analyse the level of depression among female survivors of natural disasters.\u003c/li\u003e\n\u003cli\u003eTo analyse the level of anxiety among female survivors of natural disasters.\u003c/li\u003e\n\u003cli\u003eTo analyse the level of stress among female survivors of natural disasters.\u003c/li\u003e\n\u003cli\u003eTo explore survivors\u0026apos; personal experiences related to fear, anxiety, and depression.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e1.4. Hypotheses of the research\u003c/strong\u003e\u003c/p\u003e\n\u003col class=\"decimal_type\"\u003e\n\u003cli\u003eThere is a significant level of depression among female survivors of natural disasters.\u003c/li\u003e\n\u003cli\u003eThere is a significant level of anxiety among female survivors of natural disasters.\u003c/li\u003e\n\u003cli\u003eThere is a significant level of stress among female survivors of natural disasters.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e1.5. Methodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study uses a mixed-methods, cross-sectional research design and adopts a snowball sampling approach to reach female survivors of the Chooralmala landslide,\u003c/p\u003e\n\n\u003cp\u003eas they have been displaced and scattered across different parts of Wayanad. The process began by establishing contact with one survivor, who then connected the researcher to others, gradually expanding the network to include more participants. This method ensures access to those most affected while allowing survivors to share their experiences within a trusted circle. A total of 50 women, aged 18--50 years, were included in the study, ensuring diverse representations across different age groups.\u003c/p\u003e\n\u003cp\u003eTo assess their mental health, the Depression Anxiety Stress Scale (\u003csup\u003e1\u003c/sup\u003eDASS-21) serves as the primary measurement tool. In addition to quantitative assessment, qualitative data were gathered through in-depth interviews and personal narratives, offering deeper insights into the lived experiences of the survivors. The \u003csup\u003e1\u003c/sup\u003eDASS-21 scoring system was used to evaluate depression, anxiety, and stress levels, categorizing them based on established severity criteria. The data were then analysed both quantitatively and qualitatively, allowing for a more comprehensive understanding of the psychological impact of the disaster, the emotional struggles of survivors, and their coping mechanisms.\u003c/p\u003e"},{"header":"2. Literature Review","content":"\u003cp\u003eThe \u003csup\u003e1\u003c/sup\u003eDASS-21 is a widely validated and reliable self-report instrument that evaluates the psychological dimensions of depression, anxiety, and stress. Originally developed by Lovibond \u0026amp; Lovibond (1995) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the scale has been adapted and validated across diverse populations.\u003c/p\u003e\u003cp\u003eA study of high school students in disaster-affected areas revealed persistent mental health issues, with significantly higher \u003csup\u003e1\u003c/sup\u003eDASS-21 scores than those reported in nonaffected regions (Bhatia \u0026amp; Kaur, 2024) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHealthcare workers in disaster-prone regions reported elevated \u003csup\u003e1\u003c/sup\u003eDASS-21 scores and \u003csup\u003e2\u003c/sup\u003ePTSD-like symptoms, indicating the urgent need for mental health interventions to reduce burnout (Samsoor \u0026amp; Stanikzai, 2024) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNursing students affected by the Moroccan earthquake presented notable increases in depression, anxiety, and stress levels, emphasizing the importance of targeted post-disaster mental health support (Amane et al., 2024) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The \u003csup\u003e1\u003c/sup\u003eDASS-21 has been validated as a robust tool with excellent psychometric properties, including strong internal consistency and test-retest reliability. This study aims to explore the mental health status of female survivors of landslides in Wayanad via this scale.\u003c/p\u003e"},{"header":"3. About the disaster","content":"\u003cp\u003eOn July 30, 2024, a series of catastrophic landslides struck Punjirimattom, Mundakkai, Chooralmala, and Vellarimala in Meppadi Panchayat, Vythiri taluk, Wayanad district, Kerala, India. Triggered by intense rainfall, these landslides caused widespread destruction as hillsides collapsed, sending torrents of mud, water, and rocks crashing into residential areas. The disaster led to significant loss of life and property (254 fatalities, 397 injuries and 118 people missing), making it one of the worst natural calamities in India\u0026rsquo;s recent history (Wikipedia, 2024) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the aftermath, rescue and relief operations involving local authorities, national disaster response teams, and volunteers were immediately launched. However, efforts were hindered by continuous heavy rains and the challenging terrain, which made access to affected areas difficult. Many survivors were evacuated to relief camps, where they received food, shelter, and medical assistance. This tragedy has sparked discussions on the need for improved early warning systems and sustainable land-use practices to mitigate the impact of future disasters (Wikipedia, 2024) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e"},{"header":"4. Results and Interpretation","content":"\u003cp\u003e\u003cstrong\u003e4.1. Demographic profile of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants in this study included 50 women aged between 18 and 50, reflecting a diverse age group representative of those significantly impacted by landslides in Chooralmala. Most of the participants (45) were married, whereas five were unmarried, emphasizing their varying household responsibilities and caregiving roles, which intensified their difficulties after the disaster. Prior to displacement, these women were involved primarily in occupations related to tourism, daily wage labour at local estates and resorts, or small-scale farming. Chooralmala, being a popular tourist destination, allows many participants to derive their livelihood directly or indirectly from tourism, placing them within a modest economic context.