Stress reactions in disaster victims following the Bijlmermeer plane crash.
ABSTRACT This article examined posttraumatic stress symptoms in a sample of disaster victims following the Bijlmermeer plane crash of October, 1992, in the Netherlands. Findings indicated that six months after the disaster 26% of the respondents were suffering from posttraumatic stress disorder (PTSD). The victims' PTSD was strongly associated with material damage and loss. The discussion of the results focuses on the distinction between normal and pathological stress reactions and the implications for disaster after-care.
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ABSTRACT: The DSM-III criteria for posttraumatic stress disorder (PTSD) were operationally defined for use in a structured interview. Acceptable interrater and test-retest reliabilities were shown; diagnostic validity was demonstrated relative to a standard diagnostic interview procedure; construct validity was shown in relation to a PTSD self-rating scale and to degree of combat exposure; the structured interview score correlated significantly with observer symptom scales for depression and anxiety.Journal of Nervous & Mental Disease 07/1989; 177(6):336-41. · 1.84 Impact Factor
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ABSTRACT: This review describes the history of PTSD in relation to military psychiatry, physiology, and crisis theory. It appears that the consequences of psychic trauma are often underestimated and mental health services often fail to provide adequate care. PTSD may be explained as an initially adequate reaction to danger, which becomes pathological if it does not disappear after the danger is gone. The authors argue in favour of better psychiatric intervention after traumatic events and better care for trauma victims.The British Journal of Psychiatry 01/1993; 161:742-8. · 6.61 Impact Factor
- Journal of Nervous & Mental Disease 03/1995; 183(2):107-9. · 1.84 Impact Factor
Journal of Traumatic Stress, Vol. 10, No. 2, 1997
Stress Reactions in Disaster Victims Following
the Bijlmermeer Plane Crash
Ingrid V. E. Carlier1,2 and Berthold P. R. Gersons1
This article examined posttraumatic stress symptoms in a sample of disaster
victims following the Bijlmermeer plane crash of October, 1992, in the
Netherlands. Findings indicated that six months after the disaster 26% of the
respondents were suffering from posttraumatic stress disorder (PTSD). The
victims' PTSD was strongly associated with material damage and loss. The
discussion of the results focuses on the distinction between normal and
pathological stress reactions and the implications for disaster after-care.
KEY WORDS: PTSD; disaster victims; aftermath of Bijlmermeer plane crash; trauma.
"When the plane hit, it sent me crashing across my bedroom. When
I came out of the bedroom, I saw that half of the apartment had been
destroyed. I was scared to death, and I climbed downstairs over several
different balconies. I saw people jumping off balconies in panic. Bewildered
and alone, I wandered around outside. Later I heard the family with chil-
dren living upstairs had not survived the crash. I blamed myself for not
being able to save them. Months after the crash, I would still run out of
the house in panic whenever I heard unexpected sounds like the garbage
truck" (victim account of the Bijlmermeer plane crash).
Aflame and out of control, a Boeing 747 cargo jet crashed into two
highrise apartment buildings in the Bijlmermeer, a suburb of Amsterdam
in the Netherlands, on Sunday evening, October 4, 1992. It was a disaster
with no warning, and in the first few hours little could be done. Not until
a week later did Amsterdam and the rest of the country manage to oversee
1Academic Medical Center, University of Amsterdam, Department of Psychiatry, Tafelbergweg
25,1105 BC Amsterdam, The Netherlands.
2To whom correspondence should be addressed.
0894-9867/97/0400-0329$12.50/1 C 1997 International Society for Traumatic Stress Studies
the calamity and give it a name: the Bijlmermeer plane crash (Gersons &
The crash took 43 lives, including the 4 crew members in the plane.
A large group of residents had to be rehoused, as their apartments had
been destroyed or rendered unfit for habitation. The group included 350
to 400 households or 750 individuals, of whom 525 were adults and 225
were 0 to 19 years of age. In addition to material damage, some people
had lost one or more family members in the disaster. A total of 25 families
or households suffered fatalities, in some cases more than one.
