Surviving the Vajont disaster: psychiatric consequences 36 years later

Long-term PTSD prevalence and associated adverse psychological, functional, and economic outcomes: a 12-15 year follow-up of adults with suspected serious injury

Background: An increasing number of longitudinal studies investigates long-term PTSD, related outcomes and potential gender differences herein. However, a knowledge gap exists when it comes to studies following individual civilian trauma beyond a decade post-trauma.Objective: To investigate the long-term PTSD prevalence, associated adverse psychological, functional and economic outcomes related to (suspected) serious injury of 12-15 years ago in Dutch adults, as well as potential gender differences herein.Method: N = 194 trauma-exposed adults (34% women) admitted to an emergency department following suspected serious injury completed a follow-up assessment 12-15 years (M = 14.30, SD = 1.00) post-trauma. Participants completed assessments of clinician-rated PTSD symptom severity, as well as self-report questionnaires on psychological, functional and economic outcomes.Results: Nine participants (4.8%) fulfilled the DSM-5 diagnostic criteria for PTSD related to the index trauma of 12-15 years ago. Results showed that PTSD symptom severity (CAPS-5) was significantly associated with more severe symptoms of anxiety (HADS) and depression (QIDS), lower well-being (WHO-5) and (health-related) quality of life (WHOQOL; EQ-5D-5L), but not with alcohol use (AUDIT), productivity loss at work (iPCQ) and health care use (iMCQ). No significant gender differences in the long-term PTSD prevalence nor in its related psychological, functional and economic outcomes were found.Conclusions: Our findings underscore the long-term presence of PTSD and associated adverse psychological and functional outcomes in a proportion of adults who experienced (suspected) serious injury over a decade ago. PTSD is already widely recognized for its substantial impact in the aftermath of a trauma. The current study emphasizes the potential long-term consequences of individual civilian trauma, highlighting the importance of accurate screening and prevention for PTSD.

The Impact of COVID-Related Restrictions on the Mental Health of Students

The first stage of the COVID pandemic in spring and early summer of 2020 was shaped by restrictions due to the so-called flattening-the-curve approach. Students globally were impacted when public and private colleges and universities were forced to either shut down temporarily or transition to remote learning. Studies from around the world found increased levels of stress, anxiety, depression, and suicidal ideation. Female students often reported being more affected than male students. Suicide rates, however, did not increase. The second stage, starting in late summer 2020, saw the highest case numbers but also a slow and mostly partial return to normal life enabled by vaccination efforts and policy decisions. The mental health of students in most countries recovered well, even when they had to go through repeated or continued lockdowns or restrictions. Although it cannot be predicted what portion of students will be affected by mental health issues in ten or twenty years, it is certain that there will be long-term mental health consequences for many. It is also uncertain which approach, "living with COVID" or "zero COVID," will show less impact on the mental health of students' long term.

Posttraumatic Stress Disorder 23 Years After the 1988 Spitak Earthquake in Armenia

This population-based longitudinal study examined the rates and predictors of posttraumatic stress disorder (PTSD) among 725 differentially exposed survivors of the 1988 Spitak earthquake in Armenia, 23 years after the event. Participants had been previously evaluated in 1991. Evaluations included assessment of current PTSD (based on DSM-5 criteria), and a variety of potential risk and protective factors. For the whole sample, the rate of PTSD attributed to the earthquake decreased from 48.7% in 1991 to 11.6% in 2012 (p < .001). A "dose of exposure" pattern persisted, and 15.7% of participants who were in Spitak (high exposure) and 6.6% of participants who were in Kirovagan (low exposure) during the earthquake met the criteria for PTSD (p = .003). Additionally, in 2012, another 9.9% of participants met PTSD criteria due to post-earthquake traumas, which is a 5-fold increase from pre- to postearthquake (p < . 001). Factors positively associated with PTSD included earthquake-related job loss, exposure to post-earthquake traumas, depression at baseline, and chronic illness since the earthquake. Factors inversely associated with PTSD included housing assistance within two years after the earthquake, support of family and/or friends, and to a lesser degree, higher education and high living standard. These variables accounted for 23.1% of the variance in current PTSD severity scores. These findings indicate that PTSD rates subside significantly after a catastrophic disaster, although earthquake-related PTSD persists among a subgroup of exposed individuals. Predictors of PTSD identified in this study provide guidance for planning acute and longer-term postdisaster public mental health recovery programs.

