VATTAVAN, Sri Lanka (Reuters) - When Ramakrishnan Shakthivel and his wife saw the tsunami bearing down on their house on Sri Lanka's east coast, they grabbed their three children and ran for their lives.
It was too late. The wave slammed into their village, destroying their home and sweeping them away. It was the last time he saw his wife alive.
"I was badly injured and taken to the hospital," he said on the steps of the temporary shelter he now lives in near the eastern town of Batticaloa. "Immediately after, I asked if people had seen my wife and children. Two days later, I found her body."
The Dec. 26 earthquake and resulting tsunami killed more than 231,000 people in a dozen Indian Ocean nations.
The series of giant waves killed up to three or four times as many women and children as men, international aid group Oxfam said, after surveying villages in Indonesia, India and Sri Lanka.
Aid workers had several explanations: women stayed behind to look for children; they were less likely to know how to swim and wore saris or clothing that made it hard to run from the waves; men were running errands, working in fields or out at sea when the waves struck on a Sunday morning.
A year on, many of the men are struggling to look after their surviving children. Some are seeking to remarry. Others have sunk in despair.
NEW FAMILY STRUCTURES
Save the Children, in a report this month, said the disaster has had a profound impact on communities.
"A series of new family structures, such as single-parent families, foster families, and families consisting of extended family members have been created."
All three of Shakthivel's daughters survived, but the 47-year-old fisherman, who now has no boat, says he can only look after the five-year-old.
"The older two are cared for in the orphanage," he says, holding a picture of his wife and a son who died of a snake bite before the tsunami struck.
Shakthivel is still waiting to be told when he will be given new housing and says despite massive international aid programmes in the local area, he has received no help to set up a new livelihood.
"I was all the time thinking of my wife," he says. "I feel loneliness even when I am with the children -- it is hard to explain."
Survivors throughout the tsunami zone are suffering from a variety of psychological problems -- feelings of hopelessness, suicidal thoughts, sleep disorders, flashbacks and nightmares, psychosomatic complaints, aid agencies say.
After the disaster, aid workers from Oxfam took Shakthivel and many others like him to counseling, telling him how the wave had struck a string of countries around the Indian Ocean and that he was not the only one suffering.
In another nearby settlement, Rasayayagam Murukupillai says he envies those who were widowed but still have children to care for. He can remember nothing after finding his wife and only daughter lying dead under a garbage heap two days after the wave struck.
"I can't remember what happened in those days," he said. "I'm worried she was unconscious for a long time. If I'd found her, maybe she would be alive. I was always thinking about it, when I was eating and sleeping."
Even before the tsunami, experts say Sri Lanka was facing a mental health crisis. It has one of the highest suicide rates in the world -- 5 percent of hospital deaths are from drinking pesticides -- but lack of understanding prevents many from talking about it.
NEW ROUND OF SUICIDES
Some aid workers say they fear the one-year anniversary may spark a new round of suicides. Many may only start to face up to their grief when the struggle to survive is finally over and they and their families are back in permanent housing.
Murukupillai says he is finding life more bearable with the passage of time, but he envies those who lost partners but whose children survived "to look after them".
In some tsunami-hit countries, aid workers say there has been a rush of new weddings -- and new births -- as the bereaved find new partners and have new children to replace those who died.
In India during the first months after the tsunami, some village elders proposed that daughters should not be married off until their widower fathers could remarry.
"They wanted the daughters to stay with the widower father, cook for him and take care of him until he could remarry," said M. Krishnakumar of Avvai Village Welfare Society, a NGO in Nagapattinam district, India's worst affected region.
"However this was not really implemented."
Murukupillai says he is not yet ready for remarriage.
"I don't like to, because I have lost my wife and child," he says. "But maybe in time."
(Additional reporting by Dean Yates in JAKARTA, YP Rasjeh in NAGAPATTINAM, India)