Abstract
BackgroundDisaster experiences have been associated with higher prevalence rates of (mental) health problems. The objective of this study was to examine the independent relation between a series of single disaster experiences versus the independent predictive value of a accumulation of disaster experiences, i.e. a sum score of experiences and symptoms of distress and post-traumatic stress disorder (PTSD).MethodsSurvivors of a fireworks disaster participated in a longitudinal study and completed a questionnaire three weeks (wave 1), eighteen months (wave 2) and four years post-disaster (wave 3). Ten years post-disaster (wave 4) the respondents consisted of native Dutch survivors only. Main outcome measures were general distress and symptoms of PTSD.ResultsDegree of disaster exposure (sum score) and some disaster-related experiences (such as house destroyed, injured, confusion) were related to distress at waves 2 and 3. This relation was mediated by distress at an earlier point in time. None of the individual disaster-related experiences was independently related to symptoms of distress. The association between the degree of disaster exposure and symptoms of PTSD at waves 2 and 3 was still statistically significant after controlling for symptoms of distress and PTSD at earlier point in time. The variable ‘house destroyed’ was the only factor that was independently related to symptoms of PTSD at wave 2. Ten years after the disaster, disaster exposure was mediated by symptoms of PTSD at waves 2 and 3. Disaster exposure was not independently related to symptoms of PTSD ten years post-disaster.ConclusionsUntil 4 years after the disaster, degree of exposure (a sum score) was a risk factor for PTSD symptoms while none of the individual disaster experiences could be identified as an independent risk factor. Ten years post-disaster, disaster exposure was no longer an independent risk factor for symptoms of PTSD. Since symptoms of PTSD and distress at earlier waves perpetuate the symptoms at later waves, health care workers should aim their resources at those who still have symptoms after one and a half year post-disaster, to prevent health problems at medium and long-term.
Highlights
Disaster experiences have been associated with higher prevalence rates of health problems
Statistical analysis To assess the relation between disaster exposure and psychological problems in the medium term, symptoms distress and symptoms of post-traumatic stress disorder (PTSD) at waves 2 and 3 were considered as outcomes
Let yt and zt be the vectors containing scores for symptoms distress and symptoms of PTSD at wave t respectively. yt and zt with t 2 f2; 3g were considered as outcome variables that reflect the degree of psychological problems in the medium term, while z4 was used as an outcome for psychological problems in the long run (y4 was not collected in our data)
Summary
Disaster experiences have been associated with higher prevalence rates of (mental) health problems. Each year disasters affect large numbers of people throughout the world These traumatic experiences may result in a wide range of mental and physical health consequences [1,2]. Disaster-related emotions and experiences are subject to recall bias and collecting information about disaster-related experiences shortly after the disaster may prevent recall bias as much as possible Disasterrelated experiences such as property damage and physical injury as well as initial post-traumatic stress reactions predict health problems in the longer term [5,6]. Statistical analysis To assess the relation between disaster exposure and psychological problems in the medium term, symptoms distress and symptoms of PTSD at waves 2 and 3 were considered as outcomes. Given t the following models were estimated: Model type 1 (degree of disaster exposure): a. yt 1⁄4 Xγ þ dκ þ E; zt 1⁄4 Xγ þ dκ þ E b. yt 1⁄4 Xγ þ dκ þ y1αy þ z1αz þ E; zt 1⁄4 Xγ þ dκ þ y1αy þ z1αz þ E
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