\u003c/p\u003e\n\u003cp\u003eAfter the landslides, the participants dispersed to various locations throughout Wayanad district, including Meppadi, Mananthavady, Karappuzha, Mundakkai, and Kalpetta. Currently, survivors live in temporary shelters, rented houses, or government-provided accommodations. The family sizes of the participants varied greatly, with several women experiencing profound personal losses, such as the death of their children, spouses, parents, or siblings. These painful losses significantly\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eintensified their emotional distress and economic hardship, highlighting the complex challenges survivors continue to face in their recovery and rebuilding efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Quantitative Analysis of Mental Health Status (DASS-21 scores)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDepression Levels\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Descriptive Statistics of Depression Scores among Women Survivors\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"526\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No. of Participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e22.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e9.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSource: Author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to Table 1, the descriptive statistics of depression scores among the 50 women who survived the Chooralmala landslide highlight significant psychological distress, particularly evident through their depression scores. According to the Depression Anxiety Stress Scale (\u003csup\u003e1\u003c/sup\u003eDASS-21), the average depression score among participants was 22.04 (\u003csup\u003e3\u003c/sup\u003eSD=9.02), indicating that their condition was generally severe. The substantial standard deviation suggests notable differences among individual experiences, indicating varied emotional responses and resilience in coping with the disaster.\u003c/p\u003e\n\u003cp\u003eA closer examination of individual depression scores revealed that several participants reported alarmingly high levels of depression. For example, participants labelled \u0026ldquo;E\u0026rdquo; and \u0026ldquo;Y\u0026rdquo; both scored a depression level of 42, indicating extremely severe depression. Similarly, participants \u0026ldquo;G\u0026rdquo; and \u0026ldquo;N\u0026rdquo; had scores of 38, indicating profound emotional distress. Such extreme scores reflect deep feelings of hopelessness, sadness, and a sense of loss and uncertainty regarding their future.\u003c/p\u003e\n\u003cp\u003eConversely, some participants had relatively lower depression scores. For example, participants \u0026ldquo;C,\u0026rdquo; \u0026ldquo;Q,\u0026rdquo; and \u0026ldquo;X\u0026rdquo; scored only 6, indicating significantly fewer depressive symptoms. This variability underscores that survivors\u0026rsquo; mental health experiences differ considerably and are influenced by factors such as personal losses, available support systems, and individual coping mechanisms.\u003c/p\u003e\n\u003cp\u003eThese data clearly suggest widespread depressive symptoms among the majority of survivors. Such high levels of depression necessitate immediate, structured psychological interventions and long-term mental health support to assist these women in effectively overcoming their emotional distress and fostering resilience for their future recovery and stability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnxiety Levels\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Descriptive Statistics of Anxiety Scores among Women Survivors\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No. of Participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e19.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSource: Author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnxiety emerged as a serious psychological concern among the female survivors of the Chooralmala landslide. According to the Depression Anxiety Stress Scale (\u003csup\u003e1\u003c/sup\u003eDASS-21), participants\u0026apos; anxiety scores averaged 19.24 (\u003csup\u003e3\u003c/sup\u003eSD = 8.29), indicating severe anxiety overall. This high mean underscores the profound sense of worry, unease, and emotional insecurity that many survivors continue to experience long after the physical devastation of the disaster.\u003c/p\u003e\n\u003cp\u003eDetailed analysis revealed striking individual differences among the participants. Certain survivors, notably participants \u0026ldquo;Y\u0026rdquo; (score = 40) and \u0026ldquo;N\u0026rdquo; (score = 38), reported extremely severe anxiety levels. Here, \u0026ldquo;Y\u0026rdquo; is associated with high scores for both depression and anxiety. These individuals face extreme consequences in their daily life. These extreme scores reflect ongoing fears and apprehensions about their safety, future stability, and overall ability to cope with daily life after displacement. These women often described experiencing frequent episodes of panic, excessive worries about family safety, and deep uncertainty about their future.\u003c/p\u003e\n\u003cp\u003eHowever, there were survivors whose anxiety scores were significantly lower, such as participants \u0026ldquo;V\u0026rdquo; (score = 2) and \u0026ldquo;AH\u0026rdquo; (score = 4), suggesting that anxiety experiences varied substantially on the basis of personal circumstances, resilience, and available support. This disparity in anxiety levels highlights the complexity of survivors\u0026apos; emotional states, emphasizing the need for personalized, sensitive, and contextually informed mental health interventions.