Posttraumatic stress in survivors 1 month to 19 years after an airliner emergency landing.

Posttraumatic stress (PTS) is common in survivors from life-threatening events. Little is known, however, about the course of PTS after life threat in the absence of collateral stressors (e.g., bereavement, social stigma, property loss) and there is a scarcity of studies about PTS in the long term. This study assessed the short- and long-term course of PTS, and the influence of gender, education and age on the level and course of PTS, in survivors from a non-fatal airliner emergency landing caused by engine failure at an altitude of 1 km. There were 129 persons on board. A survey including the Impact of Event Scale was distributed to 106 subjects after 1 month, 4 months, 14 months, and 25 months, and to 95 subjects after 19 years (response rates 64-83%). There were initially high levels of PTS. The majority of changes in PTS occurred from 1 to 4 months after the event. There were small changes from 4 to 25 months but further decrease in PTS thereafter. Female gender was associated with higher levels of PTS whereas gender was unrelated to the slope of the short- and long-term trajectories. Higher education was related to a quicker recovery although not to initial or long-term PTS. Age was not associated with PTS. The present findings suggest that a life-threatening experience without collateral stressors may produce high levels of acute posttraumatic stress, yet with a benign prognosis. The findings further implicate that gender is unrelated to trajectories of recovery in the context of highly similar exposure and few collateral stressors.

Acute stress among adolescents and female rape victims measured by ASC-Kids: a pilot study.

BACKGROUND: Rape is considered a stressful trauma and often with durable consequences. How the aftermath of rape is for young adolescents' girls considering acute stress is an overlooked field and remains to be studied. AIMS: In this study, we wanted to investigate acute stress among adolescent victims of rape and the psychometric properties of the Acute Stress Checklist for Children (ASC-Kids). METHODS: A clinical sample (n = 79) of raped girls, 13-17 years old who had turned to a special rape victim unit for treatment, answered the ASC-Kids. ASC-Kids was also given to a group of minor stressed, non-raped adolescents in the same age range (n = 154) together with the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD RI), and the Sense of Coherence Scale 13 (SOC-13). RESULTS: The scores from the groups were compared and showed significant differences in mean values on all the diagnostic criteria of acute stress disorder. In the clinical group, 36.7% obtained full ASD criteria. ASC-Kids could discriminate well between groups. Cronbach's alpha was found to be excellent, and the correlation between the UCLA PTSD RI and ASC-Kids found to be good; both ASC-Kids and UCLA PTSD RI had a good and moderate negative correlation with SOC-13. CONCLUSION: Adolescent female rape victims were shown to have a very high level of acute stress, and the ASC-Kids was found to have sound psychometrics and can be a valuable screening instrument to support clinicians in their assessments of an indication of adolescents after potentially stressful events such as rape.

After the flood: resilience among tsunami-afflicted adolescents.

BACKGROUND: About 7000 Swedish citizens were on Christmas holiday in the disaster area at the time of the South-east Asian tsunami in 2004, in many cases with children and adolescents in their families. AIMS: To investigate how adolescents experience a traumatic exposure to a natural disaster. METHOD: Twenty adolescents aged 16-19 years, who had experienced the 2004 tsunami and participated in a follow-up study 19 months post-disaster, were randomly selected and interviewed about their reactions, their life afterwards and their families. The study combines the face-to-face, semi-structured interviews with questionnaire data on mental health for 4910 Swedish adolescents and adults. RESULTS: The themes that emerged inductively during the analysis of the interviews were psychological reactions during the catastrophe, the coping after, changes in self-image, worldview, role in the family, risk interpretation and altruism. The disaster had profound impact on family relations, social networks and plans for the future. Many felt strengthened by the experience and by their ability to cope in comparison with other family members, but also perceived isolation and lack of understanding. The general mental health status among the adolescents did not differ significantly from those of older age at the 19-month follow-up. CONCLUSIONS: According to the adolescents', they experienced the tsunami-disaster differently than others around them. Their subjective interpretation of the event and its aftermath indicates resilience, especially among the young men. Future follow-up studies in larger samples of both symptoms and psychological functioning are warranted.

Fifteen years after a ferry disaster: clinical interviews and survivors' self-assessment of their experience.

