Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis.

We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including ≥100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1-100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40-69 years, 55.5% female) from the United Kingdom and 409,617 people (≥18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the 'acceptable' sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8-10 h and 18% report daytime sleepiness. In adults (≥18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6-19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending ≥9 h in bed, whereas poor sleep quality was more frequent in those spending <6 h in bed. TST was similar across countries, but insomnia symptoms were 1.5-2.9 times higher in the United States. Women (≥41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.

Cancer incidence in Dutch Balkan veterans.

Suspicion has been raised about an increased cancer risk among Balkan veterans because of alleged exposure to depleted uranium. The authors conducted a historical cohort study to examine cancer incidence among Dutch Balkan veterans. Male military personnel (n=18,175, median follow-up 11 years) of the Army and Military Police who had been deployed to the Balkan region (1993-2001) was compared with their peers not deployed to the Balkans (n=135,355, median follow-up 15 years) and with the general Dutch population of comparable age and sex. The incidence of all cancers and 4 main cancer subgroups was studied in the period 1993-2008. The cancer incidence rate among Balkan deployed military men was 17% lower than among non-Balkan deployed military men (hazard ratio 0.83 (95% confidence interval 0.69, 1.00)). For the 4 main cancer subgroups, hazard ratios were statistically non-significantly below 1. Also compared to the general population cancer rates were lower in Balkan deployed personnel (standardised incidence rate ratio (SIR) 0.85 (0.73, 0.99). The SIR for leukaemia was 0.63 (0.20, 1.46). The authors conclude that earlier suggestions of increased cancer risks among veterans are not supported by empirical data. The lower risk of cancer might be explained by the 'healthy warrior effect'.

Persistent mental health disturbances during the 10 years after a disaster: four-wave longitudinal comparative study.

AIM: Although some studies have examined the long-term effects of disasters, very little is known about severe persistent symptoms following disasters. The aim of the present study was to examine persistent mental health problems and to what extent disaster exposure predicts long-term persistent disturbances. METHODS: Following a major disaster, a four-wave study was conducted (surveys 2-3 weeks, 18 months, 4 years and 10 years after the event) that examined severe post-traumatic stress disorder (PTSD) symptomatology (Impact of Event Scale), anxiety and depression symptoms and sleeping problems (Symptom Check List-90-R), and use of physician-prescribed tranquilizers. Participants were affected adult Dutch native residents (n = 1083). At wave 2 and 3, a control group participated (n = 694). At wave 1, severity of disaster exposure was examined. Multiple imputation was used to target the problem of missing data across surveys due to non-response such as in the fourth wave (61%). RESULTS: In total, 6.7% (95% confidence interval [CI]: 5.1-8.2) developed persistent PTSD symptoms during the 10 years after the event. For anxiety, depression, sleeping problems these prevalences were 3.8% (95%CI: 2.7-5.0), 6.2% (95%CI: 4.7-7.6) and 4.8% (95%CI: 3.5-6.1) respectively. In total 1.3% (95%CI: 0.6-2.0) used tranquilizers at all waves. Approximately one out of 10 with severe symptoms 2-3 weeks after the event, developed persistent symptoms. Even in the long term, affected residents compared to controls had more often chronic anxiety symptoms and sleeping problems. High disaster exposure independently predicted persistent PTSD symptoms (adjusted odds ratio [adj. OR], 4.20; 95%CI: 2.02-8.74, P < 0.001), anxiety (adj. OR, 3.43; 95%CI: 1.28-9.20, P < 0.01), depression symptoms (adj. OR, 2.95; 95%CI: 1.26-6.93, P < 0.01), and sleeping problems (adj. OR, 3.74; 95%CI: 1.56-8.95, P < 0.001). CONCLUSION: Post-disaster mental health care should (also) target persistent mental health disturbances in the long term, especially PTSD, anxiety, depression symptoms, and sleeping problems. High disaster exposure may be an early marker for risk of persistent symptoms.