\u003c/p\u003e\n\u003cp\u003eAccordingly, the consistently high anxiety levels among most participants clearly indicate that the psychological aftermath of the disaster remains deeply troubling for these women. This underscores the importance of targeted psychological and emotional support initiatives aimed at alleviating anxiety and building resilience among affected communities in Wayanad\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStress Levels\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Descriptive Statistics of Stress Scores among Women Survivors\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No. of Participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e20.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e6.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSource: Author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNow, we analyse the aftermath of the Chooralmala landslide, which has deeply affected survivors, and this is profoundly reflected in their stress scores. Among the 50 female participants, the average stress level was 20.88 (\u003csup\u003e3\u003c/sup\u003eSD = 6.57), indicating significant emotional strain. These figures are more than just numbers; they represent the daily challenges these women face, such as relaxing, persistent nervousness, irritability, and the relentless feeling of being overwhelmed by life\u0026apos;s uncertainties since the disaster.\u003c/p\u003e\n\u003cp\u003eIndividual scores further illustrate how stress manifests differently among survivors. Participant \u0026ldquo;Y\u0026rdquo;, for example, had a remarkably high stress score (42), indicating extreme distress. Such severe stress is typically accompanied by feelings of emotional exhaustion, restlessness, and an inability to cope with daily responsibilities. Similarly, participant \u0026ldquo;L\u0026rdquo;, with a score of 32, exemplifies how personal circumstances, including the loss of loved ones or economic instability, contribute significantly to heightened stress levels.\u003c/p\u003e\n\u003cp\u003eHowever, amid these high levels of distress, there were survivors with relatively lower scores, such as participant \u0026ldquo;V\u0026rdquo;, whose stress score was only 6. This contrast highlights the role of individual resilience and support systems that may buffer the psychological impact of traumatic events. This finding suggests that even within the context of shared tragedy, personal experiences of stress vary widely and are shaped by individual coping skills, family support, and socioeconomic conditions.\u003c/p\u003e\n\u003cp\u003eThe significant variability in stress scores among participants underscores the critical need for tailored psychosocial interventions. While immediate relief and rebuilding efforts are essential, addressing these persistent stress symptoms through structured psychological support, community-building activities, and emotional care is crucial. These measures can help survivors manage their stress effectively, fostering emotional healing and long-term recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn examination of the data clearly revealed that certain participants consistently presented elevated scores across all three psychological domains: depression, anxiety, and stress. Notably, participants L, M, N, P, R, and Y displayed severe to extremely severe distress across these measures. For example, Participant Y recorded the highest possible scores in all three categories (depression: 42, anxiety: 40, stress: 42), indicating intense and pervasive emotional turmoil. These extreme levels highlight the profound and ongoing psychological struggles these individuals continue to face after the disaster.\u003c/p\u003e\n\u003cp\u003eOn the other hand, some participants consistently reported lower scores, reflecting relatively better psychological resilience or coping capabilities. Participants Q, U, V, and AA scored significantly lower in terms of depression, anxiety, and stress. Particularly notable is Participant V, who scored exceptionally low in anxiety and stress (anxiety: 2, stress: 6), suggesting greater resilience or possibly better support mechanisms and coping strategies available to her.\u003c/p\u003e\n\u003cp\u003eThese contrasts between consistently high and consistently low scorers underscore the diverse psychological impacts of traumatic experiences and emphasize the importance of targeted, individualized mental health interventions tailored to the varying needs of survivors.\u0026nbsp;\u003c/p\u003e"},{"header":"5. Qualitative Analysis of Survivors' Personal Experiences of Stress, Anxiety, and Depression","content":"\u003cp\u003eInitially, following the devastating Chooralmala landslide, survivors found solace and temporary comfort in relief camps, sharing mutual support and a collective sense of hope amidst the tragedy. However, as time progressed and they dispersed to various government-provided houses, Govt rented accommodations and other temporary houses scattered across Wayanad, and the survivors began confronting a stark, isolating reality. The once-close community bonds faded, which was replaced by profound loneliness and overwhelming silence that magnified their loss.\u003c/p\u003e\u003cp\u003eIn this isolation, survivors began deeply reflecting upon their losses, lost homes, cherished possessions, and most painfully, the irreplaceable absence of loved ones. For many, solitude became a harsh reminder of all they had lost, sparking an internal battle against persistent sadness and grief. Memories, both cherished and traumatic, resurfaced vividly during solitary moments, intensifying their emotional distress and making the journey toward recovery seem unattainable.\u003c/p\u003e\u003cp\u003eThe scattered living conditions drastically altered their psychological well-being. Daily life has become marked by intense fear and anxiety, triggered not only by natural elements such as thunderstorms or rain but also by ordinary sounds, such as passing motorcycles, which are now associated with the trauma of the disaster. Many survivors reported disrupted sleep, frequently waking in panic, and haunted by echoes of past trauma. Each night brought uncertainty; each dawn, a reminder of their struggle to piece together the fragments of their shattered lives.