Posttraumatic growth and depreciation six years after the 2004 tsunami.

Background: Posttraumatic growth (PTG) has been reported after various types of potentially traumatic events, as a part of the personal recovery process among survivors. Even negative changes in survivors' life view, known as posttraumatic depreciation (PTD), have been identified as an additional aspect in the personal recovery processes. Objective: To examine how the type of exposure experienced by survivors of a natural disaster, the 2004 Southeast Asia tsunami, influenced self-reported PTG and PTD six years later (T2). Additionally, the study examined the relations between psychological distress and posttraumatic stress symptoms (PTSS) 14 months after the disaster (T1), to PTG and PTD, respectively at T2. Finally, the study examined whether psychological distress and PTSS (T1) could have a mediating effect on PTG and PTD at T2. Method: The participants were 848 tsunami survivors living in Stockholm, Sweden who responded to a questionnaire at 14 months (T1) and six years (T2) after the tsunami. The material was analysed using linear regression and pathway analysis. PTG and PTD were measured on separate scales. Results: The type of exposure was significant related to both PTG and PTD six years later (T2). Those experiencing a combination of various types of exposure (including threat to life and bereavement) reported higher scores for both PTG and PTD. There were significant positive correlations between PTSS at T1 and PTG /PTD at T2, and somewhat lower correlations between psychological distress at T1 and PTG/PTD at T2. Both PTSS and psychological distress at T1 were significant mediating variables for both PTG and PTD at T2. Conclusions: Studying survivors' various types of exposure and subsequent changed view of life - both PTG and PTD - resulted in a broadened understanding of the complexity of reactions and the recovery process among survivors.

On-the-job training makes the difference: healthcare assistants' perceived competence and responsibility in the care of patients with home mechanical ventilation.

OBJECTIVES: To describe and analyse perceived competence and perceived responsibility among healthcare assistants (HC assistants), caring for patients with home mechanical ventilation (HMV) and other advanced caring needs, adjusted for socio-demographic and workplace background factors. DESIGN: A cross-sectional study was conducted including 128 HC assistants employed in Stockholm County, Sweden. METHODS: The HC assistants responded to a study-specific questionnaire on perceived competence and perceived responsibility, provided socio-demographic and workplace background data, as well as information on the patient characteristics for the understanding of their work situations. Descriptive statistics and logistic regression analyses were performed. RESULTS: Eighty per cent of the HC assistants rated their perceived competence as high, and fifty-nine per cent rated their perceived responsibility as high. Fifty-five per cent lacked formal healthcare training, and only one in five of the HC assistants had a formal training equivalent with a licensed practical nurse (LPN) examination. Males lacked formal training to a greater extent than females and rated their competence accordingly. On-the-job training was significantly associated with high ratings on both perceived competence and perceived responsibility, and clinical supervision was associated with high rating on perceived responsibility. CONCLUSIONS: HC assistants with limited formal training self-reported their competence as high, and on-the-job training was found to be important. Also, clinical supervision was found important for their perception of high responsibility. In Sweden, HC assistants have a 24-hour responsibility for the care and safety of their patient with HMV and other advanced caring needs. The study results point out important issues for further research regarding formal training requirements as well as the needs for standardised workplace training and supervision of HC assistants. The consequences of transfer of responsibility by delegation from healthcare professionals to paraprofessionals within advanced home care also need further study.

Longitudinal course of physical and psychological symptoms after a natural disaster.