Research has shown that psychological adjustment after plane crashes
has a great deal in common with adjustment after other types of disasters.
Typical stress reactions such as sleep or concentration problems, agitation
and irritability are usually temporary and disappear within a few weeks after
the disaster (Scrignor, 1984). Such symptoms are viewed as normal reactions
to an abnormal event.
This article describes a study of posttraumatic stress symptoms in a
sample of disaster victims six months after the Bijlmermeer plane crash.
PTSD can be viewed as the most characteristic disorder which follows a
traumatic event (Carlier & Gersons, 1995; Gersons & Carlier, 1992).
In cooperation with the Amsterdam Municipal Health Service, we ap-
proached by mail the residents of the most severely damaged apartment
blocks and the adjacent buildings with a view of the disaster area (eyewit-
nesses). Under Dutch privacy legislation it was not possible to obtain names
and addresses of all victims. We were also able to include those victims
who were relocated due to apartment damage. One reason for including
eyewitnesses was that, having seen and heard the disaster at a very close
range, they too might exhibit psychological effects (Weisaeth, 1991). For
practical reasons, only residents who spoke Dutch or English were selected.
A minimum age of 18 was another requirement.
It is the authors' impression that the study sample experienced equal
damage to that of the total affected population, and may therefore be re-
garded as representative. Yet, we do not have any specific information
about how the sample resembled, or did not resemble, the population of
interest. Nor have we an idea about the exact number of potential subjects
who spoke Dutch or English.
Carlier and Gersons
The study assessed 136 victims with an average age of 35 (range 18-86,
SD = 12.6); there were 57% males and 43% females. To facilitate matters
for the victims,we interviewed them in their own homes. The 6-month time
frame of the study was selected because that was the period needed to
arrange for funding of the study, informative activities, and recruitment of
The duration of the interview ranged from 1 to 1.5 hr. Diagnoses were
established by means of the Structured Interview for PTSD (SI-PTSD)
(Davidson, Smith, & Kudler, 1989; Davidson, Kudler, & Smith, 1990). SI-
PTSD was translated into Dutch and adapted to operationalize DSM-III-R
criteria for PTSD (the study was initiated prior to the introduction of DSM-
IV) (American Psychiatric Association, 1987, 1994). SI-PTSD is designed
not only to elicit information about the presence or absence of symptoms,
but also to scale the severity of the experiencing of these symptoms from
a current as well as a lifetime perspective. The SI-PTSD was used to rate
each of the 17 DSM-III-R items on a scale of 0 to 4, where 0 is absence,
1 = minimal/mild, 2 = moderate, 3 = severe, and 4 = extremely severe.
A minimum score of 2 on a particular item was required for that item to
be considered as present in a diagnostic sense sense (see also Davidson et al.,
1990). During the interview, we also gathered information regarding stres-
Posttraumatic Stress Symptoms
In Table 1, percentages for the 17 separate PTSD symptoms are pre-
sented first. This concerns the current status of respondents, 6 months post-
Table 1 shows that the highest percentages pertained to the symptoms
"emotionally upset" (52% of the re-experiencing group), followed by "hy-
peralertness" (40% of the hyperarousal group) and "intrusive thoughts"
(39% of the re-experiencing group). On the whole, the "avoidance" symp-
tom group had the lowest percentages, the "re-experiencing" group the
highest, and the "hyperarousal" group was in between.
A total of 26% of the respondents qualified for the PTSD diagnosis
6 months after the disaster.
