Coping responses in the midst of terror: the July 22 terror attack at Utøya Island in Norway

'The apocalypse': A qualitative pilot study of the psychological aftermath of the 2020 Beirut blast

BACKGROUND

There has been very limited data describing the psychological aftermath of the Beirut blast.

AIMS

This qualitative pilot study aimed to explore the psychological and physical reactions to the trauma experienced by Beirut blast survivors, as well as their coping strategies.

METHODS

From November 2020 to February 2021, in-depth, semi-structured interviews were conducted with eight Lebanese citizens who were within a 4 km radius of the Beirut port at the time of the explosion. A thematic analysis was adopted.

RESULTS

Three themes were identified: (1) the blast; (2) life after the blast: extended trauma; (3) coping strategies. First, almost all participants vividly remembered the moment of the blast and referred to it as a turning point in their lives. They also remembered being on an emotional rollercoaster, feeling physically numb, worried about another explosion and finding God in the midst of tragedy. Second, all participants reported several negative experiences in their post-blast life, which may have enhanced/prolonged their trauma, including losses of different kinds (of a country, home, loved ones, hope, safety/security, culture and heritage), the cumulative impact of the blast, the impossibility to ever return to 'normality', persistent survival guilt and somatisation. Lastly, different coping strategies were adopted to deal with trauma, such as talking it out, establishing a consistent daily routine, helping the community, overworking and detachment.

CONCLUSIONS

This study highlights the many layers of psychological suffering of Beirut blast survivors in the current context of collective distress dominating Lebanon.

High-Performance Work Systems and Coping Strategies in Regulating Burnout and Safety Workarounds in the Healthcare Sector

The healthcare sector is essential for any country because it indirectly affects its economy. The productivity of land will increase if there is a healthy workforce, and it will enhance its economy, which will, in return, lead to the human welfare of the country. The present quantitative study has investigated the relationship between high-performance work systems (HPWS) on safety workarounds through the role of burnout as mediation, and explored coping strategies as a moderator between burnout and safety workarounds. These constructs play a vital role in efficiently managing different organizational activities to generate better productivity and employee performance, and educate employees about rules that can be used and adopted to ensure a healthy work-life. The data were collected from 550 nurses through a questionnaire in the healthcare sector of Lahore, Punjab (Pakistan). AMOS and SPSS were used to test the direct relationships between the constructs, and analyze the moderation of coping strategies and the mediation effect of burnout. The results have demonstrated the strong moderated mediation of coping strategies and burnout between existing HPWS and safety workarounds. The study of coping strategies would help managers and employees handle job stress and alleviate burnout in the healthcare sector through safety workarounds to increase effectiveness and efficiency.

Anxiety, Depression and Posttraumatic Stress Disorder after Terrorist Attacks: A General Review of the Literature

Terrorism, though not well-defined, is a violent act that has been shown to have longstanding effects on the mental health of those who witness it. The aim of this general literature review is to explore the effect that terrorism has on posttraumatic stress disorder (PTSD), major depressive disorder (MDD) and anxiety disorders, as well as the bio-psycho-social determinants that mediate its impact. This paper describes the prevalence, risk factors, protective factors, common presentations and interventions identified for PTSD, depression and anxiety disorders occurring following terrorist attacks. We conducted a literature search in MEDLINE using a number of keywords detailed below. After applying inclusion and exclusion criteria, we kept 80 articles, which we summarized in tabular form. A majority of articles found detailed the impact of terrorism on PTSD, and took place in a Western, mainly American setting. The main factors that impacted the presentation of mental illness include gender, ethnicity, social supports, socioeconomic status, level of preparedness, level of exposure, pre-existing trauma and mental illness, and subsequent life stressors. The main intervention detailed in this article as showing evidence post-terrorism is trauma-focused cognitive-behavioural therapy. This study highlights the importance of this topic, and in particular, its implications for public health policy and practice.

Surviving the storm: Avoidant coping, helping behavior, resilience and affective symptoms around a major hurricane-flood

BACKGROUND

As extreme weather events increasingly affect the global population, it is valuable to understand their impacts on mental health. Extending upon previous theory and research, the current study examined a hypothesized framework of direct and indirect pathways. Exposure and psychosocial resource factors at the time of the hurricane/flood were expected to help explain post-disaster behavioral responses, such as avoidant coping, positive coping, and helping behaviors, which, in turn, would help account for post-traumatic stress symptoms (PTSS) and depressive symptoms (DS).

METHODS

Survey data were collected from adult survivors (n = 801) of Hurricane Harvey 1-3 months post-disaster. PTSS, DS, and needing help were common, and loss/disruption and helping behavior were widespread. Structural equation modeling was used to examine the hypothesized framework.

RESULTS

Models accounted for substantial variance in PTSS (70%) and DS (61%), with immediate loss/disruption, low self-reported resilience, and avoidant coping showing the strongest associations with symptoms. As predicted, results provided support for several modeled indirect pathways through avoidant coping to PTSS and DS. Further, helping behavior was consistently associated with increased PTSS, but not DS.

LIMITATIONS

Cross-sectional design and online data collection methods precluded testing of causal directionality and confirming clinical diagnoses.

CONCLUSIONS

The current study represents a step toward elucidating potential mediators of avoidant coping and how helping behavior might relate to post-disaster psychopathology. Individuals in heavily hurricane/flood-exposed areas who have low psychosocial resources (social support and resilience) might be most vulnerable and most in need of intervention.

Correlates of psychological distress among urban trauma-exposed adults: Influence of age and coping preferences

OBJECTIVE

This article examines direct and moderating effects of age on coping preferences for psychological distress among a sample of trauma-exposed adults to inform treatment approaches for this population.