\u003c/p\u003e\u003cp\u003eThrough their personal narratives, these women openly shared their emotional vulnerability, emphasizing the urgent need for compassionate, consistent mental health support. Their accounts poignantly illustrate the invisible wounds inflicted by disaster, wounds that persist long after visible scars have healed, emphasizing that rebuilding their emotional well-being is as critical as reconstructing their physical homes.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e5.1. Thematic analysis of survivors\u0026rsquo; narratives\u003c/h2\u003e\u003cp\u003eTo delve deeper into the emotional realities of the women affected by the Chooralmala landslide, a thematic analysis was conducted on the qualitative data collected through personal narratives. While quantitative scores from the \u003csup\u003e1\u003c/sup\u003eDASS-21 scale revealed significant levels of depression, anxiety, and stress, these numbers only scratched the surface of what the survivors were truly experiencing. Through open-ended conversations, the women deeply shared personal reflections about their mental state, fears, losses, and current struggles.\u003c/p\u003e\u003cp\u003eThe goal of this analysis was to identify recurring emotional and psychological patterns that emerged from their words, capturing the shared pain, resilience, and needs of a community in recovery. These themes not only contextualize the numerical data but also voice the invisible suffering that statistics often overlook. The following themes were developed via a grounded, inductive approach, drawing directly from the survivors' own expressions of trauma, grief, and hope.\u003c/p\u003e\u003cp\u003eA thematic analysis of the qualitative data collected from 50 female survivors of the Chooralmala landslide revealed six prominent themes. These themes emerged through a systematic coding of participants' narratives and reflected their ongoing emotional and psychological struggles following displacement. Each theme is discussed below with illustrative quotations and frequency of occurrence to contextualize the findings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: Persistent Fear and Sound Sensitivity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis theme was reported by 43 out of 50 participants. Many women described experiencing intense fear in response to environmental sounds such as thunderstorms, heavy rainfall, wind, and particularly the loud noise of motorcycles or heavy vehicles. These sounds act as traumatic reminders of the landslide event, often triggering episodes of panic and heightened emotional distress. Several participants mentioned experiencing panic attacks, whereas others described difficulty breathing or a sense of suffocation upon hearing certain sounds. The overwhelming fear, often accompanied by physical symptoms, suggests an enduring trauma response that continues to impact their daily functioning and emotional regulation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI feel fear whenever I hear thunderstorms, heavy winds, or rain. I can\u0026rsquo;t stand those sounds anymore.\u003c/p\u003e\u003cp\u003eI experience intense fear when I hear loud motorcycles or heavy vehicles passing by.\u003c/p\u003e\u003cp\u003eSometimes the sound makes me freeze, and my chest tightens\u0026ndash;I feel like I can\u0026rsquo;t breathe.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe recurrence of this theme suggests that environmental triggers remain powerful and emotionally destabilizing for survivors, reflecting ongoing trauma and possibly symptoms of posttraumatic stress.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Disrupted Sleep and Night-time Disturbances\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 38 participants reported that their sleep has been severely affected since the disaster. Many described waking up suddenly in the middle of the night, drenching in sweat, heart pounding, and gripping due to intense fear. Bad dreams or no dreams at all have become a regular part of their nights, with some recalling vivid nightmares of landslides, cries for help, or collapsing homes. Even those who manage to fall asleep struggle with staying asleep, often jolting awake at the slightest sound and being unable to calm their racing thoughts. This hyperalert state has left them exhausted, both mentally and physically, unable to find the rest they desperately need.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI haven\u0026rsquo;t had good sleep since the disaster, and I often wake up suddenly at night.\u003c/p\u003e\u003cp\u003eEven in sleep, I feel like I\u0026rsquo;m listening for that sound again. It\u0026rsquo;s exhausting.\u003c/p\u003e\u003cp\u003eI wake up sweating, scared, with images in my mind that I can\u0026rsquo;t erase.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis lack of restful sleep has not only impacted their physical health but also aggravated their emotional fatigue, creating a cycle of sleeplessness, fear, and helplessness that continues to haunt them long after the skies are cleared.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 3: Emotional Numbness and Disconnection from Life\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 31 participants expressed a deep sense of emotional detachment and numbness. While they continue to function physically, many shared that they no longer feel truly alive inside. Joy, excitement, and emotional connections to daily life have faded. Being alone and unoccupied often leads them into a spiral of overthinking, sadness, and mental exhaustion.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eEven though we live, we don\u0026rsquo;t feel alive anymore.\u003c/p\u003e\u003cp\u003eWe are going with the flow, but nothing makes us feel present.