Risk Factors for Posttraumatic Stress Symptoms Among Avalanche Survivors: A 16-Year Follow-Up

Few natural disaster studies have assessed factors associated with posttraumatic stress disorder (PTSD) beyond a decade after trauma. Using North's disaster model as a framework, the aim of this study was to identify factors associated with clinically significant posttraumatic stress symptoms (CS-PTSDS) in avalanche survivors (n = 399) 16 years after the disaster. Completed self-report questionnaires were received from 286 (72%) survivors. CS-PTSDS were assessed with the Posttraumatic Diagnostic Scale. Predictors of CS-PTSDS in a multivariate analysis were secondary sequelae factors of lack of social support (adjusted relative risk [RR], 2.90; 95% confidence interval [CI], 1.37-6.13) and financial hardship in the aftermath of the trauma (adjusted RR, 2.47; 95% CI, 1.16-5.26). In addition, the community factor of providing assistance in the aftermath of the avalanche (adjusted RR, 1.95; 95% CI, 1.04-3.64) was inversely associated with CS-PTSDS. Screening for these factors may be useful in identifying those most vulnerable to developing chronic PTSD after this unique type of disaster.

Posttraumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors

To date, no study has investigated the effects of avalanches on survivor's health beyond the first years. The aim of this study was to examine long-term health status 16 years after exposure to avalanches using a matched cohort design. Mental health, sleep quality and somatic symptoms among avalanche survivors (n=286) and non-exposed controls (n=357) were examined. Results showed that 16% of survivors currently experience avalanche-specific PTSD symptoms (PDS score>14). In addition, survivors presented with increased risk of PTSD hyperarousal symptoms (>85th percentile) (aRR=1.83; 98.3% CI [1.23-2.74]); sleep-related problems (PSQI score>5) (aRR=1.34; 95% CI [1.05-1.70]); PTSD-related sleep disturbances (PSQI-A score≥4) (aRR=1.86; 95% CI [1.30-2.67]); musculoskeletal and nervous system problems (aRR 1.43; 99% CI 1.06-1.93) and gastrointestinal problems (aRR 2.16; 99% CI 1.21-3.86) compared to the unexposed group. Results highlight the need for treatment for long-term PTSD symptoms and sleep disruption in disaster communities.

Posttraumatic stress in survivors 1 month to 19 years after an airliner emergency landing

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.

Relationship of locus of control, psychological distress, and trauma exposure in groups impacted by intense political conflict in Egypt

INTRODUCTION

Social and political instability have become common situations in many parts of the world. Exposure to different types of traumatic circumstances may differentially affect psychological status.

OBJECTIVE

The aim of this study was to compare the relationship between personal perceptions of control over the events happening in one's life and psychological distress in two groups who experienced physical trauma but differed as to whether the trauma was a result of political upheaval and violence. Views on the extent to which the state was interested in the individual were also assessed.

METHODS

The sample consisted of 120 patients who were injured in the Cairo epicenter and 120 matched controls from the greater Cairo area whose injuries were from other causes. The Brown Locus of Control Scale and the Symptom Checklist-90-Revised (SCL 90-R) were administered approximately three months after the January 2011 start of the demonstrations and subsequent overthrow of the government.

RESULTS

The groups did not differ on locus of control. For both groups, externality was associated with greater distress, suggesting a relationship between perceived helplessness in controlling one's life and distress. The Cairo group scored significantly higher than the control group on the SCL 90-R Global Severity Index (GSI) and Positive Symptom Total (PST). Perceptions of state interest in the population were low; overall, 78% viewed the state as having little or no interest in them. Discussion The relationship between exposure intensity and psychological distress is examined. In addition, differences in findings in populations experiencing political chaos compared with other types of disasters are considered.

