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Strøm IF, Wentzel-Larsen T, Stensland S, Dyb G, Stene LE. Health care needs, experiences, and satisfaction after terrorism: a longitudinal study of parents of survivors of the Utøya attack. BMC Health Serv Res 2024; 24:277. [PMID: 38454472 PMCID: PMC10921612 DOI: 10.1186/s12913-024-10592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up. METHODS Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up. RESULTS Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported "very high/high" needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received. CONCLUSIONS Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.
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Affiliation(s)
- Ida Frugård Strøm
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway.
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Synne Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
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Haga JM, Thoresen S, Stene LE, Wentzel-Larsen T, Dyb G. Healthcare to parents of young terrorism survivors: a registry-based study in Norway. BMJ Open 2017; 7:e018358. [PMID: 29273662 PMCID: PMC5778306 DOI: 10.1136/bmjopen-2017-018358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess changes in parents' short-term and long-term primary and specialised healthcare consumption following a terrorist attack threatening the lives of their children. DESIGN Registry-based study comparing parental healthcare service consumption in the 3 years before and the 3 years after a terrorist attack. SETTING The aftermath of the Utøya terrorist attack. The regular, publicly funded, universal healthcare system in Norway. INTERVENTION Parents learning of a terrorist attack on their adolescent and young adult children. PARTICIPANTS Mothers (n=226) and fathers (n=141) of a total of 263 survivors of the Utøya terrorist attack (54.6% of all survivors 13-33 years, n=482). MAIN OUTCOME MEASURES We report primary and specialised somatic and mental healthcare service consumption in the early (0-6 months) and delayed (>6-36 months) aftermath of the attack, both in terms of frequency of services consumed (assessed by age-adjusted negative binomial hurdle regression) and proportions of mothers and fathers provided for (mean semiannual values). The predisaster and postdisaster rates were compared by rate ratios (RRs), and 95% CI were generated through bootstrap replications. RESULTS Frequency of primary healthcare service consumption increased significantly in both mothers and fathers in the early aftermath of the attack (mothers: RR=1.97, 95% CI 1.76 to 2.23; fathers: RR=1.73, 95% CI 1.36 to 2.29) and remained significantly elevated throughout the delayed aftermath. In the specialised mental healthcare services, a significant increase in the frequency of service consumption was observed in mothers only (early: RR=7.00, 95% CI 3.86 to 19.02; delayed: RR=3.20, 95% CI 1.49 to 9.49). In specialised somatic healthcare, no significant change was found. CONCLUSION Following terrorist attacks, healthcare providers must prepare for increased healthcare needs in survivors and their close family members, such as parents. Needs may present shortly after the attack and require long-term follow-up.
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Affiliation(s)
- Jon Magnus Haga
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre of Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Holt T, Jensen T, Dyb G, Wentzel-Larsen T. Emotional reactions in parents of the youth who experienced the Utøya shooting on 22 July 2011; results from a cohort study. BMJ Open 2017; 7:e015345. [PMID: 29042373 PMCID: PMC5652501 DOI: 10.1136/bmjopen-2016-015345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE AND SETTING The objective of this study was to provide knowledge about the emotional reactions in parents whose offspring experienced a mass shooting on Utøya island in Norway in 2011. The research questions included whether parents' reactions were influenced by their offspring's symptom level, age, living situation and parental gender. DESIGN The study was designed as an open cohort study. The data were collected at two time points; 4-5 months and 14-15 months after the shooting. PARTICIPANTS The participants were 531 parents of youth exposed to the Utøya island attack. OUTCOME MEASURES The Parental Emotional Reaction Questionnaire measured parents' reactions, and University of California, Los Angeles Post-traumatic Stress Disorder Reaction Index measured youths' post-traumatic stress symptoms. RESULTS Parental emotional reactions were positively related to post-traumatic stress reactions in offspring at wave 1: Est.=0.20, 95% CI 0.10 to 0.30, p<0.001, over time (wave 1and wave 2 nested within individuals): Est.=0.23, CI 0.13 to 0.32, p<0.001, and at wave 2: Est.=0.26, CI 0.12 to 0.39, p<0.001. Youths' age was not significantly related to parental emotional reactions, neither at wave 1: Est.=0.19, CI -0.40 to 0.77, p=0.531, over time: Est.=0.26, CI -0.27 to 0.79, p=328, nor at wave 2: Est.=0.32, CI -0.41 to 1.05, p=0.389. Mothers were more emotionally upset than fathers both at wave 1: Est.=-5.66, CI -7.63 to -3.69, p<0.001, over time: Est.=-5.36, CI -7.18 to -3.55, p<0.001, and at wave 2: Est.=-5.33, CI -7.72 to -2.53, p<0.001. CONCLUSIONS The findings suggest that parenting after trauma should be addressed in outreach programmes and in planning of healthcare services.