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis theme reflects a survival mechanism, keeping busy to distract from inner pain.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 4: Hopelessness and Loss of Motivation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis theme appeared in the narratives of 35 participants. Many survivors indicated that they had lost interest in working, setting goals, or planning for the future. Several women mentioned that they engage in small tailoring jobs or occasional work, not for income but simply because they cannot bear to sit idle at home. The disaster not only took away their homes and livelihoods but also eroded their inner drive and sense of purpose.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI\u0026rsquo;ve lost interest in everything after the disaster. There\u0026rsquo;s no motivation to work or earn anymore.\u003c/p\u003e\u003cp\u003eWe live without dreams now. The only thing we wish for is a permanent home.\u003c/p\u003e\u003cp\u003eI started stitching just so I won\u0026rsquo;t sit and think too much; it\u0026rsquo;s not for money anymore.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis consistent loss of motivation highlights the psychological paralysis that can follow when survivors face an uncertain future with limited resources and disrupted routines. The work they do is no longer tied to dreams or ambition but has become a tool to simply keep their minds away from memories too heavy to carry in silence.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 5: Grief and Sadness Over Irreparable Loss\u003c/b\u003e\u003c/p\u003e\u003cp\u003eGrief and a deep sense of loss were articulated by 40 participants. Their grief was not limited to material destruction but extended to the emotional trauma of losing homes, close-knit communities, and loved ones. The memory of the disaster lingers in sensory experiences, particularly smell and sound, reinforcing their sense of irreversible loss.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe were financially stable, but now we\u0026rsquo;ve lost everything.\u003c/p\u003e\u003cp\u003eThe feeling of loss is overwhelming. I still remember the smell of clay from the landslide.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis theme underscores the multidimensional nature of loss, material, emotional, and relational, and its lasting impact on survivors' mental health.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 6: Suicidal Thoughts and Existential Crisis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAlthough not widespread, 11 participants openly discussed having suicidal thoughts or feeling that life no longer held meaning. These narratives reflected deep emotional exhaustion, identity loss, and existential questioning in the aftermath of overwhelming trauma. What makes this theme even more concerning is the ripple effect it has had on families and communities. Several women shared that even children and young girls have begun expressing a desire to die, overwhelmed by grief and hopelessness. Survivors are often left struggling to comfort and restrain their loved ones, even as they themselves grapple with internal emotional collapse.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSometimes I think about suicide because life feels meaningless without our lost home and community.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTwo participants also recounted the death of a 20-year-old girl from their neighbourhood who was found hanging, an incident that deeply disturbed many in the survivor community, particularly the younger generation. For those who lost close family, friends, or neighbours in the landslide, the grief continues to haunt them like a shadow that refuses to fade.\u003c/p\u003e\u003cp\u003eA few participants shared that the only reason they had not attempted suicide was because their faith strictly prohibits it. They admitted that without this religious restraint, they might have given in to the urge to end their suffering. This reveals how intense the psychological pain is and how religion, while offering strength and structure, is also relied upon as the last thread of emotional control in the absence of formal mental health care.\u003c/p\u003e\u003cp\u003eThis theme highlights a quiet but serious mental health emergency and underscores the critical need for culturally sensitive, trauma-informed mental health interventions, crisis counselling, and consistent psychological support, especially for vulnerable women and youth navigating this unseen emotional aftermath.\u003c/p\u003e\u003c/div\u003e"},{"header":"6. Discussion","content":"\u003cp\u003eThe findings of this study present a deeply human and empirically supported account of the psychological toll faced by female survivors of the Chooralmala landslide. Through the combined use of the \u003csup\u003e1\u003c/sup\u003eDASS-21 scale and in-depth qualitative interviews, research has illuminated both measurable and lived experiences of depression,\u003c/p\u003e\u003cp\u003eanxiety, and stress within this vulnerable population. These findings are consistent with, yet extend beyond, the literature, offering new insights and addressing key gaps in the current understanding of post-disaster mental health in gendered contexts.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e6.1 Integration of quantitative and qualitative findings\u003c/h2\u003e\u003cp\u003eQuantitative data analysis revealed high average scores across all three dimensions: depression (M\u0026thinsp;=\u0026thinsp;22.04), anxiety (M\u0026thinsp;=\u0026thinsp;19.24), and stress (M\u0026thinsp;=\u0026thinsp;20.88), all indicating severe levels of psychological distress. Particularly alarming were the consistently high scores among a subset of participants who scored severely across all domains, suggesting deep emotional trauma that requires urgent intervention.