CONCLUSION

Beliefs regarding personal control over one's life circumstances are more closely associated with psychological distress than the circumstances in which the trauma occurred.

Prevalence and duration of PTSD in survivors 6 years after a natural disaster

The present study aimed to examine the prevalence of posttraumatic stress disorder (PTSD) in survivors with low levels of risk factors for PTSD. The sample included 142 adults (58% women, 54% university education, 93% employed/students/retired) on vacation in Southeast Asia during the 2004 Indian Ocean disaster. Semi-structured clinical interviews (SCID-I) were performed after 6 years including PTSD, depression, specific phobia, and alcohol abuse. The 6-year prevalence of PTSD was 11.3% and the current prevalence was 4.2%, with onset mainly within 1 month and remission within 3 years post-disaster. Suicidal ideation and comorbidity were common in PTSD cases. Lifetime prevalence of depression was 19%, specific phobia 7%, and alcohol abuse 4%. The findings suggest elevated levels of PTSD but not other disorders as compared with general population samples, but still lower levels than other disaster samples. Despite benign circumstances, however, the course and burden of PTSD were comparable to similar studies.

Fifteen years after a ferry disaster: clinical interviews and survivors' self-assessment of their experience

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 long-term 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. Post-disaster interventions need to attend to common barriers to support.

Health Impacts of Floods

Introduction:

Floods are the most common hazard to cause disasters and have led to extensive morbidity and mortality throughout the world. The impact of floods on the human community is related directly to the location and topography of the area, as well as human demographics and characteristics of the built environment.

Objectives:

The aim of this study is to identify the health impacts of disasters and the underlying causes of health impacts associated with floods. A conceptual framework is developed that may assist with the development of a rational and comprehensive approach to prevention, mitigation, and management.

Methods:

This study involved an extensive literature review that located >500 references, which were analyzed to identify common themes, findings, and expert views. The findings then were distilled into common themes.

Results:

The health impacts of floods are wide ranging, and depend on a number of factors. However, the health impacts of a particular flood are specific to the particular context. The immediate health impacts of floods include drowning, injuries, hypothermia, and animal bites. Health risks also are associated with the evacuation of patients, loss of health workers, and loss of health infrastructure including essential drugs and supplies. In the medium-term, infected wounds, complications of injury, poisoning, poor mental health, communicable diseases, and starvation are indirect effects of flooding. In the long-term, chronic disease, disability, poor mental health, and poverty-related diseases including malnutrition are the potential legacy.

Conclusions:

This article proposes a structured approach to the classification of the health impacts of floods and a conceptual framework that demonstrates the relationships between floods and the direct and indirect health consequences.

Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic

AIM

The aim of the study was to examine, among hospital employees exposed to an outbreak of severe acute respiratory syndrome (SARS), post-outbreak levels of depressive symptoms and the relationship between those depressive symptom levels and the types of outbreak event exposures experienced.

METHODS

In 2006, randomly selected employees (N = 549) of a hospital in Beijing were surveyed concerning their exposures to the city's 2003 SARS outbreak and the ways in which the outbreak had affected their mental health. Subjects were assessed on sociodemographic factors, on types of exposure to the outbreak, and on symptoms of posttraumatic stress disorder and depression.

RESULTS

The results of multinomial regression analyses showed that, with other relevant factors controlled for, being single, having been quarantined during the outbreak, having been exposed to other traumatic events before SARS, and perceived SARS-related risk level during the outbreak were found to increase the odds of having a high level of depressive symptoms 3 years later. Altruistic acceptance of risk during the outbreak was found to decrease the odds of high post-outbreak depressive symptom levels.

CONCLUSIONS

Policy makers and mental health professionals working to prepare for potential disease outbreaks should be aware that the experience of being quarantined can, in some cases, lead to long-term adverse mental health consequences.

