Medication use in populations exposed to the 2010 Eyjafjallajökull eruption: an interrupted time series analysis.

OBJECTIVES: To assess the trends in medication use indicative of physical and psychological morbidity following the 2010 volcanic eruption in Eyjafjallajökull immediately after and during a 3-year period following the eruption. DESIGN: Population-based register study. SETTING: Eyjafjallajökull eruption in Iceland, 2007-2013. PARTICIPANTS: All residents in Iceland who received at least one medication dispensing were identified. Residents of exposed areas were classified into exposure groups (individual-level data) and residents in other parts of Iceland were included as a non-exposed group (aggregated data). INTERVENTION/EXPOSURE: Eyjafjallajökull erupted on 14 April 2010 and continued for 39 days, producing heavy ash fall in South Iceland. MAIN OUTCOME MEASURES: Using interrupted time series analysis, we examined annual and quarterly changes in medicine use, measured as number of dispensed defined daily dose (DDD) per 1000 individuals. We calculated the level shift (immediate change) and change in slope from pre-eruption to post-eruption (long-term change) in medication dispensing. RESULTS: Among exposed residents, there was a 6% decrease (95% CI -7% to -4%) in the annual number of dispensed DDDs 1-year post-eruption in the overall medication class, including analgesics (-5%, 95% CI -6% to -3%), hypnotics and sedatives (-9%, 95% CI -11% to -7%) and respiratory medications (-7%, 95% CI -9% to -5%; -8%, 95% CI -11% to -4%). Simultaneously, there was a 9% decrease (95% CI -14% to -4%) in the overall medication class among non-exposed residents. Moreover, among exposed residents, we observed change in slope of -4% (95% CI -7% to -1%) in the overall medication class, including for analgesics (-6%, 95% CI -8% to -3%) and other respiratory drugs (-10%, 95% CI -16% to -4%). CONCLUSION: Our findings indicate that the eruption did not lead to increases in medication dispensing among residents of exposed areas, rather decreases for some medicine classes. The results should be interpreted with caution since the content of each eruption differs.

Mental health effects following the eruption in Eyjafjallajökull volcano in Iceland: A population-based study.

AIM: Volcanic eruptions and other natural disasters may affect survivor's physical and mental health. The aim of this study was to examine the mental health effects of the 2010 Eyjafjallajökull volcanic eruption in Iceland on nearby residents, by exposure level and experience. METHODS: This population-based study included 1615 residents living in an area close to the Eyjafjallajökull volcano at the time of the eruption and a sample of 697 residents from a non-exposed area. All participants received a questionnaire 6-9 months after the eruption assessing mental health (GHQ-12, PSS-4 and PC-PTSD). The exposed group also received questions related to the experience of the eruption. RESULTS: Replies were received from 1146 participants in the exposed group (71%) and 510 participants in the non-exposed group (73%). Compared to the non-exposed group, participants living in the high-exposed area were at increased risk of experiencing mental distress (GHQ) 6-9 months following the eruption (odds ratio (OR) 1.45%; 95% confidence interval (CI) 1.11-1.90). High-exposed participants were furthermore at increased risk of experiencing symptoms of post-traumatic stress disorder (PTSD) compared to those living in the low-exposed area (OR 3.71; 95% CI 1.34-15.41). We further found that those who had direct experience of the eruption were more likely to suffer from symptoms of mental distress, PTSD symptoms and perceived stress, compared to those less exposed. CONCLUSIONS: The findings indicate that screening for these factors (e.g. experience of the event) could potentially aid in identifying those most vulnerable to developing psychological morbidity after this unique type of disaster.

Long-term health of children following the Eyjafjallajökull volcanic eruption: a prospective cohort study.

Background: More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children's health beyond the first year are sparse. Objective: To examine the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms. Method: In a population-based prospective cohort study, data was collected on the adult population (N = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group (N = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results: In 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07-2.03; high exposed OR 1.52; 95% CI 1.03-2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67-3.45; high exposed OR 2.77; 95% CI 1.81-4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13-2.32) and depressed mood (OR 1.55; 95% CI 1.07-2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Conclusions: Adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster.