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Affiliation(s)
- Tonje Holt
- Mental & Physical health, Norwegian Institute of Public Health and Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Tine Jensen
- Department of Psychology, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Bitton S, Tuval-Mashiach R, Freedman S. Distress Levels among Parents of Active Duty Soldiers during Wartime. Front Psychol 2017; 8:1679. [PMID: 29018394 PMCID: PMC5622972 DOI: 10.3389/fpsyg.2017.01679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: Military service is a highly stressful period both for the soldiers serving and for their parents. Surprisingly, parents’ experience has been mostly ignored in the research. This study’s goal is to shed light on the experience and distress levels of parents of active duty combat soldiers during Operation Protective Edge, a military operation carried out by the Israel Defense Forces during July and August of 2014. Methods: During the advanced stages of the operation, 69 parents of Israeli male combat soldiers (55 mothers and 14 fathers) completed an online survey measuring symptoms of Posttraumatic Stress Disorder (PTSD-Checklist-5) and distress (Brief Symptom Inventory-18). Participants were recruited using a convenience sample, by posting ads on the public Facebook pages of the researchers and of the groups dedicated to parents of Israeli soldiers. Results: Parents’ depression and anxiety symptom levels were higher than depression and anxiety symptom levels of the adult community norms in Israel. General distress rates of parents were similar to those presented by adults in southern Israel who were exposed for 7 years to the ongoing threat of daily rocket fire from Gaza, and higher than rates of a non-threatened Israeli population. Finally, 20.2% of the parents presented PTSD-like symptoms, a higher percentage than the probable PTSD diagnosis rates that were found in the general population in Israel during previous terror waves. Conclusion: This study provides preliminary evidence of soldiers’ parents’ distress and indicates the need for a better understanding of the impact of military service on soldiers’ parents.
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Affiliation(s)
- Shahar Bitton
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Sara Freedman
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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Thoresen S, Jensen TK, Wentzel-Larsen T, Dyb G. Parents of terror victims. A longitudinal study of parental mental health following the 2011 terrorist attack on Utøya Island. J Anxiety Disord 2016; 38:47-54. [PMID: 26812593 DOI: 10.1016/j.janxdis.2016.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Little is known about parents' health following their children's exposure to trauma. We investigated the mental health of parents of young terrorist survivors and assessed parental distress and guilt as potential predictors of mental health. METHOD Mothers and fathers (N=531) participated in two study waves 4-5 and 14-15 months after the shooting. Posttraumatic stress reactions (PTSS) and anxiety/depression were compared with age- and gender-adjusted expected scores that were calculated from a concurrent population study. Mixed effects models investigated the associations between parental distress, parental guilt, and mental health. RESULTS Parents' level of anxiety/depression was three times higher and PTSS was five times higher than that of the general population. Parental distress and guilt about their child's traumatic experience contributed uniquely to symptoms at both time points. CONCLUSIONS Parents of traumatized youth constitute a vulnerable group that has been overlooked in the literature. Intervention strategies following trauma should include both survivors and their parents.
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Affiliation(s)
- Siri Thoresen
- Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugvn 1-3, 5th floor, 0408 Oslo, Norway.
| | - Tine K Jensen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Harald Schjelderup House, Forskningsveien 3A, 0373 Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugvn 1-3, 5th floor, 0408 Oslo, Norway.
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugvn 1-3, 5th floor, 0408 Oslo, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway.
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugvn 1-3, 5th floor, 0408 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.
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Haga JM, Stene LE, Wentzel-Larsen T, Thoresen S, Dyb G. Early postdisaster health outreach to modern families: a cross-sectional study. BMJ Open 2015; 5:e009402. [PMID: 26681694 PMCID: PMC4691779 DOI: 10.1136/bmjopen-2015-009402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/07/2015] [Accepted: 10/21/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This study investigated whether the early outreach programme following the Utøya massacre reached out to the parents of the young survivors. Additionally, we explored whether specialised mental healthcare services were provided to parents presenting elevated levels of PTSD and depression reactions. DESIGN Cross-sectional survey, face-to-face interviews and questionnaires. SETTING Norway, aftermath of the Utøya massacre, 4-7 months postdisaster. BACKGROUND Following the Utøya massacre, proactive early outreach programmes were launched in all municipalities that were affected, facilitating access to appropriate healthcare services. PARTICIPANTS A total of 453 parents of the Utøya survivors aged 13-33 years took part. Overall, 59.8% of the survivors were represented by one or more parent in our study. MAIN OUTCOME MEASURES Engagement with the proactive early outreach programme (psychosocial crisis teams and contact persons in the municipalities), utilisation of healthcare services (general practitioner and specialised mental healthcare services) and mental distress (UCLA PTSD-RI and HSCL-8). RESULTS A majority of the participants reported contact with the proactive early outreach programme (crisis team, 73.9%; and contact person, 73.0%). Failure of outreach to parents was significantly associated with non-intact family structure (crisis team: OR 1.69, 95% CI 1.05 to 2.72, p=0.032) and non-Norwegian origin (crisis team: OR 2.39, 95% CI 1.14 to 4.98, p=0.021). Gender of the parent was not significantly associated with failure of the outreach programme (p ≥ 0.075). Provision of specialised mental healthcare services was significantly associated with higher levels of PTSD (OR 2.08, 95% CI 1.55 to 2.79, p<0.001) and depression (OR 2.42, 95% CI 1.71 to 3.43, p<0.001) and not with the sociodemography (p ≥ 0.122). CONCLUSIONS Proactive early outreach strategies may be helpful in identifying healthcare needs and facilitating access to the required services in a population struck by disaster. Our findings prompt increased attention to the complexity of family structures in reaching out universally to modern families following a disaster.
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Affiliation(s)
- Jon Magnus Haga
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Department of Social Pediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
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Abstract
The adverse health consequences of the Iraq War (2003-11) were profound. We conclude that at least 116,903 Iraqi non-combatants and more than 4800 coalition military personnel died over the 8-year course. Many Iraqi civilians were injured or became ill because of damage to the health-supporting infrastructure of the country, and about 5 million were displaced. More than 31,000 US military personnel were injured and a substantial percentage of those deployed suffered post-traumatic stress disorder, traumatic brain injury, and other neuropsychological disorders and their concomitant psychosocial problems. Many family members of military personnel had psychological problems. Further review of the adverse health consequences of this war could help to minimise the adverse health consequences of, and help to prevent, future wars.
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Affiliation(s)
- Barry S Levy
- Tufts University School of Medicine, Boston, MA, USA.
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