Southeast Asian Tsunami Research Articles

To foreignize or to domesticate? How media vary cross-nationally in their degrees of incorporating foreign events

While the domestication literature indicates how national media link foreign events to a country’s domestic affairs, it has thus far only examined modes of domestication - the ways through which these links are created. In this article, we introduce a different dimension of the phenomenon: degrees of domestication. This includes the extents to which a foreign event gets connected with the domestic. By making a topic-modeling analysis of French and Dutch newspaper articles about 9/11, the 2004 tsunami in Southeast Asia, the Arab Spring and Donald Trump’s political rise, we provide an explorative case study of this dimension. We inductively arrive at a scale ranging from no to extreme domestication of the event, classified according to four degrees of domestication: (1) an entirely foreign affair; (2) a foreign political affair involving domestic actors; (3) a domestic political affair; (4) or a personal disruption. French newspapers score higher on the second degree, the Dutch ones on the third and fourth. A deepening of this pattern shows how these differences stem from two distinctive cultural repertoires that journalists and other media participants employ when relating to foreign events: a French one, which sees them as an opportunity to dominate the international political stage, and a Dutch one, which considers them a reason for reflecting on domestic or personal matters. These clear differences indicate the concept’s importance for the literature and for investigating it within other national media contexts.

Rates of Clinically Confirmed Stress-related Psychiatric Disorders Among Swedish Tsunami Survivors: 9-year Follow-up

To the Editor: Our register-based follow-up study of Swedish survivors of the 2004 Southeast Asian tsunami published in Lancet Psychiatry revealed an increased risk of stress-related psychiatric disorders among adult survivors, compared to matched unexposed Swedes, throughout the 5 years after the disaster.1 Very little is known about the temporal pattern of stress-related psychiatric disorders among survivors beyond the first years after the event2,3 and we therefore conducted an additional follow-up of adult survivors for up to 9 years after the tsunami. We used the Swedish Tsunami Cohort1 consisting of 8,762 adult survivors (age ≥ 18 years in 2004) with permanent residence in Sweden who were confirmed alive through the register of the state police services in the aftermath of the tsunami. The unexposed group comprises 864,088 adults matched on sex, birth year, cohabitation status, and socioeconomic status. We retrieved clinical diagnoses of stress-related disorders (ICD-10: F43) from the Swedish Patient Register, which includes diagnoses made in specialized healthcare. Using flexible parametric models, we estimated hazard ratios (HRs) and 95% confidence intervals (CI) of stress-related disorders over the 9-year follow-up time, adjusting for pretsunami psychiatric disorders. The study was approved by the Regional Ethics Committees of Karolinska Institutet and Uppsala University. After register-linkage on national identifiers, unique for every Swedish resident, data analyses were done on de-identified datasets. Over the 9-year follow up, 3.6% (n = 313) of the Swedish adult tsunami survivors and 2.2% (n = 19,080) of the unexposed group received their first registered stress-related disorder diagnosis, with a corresponding elevated risk of stress-related disorders (3.56 vs. 2.19 per 1000 person-years, adjusted HR 1.72, 95% CI: 1.54, 1.93), highest for posttraumatic stress disorder (0.69 vs. 0.16 per 1000 person-years; adjusted HR 5.05, 95% CI: 3.89, 6.55). The results were similar across sexes. To assess temporal patterns, we performed an additional analysis in which we estimated separate HRs for different follow-up periods. The relative risk for stress-related disorders was substantially elevated during the first year posttsunami, decreased in magnitude thereafter, and no increased risk could be detected from 5 years and onwards (adjusted HR 1.04, 95% CI: 0.86, 1.26) (Figure 1).FIGURE 1.: Hazard ratios and 95% CIs of stress-related disorders among adult tsunami survivors as compared with matched unexposed individuals, adjusted for pre-event psychiatric history. We estimated hazard ratios from flexible parametric survival models.Our study indicates that after a transient major disaster, the dramatic rise in incidence of severe stress-related psychiatric disorders among survivors returns to unity around 5–6 years after the event. The temporal pattern of stress-related disorders in our study seems similar to research in populations suffering other types of life stressors, such as a diagnosis of a life threatening illness.4 While these results suggest that new onsets of stress-related psychiatric disorders among disaster survivors return to baseline after 5 years, we note that our previous studies of a subset of the tsunami cohort suggest that 16% of survivors are experiencing self-reported PTSD symptoms in a clinically significant range beyond 5 years after the disaster.5 Indeed, many disaster survivors with psychiatric morbidity defer seeking out treatment6 and may, as time goes by, instead seek treatment for other comorbid psychiatric disorders, such as substance abuse, sleep disturbances, anxiety, and depression. Due to the socio-economic characteristics of the sample and the particularly benign post-disaster context, our results may reflect a conservative estimate of the increased incidence of severe stress-related disorders seen in specialized or inpatient healthcare only. ACKNOWLEDGMENTS Authors’ contributors: E.B.T., H.S., and U.A.V. designed the study. E.B.T. and U.A.V. drafted the article, H.S. conducted the statistical analyses, and H.S., E.B.T. and U.A.V. had full access to all data and ensured their integrity. U.A.V. supervised the study. All authors took part in data interpretation and critical revision of the article. With approval from all authors, E.B.T. and U.A.V. had the final decision to submit.