Police officers: a high-risk group for the development of mental health disturbances? A cohort study.

OBJECTIVES: Policing is generally considered a high-risk profession for the development of mental health problems, but this assumption lacks empirical evidence. Research question of the present study is to what extent mental health disturbances, such as (very) severe symptoms of anxiety, depression and hostility are more prevalent among police officers than among other occupational groups. DESIGN: Multicomparative cross-sectional study using the data of several cross-sectional and longitudinal studies in the Netherlands. PARTICIPANTS: Two samples of police officers (N=144 and 503), employees of banks (N=1113) and employees of banks who were robbed (N=144); employees of supermarkets (N=335), and a psychiatric hospital (N=219), employees of a governmental social welfare organisation (N=76), employees who followed a training based on rational-motive therapy to strengthen their assertiveness (N=710), soldiers before deployment (N=278) and before redeployment (N=236) and firefighters (N=123). The numbers refer to respondents with complete data. PRIMARY OUTCOMES: Prevalence of severe (subclinical level) and very severe symptoms (clinical level) were computed using the Dutch norm tables (80th percentile and 95th percentile, respectively) of the Symptom Check List Revised (SCL-90-R). All comparisons were controlled for age, gender and education. RESULTS: Multivariate logistic regression and analyses showed that the prevalence of clinical and subclinical levels of symptoms of anxiety, depression and hostility among police officers were not significantly higher than among comparison groups. The same pattern was found for the other SCL-90-R subscales. CONCLUSIONS: We found no indications that self-reported mental health disturbances were more prevalent among police officers than among groups of employees that are not considered high-risk groups, such as employees of banks, supermarkets, psychiatric hospital and soldiers before deployment.

Disaster exposure as a risk factor for mental health problems, eighteen months, four and ten years post-disaster--a longitudinal study.

BACKGROUND: Disaster experiences have been associated with higher prevalence rates of (mental) health problems. The objective of this study was to examine the independent relation between a series of single disaster experiences versus the independent predictive value of a accumulation of disaster experiences, i.e. a sum score of experiences and symptoms of distress and post-traumatic stress disorder (PTSD). METHODS: Survivors of a fireworks disaster participated in a longitudinal study and completed a questionnaire three weeks (wave 1), eighteen months (wave 2) and four years post-disaster (wave 3). Ten years post-disaster (wave 4) the respondents consisted of native Dutch survivors only. Main outcome measures were general distress and symptoms of PTSD. RESULTS: Degree of disaster exposure (sum score) and some disaster-related experiences (such as house destroyed, injured, confusion) were related to distress at waves 2 and 3. This relation was mediated by distress at an earlier point in time. None of the individual disaster-related experiences was independently related to symptoms of distress. The association between the degree of disaster exposure and symptoms of PTSD at waves 2 and 3 was still statistically significant after controlling for symptoms of distress and PTSD at earlier point in time. The variable 'house destroyed' was the only factor that was independently related to symptoms of PTSD at wave 2. Ten years after the disaster, disaster exposure was mediated by symptoms of PTSD at waves 2 and 3. Disaster exposure was not independently related to symptoms of PTSD ten years post-disaster. CONCLUSIONS: Until 4 years after the disaster, degree of exposure (a sum score) was a risk factor for PTSD symptoms while none of the individual disaster experiences could be identified as an independent risk factor. Ten years post-disaster, disaster exposure was no longer an independent risk factor for symptoms of PTSD. Since symptoms of PTSD and distress at earlier waves perpetuate the symptoms at later waves, health care workers should aim their resources at those who still have symptoms after one and a half year post-disaster, to prevent health problems at medium and long-term.

Symptom attribution and presentation in general practice after an extreme life event.