Planteamiento: Más de 500 millones de personas en todo el mundo viven dentro del área de exposición de un volcán activo y los niños son un subgrupo vulnerable de dichas poblaciones que se encuentran expuestas. Sin embargo, hasta la fecha, los estudios sobre los efectos de las erupciones volcánicas en la salud de los niños más allá del primer año son escasos. Objetivo: Examinar el efecto de la erupción del Eyjafjallajökull en 2010 en los síntomas de salud física y mental entre niños expuestos en 2010 y 2013 e identificar los posibles factores predictivos de los síntomas. Método: En un estudio de cohortes prospectivo basado en la población, se recopiló información sobre la población adulta (N = 1615) que estuvo expuesta a la erupción del Eyjafjallajökull en 2010 y un grupo que no estuvo expuesto (N = 697). El grupo expuesto se dividió además según el nivel de exposición. Todos los participantes respondieron cuestionarios que evaluaban el estado de salud que percibían tanto sus hijos como de sí mismos en 2010 y 2013. Resultados: En 2010, los niños expuestos tenían más probabilidades que los niños no expuestos de experimentar síntomas respiratorios (OR exposición media 1.47, IC 95% 1.07-2.03, OR exposición elevada 1.52, IC 95% 1.03-2.24) y ansiedad/preocupaciones (OR exposición media 2,39; IC del 95%: 1,67 a 3,45; OR exposición elevada, 77; IC del 95%: 1,81 a 4,27). Ambos sexos tenían un mayor riesgo de síntomas de ansiedad/preocupaciones, pero solo los niños expuestos tenían un mayor riesgo de experimentar dolores de cabeza y trastornos del sueño en comparación con los niños no expuestos. Dentro del grupo expuesto, los niños cuyas casas sufrieron daños tenían un mayor riesgo de experimentar ansiedad/preocupaciones (OR 1.62, IC 95% 1.13-2.32) y estado de ánimo deprimido (OR 1.55, IC 95% 1.07-2.24) que los niños cuyas casas no estaban dañado. Entre los niños expuestos, no se detectó una disminución significativa de los síntomas entre 2010 y 2013. Conclusiones: Los problemas físicos y mentales adversos experimentados por los niños expuestos a la erupción parecen persistir durante un período de hasta tres años después del desastre. Estos resultados subrayan la importancia de un seguimiento adecuado para los niños y la identificación de los posibles grupos de riesgo después de un desastre natural.

Long-term health effects of the Eyjafjallajökull volcanic eruption: a prospective cohort study in 2010 and 2013.

OBJECTIVES: To examine the long-term development of physical and mental health following exposure to a volcanic eruption. DESIGN: Population-based prospective cohort study. SETTING: In spring 2010, the Icelandic volcano Eyjafjallajökull erupted. Data were collected at 2 time points: in 2010 and 2013. PARTICIPANTS: Adult residents in areas close to the Eyjafjallajökull volcano (N=1096), divided according to exposure levels, and a non-exposed sample (n=475), with 80% participation rate in 2013. MAIN OUTCOME MEASURES: Physical symptoms in the previous year (chronic) and previous month (recent), and psychological distress (General Health Questionnaire-12-item version, GHQ-12), perceived stress (Perceived Stress Scale, PSS-4) and post traumatic stress disorder (PTSD) symptoms (Primary Care PTSD, PC-PTSD). RESULTS: In the exposed group, certain symptoms were higher in 2013 than in 2010, for example, morning phlegm during winter (OR 2.14; 95% CI 1.49 to 3.06), skin rash/eczema (OR 2.86; 95% CI 1.76 to 4.65), back pain (OR 1.45; 95% CI 1.03 to 2.05) and insomnia (OR 1.53; 95% CI 1.01 to 2.30), in addition to a higher prevalence of regular use of certain medications (eg, for asthma (OR 2.80; 95% CI 1.01 to 7.77)). PTSD symptoms decreased between 2010 and 2013 (OR 0.33; 95% CI 0.17 to 0.61), while the prevalence of psychological distress and perceived stress remained similar. In 2013, the exposed group showed a higher prevalence of various respiratory symptoms than did the non-exposed group, such as wheezing without a cold (high exposure OR 2.35; 95% CI 1.27 to 4.47) and phlegm (high exposure OR 2.81; 95% CI 1.48 to 5.55), some symptoms reflecting the degree of exposure (eg, nocturnal chest tightness (medium exposed OR 3.09; 95% CI 1.21 to 10.46; high exposed OR 3.42; 95% CI 1.30 to 11.79)). CONCLUSIONS: The findings indicate that people exposed to a volcanic eruption, especially those most exposed, exhibit increased risk of certain symptoms 3-4 years after the eruption.