Disaster survivors in their third decade: trajectories of initial stress responses and long-term course of mental health

This study analyzed trajectories of initial stress and long-term mental health after the 1980 North Sea oil rig disaster. A growth-mixture model of the survivors' stress manifestations in the first 8 weeks (Posttraumatic Stress Scale, [PTSS-10]) and general mental health in 1980, 1981, 1985, and 2007 (General Health Questionnaire, [GHQ-20]) was estimated. Survivors' GHQ-scores in 1985 and 2007 were contrasted to those of a comparison group. Four trajectories were identified among survivors. The resilient (n = 43) displayed initially moderate stress that rapidly declined. The recovery (n = 10), chronic (n = 8), and relapse (n = 9) showed initially stable high stress scores, but the long-term mental health differed. Early screening may identify those at long-term risk.

Traumatic bereavement, acute dissociation, and posttraumatic stress: 14 years after the MS Estonia disaster

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.

Long-term physical and psychological effects of the Vajont disaster

BACKGROUND

Few studies to date investigated the long-term consequences of disasters on physical health.

OBJECTIVE

The aim of the present report was to study the consequence on physical health of exposure to the Vajont disaster after 40 years. We also explored the effects of severity of trauma, posttraumatic stress disorder (PTSD), and major depression disorder on physical health and health-related quality of life.

METHOD

Sixty survivors of the Vajont disaster and 48 control subjects of similar gender, education, and age participated in the study. Physician-reported and subjective measures of physical health have been employed.

RESULTS

Survivors reported a greater number of physical complaints than controls (p<0.001), and some type of diseases showed a significant relationship with PTSD or PTSD symptoms. Quality of life differed between the two groups as regards the perception of physical health. The number of intrusive PTSD symptoms showed a significant negative effect on the quality of life of survivors.

CONCLUSIONS

Our study shows that large-scale disasters such as the Vajont one may have deleterious effects on both psychological and physical health.

Symptomatic profile and health-related quality of life of persons affected by the Prestige catastrophe

This study analyses the impact of the Prestige oil spill on the mental health and the perception of physical health and functional capacity in the affected population. The sample comprised 926 residents from the section of the Spanish coast affected by the oil spill. The data was collected slightly more than one year after the accident. Scales referring to clinical symptoms (SCL-36) and health-related quality of life (SF-36) were administered. The results suggest that individuals with higher degrees of exposure or residing in areas closest to the spill show lower levels of mental health in comparison to those with lower levels of exposure or living in areas farther away from the spill. This study also finds that women and fishermen tend to suffer more from the consequences of these types of disaster.

Initial stress responses in relation to outcome after three decades

The present study aimed at predicting posttraumatic stress 5 and 27 years after the North Sea oil rig disaster. The predictions were based on the initial levels of stress responses and the early recovery as reported in 1980. The Posttraumatic Stress Scale (PTSS) was used at 3 measure points. From 1980, data from 69 survivors were used in latent growth modeling. Follow-up studies included 65 survivors and 85 matched unexposed oil-rig workers in 1985; and 47 and 62 in 2007. In 1985, the survivors had higher total PTSS scores and more frequent endorsements on most single PTSS-items than the comparison group. In 2007, a few single items remained different. The initial levels of stress responses and the early recovery rate predicted the long-term outcomes after 5 and 27 years. Initial screenings may be helpful in the early detection of posttraumatic stress in the very long-term perspective.

Post-traumatic stress disorder following disasters: a systematic review

BACKGROUND

Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters. MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated.

RESULTS

We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13).

CONCLUSIONS

The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.

The psychological impact of a catastrophic earthquake: a retrospective study 50 years after the event

Aim of the present study was to retrospectively assess the impact of a catastrophic earthquake in a sample of 121 survivors, 50 years after the event. Mean age +/- SD of the responders was 72.2 +/- 6.1 years. The majority of the victims (78%) acknowledged a strong overall impact of the earthquake on their lives, and almost all of them had intense recollection of the event at its anniversary. The most frequent symptom during the 6 months after the earthquake was persistent remembering or "reliving" of the event; women had considerably more often recurrent dreams of the earthquake and distress than did men. Women and young adults at the time of the earthquake appear to be the most vulnerable groups regarding the psychological effects of the event.