BACKGROUND: Disasters yield increased rates of psychological disorders decades later. Other consequences, however, have received little attention in the past. OBJECTIVE: We aimed to examine diagnostic status and survivors' views on disaster-related consequences and social support. METHODS: A mixed-methods approach was used with 22 survivors (of 49 eligible) 15 years after a ferry disaster. Data collection included audiotaped interviews with open-ended questions and diagnostic assessment of Axis-I disorders. RESULTS: The post-disaster incidence was 54% (12/22) for Axis-I disorders, and 45% (10/22) for full or subsyndromal posttraumatic stress disorder. Thematic analysis revealed that survivor perception of the long-term consequences included positive (character change) and negative aspects (being ascribed a survivor identity). Participants' sought social support for several years, yet many felt hindered by experiential dissimilarity and distress of significant others. CONCLUSIONS: Axis-I disorders were prevalent, but not salient to survivors' perceptions in the long-term. Post-disaster interventions need to attend to common barriers to support.

Social support moderates posttraumatic stress and general distress after disaster.

Social support buffers the negative impact of stressful events. Less, however, is known about the characteristics of this association in the context of disaster and findings have been discrepant regarding direct and buffering effects. This study tested whether the protective effects of social support differed across levels of exposure severity (i.e., buffered distress) and assessed whether the buffering effect differed between event-specific and general distress. Participants were 4,600 adult Swedish tourists (44% of invited; 55% women) repatriated within 3 weeks after the 2004 Indian Ocean tsunami. A survey 14 months after the disaster included the Crisis Support Scale, the Impact of Event Scale-Revised (IES-R), and the General Health Questionnaire (GHQ-12). Social support buffered the negative impact of exposure on both outcomes. The support and distress association ranged from very small in participants with low exposure to moderate in those with high exposure (η(p)(2) = .004 to .053). The buffering effect was not found to differ between the IES-R and GHQ-12, F(2, 4589) = 0.87, p = .42. The findings suggest that social support moderates the stressor-distress relationship after disasters. This study might help explain discrepant findings and point to refinements of postdisaster interventions.

Impact of physical injury on mental health after the 2004 Southeast Asia tsunami.

BACKGROUND: The risk of developing enduring post-traumatic stress reactions and mental health problems in the aftermath of disasters is substantial. However, there are inconsistencies regarding the contribution of physical injury as an independent risk factor for developing psychiatric morbidity after disasters. AIMS: The aim was to assess whether physical injury was associated with post-traumatic stress reactions and general mental health after adjusting for perceived life-threat in the aftermath of the 2004 tsunami. METHODS: A sample of 1501 highly exposed survivors from the 2004 Southeast Asia tsunami was selected from a cohort of Swedish survivors surveyed 14 and 36 months after the event. The impact of physical injury on post-traumatic stress and general mental health was assessed by regression models accounting for subjective life-threat. RESULTS: Physical injury was associated with higher levels of post-traumatic stress reactions and poorer general mental health. These associations were observed at both 14 and 36 months after the disaster. CONCLUSIONS: Physical injury has a specific contribution to the association between traumatic experience and both post-traumatic stress reactions and general mental health in victims of the 2004 tsunami. The effect is stable over several years.

Prolonged grief among traumatically bereaved relatives exposed and not exposed to a tsunami.

Numerous studies on the mental health consequences of traumatic exposure to a disaster compare those exposed to those not exposed. Relatively few focus on the effect of the death of a close relative caused by the disaster-suffering a traumatic bereavement. This study compared the impact on 345 participants who lost a close relative in the 2004 Indian Ocean tsunami, but who were themselves not present, to 141 who not only lost a relative, but also were themselves exposed to the tsunami. The focus was on psychological distress assessed during the second year after the sudden bereavement. Findings were that exposure to the tsunami was associated with prolonged grief (B = 3.81) and posttraumatic stress reactions (B = 6.65), and doubled the risk for impaired mental health. Loss of children increased the risk for psychological distress (prolonged grief: B = 6.92; The Impact of Event Scale-Revised: B = 6.10; General Health Questionnaire-12: OR = 2.34). Women had a higher frequency of prolonged grief. For men, loss of children presented a higher risk for prolonged grief in relation to other types of bereavement (B = 6.36 vs. loss of partner). Further long-term follow-up could deepen the understanding of how recovery after traumatic loss is facilitated.