METHOD

Using data from a community survey of trauma-exposed, urban-dwelling adults (n = 181), direct and moderating effects of coping preferences on the relationship between age and psychological distress were examined using hierarchical linear regression.

RESULTS

Direct effects with distress were supported for age, gender, and coping preferences of avoidance and positive reframing. No direct effects with problem-focused coping were present; however, a significant interaction resulted with the relationship between age and level of reported distress.

DISCUSSION

Problem-focused coping may provide a buffering effect on experiences with distress for older trauma-exposed adults. Findings highlight the benefits of directive and action-oriented approaches to care for aging adults. Implications for future intervention research and clinical considerations for treating trauma over the life course are discussed. (PsycINFO Database Record

Emergency Preparedness and Role Clarity among Rescue Workers during the Terror Attacks in Norway July 22, 2011

BACKGROUND

Few studies address preparedness and role clarity in rescue workers after a disaster. On July 22, 2011, Norway was struck by two terror attacks; 77 people were killed and many injured. Healthcare providers, police officers and firefighters worked under demanding conditions. The aims of this study were to examine the level of preparedness, exposure and role clarity. In addition, the relationship between demographic variables, preparedness and exposure and a) role clarity during the rescue operations and; b) achieved mastering for future disaster operations.

METHODS

In this cross-sectional study, healthcare providers (n = 859), police officers (n = 252) and firefighters (n = 102) returned a questionnaire approximately 10 months after the terror attacks.

RESULTS

The rescue personnel were trained and experienced, and the majority knew their professional role (healthcare providers M = 4.1 vs. police officers: M = 3.9 vs. firefighters: M = 4.2, p < .001, [scale 1-5]). The police officers reported significantly more lack of control (p < .001). In the multivariable analysis, being female (OR 1.4, p < .05), having more years of work experience (OR 2.3, p = < .001), previous training (OR 1.6, p < .05) and the experience of an event with > 5 fatalities (OR 1.6, p < .05) were all associated with role clarity, together with a feeling of control, not being obstructed in work and perceiving the rescue work as a success. Moreover, independent predictors of being more prepared for future operations were arousal during the operation (OR 2.0, p < .001) and perceiving the rescue work as a success (OR 1.5, p < .001).

CONCLUSION

Most of the rescue workers were experienced and knew their professional role. Training and everyday-work-experience must be a focal point when preparing rescue workers for disaster.

The relationship between posttraumatic stress symptoms and narrative structure among adolescent terrorist-attack survivors

BACKGROUND

The structure of trauma narratives is considered to be related to posttraumatic stress symptomatology and thus the capacity to make a coherent narrative after stressful events is crucial for mental health.

OBJECTIVE

The aim of this study is to understand more of the relationship between narrative structure and posttraumatic stress symptoms (PTSS). More specifically, we investigated whether internal and external focus, organization, fragmentation, and length differed between two groups of adolescent survivors of a mass shooting, one group with low levels of PTSS and one group with high levels of PTSS.

METHOD

The sample comprised 30 adolescents who survived the shooting at Utøya Island in Norway in 2011. They were interviewed 4-5 months after the shooting and provided a free narrative of the event. PTSS were assessed using the UCLA Posttraumatic Stress Disorder Reaction Index (PTSD-RI).

RESULTS

We found that survivors with high levels of PTSS described more external events and fewer internal events in their narratives compared with survivors with low levels of symptoms. The analysis also showed that especially narratives containing more descriptions of dialogue and fewer organized thoughts were related to higher levels of PTSS. The groups did not differ in levels of narrative fragmentation or in length of the narratives.

CONCLUSION

Specific attributes of narrative structure proved to be related to the level of PTSS. On the basis of our results, we can recommend that practitioners focus especially on two elements of the trauma narratives, namely, the amount of external events, particularly dialogues, within the narrative and the number of organized thoughts. Participants with high levels of PTSS provided trauma narratives with low amount of organized (explanatory) thoughts accompanied by detailed descriptions of dialogues and actions, which is indicative for "here and now" quality of recall and a lack of trauma processing.

Sick-leave and help seeking among rescue workers after the terror attacks in Norway, 2011

BACKGROUND

Several studies have addressed psychological problems after terror attacks, especially among victims. Fewer have addressed possible health consequences among rescue workers involved with terror attacks. This study's aim was to investigate the levels of sick-leave and psychological help seeking among rescue workers involved in the terror attacks in Norway on July 22, 2011, and to identify associations between sick-leave and background-, exposure- and work-related variables.

METHODS

This cross-sectional study included five groups of professional rescue personnel and one group of unaffiliated volunteers. The questionnaire was distributed approximately 10 months after the terror attacks, with a response rate of 61.3 % (N = 1790).

RESULTS

A total of 9.7 % of participants self-reported sick-leave. The rate varied from 2.4 % among police officers to 14.5 % among unaffiliated volunteers, p < .001. There were 0.0-1.2 % of the professionals who were on sick-leave for more than 2 weeks and 5.5 % among the unaffiliated volunteers. More unaffiliated volunteers (42.6 %) and psychosocial personnel (16.3 %) consulted a psychologist or psychiatrist compared to other groups (3-9 %), p < .001. General healthcare providers (OR 6.1), psychosocial personnel (OR 6.3) and unaffiliated volunteers (OR 5.7) were associated with sick-leave, together with unwanted stress reactions (OR 1.6) and starting work on July 22 (OR 1.6).

CONCLUSIONS

A small minority of professional rescue workers reported sick-leave for more than 2 weeks, and few had sought psychological help. Unaffiliated volunteers reported more stress symptoms, longer sick-leave duration and more psychological help seeking. This group may benefit from more support.