Early post-traumatic stress disorder in relation to acute stress reaction: an ICD-10 study among help seekers following an earthquake

Disaster research related to earthquakes has almost exclusively dealt with their long-term psychosocial impact; besides, diagnoses were previously based only on DSM criteria. Therefore, it is pertinent to assess stress-related reactions of earthquake victims during the early post-disaster period through the application of ICD-10 criteria. For the first 3 weeks following an earthquake, 102 help-seekers were assessed based on a checklist of sociodemographic variables and a semi-structured interview for the detection of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) according to ICD-10. Forty-four subjects (43%) fulfilled the ICD-10 criteria for PTSD; all but one of them had suffered ASR. Moreover, among a series of potential predictors for PTSD, ASR was found to be the only significant one; this indicates a definite association between ASR and early development of PTSD. Logistic regression to predict group membership (PTSD/no PTSD) based on specific ASR symptoms showed that accelerated heart rate and feelings of derealization were the only significant predictors for early PTSD. Individuals who fulfill the ICD-10 diagnostic criteria for ASR following an earthquake are at high risk for subsequent occurrence of early PTSD. Increased heart rate and feelings of derealization within the first 48 h after the traumatic event appear to be the principal factors associated with the development of early PTSD. In addition to their potential value for timely prevention and treatment, these findings raise important nosological issues pertaining to the current diagnostic classification of stress-related disorders (ICD-10 versus DSM-IV).

Quality of life and psychological status in survivors of severe acute respiratory syndrome at 3 months postdischarge

BACKGROUND

Little is known about the long-term consequence of severe acute respiratory syndrome (SARS). We carried out an assessment on SARS patients after their recovery from their acute illness.

METHOD

Postal survey comprising Health-Related Quality of Life (HRQoL) questionnaires and anxiety and depression measures was sent to them at 3 months' postdischarge.

RESULTS

There was a significant impairment in both the HRQoL and mental functioning. Forty-one percent had scores indicative of a posttraumatic stress disorder (PTSD); about 30% had likely anxiety and depression.

CONCLUSION

SARS has significant impact on HRQoL and psychological status at 3 months.

One-year follow-up study of posttraumatic stress disorder among earthquake survivors in Turkey

Earthquakes and their consequences present a major global public health problem. In 1998, a major earthquake struck Southern Turkey. The aims of this study were to describe longitudinally the severity and the course of posttraumatic stress disorder (PTSD) and depression among earthquake survivors in Turkey and to explore risk factors associated with psychiatric disorders. The sample of this study consists of 105 consecutive subjects who used our psychiatric service, via either outpatient clinic or home visit. PTSD was assessed by the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of depression was assessed using Beck Depression Inventory. The rates of earthquake-related Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD were 42% within 1 month and 23% within 13 months. The diagnosis of PTSD was significantly related to the presence of injury and to less social support in the initial assessment. In the follow-up assessment, although the mean total Clinician-Administered PTSD Scale severity score improved significantly, the mean Beck Depression Inventory score did not change significantly. The decrease in posttraumatic stress symptoms 13 months after the earthquake may be related to relatively good living conditions and adequate social and health services. Early mental health intervention may serve to prevent the chronicity of posttraumatic stress reactions among earthquake victims.

Salud Mental

In the present article, we first describe the most frequent psychological alterations provoked by terrorist attacks. Subsequently, we describe the organization and interventions carried out on 11 March by the Department of Psychiatry of our hospital to attend both the victims of the attacks and their families, as well as the follow-up of victims after 11 March. The department's psychiatrists and psychologists were distributed through the distinct departments of the hospital to attend the first patients admitted and their relatives and two psychologists were specifically designated to attend the relatives of the few deceased who were transferred to the hospital.