Posttraumatic responses to the July 22, 2011 Oslo Terror among Norwegian high school students.

The July 22, 2011, Oslo Terror was defined as a national disaster. Former studies on terror attacks and mass shootings have shown elevated levels of posttraumatic complaints both in direct victims and in general populations. Little is known about how such extreme events in a generally safe society such as Norway would affect an adolescent population. This study examines posttraumatic stress reactions and changes in worldview in relationship to risk factors among 10,220 high school students using data from the ung@hordaland survey. One out of 5 respondents knew someone directly exposed, 55.7% experienced the events to some extent as threatening to their own or their close ones' lives, and 79.9% reported their worldview to be changed. For posttraumatic stress disorder (PTSD) DSM IV criteria, 0.8% reported substantial symptoms of reexperiencing (Criterion B), 4.9% of avoidance (Criterion C), and 1.1% of hyperarousal (Criterion D). Greater personal proximity to the events, higher levels of perceived life threat, and being a female or an immigrant predicted higher levels of PTSD symptom distress. Results indicate that the terror events made a deep impression on Norwegian adolescents, but without causing markedly elevated levels of PTSD symptomatology in the general young population.

Patients' Experiences of Using an eHealth Pain Management Intervention Combined With Psychomotor Physiotherapy: Qualitative Study.

BACKGROUND: Chronic pain is a major health challenge to those affected. Blended care with psychomotor physiotherapy (PMP) combined with eHealth self-management might be beneficial. OBJECTIVE: This study aims to explore how patients with chronic pain experience the combination of PMP and the use of EPIO, an eHealth self-management intervention for chronic pain. METHODS: Individual semistructured interviews were conducted with 5 adult patients with chronic pain (ie, participants) who used EPIO in combination with PMP over a period of 10 to 15 weeks. Interviews explored participants' experiences using this treatment combination in relation to their pain and analyzed their experiences using systematic text condensation. RESULTS: Participants described having benefited from using EPIO in combination with PMP in terms of increased awareness of bodily signals and how pain was related to stress and activity. They also described changes in the relationship to themselves in terms of increased self-acceptance, self-assertion, and hope and their relationship to their pain in terms of seeing pain as less harmful and engaging in more active coping strategies. CONCLUSIONS: Results indicate that a blended care approach combining eHealth self-management interventions such as EPIO with PMP may be of value to patients living with chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104.

Coping with loss and bereavement in post-war Tigray, Ethiopia.

Drawing upon data collected through in-depth interviews with 20 victims of the Ethio-Eritrean war, this article addresses how psychosocial impacts of political violence are coped with in a Tigrayan context in northern Ethiopia. Qualitative procedures of condensation and categorization of interview texts revealed that informants presented three kinds of coping strategies, all aimed at avoiding indulging in sorrow: (1) diverted thinking, (2) distraction, and (3) future investment. As their main rationale for employing such coping strategies, informants reported the belief that grieving and crying would have negative impacts on their health, their household, and on their relationship with God. This belief is discussed in terms of how it is informed by sociocultural discourses of the Tigrayan community in general, and discourses of the Ethiopian Orthodox Church in particular. Some implications concerning the mismatch between the western trauma discourse and local discourses for psychosocial coping are discussed.

Prior adversities predict posttraumatic stress reactions in adolescents following the Oslo Terror events 2011.

BACKGROUND: Former studies suggest that prior exposure to adverse experiences such as violence or sexual abuse increases vulnerability to posttraumatic stress reactions in victims of subsequent trauma. However, little is known about how such a history affects responses to terror in the general adolescent population. OBJECTIVE: To explore the role of prior exposure to adverse experiences as risk factors for posttraumatic stress reactions to the Oslo Terror events. METHOD: We used data from 10,220 high school students in a large cross-sectional survey of adolescents in Norway that took place seven months after the Oslo Terror events. Prior exposure assessed was: direct exposure to violence, witnessing of violence, and unwanted sexual acts. We explored how these prior adversities interact with well-established risk factors such as proximity to the events, perceived life threat during the terror events, and gender. RESULTS: All types of prior exposure as well as the other risk factors were associated with terror-related posttraumatic stress reactions. The effects of prior adversities were, although small, independent of adolescents' proximity to the terror events. Among prior adversities, only the effect of direct exposure to violence was moderated by perceived life threat. Exposure to prior adversities increased the risk of posttraumatic stress reactions equally for both genders, but proximity to the terror events and perceived life threat increased the risk more in females. CONCLUSIONS: Terror events can have a more destabilizing impact on victims of prior adversities, independent of their level of exposure. The findings may be relevant to mental health workers and others providing post-trauma health care.

Post-disaster psychosocial services across Europe: the TENTS project.

At present post-disaster activities and plans seem to vary widely. An adequate estimation of the availability of post-disaster psychosocial services across Europe is needed in order to compare them with recently developed evidence-informed psychosocial care guidelines. Here we report on the results of a cross-sectional web-based survey completed in 2008 by two hundred and eighty-six representatives of organizations involved in psychosocial responses to trauma and disaster from thirty-three different countries across Europe. The survey addressed planning and delivery of psychosocial care after disaster, methods of screening and diagnosis, types of interventions used, and other aspects of psychosocial care after trauma. The findings showed that planning and delivery of psychosocial care was inconsistent across Europe. Countries in East Europe seemed to have less central coordination of the post-disaster psychosocial response and fewer post-disaster guidelines that were integrated into specific disaster or contingency plans. Several forms of psychological debriefing, for which there is no evidence of efficacy to date, were still used in several areas particularly in North Europe. East European countries delivered evidence-based interventions for PTSD less frequently, whilst in South- and South-Eastern European countries anxiety suppressing medication such as benzodiazepines were prescribed more frequently to disaster victims than in other areas. Countries across Europe are currently providing sub-optimal psychosocial care for disaster victims. This short report shows that there is an urgent need for some countries to abandon non-effective interventions and others to develop more evidence based and effective services to facilitate the care of those involved in future disasters.

Beyond PTSD: Socio-economic Bereavement in Tigray, Ethiopia.

By drawing upon data collected through in-depth interviews with 20 victims of the Ethio-Eritrean war, this paper addresses how psychosocial consequences of political war are expressed and conceptualized by people from Tigray, Ethiopia. War events were typically described in terms of their negative impacts on the household's means for income generation, and psychosocial complaints centred on aspects of impaired post-war economy rather than on politically violent experiences. The most reported complaints were (a) household erosion complaints, (b) social marginalization complaints and (c) education abortion complaints. Post-war psychosocial health problems were perceived as consequences of these aspects of impaired household economy, and were described in terms of their negative impacts on future income generation. Informants' expressions of distress were found to be highly informed by the socio-cultural and socio-economic structures of the Tigrayan society. Being the only study of its kind from this context, the study provides a unique illustration of the limitations of western trauma measures and calls for a context-based conceptualization of trauma.