Traumatic bereavement, acute dissociation, and posttraumatic stress: 14 years after the MS Estonia disaster.

This prospective longitudinal study aimed to examine posttraumatic stress in survivors 14 years after a ferry disaster, and estimate short- and long-term changes in stress associated with traumatic bereavement and acute dissociation. There were 852 people who perished in the disaster, 137 survived. The 51 Swedish survivors were surveyed with the Impact of Event Scale-Revised (IES-R) at 3 months, 1, 3, and 14 years (response rates 82%, 65%, 51%, and 69%). Symptoms decreased from 3 months to 1 year; no change was found thereafter. After 14 years, 27% reported significant symptoms. Traumatic bereavement, but not acute dissociation, was associated with long-term symptom elevation. Chronic posttraumatic stress can persist in a minority of survivors, and traumatic bereavement appears to hinder recovery.

A longitudinal follow-up of posttraumatic stress: from 9 months to 20 years after a major road traffic accident.

BACKGROUND: Although road traffic accidents (RTA) are a major cause of injury and a cause of posttraumatic stress (PTS) in the aftermath, little is known about the long-term psychological effects of RTA. METHODS: This prospective longitudinal study assessed long-term PTS, grief, and general mental health after a bus carrying 23 sixth-grade schoolchildren crashed on a school outing and 12 children died. Directly affected (i.e., children in the crash) and indirectly affected children (i.e., all pupils in the sixth grade who were not in the crash) were surveyed at 9 months (N = 102), 4 years (N = 51), and 20 years (N = 40) after the event. Psychological distress was assessed by single items, including sadness, avoidance, intrusions, and guilt. After 20 years, PTS was assessed by the Impact of Event Scale-Revised. RESULTS: Stress reactions were prevalent 9 months after the event, with sadness (69%) and avoidance (59%) being highly represented in both directly and indirectly affected groups, whereas, nightmares (60%) and feelings of guilt (50%) were only frequent in those directly affected. The frequency of sadness and avoidance decreased after 4 years in the indirectly exposed (ps < .05). After 20 years, the directly affected had a higher prevalence of PTS (p = .003), but not decreased general mental health (p = .14), than those indirectly affected. CONCLUSIONS: The limitations preclude assertive conclusions. Nonetheless, the findings corroborate previous studies reporting traumatic events are associated with long-term PTS, but not with decreased general mental health.

Tsunami-exposed tourist survivors: signs of recovery in a 3-year perspective.

Long-term follow-up after disaster exposure indicates increased rates of psychological distress. However, trajectories and rates of recovery in large samples of disaster-exposed survivors are largely lacking. A group of 3457 Swedish survivors temporarily on vacation in Southeast Asia during the 2004 tsunami were assessed by postal questionnaire at 14 months and 3 years after the tsunami regarding post-traumatic stress reactions (IES-R) and general mental health (GHQ-12). There was a general pattern of resilience and recovery 3 years postdisaster. Severe exposure and traumatic bereavement were associated with increased post-traumatic stress reactions and heightened risk for impaired mental health. The rate of recovery was lower among respondents exposed to life threat and among bereaved. Severe trauma exposure and bereavement seem to have considerable long-term impact on psychological distress and appear to slow down the recovery process. Readiness among health agencies for identification of symptoms and provision of interventions might facilitate optimal recovery.

The effect of traumatic bereavement on tsunami-exposed survivors.

Fourteen months after the 2004 tsunami, mental health outcome was assessed in 187 bereaved relatives, 308 bereaved friends, and in 3,020 nonbereaved Swedish survivors. Of the bereaved relatives, 41% reported posttraumatic stress reactions and 62% reported impaired general mental health. Having been caught or chased by the tsunami in combination with bereavement was associated with increased posttraumatic stress reactions. Complicated grief reactions among relatives were almost as frequent as posttraumatic stress reactions. The highest levels of psychological distress were found among those who had lost children. Traumatic bereavement, in combination with exposure to life danger, is probably a risk factor for mental health sequelae after a natural disaster.

