Posttraumatic stress and symptom improvement in Norwegian tourists exposed to the 2004 tsunami – a longitudinal study

Background Mental health consequences of disasters are frequently studied. However, few studies have investigated symptom improvement in victims after natural disasters. This study aimed to identify predictors of 6 months post-disaster stress symptoms and to study 6 months and 24 months course of symptoms among Norwegian tourists who experienced the 2004 tsunami. Methods Norwegian tourists (≥18 years) who experienced the 2004 tsunami (n = 2468) were invited to return a postal questionnaire at two points of time. The first data set was collected at 6 months (T1, n = 899) and the second data set at 24 months post-disaster (T2, n = 1180). The population studied consisted of those who responded at both assessments (n = 674). Impact of Event Scale Revised (IES-R) was used to measure posttraumatic stress symptoms. IES–R score ≥33 (caseness) was used to identify various symptom trajectories from T1 to T2. Multiple linear regression was used to determine predictors of posttraumatic stress at T1 and to identify variables associated with symptom improvement from T1 to T2. Results The majority was identified as non-case at both assessments (57.7%), while 20.8% of the respondents were identified as case at both assessments. Symptoms at T1 were positively related to female gender, older age, unemployment, being chased or caught by the waves, witnessing death or suffering, loss of loved ones, experiencing intense fear during the disaster, low conscientiousness, neuroticism and low levels of social support. The IES-R sum score declined from 24.6 (SD = 18.5) at T1 to 22.9 (SD = 18.3) at T2, p < 0.001. Emotional stability and high IES-R scores at T1 were positively related to symptom improvement, while received social support was not. Being referred to a mental health specialist was negatively related to symptom improvement. Conclusions A significant minority (20-30%) among Norwegian tourists developed enduring posttraumatic stress symptoms in the aftermath of the 2004 tsunami. Tsunami exposure, peritraumatic fear, neuroticism and low levels of social support were the strongest predictors of posttraumatic stress at 6 months post-disaster. Decrease in posttraumatic stress was related to emotional stability and higher symptom levels at T1. Being referred to a mental health specialist did not facilitate symptom improvement

Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: A systematic review and meta-analysis

Background Early trauma-focused cognitive-behavioural therapy (TFCBT) holds promise as a preventive intervention for people at risk of developing chronic post-traumatic stress disorder (PTSD). The aim of this review was to provide an updated evaluation of the effectiveness of early TFCBT on the prevention of PTSD in high risk populations. Methods We performed a systematic literature search in international electronic databases (MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, ISI and PILOTS) and included randomised controlled trials comparing TFCBT delivered within 3 months of trauma, to alternative interventions. All included studies were critically appraised using a standardised checklist. Two independent reviewers selected studies for inclusion and assessed study quality. Data extraction was performed by one reviewer and controlled by another. Where appropriate, we entered study results into meta-analyses. Results Seven articles reporting the results of five RCTs were included. All compared TFCBT to supportive counselling (SC). The study population was patients with acute stress disorder (ASD) in four trials, and with a PTSD diagnosis disregarding the duration criterion in the fifth trial. The overall relative risk (RR) for a PTSD diagnosis was 0.56 (95% CI 0.42 to 0.76), 1.09 (95% CI 0.46 to 2.61) and 0.73 (95% CI 0.51 to 1.04) at 3–6 months, 9 months and 3–4 years post treatment, respectively. A subgroup analysis of the four ASD studies only resulted in RR = 0.36 (95% CI 0.17 to 0.78) for PTSD at 3–6 months. Anxiety and depression scores were generally lower in the TFCBT groups than in the SC groups. Conclusion There is evidence for the effectiveness of TFCBT compared to SC in preventing chronic PTSD in patients with an initial ASD diagnosis. As this evidence originates from one research team replications are necessary to assess generalisability. The evidence about the effectiveness of TFCBT in traumatised populations without an ASD diagnosis is insufficient

Norge etter 22. juli

"At the time of this book’s publication, almost seven years have passed since the dramatic and brutal terror attacks at Norway’s Government Headquarters in Oslo and the island of Utøya on 22 July 2011. How have we coped during this time? Which values have been important? Have we managed to protect the ideals of democracy, openness and humanity? And not least: Who is this ""we"" that we are referring to? This scholarly anthology includes articles from researchers associated with the project NECORE (Negotiating Values: Collective Identities and Resilience after 22 July) and other researchers whose work is closely associated with the project. They give us insights, opinions and sharp perspectives on not just 22 July, but also about Norway today, about values, identities and resilience in Norwegian society in the wake of the terror attacks. An important backdrop for the book and the project is the assertion that, as the events themselves recede into the past, it is even more important to focus on what the terror events have led to and how we can learn from them. In a world where terrorism has become an all too common part of political reality, it is crucial that we understand how we ought to think about terror, and how we as a society encounter it.