\u003c/p\u003e\u003cp\u003eThe qualitative data mirrored and enriched these findings, revealing profound themes such as persistent fear, disrupted sleep, emotional numbness, hopelessness, grief, and suicidal ideation. Survivors spoke of panic triggered by natural sounds, nightmares, loneliness, and even witnessing suicide in their community. These narratives added texture to the \u003csup\u003e1\u003c/sup\u003eDASS scores, showing that the trauma experienced is not episodic but woven into the fabric of daily life, especially after forced displacement and community scattering.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e6.2 Consistency with the literature\u003c/h2\u003e\u003cp\u003eThe findings of this study are consistent with previous research conducted in similar post disaster contexts. Bhatia \u0026amp; Kour (2024) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] reported significantly higher DASS-21 scores among adolescents in disaster-hit regions, confirming that disaster exposure is directly linked to increased psychological distress. Similarly, Elbay et al. (2020) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported elevated \u003csup\u003e1\u003c/sup\u003eDASS scores and \u003csup\u003e2\u003c/sup\u003ePTSD symptoms among healthcare professionals during the COVID-19 crisis, reinforcing how sustained exposure to stressors leads to burnout and mental decline.\u003c/p\u003e\u003cp\u003eThe Turkish study by Cambridge University Press (2020) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] on pregnant and postpartum women further affirms this, showing that psychosocial health outcomes worsen in disaster settings, especially among women, owing to their compounded vulnerabilities. Our study aligns with these global findings, but it also adds a local and gender-specific dimension within the Indian context, particularly for marginalized women in rural Kerala.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e6.3 Addressing the research gaps\u003c/h2\u003e\u003cp\u003eDespite growing research on disaster-related mental health, three major gaps have been identified in the literature:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eLack of gender-focused disaster mental health studies in India - Most Indian studies are generalized or focus on infrastructure and economic loss. Our study specifically captures the emotional landscape of female survivors, providing much-needed data for gender-sensitive policy interventions.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eUnderrepresentation of qualitative experiences - Existing research heavily relies on quantitative tools, with little attention given to how survivors feel, narrate, and internalize trauma. By incorporating rich personal narratives, this study presents a more holistic picture of mental health challenges.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eNeglect of long-term displacement effects - Most studies focus on immediate relief camp scenarios. Our research highlights how psychological distress increases post-resettlement, when survivors are scattered and isolated, losing the comfort of communal healing that can be briefly provided.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThis study bridges these gaps by employing a mixed-methods approach in a localized setting, focusing exclusively on women, and exploring the transition from immediate relief to long-term recovery, a phase often ignored in the disaster psychology literature.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e6.4 Implications for Policy and Practice\u003c/h2\u003e\u003cp\u003eThis research highlights the urgent need for long-term, trauma-informed mental health care for disaster survivors, especially women and young girls. Intervention models must include the following:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCommunity-based psychological services\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMobile counselling units for rural or displaced populations\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCulturally sensitive therapy that acknowledges religious and social coping mechanisms\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEconomic and housing stability as fundamental mental health support\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eProvide job-oriented training and workshops for women.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIn the absence of readily available psychological services, it is crucial to equip local health workers with mental health first aid training and establish peer-led emotional support groups within affected communities. Several participants in this study reported that their emotional distress peaks during the night, especially when they are alone, or when it starts raining, as these moments serve as haunting reminders of their traumatic experiences. For many, these are the hours when fear, grief, and panic spiral uncontrollably, with no one turning to. As such, mental health\u003c/p\u003e\u003cp\u003eprofessionals must be available around the clock, particularly during evenings and early mornings, to provide timely intervention. Crisis helplines, mobile counselling units, and local volunteers trained in trauma-informed care can play a transformative role in bridging this critical gap.\u003c/p\u003e\u003cp\u003eFrom a criminological standpoint, the urgency becomes even more pronounced. According to the routine activity theory proposed by Cohen and Felson (1979) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], crime occurs when a motivated offender, a suitable target, and the absence of a capable guardian intersect. In the current scenario, displaced women, some of whom are living in isolated, unstable conditions without some, are mentally‒physically weak, have consistent protection, and fulfil all the criteria of potential victimization. Survivors\u0026rsquo; emotional vulnerability, economic insecurity, and physical isolation place them at elevated risk of becoming targets of human trafficking, sexual exploitation, theft, or even organ trafficking. Without strong social safety nets or psychological resilience, many of these women lack what the theory describes as a 'capable guardian', whether in the form of community, law enforcement, or institutional support. Thus, mental health care is not just a matter of emotional healing; it is a crucial line of defence against future victimization and criminal exploitation.