BACKGROUND: A serious life event is likely to shape attributions relating to symptoms experienced afterwards. While they may play an important role in prognosis and seeking care, such perceptions have hardly been studied among survivors of a disaster. OBJECTIVE: To investigate the association between self-reported health problems that have been attributed to an extreme life event and the symptoms presented to GPs. METHODS: A two-wave longitudinal survey (2-3 weeks and 18 months) among survivors of a fireworks disaster was combined with a continuous morbidity surveillance in general practice. Symptoms attributed to the disaster reported in an open-ended question in the two waves were analysed using descriptive statistics. Differences in presented symptoms over time were analysed using logistic multilevel analysis. RESULTS: More than half of the respondents reported health problems, which were, in their opinion, related to the disaster. Psychological problems were most frequently reported in association with the disaster, and in contrast to physical attributed symptoms, presentation of these problems in general practice decreased over time. In the total sample, musculoskeletal symptoms were less frequently presented in the longer term. Survivors who attributed symptoms to the disaster at both waves or after 18 months only most often presented such symptoms to the GP. CONCLUSION: Survivors attributed psychological problems and physical symptoms to the disaster at short-term and midterm post-disaster. Most of these survivors presented such symptoms to the GP. Attribution of symptoms to an extreme life event such as a disaster may therefore require special attention from the GP.

Application of biological monitoring for exposure assessment following chemical incidents: a procedure for decision making.

Determination of the level of exposure during and after a chemical incident is crucial for the assessment of public health risks and for appropriate medical treatment, as well as for subsequent health studies that may be part of disaster management. Immediately after such an incident, there is usually no opportunity to collect reliable quantitative information on personal exposures and environmental concentrations may fall below detectable levels shortly after the incident has passed. However, many substances persist longer in biological tissues and thus biological monitoring strategies may have the potential to support exposure assessment, as part of health studies, even after the acute phase of a chemical incident is over. Reported successful applications involve very persistent chemical substances such as protein adducts and include those rare cases in which biological tissues were collected within a few hours after an incident. The persistence of a biomarker in biological tissues, the mechanism of toxicity, and the sensitivity of the analysis of a biomarker were identified as the key parameters to support a decision on the feasibility and usefulness of biological monitoring to be applied after an incident involving the release of hazardous chemicals. These input parameters could be retrieved from published methods on applications of biomarkers. Methods for rapid decision making on the usefulness and feasibility of using biological monitoring are needed. In this contribution, a stepwise procedure for taking such a decision is proposed. The persistence of a biomarker in biological tissues, the mechanism of toxicity, and the sensitivity of the analysis of a biomarker were identified as the key parameters to support such a decision. The procedure proposed for decision making is illustrated by case studies based on two documented chemical incidents in the Netherlands.

Rapid Health and Needs assessments after disasters: a systematic review.

BACKGROUND: Publichealth care providers, stakeholders and policy makers request a rapid insight into health status and needs of the affected population after disasters. To our knowledge, there is no standardized rapid assessment tool for European countries. The aim of this article is to describe existing tools used internationally and analyze them for the development of a workable rapid assessment. METHODS: A review was conducted, including original studies concerning a rapid health and/or needs assessment. The studies used were published between 1980 and 2009. The electronic databasesof Medline, Embase, SciSearch and Psychinfo were used. RESULTS: Thirty-three studies were included for this review. The majority of the studies was of US origin and in most cases related to natural disasters, especially concerning the weather. In eighteen studies an assessment was conducted using a structured questionnaire, eleven studies used registries and four used both methods. Questionnaires were primarily used to asses the health needs, while data records were used to assess the health status of disaster victims. CONCLUSIONS: Methods most commonly used were face to face interviews and data extracted from existing registries. Ideally, a rapid assessment tool is needed which does not add to the burden of disaster victims. In this perspective, the use of existing medical registries in combination with a brief questionnaire in the aftermath of disasters is the most promising. Since there is an increasing need for such a tool this approach needs further examination.

Risk factors for unexplained symptoms after a disaster: a five-year longitudinal study in general practice.