Late Reminders Nine Years Post Disaster in Adults Who As Children or Adolescents Were Exposed to the 2004 Southeast Asian Tsunami

ABSTRACT Objective: The main aim of this study was to determine if young adults, who as children and adolescents were heavily exposed to the 2004 tsunami in Southeast Asia, had late reminders of this disaster nine years post disaster and, if so, how they handled these late reminders. Method: The subjects who had been exposed when they were between 10 and 15 years old were interviewed nine years post disaster when they had reached adulthood. Results: All those interviewed stated that they had experienced different late reminders of the 2004 tsunami even nine years later. They said that they could plan in advance or deal with late reminders should they occur. Two types of reminders were identified, one type designated as external and the other as internal. The interview subjects described how they had handled these reminders by striving for balance by thinking, talking, letting feelings out, doing something else or by avoiding. Conclusions: These young adults strived to find a balance between their function as adults in society and continued effects from the 2004 tsunami. A person, even if not affected functionally, can be affected in different ways in adulthood by the natural disaster they had experienced during childhood or adolescence. This is something important for anyone to think about when he or she meets persons who have been heavily exposed to a natural disaster many years earlier.

Disaster Risk Reduction and Health: The Potential of Health Registers for Public Health Monitoring

Introduction:The Sendai Framework seeks to substantially reduce disaster risk and losses in lives, livelihoods, health, and other assets including persons, communities, and countries. The framework focuses on reducing mortality while increasing population wellbeing, early warning, and promotion of health systems resilience. The use of scientific evidence to inform policy and formulate effective initiatives and interventions is crucial to disaster risk reduction within health. Different instruments and methodologies are available to guide policy and operations. The potential value of routinely collected patient data from health registers is that they can provide pre-event health and comparison group data without burdening affected populations.Aim:The current contribution aims to illustrate how health registers can help monitor the health impact of natural and human-made disasters.Methods:Patient data from health registers of general practitioners and other health professionals, sometimes combined with other registers and data sources, have been utilized to monitor the health impact of disasters and environmental hazards in the Netherlands, Norway, and Sweden since 2000.Results:Health registers allowed monitoring of mental health problems, medically unexplained symptoms, chronic health problems, and social problems. These were compared to groups not directly exposed. The health impact and care utilization was tracked after the fireworks explosion in Enschede affecting inhabitants of the neighborhood (2000; data range 1999-2005), children and parents after the Volendam café fire (2001; data range 2000-2006), Swedish survivors of the Tsunami in Southeast Asia (2004; data range 2004-2010), and parents of children affected by the terrorist attack on Utøya (2011; data range 2008-2014).Discussion:Health systems with registers have an important advantage when it comes to the potential for monitoring population health, and perhaps offer early warnings of pandemics. However, data generation should be closely connected to policy-making before and during the planning and evaluation of public health intervention.

Evacuation of Swedish survivors after the 2004 Southeast Asian tsunami: The survivors' perspective and symptoms of post-traumatic stress.

Following the 2004 Southeast Asian tsunami, Swedish authorities received public criticism for slow implementation of rescue work. Meanwhile, data are scarce on survivors' perspectives and potential mental health symptoms associated with timing of evacuation. Therefore, the aim of this study was to investigate survivors' contentment with evacuation time and whether duration at disaster site following the 2004 tsunami was associated with post-traumatic stress symptoms (PTSS) and psychological morbidity. Of 10,116 Swedish tsunami survivors who returned to Sweden in the first 3 weeks post tsunami, 4910 (49%) answered a questionnaire 14 months later including questions on evacuation time, contentment with evacuation time and PTSS (Impact of Event Scale). We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CI) of PTSS by timing of evacuation adjusting for gender, age, education, various indicators of trauma exposure and pre-tsunami psychiatric diagnoses. More than half of the survivors (53%) were content with evacuation time while 33% wanted later evacuation and 13% earlier evacuation. Compared with those evacuated 14-21 days post tsunami, individuals evacuated at day 1-4 presented with increased odds of PTSS (crude OR 3.0, 95% CI 2.0-4.5; and multivariable adjusted OR 2.0, 95% CI 1.3-3.0) and impaired mental health (crude OR 1.7, 95% CI 1.2-2.4; and multivariable adjusted OR 1.4 95% CI 1.0-2.0). One-third of Swedish tsunami survivors preferred a later evacuation from disaster sites. These findings call for further studies, with prospective designs, to disentangle the causal direction of the association between evacuation time and PTSS.

Is mindfulness protective against PTSD? A neurocognitive study of 25 Tsunami disaster survivors.

