Tsunami-affected Scandinavian tourists: Disaster exposure and post-traumatic stress symptoms

Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, Oslo, Norway.
Nordic journal of psychiatry (Impact Factor: 1.5). 02/2011; 65(1):9-15. DOI: 10.3109/08039481003786394
Source: PubMed

ABSTRACT Studies of short- and long-term mental effects of natural disasters have reported a high prevalence of post-traumatic stress. Less is known about disaster-exposed tourists repatriated to stable societies.
To examine the association between exposure to the 2004 Southeast Asian tsunami and symptoms of post-traumatic stress in three Scandinavian tourist populations.
Postal survey of Norwegian, Danish and Swedish Southeast Asia tourists registered by the police when arriving at national airports. Follow-up time was 6 (Norway), 10 (Denmark) and 14 months (Sweden) post-disaster; 6772 individuals were included and categorized according to disaster exposure: danger exposed (caught or chased by the waves), non-danger exposed (other disaster-related stressors) and non-exposed. Outcome measures were the Impact of Event Scale-Revised (IES-R) and Post Traumatic Stress Disorder Check List (PCL).
Danger exposed reported more post-traumatic stress than non-danger exposed, and the latter reported more symptoms than non-exposed (each P<0.001). Comparison of the Norwegian and Swedish data suggested that symptoms were attenuated at 14 months follow-up (P<0.001). Female gender and low education, but not age, predicted higher levels of symptoms.
Disaster-exposed tourists repatriated to unaffected home environments show long-term post-traumatic stress disorder symptoms related to the severity of exposure.

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    • "that study which looked at disaster workers , our participants were the direct target of the terrorist attack . The importance of education for threat and safety perception is congruent with the known protective effect of education on the development of post - disaster reactions in general ( e . g . Breslau , Davis , Andreski , & Peterson , 1991 ; Heir et al . , 2011 ) We have previously shown that leaders were less susceptible to PTSD than non - leaders ( Hansen et al . , 2013 ) . Our finding that employees with leadership responsibilities had lower perceived threat and higher perceived safety at work might be related to observations that leaders in normal situations have lower levels of the stress "
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    ABSTRACT: Background and objectives: Terrorism can heighten fears and undermine the feeling of safety. Little is known, however, about the factors that influence threat and safety perception after terrorism. The aim of the present study was to explore how proximity to terror and posttraumatic stress reactions are associated with perceived threat and safety after a workplace terrorist attack. Design and methods: A cross-sectional questionnaire survey was administered to employees in 14 of 17 Norwegian ministries 9-10 months after the 2011 bombing of the government headquarters in Oslo (N=3520). Results: 198 of 1881 employees completing the survey were at work when the bomb exploded. Regression analysis showed that this high-exposed group had elevated perceived threat (β=0.36; 95%CI, 0.19 to 0.53) and reduced perceived safety (β=-0.42; 95%CI, -0.62 to -0.23) compared to a reference group of employees not at work. After adjusting for posttraumatic stress reactions, however, proximity to the explosion no longer mattered, whereas posttraumatic stress was associated with both high perceived threat (β= 0.55; 95%CI, 0.48 to 0.63) and low perceived safety (β=-0.71; 95%CI, -0.80 to -0.63). Conclusion: Terror-exposed employees feel more threatened and less safe after a workplace terrorist attack, and this is closely linked to elevated levels of posttraumatic stress reactions.
    Anxiety Stress & Coping 01/2015; DOI:10.1080/10615806.2015.1009831 · 1.97 Impact Factor
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    • "All of the Norwegian tourists visiting in South East Asia at the time of the tsunami were repatriated to stable home communities within short time [20]. This unforeseen situation resulted in a unique possibility to study mental health affects following a fatal natural disaster among a whole population of tourists who escaped secondary disaster stressors. "
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    ABSTRACT: 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. 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. 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. 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.
    BMC Psychiatry 09/2013; 13(1):232. DOI:10.1186/1471-244X-13-232 · 2.24 Impact Factor
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    • "The study population comprised Norwegians aged 18 years or older who were repatriated from disaster-stricken areas after the 2004 tsunami [25]. The vast majority of participants (96%) were in Southeast Asia on vacation at the time of the disaster. "
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    ABSTRACT: Background Many studies suggest that disaster exposure is related to a subsequent increase in alcohol consumption. Most of these studies have relied on retrospective self-reports to measure changes in alcohol use. The aim of the present study was to examine the association between disaster exposure and drinking behaviors more closely, analyzing data on both self-perceived changes in alcohol consumption and current drinking habits in groups with different extents of disaster exposure. Methods A sample of Norwegian adults (≥ 18 years) who resided in areas affected by the 2004 Southeast Asia tsunami (N = 899) were assessed by a postal questionnaire 6 months after the disaster. Based on detailed questions about experiences with the tsunami, participants were grouped according to their extent of disaster exposure. The Impact of Event Scale-Revised was applied to measure the level of post-traumatic stress. Participants were asked whether they had increased or decreased their alcohol consumption after the disaster. Moreover, weekly alcohol consumption and frequency of intoxication during the past month were used as indicators of current drinking behaviors. Results Severely exposed individuals more often reported changing their alcohol consumption compared with those who were less exposed. Severe exposure to the tsunami was associated with both a self-perceived increase (OR 21.38, 95% CI 2.91–157.28) and decrease in alcohol consumption (OR 7.41, 95% CI 1.74–31.51). The odds ratios decreased and were not significant when adjusting for post-traumatic stress symptoms. Weekly consumption and frequency of intoxication during the past month did not vary with extent of disaster exposure. Conclusions Our findings indicate a polarization effect of severe disaster exposure on self-perceived changes in alcohol consumption; that is, disaster exposure was associated with self-perceived increases and decreases in drinking. However, the absence of associations between disaster exposure and indicators of current drinking behaviors suggests that the observed polarization effect may be overestimated because of attribution and recall bias.
    BMC Public Health 01/2013; 13(1):58. DOI:10.1186/1471-2458-13-58 · 2.32 Impact Factor
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