Impact of exposure to trauma on posttraumatic stress disorder symptomatology in Swedish tourist tsunami survivors.

The aim was to examine long-term mental health and posttraumatic stress symptomatology in a Swedish tourist population after exposure to the 2004 Southeast Asian tsunami. Data from 4822 returned questionnaires 14 months after the disaster were analyzed. Respondents were categorized into 3 subgroups: (1) danger-to-life exposure group (having been caught or chased by the waves), (2) nondanger-to-life exposure group (exposed to other disaster-related stressors), and (3) low exposure group. Main outcome measures were General Health Questionnaire-12 and Impact of Event Scale-22-Revised. Danger-to-life exposure was an important factor in causing more severe posttraumatic stress symptoms and in affecting mental health. Female gender, single status, and former trauma experiences were associated with greater distress. Other factors related to more severe symptoms were loss of relatives, physical injuries, viewing many dead bodies, experiencing life threat, and showing signs of cognitive confusion. Disaster exposure has a substantial impact on survivors, which stresses the need for long-lasting support.

KAMEDO Report No. 91: 2004 tsunami disaster in Asia--home transport and emergency care in Sweden.

This is a descriptive report of the Swedish authorities' responses to the tsunami that affected Southeast Asia in December 2004. The main focus is the care of survivors and the injured during their transportation from Thailand and their return to Sweden. The psychological and physical after-effects also are presented based on a poll conducted one year after the tsunami.

Suicide rate among former Swedish peacekeeping personnel.

Increased suicide rates for military personnel suffering from post-traumatic stress disorders have been reported in various countries. Although it is known that some peacekeepers are exposed to potentially traumatic events and are thus at risk of suffering from post-traumatic stress reactions, only a few studies have examined suicide rates in this group. Therefore, the aim of this study was to investigate the suicide rate among former Swedish peacekeeping personnel. We compared 39,768 former Swedish peacekeepers to the general population in the National General Population Registry and the Cause-of-Death Registry. A lower number of suicides was found among former Swedish peacekeepers than in the general population. In conclusion, Swedish personnel serving in international peace-keeping operations do not show a higher suicide rate than the general population. Unique problems associated with this research area are discussed.

Traumatic impact of a fire disaster on survivors--a 25-year follow-up of the 1978 hotel fire in Borås, Sweden.

The objective of this study was to investigate the long-term psychological and mental health outcomes among survivors of a disastrous hotel fire. A 25-year follow-up investigation among adolescent and young adult survivors of a fire disaster was conducted in Borås, Sweden. A self-evaluation questionnaire and four self-rating scales - the IES-22, PTSS-10, GHQ-28 and SoC - were sent by mail to the participants. The results from the self-reported data showed low levels of psychiatric illness. Moreover, the respondents reported a low level of traumatic stress symptoms. More than 50% of the participants stated that the fire had a determining effect on their lives. Sixteen (21.3%) respondents indicated that the fire still had an impact on their daily lives. Differences between men and women were reported in most of the self-rating scales. The results indicate that a traumatizing experience (such as a fire disaster) still had a small effect on psychological health in a long-term perspective.

KAMEDO report no. 84: terrorist attacks against the World Trade Center, 11 September 2001.

On 11 September 2001, two hijacked airplanes collided with the World Trade Center in New York. Both towers collapsed, spreading smoke and debris for miles. Rescue personnel arrived rapidly, but the collapse of the towers made the scene too dangerous for these teams to rescue all those trapped inside. Although this collapse was impossible to predict, fires occurring in skyscrapers can cause the structures to collapse. When a fire erupts in the upper levels of the building, it is even more difficult for those trapped inside to escape. Communications systems were shut down. In future incidents with large numbers of injured victims, the injured should be transported to hospitals by non-traditional medical transport vehicles (taxis, cars, etc.). If future disasters occur in the vicinity of a hospital, the most severely injured victims should go to the hospital instead of congregating at assembly points. These victims often are already at hospitals before substantial aid arrives at the assembly points. On-scene care must be documented, and easy-to-read triage tags should be used. Reserve power supplies in major cities should be maintained in preparation for emergencies. Both victims and rescue personnel are susceptible to post-traumatic, psychosocial reactions.