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Long-Term Posttraumatic Stress in Survivors from Disasters and Major Accidents
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, University Hospital.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Långvarig posttraumatisk stress hos överlevande efter katastrofer och stora olyckor (Swedish)
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 [en]
Posttraumatic stress disorder, Anxiety disorders, Transportation disasters, Motor vehicle accidents, Survivors, Children, Longitudinal studies
Keyword [sv]
Posttraumatisk stresstörning, PTSD, ångeststörningar, katastrofer, transportolyckor, trafikolyckor, överlevande, barn, longitudinella studier
National Category
Psychiatry Psychology
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-169532ISBN: 978-91-554-8295-4 (print)OAI: oai:DiVA.org:uu-169532DiVA: diva2:507872
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
List of papers
1. Traumatic bereavement, acute dissociation, and posttraumatic stress: 14 years after the MS Estonia disaster
Open this publication in new window or tab >>Traumatic bereavement, acute dissociation, and posttraumatic stress: 14 years after the MS Estonia disaster
2011 (English)In: Journal of Traumatic Stress, ISSN 0894-9867, E-ISSN 1573-6598, Vol. 24, no 2, 183-190 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
posttraumatic stress disorder, bereavement, dissociation, disasters, survivors, Estonia prospective studies, posttraumatisk stress, förlustdrabbade, dissociation, katastrof, överlevande, Estonia
National Category
Psychiatry Psychology
Research subject
Psychiatry; Psychology
Identifiers
urn:nbn:se:uu:diva-151374 (URN)10.1002/jts.20629 (DOI)000289528300006 ()21442665 (PubMedID)
Projects
Long-term posttraumatic stress in survivors from disasters and major accidents
Available from: 2011-04-11 Created: 2011-04-11 Last updated: 2017-12-11Bibliographically approved
2. Fifteen years after a ferry disaster: Clinical interviews and survivors’ self-assessment of their experience
Open this publication in new window or tab >>Fifteen years after a ferry disaster: Clinical interviews and survivors’ self-assessment of their experience
2013 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 4, 20650- p.Article in journal (Refereed) Published
Abstract [en]

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 longterm 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. Postdisaster interventions need to attend to common barriers to support.

Keyword
posttraumatic stress disorder, survivors, diagnosis, social support, posttraumatic growth, mixed methods, PTSD, överlevande, posttraumatisk stress, socialt stöd, Estonia
National Category
Psychiatry Psychology
Research subject
Psychiatry; Psychology
Identifiers
urn:nbn:se:uu:diva-169280 (URN)10.3402/ejpt.v4i0.20650 (DOI)000332099200001 ()
Projects
Long-term posttraumatic stress in survivors from disasters and major accidents
Available from: 2012-02-27 Created: 2012-02-27 Last updated: 2017-12-07Bibliographically approved
3. Posttraumatic stress in survivors 1 month to 19 years after an airliner emergency landing
Open this publication in new window or tab >>Posttraumatic stress in survivors 1 month to 19 years after an airliner emergency landing
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, e0119732Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Aviation disasters, Posttraumatic stress, Longitudinal studies, Long-term studies
National Category
Psychiatry Psychology
Research subject
Psychiatry; Psychology
Identifiers
urn:nbn:se:uu:diva-169279 (URN)10.1371/journal.pone.0119732 (DOI)000350314700063 ()25734536 (PubMedID)
Projects
Long-term posttraumatic stress in survivors from disasters and major accidents
Available from: 2012-02-27 Created: 2012-02-27 Last updated: 2017-12-07Bibliographically approved
4. A longitudinal follow-up of posttraumatic stress: from 9 months to 20 years after a major road traffic accident
Open this publication in new window or tab >>A longitudinal follow-up of posttraumatic stress: from 9 months to 20 years after a major road traffic accident
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
Keyword
road traffic accidents, posttraumatic stress, children, adolescents, disasters
National Category
Psychiatry
Research subject
Psychiatry; Psychology; Child and Youth Psychiatry; Psychology
Identifiers
urn:nbn:se:uu:diva-150258 (URN)10.1186/1753-2000-5-8 (DOI)
Available from: 2011-04-09 Created: 2011-03-28 Last updated: 2012-04-19Bibliographically approved

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