Stress Reactions in Disaster Victims
Carlier and Gersons
Table 1. Separate PTSD Symptoms and PTSD Diagnosis, 6
Months Postdisaster (N = 136)
PTSD-symptoms (DSM III-R)
B: Re-experiencing the disaster
C Avoidance of memory of the disaster
5-Avoidance of thoughts and feelings
6-Avoidance of places, activities
8-Loss of interest
9-Detachment from others
11-Foreshortened sense of future
PTSD-diagnosis (DSM III-R)
Psychological Effects in Relation to Material Consequences
To describe the relation between the material consequences and the
psychological effects of the disaster, we designed a risk index. Respondents
were classified according to the extent to which they experienced stressors
from the disaster. The risk index ranges from low (Index 1} to high (Index
4). Index 1, the fewest material consequences, included respondents who
were not home at the time of the disaster and who did not (a) suffer any
material damage or lose their home, and did not (b) lose any good friends
or loved ones. Index 2 included respondents who were not home at the
time of the disaster, but did suffer material damage and/or lose a loved
one. Index 3 included respondents who were home at the time of the dis-
aster but did not sutler any consequences. Last, Index 4, the most material
consequences, included the respondents from the most severely affected
apartments who were home at the time of the disaster and suffered one
to three consequences. In addition to consequences (a) and (b), they may
also have been injured themselves in the disaster (c). It should be noted
here that an additional index could have been formulated to contain re-
spondents who lived in neighboring buildings, were home at the time of
the disaster, and suffered one to three consequences. Since no respondents
fell into this category, we did not include it
Using regression analysis, we measured the extent to which the risk
index predicted the PTSD diagnosis. Of the separate risk aspects, three
appeared to have predictive value as regards PTSD: "lost a loved one,"
F(1, 125) = 51.51, p < .001, R2 = .29; "suffering material damage or lost
home" F(2, 125) = 28.79, p < .05, R2 = .32. and "was home at time of
disaster," F(3, 124) = 21.90, p < .05, R2 = .35. We can thus conclude that
PTSD also affected residents of neighboring buildings or tenants who were
not injured themselves.
Finally, no correlation was observed between PTSD and gender, edu-
cational level, nationality or country of origin (Carlier, Van Uchelen, &
The most important conclusion that could be drawn 6 months follow-
big the plane crash was that 26% of the respondents were suffering from
PTSD. In view of the problems described above in compiling a repre-
sentative sample, however this number must be interpreted cautiously. On
the other hand, the percentages of PTSD coincides with the figures in the
literature. Kleber and Brom (1992) estimated that in general approximately
20% to 30% of victims develop PTSD after a disaster (see also Lundin,
1995; Smith & North, 1993). The enormous psychological impact of the
Bijlmermeer plane crash is evident from the fact that some tenants of
neighboring buildings with a view of the disaster area (eyewitnesses) were
suffering from PTSD as well.
It was interesting to note that 10% of respondents who met the criteria
for (acute) PTSD had recovered 6 months later without professional treat-
ment Posttraumatic stress reactions may thus be part of a process of natu-
ral adjustment to extreme stress.
On the other hand, the present study also showed that 44% of the
respondents who did not satisfy the criteria for a full PTSD diagnosis did
exhibit PTSD symptomatology. We do not know to what extent the reac-
tions experienced have led to generalized functional impairments or ad-
justment difficulties. Persistence of PTSD symptomatology or subthreshold
PTSD (Blank, 1993; Carlier & Gersons, 1995) over a lengthy period could
mean that the amount of time needed to cope with repercussions of a dis-
aster is presently being underestimated. In 1944, Lindemann assumed that
Stress Reactions in Disaster Victims
the mourning period manifested in psychological complaints such as de-
spondency lasted from four to six weeks. Later research (Parkes, 1972)
demonstrated that widows needed about five years on the average. It is
therefore plausible that a similar underestimation of the persistence of
stress reactions has occurred with regard to posttraumatic stress symptoms.
If this is the case, it has certain implications for the nature of the care
required. Victims should be informed about this possibility, and care should
be oriented to dealing as effectively as possible with complaints over a far
longer stretch of time.
This study was funded by the Prevention Fund, the Ministry of Home
Affairs, the National Mental Health Fund, the Municipality of Amsterdam
and the Ministry of Health, Welfare, and Sport and the Mental Health
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Stress Reactions in Disaster Victims