BACKGROUND: Medically unexplained symptoms (MUS) are a common reason to seek medical care. When presented to the general practitioner (GP), more than three-quarters of symptoms such as stomach ache, headache, and pain in bones and muscles cannot be explained by a medical disorder. OBJECTIVE: The authors examined the course of MUS presented to the GP in the 1 year before the disaster and in the 4 years after a disaster in order to study the risk factors for MUS. METHOD: Data were extracted from the electronic medical records of survivors and from a questionnaire (N=1,216). RESULTS: Although the mean number of MUS was significantly increased statistically in the first 2 years post-disaster, the increase was not clinically significant. CONCLUSION: The authors identified several important risk factors, such as immigrant status and psychological problems, that are easy for GPs to recognize. Despite this, the sensitivity of the regression model was relatively low.

The public health dimension of disasters--health outcome assessment of disasters.

A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters. During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment? A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by a disaster. Different methods can be used to examine these health problems such as: (1) rapid assessment of health needs; (2) (longitudinal) epidemiological studies using questionnaires; (3) continuous surveillance of health problems using existing registration systems; (4) assessment of the use and distribution of health services; and (5) research into the etiology of the health effects of disasters. The public health impact of a disaster may not be immediately evident. Disaster health outcome assessment provides insight into the health related consequences of disasters. The information that is obtained by performing a disaster health outcome assessment can be used to initiate and adapt the provision of health care. Besides information for policymakers, disaster health outcome assessments can contribute to the knowledge and evidence base of disaster health outcomes (scientific objective). Finally, disaster health outcome assessment might serve as a signal of recognition of the problems of the survivors. Several stakeholders may benefit from the information obtained from a disaster health outcome assessment. Disaster decision-makers and the public health community benefit from performing a disaster health outcome assessment, since it provides information that is useful for the different aspects of disaster management. Also, by providing information about the nature, prevalence, and course of health problems, (mental) health care workers can anticipate the health needs and requirements in the affected population. It is important to realize that the disaster is not over when the acute care has been provided. Instead, disasters will cause many other health problems and concerns such as infectious diseases and mental health problems. Disaster health outcome assessments provide insight into the public health impact of disasters.

Are physical symptoms among survivors of a disaster presented to the general practitioner? A comparison between self-reports and GP data.

BACKGROUND: Most studies examining medically unexplained symptoms (MUS) have been performed in primary or secondary care and have examined symptoms for which patients sought medical attention. Disasters are often described as precipitating factors for MUS. However, health consequences of disasters are typically measured by means of questionnaires, and it is not known whether these self-reported physical symptoms are presented to the GP. It is also not known if the self-reported symptoms are related to a medical disorder or if they remain medically unexplained. In the present study, three research questions were addressed. Firstly, were self-reported symptoms among survivors presented to the GP? Secondly, were the symptoms presented to the GP associated with a high level of functional impairment and distress? Thirdly, what was the GP's clinical judgment of the presented symptoms, i.e. were the symptoms related to a medical diagnosis or could they be labeled MUS? METHODS: Survivors of a man-made disaster (N = 887) completed a questionnaire 3 weeks (T1) and 18 months (T2) post-disaster. This longitudinal health survey was combined with an ongoing surveillance program of health problems registered by GPs. RESULTS: The majority of self-reported symptoms was not presented to the GP and survivors were most likely to present persistent symptoms to the GP. For example, survivors with stomachache at both T1 and T2 were more likely to report stomachache to their GP (28%) than survivors with stomachache at only T1 (6%) or only T2 (13%). Presentation of individual symptoms to the GP was not consistently associated with functional impairment and distress. 56 - 91% of symptoms were labeled as MUS after clinical examination. CONCLUSION: These results indicate that the majority of self-reported symptoms among survivors of a disaster are not presented to the GP and that the decision to consult with a GP for an individual symptom is not dependent on the level of impairment and distress. Also, self-reported physical symptoms such as headache, back pain and shortness of breath are likely to remain medically unexplained after the clinical judgment of a GP.