Psychosocial intervention models and outcomes after a terror disaster

On July 22, 2011 a car bomb blast in the government quarter in Oslo killed 8, injured 209 of 18 the 350 employees who were at work, and destroyed 1700 of the 3500 work places in the 19 ministries. Shortly afterwards the terrorist killed 69 adolescents and young adults and 20 injured another 110 of the 495 survivors at a summer camp on an island outside Oslo 21 organized by the Youth league of the ruling Labor party. 22 The paper describes the two disaster models that were applied in providing the preventive 23 and therapeutic psychosocial interventions: The company/organization model for the 24 governmental employees and a combined community and organization model for the 25 victims of the massacre and their families. 26 Some of the findings from the longitudinal research and outreach programs that were 27 conducted are reported

Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study

Background The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned. Aims We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster. Method Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events. Results When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events. Conclusions Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event

Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study

Background The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned. Aims We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster. Method Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events. Results When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events. Conclusions Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event

Psykososiale tiltak ved store ulykker og katastrofer

In September 2004, the Directorate for Health and Social Affairs commissioned the Norwegian Knowledge Centre for the Health Services to do a systematic review of the effects of psychosocial interventions after crises, accidents and disasters. We assembled an external expert panel consisting of five persons to assist the systematic review work. It was decided to focus exclusively on interventions after large accidents (transport or industrial accidents) and disasters. We carried out systematic searches in international research databases, study selection according to set criteria, study quality assessments with the use of checklists, and summaries on standardised data collection forms. Results from the included studies were summarised in text only. Fourteen studies were included in the report: six randomised controlled trials, six controlled before-and-after studies, and two cohort studies. Four RCTs investigated the effects of psychological debriefing (PD) after large traumatic events. Two of these reported reductions in psychological distress after PD, but none of the studies were sufficiently methodologically robust to produce reliable effect estimates. The remaining ten studies included various other therapeutic modalities, from specific interventions like “Eye Movement Desensitization and Reprocessing (EMDR) and “Experimental Mastery Technique” to more general group psychotherapy. No or marginal differences in psychological distress between the intervention and control groups were observed. A major trend seemed to be that several types of psychosocial interventions may be beneficial. However, the potential effects of these interventions remain uncertain due to poor study quality, low number of studies, small samples and heterogeneity

The trajectory of symptom burden in exposed and unexposed survivors of a major avalanche disaster: a 30 year long-term follow-up study

Background Limited research exists concerning the long-term effects of avalanches on survivors’ mental health beyond the first years after the accident. The aims of this study were to describe and evaluate possible differences in long-term mental health symptoms after a major avalanche disaster between exposed and unexposed soldiers using a longitudinal design. Method Present mental health symptoms were examined among avalanche exposed (n = 12) and unexposed (n = 9) soldiers by PTSS-10, IES-15 and STAI-12 in four waves (1986–1987 and 2016). Results Binary logistic regression revealed that the odds to score above the cut-off were significantly lower for both groups after one year compared to baseline for PTSS-10 (p = 0.018) and significantly lower after 30 days compared to baseline for IES-15 (p = 0.005). Data did not reveal significant differences between the exposed and unexposed groups regarding adjusted PTSS-10, IES-15 or STAI-12 mean scores compared. Linear mixed model-analyses revealed significant effects of time. The adjusted mean scores declined over time for both groups: PTSS-10 (p = 0.001), IES-15 (p = 0.026) and STAI-12 (p = 0.001), and the time trajectories for PTSS-10 were significantly different between the groups (p = 0.013). Although not significant (all p > 0.05), results indicated that a larger proportion of soldiers in the exposed group experienced posttraumatic stress symptoms (5/12) (PTSS-10 score ≥ 4) and distress symptoms (6/12) (IES-15 score ≥ 26) above cut-off points, 30 years post-disaster. Conclusions The course of mental health symptoms may persist, and even increase, in selected and trained military personnel 30 years after exposure to a natural disaster. These findings may be of great importance for health authorities planning appropriate follow-up