BACKGROUND: After disaster, physical symptoms are common although seldom recognized due to lack of knowledge of the course of symptoms and relation to more studied psychological symptoms. OBJECTIVE: This study aimed to investigate the change in the reporting of different physical symptoms after a disaster, including possible factors for change, and whether psychological symptoms predict physical symptoms reporting at a later point in time. METHOD: A longitudinal study of citizens of Stockholm who survived the 2004 Indian Ocean tsunami. A total of 1,101 participants completed questionnaires on somatic symptoms, general distress, posttraumatic stress, exposure, and demographic details 14 months and 3 years after the disaster. Physical symptoms occurring daily or weekly during the last year were investigated in four symptom indices: neurological, cardiorespiratory, gastrointestinal, and musculoskeletal. We used generalized estimating equations (GEE) analysis to determine odds ratios for a change in symptoms, and pathway analysis to predict the influence of psychological symptoms on physical symptoms. RESULTS: There was a general decrease of reporting in all physical symptom indices except the musculoskeletal symptom index. The change in the neurological symptom index showed the strongest association with exposure, and for women. General distress and posttraumatic stress at 14 months postdisaster predicted physical symptoms at 3 years. CONCLUSION: Physical symptoms were predicted by psychological symptoms at an earlier time point, but in a considerable proportion of respondents, physical symptoms existed independently from psychological symptoms. Physicians should be observant on the possible connection of particular pseudoneurological symptoms with prior adversities.

Support, opinion of support and psychological health among survivors of a natural disaster.

BACKGROUND: Although formal intervention after disasters is recommended, the evidence base for this is weak. Satisfaction with support after disasters is seldom investigated and the relation to psychological symptoms is unknown. AIMS: To investigate whether dissatisfaction with social and formalized support are associated with post-disaster psychological symptoms. METHODS: A total of 1,505 Swedish survivors of the 2004 Indian Ocean tsunami responded to a questionnaire 14 months after the disaster, including the General Health Questionnaire-12, the Impact of Events Scale - Revised, the Crisis Support Scale, and questions concerning the reception and appraisal of social and formalized support from health care, psychological services and insurance agencies. Disaster exposure and background factors were controlled for in the analyses. RESULTS: Reception of formalized support, but not social support, was associated with both psychological distress and post-traumatic stress. Dissatisfaction with social but not formalized support, with the exception of support from insurance agencies, was associated with psychological distress. CONCLUSIONS: Social support and formalized support should be differentiated in future studies in order to improve preventive intervention efforts after disasters. The reporting of dissatisfaction with social support merits special attention, since this may indicate increased risk for psychological symptoms.

Physical symptoms 14 months after a natural disaster in individuals with or without injury are associated with different types of exposure.

OBJECTIVE: To investigate whether different types of exposure to the 2004 tsunami were associated with physical symptoms 14 months after the disaster and to study correlations between survivors' physical and psychological symptoms. METHODS: Using a cross-sectional design, 1505 survivors from the 2004 Indian Ocean Tsunami, tourists from Stockholm, who had been present in the disaster areas, responded to a postal questionnaire. Eight groups based on type of exposure were created. Physical symptoms occurring on a daily or weekly basis over the past year were investigated in four indices: musculoskeletal, cardiorespiratory, neurological, and gastrointestinal. Mental health symptoms (General Health Questionnaire-12) and posttraumatic stress symptoms (Impact of Event Scale-Revised) were also investigated. Multiple logistic regression analyses were conducted with controls for background variables and exposure, with physical symptoms as outcome variables. The association between physical and psychological symptoms was studied with the Spearman Rank Order Correlation. RESULTS: Different types of exposure during the disaster were associated with physical symptoms 14 months later for survivors both with and without severe physical injury. The single exposure of life threat, also in combination with other exposures, was associated with a higher risk for reporting of physical symptoms. Physical symptoms showed modest yet significant correlation with psychological symptoms. CONCLUSION: It is important to pay attention to both physical and psychological symptoms among disaster survivors whether they have been injured or not. A relatively simple questionnaire about physical symptoms may be a good complement to the scales used to assess psychological problems after disaster.

Childhood life events and psychological symptoms in adult survivors of the 2004 tsunami.