Use of mental health services among disaster survivors: predisposing factors.

BACKGROUND: Given the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000). METHODS: Electronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2-3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0-18 months and 18-36 months post-disaster were examined using multiple logistic regression models. RESULTS: In multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48-5.53), hostility (OR:2.04; CI:1.28-3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25-2.65), injuries as a result of the disaster (OR:1.80;CI:1.13-2.86), social functioning problems (OR:1.61;CI:1.05-2.44) and younger age (OR:0.98;CI:0.96-0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04-5.07) and hostility (OR:3.77;CI:1.51-9.40) predicted MHS utilization following 18 months post-disaster. CONCLUSION: This study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases.

Disaster-related posttraumatic stress disorder and physical health.

OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and self-reported as well as physician-recorded physical health in a sample of survivors (n = 896) of a man-made disaster, using a longitudinal design that included predisaster health data. Most studies on the relationship between PTSD and physical health are cross-sectional and use self-reported physical health outcomes. METHODS: A surveillance using the electronic medical records of survivors' family practitioners (FPs), 1 year predisaster until 4 years postdisaster, was combined with a survey, 3 weeks and 18 months postdisaster. Self-reported PTSD and self-reported physical health were assessed at 18 months postdisaster. FP-recorded physical health problems in the subsequent 2 years were classified according to the International Classification of Primary Care. Multiple regression analyses were used to describe the relationships between PTSD and physical health. RESULTS: After adjusting for demographics, smoking behavior, and predisaster physical health, PTSD was significantly associated with FP-recorded vascular, musculoskeletal, and dermatological problems, and with all self-reported physical health aspects. Prospectively, PTSD signaled an increased risk of new vascular problems (odds ratio = 1.92; 1.04-3.55). CONCLUSIONS: This study suggests an effect of PTSD in the development of vascular problems. The results imply that clinicians should be alert that disaster survivors with PTSD can suffer from comorbid medical problems as well.

Smoking as a risk factor for mental health disturbances after a disaster: a prospective comparative study.

OBJECTIVE: To assess whether smoking is a(n) (independent) risk factor for mental health problems among adult disaster victims and among a nonexposed comparison group. METHOD: Surveys were conducted 18 months (T1) and 4 years (T2) after a fireworks disaster in Enschede, the Netherlands (May 13, 2000), among adult victims (N = 662) and a comparison group (N = 526) of residents of a city located in another part of the Netherlands. The surveys included measures of smoking (Dutch Local and National Public Health Monitor); severe anxiety, depression, and hostility symptoms (the Symptom Checklist-90, revised); and disaster-related post-traumatic stress disorder (PTSD; DSM-IV criteria) (the PTSD self-rating scale). RESULTS: Victims who smoked at T1 had a higher chance to suffer from severe anxiety symptoms (adjusted OR = 2.32 [95% CI = 1.19 to 4.53]), severe hostility symptoms (adjusted OR = 1.84 [95% CI = 1.06 to 3.22]), and disaster-related PTSD (adjusted OR = 2.64 [95% CI = 1.05 to 6.62]) at T2 than victims who did not smoke at T1, when controlling for symptoms at T1, demographic characteristics, and life events. Among the total comparison group, smoking was not an independent risk factor. However, smoking at T1 was associated with severe anxiety symptoms at T2 among controls who were confronted with stressful life events (adjusted OR = 4.11 [95% CI = 1.03 to 16.47]). CONCLUSIONS: Smoking is an independent risk factor for severe anxiety and hostility symptoms and PTSD among adult disaster victims and for anxiety symptoms among adult people who are confronted with stressful life events. Questions about smoking behavior among disaster victims may help to identify adult victims who are at risk for postevent mental health disturbances.

Selective attrition and bias in a longitudinal health survey among survivors of a disaster.