\u003c/p\u003e\u003c/div\u003e"},{"header":"7. Conclusion","content":"\u003cp\u003eThis study explored the mental health status of female survivors of the 2024 Chooralmala landslide in Wayanad through a mixed-methods approach that combines the quantitative power of the \u003csup\u003e1\u003c/sup\u003eDASS-21 scale with the emotional depth of qualitative narratives. The findings compellingly demonstrate that the psychological aftermath of natural disasters extends far beyond immediate physical and economic losses, manifesting in long-term emotional distress, especially among socioeconomically and geographically vulnerable women.\u003c/p\u003e\u003cp\u003eQuantitatively, the validated \u003csup\u003e1\u003c/sup\u003eDASS-21 scale revealed high average scores in all three domains\u0026mdash;Depression (M\u0026thinsp;=\u0026thinsp;22.04), Anxiety (M\u0026thinsp;=\u0026thinsp;19.24), and Stress (M\u0026thinsp;=\u0026thinsp;20.88)\u0026mdash;which fell into the severe range for most participants. These findings confirm all three research hypotheses, validating the presence of significant levels of depression, anxiety, and stress among survivors. More importantly, the qualitative data offered an intimate and textured view of these psychological states. The recurring themes of persistent fear, sleep disturbances, emotional numbness, loss of motivation, and suicidal ideation were drawn directly from the survivors' own voices. These\u003c/p\u003e\u003cp\u003eemotional narratives provided not just context but also urgency, revealing the silent epidemic of trauma that unfolded long after the disaster faded from public memory.\u003c/p\u003e\u003cp\u003eThe study also fills several critical research gaps. It highlights the gender-specific emotional toll of natural disasters within a rural Indian context, employs qualitative inquiry to humanize standardized psychological assessments, and most notably, addresses the neglected phase of post-resettlement trauma, where survivors are scattered across unfamiliar terrains and stripped of their communal coping structures. Furthermore, this research integrates a criminological lens, invoking routine activity theory, to suggest that without capable guardianship, social, institutional, or psychological, emotionally and economically vulnerable women remain at risk of secondary victimization, including human trafficking and exploitation.\u003c/p\u003e\u003cp\u003eHowever, this study is not without its limitations. The sample size was modest (N\u0026thinsp;=\u0026thinsp;50), and the use of snowball sampling, while contextually necessary, may introduce selection bias and limit the generalizability of the findings. Additionally, the study focused solely on women aged 18\u0026ndash;50 years, excluding the experiences of older women, men, and children, who may exhibit different psychological responses. The emotional sensitivity of the interviews may also have led to underreporting or guarded responses despite efforts to create a safe and empathetic space.\u003c/p\u003e\u003cp\u003eFuture research should expand both geographically and demographically, employing longitudinal methods to assess how trauma evolves over time and how effective mental health interventions can be tailored and implemented in rural disaster-prone areas. Interdisciplinary collaboration with public health, criminology, psychology, and social workers will be essential to address the complex aftermath of climate-induced displacement holistically.\u003c/p\u003e\u003cp\u003eIn conclusion, this study reinforces the urgent need to move beyond temporary relief models toward sustainable, trauma-informed, and community-rooted mental health care, especially for disaster-affected women. It argues for policy reforms that integrate mental health as a core component of disaster recovery and highlights the value of listening\u0026mdash;truly listening to the lived experiences of survivors. Healing begins not just with rehabilitation but also with recognition. This study stands as a call to recognize, respond, and rebuild with empathy, equity, and evidence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the women survivors of the Chooralmala landslide for their courage in sharing their experiences. We are also grateful to the people of Wayanad for their support and cooperation. Special thanks to Karunya Institute of Technology and Sciences, Srinivas University, and the Government of Kerala for their institutional and logistical support throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics, Consent to Participate, and Consent to Publish:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not involve any clinical intervention or experimental treatment. All methods were carried out in accordance with relevant guidelines and regulations of APA and ICMR. Informed verbal consent was obtained from all participants prior to data collection, and their confidentiality and anonymity were strictly maintained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Institutional Ethics Committee of Karunya Institute of Technology and Sciences, Coimbatore, India (KITS/CR\u0026amp;FS/ECL/2024/09). The Committee under the supervision of Dr. C. Joseph Kennady and Dr. A. Shakunthala waived the need for formal ethical approval, as the study involved non-invasive interviews and posed minimal risk to participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eREST. (2024). The silent suffering: Suicide risks among trafficking survivors. Retrieved from https://iwantrest.com/blog/the-silent-suffering-suicide-risks-among-trafficking-survivors\u003c/li\u003e\n\u003cli\u003eReuters. (2024, December 11). Human trafficking rises sharply after dropping during pandemic, UN says. Reuters. https://www.reuters.com/world/human-trafficking-rises-sharply-after-dropping-during-pandemic-un-says-2024-12-11/\u003c/li\u003e\n\u003cli\u003eSteinberg, A., \u0026amp; Ritzmann, R. F. (1990). A living systems approach to understanding the concept of stress. Behavioral Science, 35(2), 138\u0026ndash;146. https://doi.org/10.1002/bs.3830350206\u003c/li\u003e\n\u003cli\u003eSpielberger, C.D. (1983). Manual for the state-trait anxiety inventory. Palo Alto, C.A: Consulting Psychologists Press.