BACKGROUND: Negative life events in childhood have an adverse influence on adult psychological health, and increase vulnerability to subsequent potential traumas. It remains unclear whether this is also true in the case of disasters. AIM: This study investigates whether the experience of negative life events in childhood and adolescence was associated with psychological symptoms in groups of Swedish survivors with different types of exposure to the tsunami. METHODS: 1505 survivors from Stockholm responded to a questionnaire on psychological distress, which was sent by post 14 months after the 2004 Indian Ocean tsunami. Psychological distress was measured by General Health Questionnaire-12 and suicidal ideation, and post-traumatic stress was measured by Impact of Event Scale-Revised. Life events prior to age 16 were collected and categorized under the indices accident, violence, loss and interpersonal events. Exposure to the tsunami was categorized in different types, and controlled for in the analyses. RESULTS: With the adjustment for confounders, significant odds ratios were found for all indices on at least one outcome measure, despite the powerful effect of the tsunami. We could not discern any distinct difference in the distribution of the tendency to report the different outcomes depending on types of prior life events. CONCLUSIONS: The implication of the study is that, for adult survivors of disaster, the reporting of adverse life events from childhood may influence future decisions regarding therapy.

Psychological distress and sick leave in Swedish survivors of the 2004 tsunami: a comparison with a population sample.

Disaster studies of the effects of trauma exposure on subsequent psychological health have seldom used population comparisons. A total of 1463 tsunami survivors from Stockholm were categorized according to type of exposure, and compared on measures of General Health Questionnaire and sick leave, with a matched population-based sample of 12,045 individuals from the same region. Data from the survivor group were obtained through a postal questionnaire 14 months postdisaster. Data from the population sample were collected in the same year. In comparison to the population sample, levels of sick leave ranged from higher in multiply exposed groups to lower in the least exposed group. For psychological distress, levels in multiply and moderately exposed groups were higher, and in lower exposed groups comparable. The use of a population comparison resulted in a support of recent research showing a relative resiliency of survivors exposed during disaster to potential trauma of lesser severity.

Different types of exposure to the 2004 tsunami are associated with different levels of psychological distress and posttraumatic stress.

The impact of traumatic exposure on psychological distress and posttraumatic stress was investigated at 14 months through self-report in 1,505 Swedish tourists who survived the 2004 Indian Ocean Tsunami. Exposure, differentiated in single and multiple types, was associated with different levels of impaired mental health measured by General Health Questionnaire (GHQ) and Impact of Event Scale-Revised (IES-R). Additionally, having sole exposure to subjective life threat brought about specific psychological effects. Some demographic factors are associated with outcome on either the GHQ or the IES-R. Identifying specific types of exposure of disaster survivors may be a way to identify individuals who could be screened for psychological ill health at a later point in time.

Gender differences in the effects from working conditions on mental health: a 4-year follow-up.

OBJECTIVES: The overall aim was to examine how working conditions in 1993 influenced the occurrence of poor mental health in 1997 among women and men from the general population. Also, the relative importance of other living conditions in relation to poor mental health in 1997 was examined. METHODS: A sample from the general Swedish population (originally examined in 1969) was followed up in 1993 and 1997. Data from these follow-ups were analysed, and both bivariate and multivariate analyses of associations between occupational and non-occupational conditions in 1993 and poor mental health in 1997 -- defined as sub-clinical depression, reduced psychological well-being and high alcohol consumption -- were performed. RESULTS: Several occupational risk indicators were identified for poor mental health among women, especially sub-clinical depression and high alcohol consumption. Occupational factors such as shift work, job strain, no education at the employer's expense, low occupational pride, low stimulation at work and poor social support were related to poor mental health among women. For poor mental health among men, mainly sub-clinical depression, shift work and low occupational pride were identified as risk indicators. Non-occupational factors related to poor mental health among women were poor quality of social contacts, demanding life events, physical inactivity, high perceived physical load outside work and inadequate coping strategies. Among men, smoking and inadequate coping strategies were related to poor mental health. CONCLUSIONS: The difference between women and men, regarding the numbers of identified occupational and non-occupational risk indicators, may partly be explained by the gender-segregated labour market, and partly by other explanations. In our study, we have not succeeded in collecting the relevant information about occupational conditions that is important for men's mental health.