BACKGROUND: Little is known about the response mechanisms among survivors of disasters. We studied the selective attrition and possible bias in a longitudinal study among survivors of a fireworks disaster. METHODS: Survivors completed a questionnaire three weeks (wave 1), 18 months (wave 2) and four years post-disaster (wave 3). Demographic characteristics, disaster-related factors and health problems at wave 1 were compared between respondents and non-respondents at the follow-up surveys. Possible bias as a result of selective response was examined by comparing prevalence estimates resulting from multiple imputation and from complete case analysis. Analysis were stratified according to ethnic background (native Dutch and immigrant survivors). RESULTS: Among both native Dutch and immigrant survivors, female survivors and survivors in the age categories 25-44 and 45-64 years old were more likely to respond to the follow-up surveys. In general, disasters exposure did not differ between respondents and non-respondents at follow-up. Response at follow-up differed between native Dutch and non-western immigrant survivors. For example, native Dutch who responded only to wave 1 reported more depressive feelings at wave 1 (59.7%; 95% CI 51.2-68.2) than Dutch survivors who responded to all three waves (45.4%; 95% CI 41.6-49.2, p < 0.05). Immigrants who responded only to wave 1 had fewer health problems three weeks post-disaster such as depressive feelings (M = 69.3%; 95% CI 60.9-77.6) and intrusions and avoidance reactions (82.7%; 95% CI 75.8-89.5) than immigrants who responded to all three waves (respectively 89.9%; 95% CI 83.4-96.9 and 96.3%; 95% CI 92.3-100, p < .01). Among Dutch survivors, the imputed prevalence estimates of wave 3 health problems tended to be higher than the complete case estimates. The imputed prevalence estimates of wave 3 health problems among immigrants were either unaffected or somewhat lower than the complete case estimates. CONCLUSION: Our results indicate that despite selective response, the complete case prevalence estimates were only somewhat biased. Future studies, both among survivors of disasters and among the general population, should not only examine selective response, but should also investigate whether selective response has biased the complete case prevalence estimates of health problems by using statistical techniques such as multiple imputation.

The association between dispositional optimism and mental health problems among disaster victims and a comparison group: a prospective study.

BACKGROUND: It is unclear whether the associations between the level of dispositional optimism on the one hand, and depression symptoms and other health problems on the other hand among disaster victims differ from the associations among non-affected residents. METHODS: To assess the associations between the level of dispositional optimism and health problems among disaster victims and non-affected residents, data of the longitudinal Enschede Fireworks Disaster Study was analyzed. Participants in the present study consisted of adult native Dutch victims of the disaster (N=662) and a non-affected comparison group (N=526). Both groups participated 18 months (T1) and almost four years post-disaster (T2). Multivariate logistic regression analyses were applied to examine the association between optimism and health problems among both groups. RESULTS: Results showed that pessimistic victims were more at risk for severe depression symptoms and obsessive-compulsive symptoms than optimistic victims when controlling for demographic characteristics, life events, smoking, and existing health problems at T1. However, pessimistic participants in the comparison group were also more at risk for severe anxiety symptoms, sleeping problems, somatic problems, and problems in social functioning than optimistic control participants. LIMITATIONS: We had no information on dispositional optimism before 18 months post-disaster. CONCLUSIONS: Pessimists at baseline are more at risk for health problems after 27 months than optimists. However, among non-affected residents pessimism is a stronger independent risk factor than among victims. Results suggest that professional helpers such as general practitioners, psychologists and psychiatrists should not rely too much on optimistic views of disaster victims.

The correspondence between persistent self-reported post-traumatic problems and general practitioners' reports after a major disaster.