\u003c/li\u003e\n\u003cli\u003eBarlow, D.H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guiford Press.\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.\u003c/li\u003e\n\u003cli\u003eEskin, M., Ertekin, K., Harlak, H., \u0026amp; Dereboy, C. (2008). Prevalence of and factors related to depression in high school students. Turk Psikiyatri Dergisi = Turkish Journal of Psychiatry, 19(4), 382\u0026ndash;389.\u003c/li\u003e\n\u003cli\u003eLovibond, S. H., \u0026amp; Lovibond, P. F. (1995). Manual for the Depression Anxiety \u0026amp; Stress Scales (2nd ed.). Sydney: Psychology Foundation.\u003c/li\u003e\n\u003cli\u003eBhatia, R., \u0026amp; Kour, J. (2024). Studying the psychological distress among high school students in disaster-affected areas. International Journal for Multidisciplinary Research, 6(1), 1\u0026ndash;9. https://doi.org/10.36948/ijfmr.2024.v06i01.14193\u003c/li\u003e\n\u003cli\u003eSamsoor, A. A., \u0026amp; Stanikzai, M. H. (2024). Depression, Anxiety and Stress Symptoms among Afghan Healthcare Workers: A Cross-Sectional Analytical Study. Indian Journal of Occupational and Environmental Medicine, 28(2), 154\u0026ndash;158. https://doi.org/10.4103/ijoem.ijoem_34_24\u003c/li\u003e\n\u003cli\u003eMounia Amane, Nadia Hachoumi, Rquia Laabidi, Loubna Mazzi, Souad Yakini, Sokaina Loulidi, Siham Jbari, El Hassane Mourid, Samia Boussaa, Mental health of nursing students regarding the Moroccan earthquake: A cross-sectional study, Enfermer\u0026iacute;a Cl\u0026iacute;nica (English Edition), Volume 34, Issue 5,2024, Pages 377-385, ISSN24451479, https://doi.org/10.1016/j.enfcle.2024.09.002\u003c/li\u003e\n\u003cli\u003eWikipedia. (2024). 2024 Wayanad landslides. Retrieved from https://en.wikipedia.org/wiki/2024_Wayanad_landslides\u003c/li\u003e\n\u003cli\u003eR\u0026uuml;meysa Yeni Elbay, Ayşe Kurtulmuş, Selim Arpacıoğlu, Emrah Karadere. (2020). Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Research, 290, 113130. https://doi.org/10.1016/j.psychres.2020.113130\u003c/li\u003e\n\u003cli\u003eCambridge University Press. (2020). Determinants of psychosocial health status in pregnant and postpartum women experiencing earthquake in Turkey. Disaster Medicine and Public Health Preparedness. https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/determinants-of-psychosocial-health-status-in-pregnant-and-postpartum-women-experiencing-earthquake-in-turkey/3877A882A5CBEEF500D371B24DD0183B\u003c/li\u003e\n\u003cli\u003eCohen, L. E., \u0026amp; Felson, M. (1979). Social change and crime rate trends: A routine activity approach. American Sociological Review, 44(4), 588\u0026ndash;608. https://doi.org/10.2307/2094589\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\n \u003cli\u003eDepression Anxiety Stress Scale= DASS\u003c/li\u003e\n \u003cli\u003ePost-traumatic stress disorder= PTSD\u003c/li\u003e\n \u003cli\u003eStandard Deviation= SD\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Depression, Anxiety, Stress, DASS-21, Wayanad landslide, Women’s mental health, Natural disaster trauma, Suicide prevention, Crisis intervention","lastPublishedDoi":"10.21203/rs.3.rs-6695309/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6695309/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe 2024 landslides in Chooralmala, Wayanad, and Kerala had severe psychological impacts, particularly affecting women aged 18\u0026ndash;50 years due to trauma, displacement, weakened community bonds, and insufficient mental health support from authorities. Addressing the mental health needs of disaster survivors, especially vulnerable women, is essential for effective rehabilitation and recovery. Understanding their emotional experiences helps in creating targeted psychological interventions.\u003c/p\u003e\u003cp\u003eUsing a mixed-methods design, the study involved 50 female survivors selected through snowball sampling due to their dispersed relocation. Quantitative assessments were performed via the \u003csup\u003e1\u003c/sup\u003eDASS-21 scale, whereas qualitative narratives from in-depth interviews explored personal emotional experiences. The results revealed high levels of depression (M\u0026thinsp;=\u0026thinsp;22.04), anxiety (M\u0026thinsp;=\u0026thinsp;19.24), and stress (M\u0026thinsp;=\u0026thinsp;20.88). The qualitative findings revealed recurring themes: persistent fear, disrupted sleep, emotional detachment, hopelessness, grief, suicidal ideation, panic responses to environmental triggers, social isolation, and deterioration of mental health due to displacement.\u003c/p\u003e\u003cp\u003eThis study underscores the urgent necessity for continuous, culturally sensitive, trauma-informed mental health interventions. Recommendations include gender-specific strategies and the integration of community-based mental health services within disaster response frameworks to improve psychological resilience and recovery among female survivors.\u003c/p\u003e","manuscriptTitle":"Post-disaster Mental Health Status: A Study of Women from Chooralmala Landslide in Kerala, India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-26 05:02:13","doi":"10.21203/rs.3.rs-6695309/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87980b5d-fe87-482d-bf2a-aa0c45bb1a1d","owner":[],"postedDate":"September 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-26T05:02:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-26 05:02:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6695309","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6695309","identity":"rs-6695309","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}