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A longitudinal follow-up of posttraumatic stress: from 9 months to 20 years after a major road traffic accident
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
Institutionen för kvinnors och barns hälsa, Karolinska Institutet.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
2011 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, Vol. 5, no 8Article in journal (Refereed) Published
Abstract [en]

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 distresswas 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.

Place, publisher, year, edition, pages
London: BioMed Central , 2011. Vol. 5, no 8
Keyword [en]
road traffic accidents, posttraumatic stress, children, adolescents, disasters
National Category
Psychiatry
Research subject
Psychiatry; Psychology; Child and Youth Psychiatry; Psychology
Identifiers
URN: urn:nbn:se:uu:diva-150258DOI: 10.1186/1753-2000-5-8OAI: oai:DiVA.org:uu-150258DiVA: diva2:406880
Available from: 2011-04-09 Created: 2011-03-28 Last updated: 2012-04-19Bibliographically approved
In thesis
1. Long-Term Posttraumatic Stress in Survivors from Disasters and Major Accidents
Open this publication in new window or tab >>Long-Term Posttraumatic Stress in Survivors from Disasters and Major Accidents
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Långvarig posttraumatisk stress hos överlevande efter katastrofer och stora olyckor
Abstract [en]

Disasters and major accidents are a significant cause of distress worldwide. High levels of posttraumatic stress can become chronic after severe and prolonged psychological trauma, raising concerns about the extent of adverse long-term consequences after single events. The present thesis aimed to describe the course and burden of posttraumatic stress in survivors from a ferry disaster in the Baltic Sea, an airliner crash-landing in Gottröra, Sweden, and a bus accident involving Swedish 6th grade schoolchildren in Måbødalen, Norway.

The participants were surveyed 1 month to 4 years after the events and again after 14 to 20 years. The follow-up surveys included 33 ferry disaster survivors, 70 airline survivors, and 7 surviving schoolchildren with a comparison group from the same school (n = 33). Short- and long-term changes in posttraumatic stress were estimated separately in generalised regression models refined by linear splines. In-depth interviews were conducted with 22 ferry survivors 15 years after the disaster, including structured clinical interviews and thematic analysis of survivors’ descriptions of consequences of the event and social support.

Approximately half of all survivors experienced significant posttraumatic stress at the initial assessments. Significant long-term distress was noted in one fourth of the ferry survivors and one sixth of the airline survivors. The bus crash was not associated with significant long-term posttraumatic stress. A poorer long-term outcome was noted in women and in bereaved survivors.

The thematic analysis revealed that long-term consequences not only included negative aspects but also positive ones, including personal growth and existential awareness. There was ample availability of social support, although the need for support extended over a period of several years. Barriers to support from significant others were described in detail by the survivors.

The results extend previous research by providing a comprehensive account of long-term consequences of disasters and major accidents in light of early reactions. The interviews provide some new insights into features of social support that warrant further study. Important future challenges include evaluating whether timely attention to survivors at risk for chronic distress and significant others can facilitate recovery.

Abstract [sv]

Allvarliga händelser som katastrofer eller stora olyckor kan leda till svår psykisk belastning på kort sikt. Svåra posttraumatiska stressreaktioner kan bli beständiga efter svår traumatisering som omsorgssvikt eller övergrepp. Det är därför angeläget att undersöka omfattningen av psykologiska konsekvenser efter enskilda händelser som katastrofer och stora olyckor. Denna avhandling syftade till att beskriva utvecklingen av posttraumatisk stress på lång sikt hos överlevande efter förlisningen av MS Estonia 1994, nödlandingen av ett passagerarflygplan i Gottröra 1991 och efter en olycka med en skolbuss medförande en skolklass från årskurs sex.

De överlevande tillskickades enkäter 1 månad till 4 år efter händelsen, samt efter 14 till 20 år. Långtidsenkäterna besvarades av 33 överlevande från färjekatastrofen, 70 från flygolyckan samt 7 överlevande från bussolyckan och 33 personer från parallellklasserna. Intervjuer genomfördes med 22 överlevande 15 år efter färjekatastrofen.

Ungefär hälften av alla överlevande upplevde betydande posttraumatiska stressreaktioner vid tidpunkten för den första enkäten. Frekventa stressreaktioner fanns kvar hos 27 % fjorton år efter färjekatastrofen, medan andelen var 16 % nitton år efter flygolyckan. Tjugo år efter bussolyckan upplevde de nu drygt trettioåriga svarande låga nivåer av posttraumatisk stress. Förlustdrabbade överlevande upplevde i genomsnitt en mindre återhämtning under det första året och hade också svårare reaktioner efter många år. Kvinnor upplevde i genomsnitt svårare reaktioner än män såväl på kort sikt som på lång sikt, medan återhämtningen inte skiljde sig åt mellan män och kvinnor.

Konsekvenser på lång sikt innefattade enligt de överlevande negativa men också positiva aspekter som personlig mognad och existentiell medvetenhet. De flesta intervjuade hade upplevt gott om stöd från närstående, dock kunde ett visst behov av stöd kvarstå i flera år efter händelsen. Många berättade om hinder för att söka stöd, t.ex. att den närstående var känslomässigt belastad.

 Avhandlingen utvidgar det som hittills varit känt om posttraumatisk stress hos överlevande efter katastrofer och stora olyckor. Intervjuerna pekar på viktiga aspekter av socialt stöd att utforska vidare. Resultaten visar att dessa händelser är förknippade med övergående stressreaktioner hos majoriteten av de överlevande. Vidare forskning behövs för att bättre förstå den naturliga återhämtningen och närmare vilka insatser till överlevande och anhöriga som kan underlätta återhämtning.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 747
Keyword
Posttraumatic stress disorder, Anxiety disorders, Transportation disasters, Motor vehicle accidents, Survivors, Children, Longitudinal studies, Posttraumatisk stresstörning, PTSD, ångeststörningar, katastrofer, transportolyckor, trafikolyckor, överlevande, barn, longitudinella studier
National Category
Psychiatry Psychology
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-169532 (URN)978-91-554-8295-4 (ISBN)
Public defence
2012-04-27, Universitetshuset, sal X, Biskopsgatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Projects
Long-term posttraumatic stress in survivors from disasters and major accidents
Available from: 2012-04-03 Created: 2012-03-02 Last updated: 2012-04-19Bibliographically approved

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