BACKGROUND: Little is known about the correspondence between persistent self-reported disaster-related psychological problems and these problems reported by general practitioners (GPs). The aim of this study is to analyse this correspondence and to identify the factors associated with GPs' detection of persistent psychological problems. METHOD: This study was conducted in a sample of 879 adult disaster-affected victims, taken from two longitudinal sources: the Enschede Firework Disaster Study and the GP-Monitor Study. Participants filled out a questionnaire 2-3 weeks and 18 months post-disaster and these data were combined with data from a GP-monitor collected up to 18 months post-disaster. The correspondence between persistent self-reported and GP-reported psychological problems was analysed with cross-tabulations. Logistic regression analyses were performed to identify variables which predicted GPs' detection of psychological problems. RESULTS: The correspondence rate among victims who visited their GP 18 months post-disaster was 60.4% for persistent intrusions and avoidance reactions, 72.6% for persistent general psychological distress and less than 20% for persistent depression and anxiety symptoms or sleep disturbances. Characteristics that predict GPs' identification of post-traumatic reactions or psychological distress were the level of self-reported post-traumatic symptoms/mental health, the number of contacts the victims had with their GP and the level of the victims' disaster-related experiences. CONCLUSIONS: In general, there is a considerable correspondence between GP-reported and persistent self-reported incidences of post-traumatic stress and general psychological distress in disaster-affected victims. However, the correspondence declines in the case of more specific psychological symptoms.

Health-related quality of life and mental health problems after a disaster: are chronically ill survivors more vulnerable to health problems?

Studies have shown that the chronically ill are at higher risk for reduced health-related quality of life (HRQL) and for mental health problems. A combination with traumatic events might increase this risk. This longitudinal study among 1216 survivors of a disaster examines whether chronically ill survivors had a different course of HRQL and mental health problems compared to survivors without chronic diseases. HRQL and mental health problems were measured 3 weeks, 18 months and 4 years post-disaster. Data on pre-disaster chronic diseases was obtained from the electronic medical records of general practitioners. Random coefficient analyses showed significant interaction effects for social functioning, bodily pain and emotional role limitations at T2 only. Chronically ill survivors did not consistently have a different course of general health, physical role limitations, and mental health problems. In conclusion, chronic diseases were not an important risk factor for impaired HRQL and mental health problems among survivors.

Risk factors for psychological and physical health problems after a man-made disaster. Prospective study.

BACKGROUND: There are few prospective studies on risk factors for health problems after disasters in which actual pre-disaster health data are available. AIMS: To examine whether survivors' personal characteristics, and pre-disaster psychological problems, and disaster-related variables, are related to their post-disaster health. METHOD: Two studies were combined: a longitudinal survey using the electronic medical records of survivors' general practitioners (GPs), from 1 year before to 1 year after the disaster, and a survey in which questionnaires were filled in by survivors, 3 weeks and 18 months after the disaster. Data from both surveys and the electronic medical records were available for 994 survivors. RESULTS: After adjustment for demographic and disaster-related variables, pre-existing psychological problems were significantly associated with post-disaster self-reported health problems and post-disaster problems presented presented to the to the GP. This association was found for both psychological and physical post-disaster problems. CONCLUSIONS: In trying to prevent long-term health consequences after disaster, early attention to survivors with pre-existing psychological problems, and to those survivors who are forced to relocate or are exposed to many stressors during the disaster, appears appropriate.

The independent predictive value of peritraumatic dissociation for postdisaster intrusions, avoidance reactions, and PTSD symptom severity: a 4-year prospective study.

This 4-year prospective study (N=662) of victims of a fireworks disaster examines the independent predictive value of peritraumatic dissociation for self-reported intrusions, avoidance reactions, and posttraumatic stress disorder (PTSD) symptom severity at both 18-months (T2) and almost 4-years postdisaster (T3). Peritraumatic dissociation was measured 2-3 weeks after the disaster (T1). Hierarchical multiple regression analyses revealed that peritraumatic dissociation was not a strong independent predictor for intrusions and avoidance reactions and PTSD symptom severity at T2 or at T3 above initial intrusions, avoidance reactions, and psychological distress (T1). Results suggest that an early screening procedure for peritraumatic dissociation, which is aimed at identifying disaster victims who are at risk for long-term psychological disturbances can be omitted.