BackgroundIt has been suggested that mindfulness is a protective factor that buffers individuals from experiencing severe posttraumatic stress following exposure to a trauma.We aimed to examine the association between dispositional (trait) mindfulness and posttraumatic stress in individuals who had been exposed to the trauma of a natural disaster.MethodA disaster group (n = 25) consisting of Norwegian tourists who survived the 2004 South East Asian tsunami at a location with high mortality rates was recruited. Dispositional mindfulness and posttraumatic stress were measured with the Five-Facet Mindfulness Questionnaire and the Impact of Event Scale-Revised Version, respectively.ResultsThere was no significant association between mindfulness and posttraumatic stress. Moreover, there were no significant associations between posttraumatic stress and the mindfulness sub-facets of observing, acting with awareness, non-judging, and non-reacting. However, there was a significant positive correlation between the descriptive factor of mindfulness and IES-R total. There were no significant linear correlations between the five sub-facets of mindfulness and the three categories of posttraumatic symptoms, intrusion, avoidance and hyper-arousal.ConclusionsOur findings do not indicate a relationship between dispositional mindfulness and posttraumatic stress levels after exposure to a trauma, except for the descriptive sub-facet of mindfulness and here the correlation is positive and not negative as would be expected if mindfulness is a protective factor for posttraumatic stress. Future studies should investigate the relationship between mindfulness and posttraumatic stress while accounting for factors such as trauma history, type of trauma, and individual differences in traumatic stress reactions.

Sex differentials in the risk factors of post traumatic stress disorder among tsunami survivors in Tamil Nadu, India.

This study assessed if pre disaster, with-in disaster and post disaster factors predicted Post Traumatic Stress Disorder (PTSD) differently, among men and women survivors of the 2004 Southeast Asian tsunami in Kanyakumari district, Tamil Nadu, India. PTSD was identified using a validated tool, Impact of Events Scale-Revised (IES-R) among the participants in a cross-sectional community based survey (n=485). Case control analysis of 299 subjects was done to determine the predictors of PTSD. The odds of having PTSD were 6.35 times higher in women than men. Higher odds for PTSD was seen among women who were married, aged over 40, belonged to low socioeconomic status and resided in heavily damaged areas. Protective odds for PTSD was found among women who had received more than three times of counseling services whereas men were not at risk if they were free from fear of recurrence of tsunami, when adjusted for other variables. Women were vulnerable to PTSD because of their socially constructed roles. It is important to consider gender based vulnerabilities while designing interventions to combat mental health problems among disaster affected communities.

General self-efficacy and posttraumatic stress after a natural disaster: a longitudinal study.

BackgroundSelf-efficacy may be an important factor in individuals’ recovery from posttraumatic stress reactions after a natural disaster. However, few longitudinal studies have investigated whether self-efficacy predicts the course of posttraumatic recovery beyond lower initial levels of distress. The purpose of the present study was to investigate whether general self-efficacy is related to recovery from posttraumatic stress reactions from a longitudinal perspective.MethodsA total of 617 Norwegians exposed to the 2004 Southeast Asian tsunami completed self-report questionnaires measuring their level of disaster exposure and general self-efficacy at 6 months and posttraumatic stress reactions 6 months and 2 years post-disaster. Predictors of changes in posttraumatic stress reactions were analyzed with multivariate mixed effects models.ResultsSelf-efficacy at 6 months post-disaster was unrelated to trauma exposure and inversely related to posttraumatic stress reactions at 6 months and 2 years post-disaster. However, self-efficacy was not related to recovery from posttraumatic stress reactions between 6 months and 2 years post-disaster.ConclusionsIn conclusion, general self-efficacy is related to lower levels of posttraumatic stress reactions in the first months after a disaster but does not appear to be related to improved recovery rates over the longer term.

The role of personality traits in trajectories of long-term posttraumatic stress and general distress six years after the tsunami in Southeast Asia

The aims were to examine whether trajectories of posttraumatic stress (PTS) and general distress are related to personality traits and to investigate personality's contributing factor to PTS and general distress. The sample was 2549 Swedish tourists who survived the 2004 Indian Ocean tsunami and responded to postal surveys at 1, 3 and 6years after the tsunami, including assessment of personality traits, PTS and general distress. The sample was categorized into a direct exposure group and an indirect exposure comparison group.For both PTS and general distress, individuals with a resilient trajectory were lower in the trait neuroticism than those in the symptomatic trajectories whereas there were no differences in personality traits between the resilient trajectory and the low exposure comparison group. Neuroticism was strongly related to trajectories of both PTS and general distress even when adjusting for important risk factors such as traumatic bereavement and exposure severity. Other personality traits demonstrated weak associations with the trajectories. The present findings correspond with the notion of neuroticism as a vulnerability factor for symptomatic long-term trajectories of posttraumatic and general distress whereas resiliency was not predicated by particularly low levels of neuroticism.

Dressing an existential wound (DEW) - a new model for long-term care following disasters.

Presence, concern, compassion and universal or ontological unity between human beings have emerged as crucial to the healthy development of people who have experienced disasters. The aim of this article was to present a new model for long-term care following disasters. The objective of the model was to contribute to the readiness for long-term care following disasters in professionals and nonprofessionals as a result of their understanding of the model. A longitudinal qualitative study of Swedish tourists affected by the South East Asian tsunami in 2004 is the empirical base for this clinical model, which was developed within the framework of caring science. A hermeneutic method was used. The model is based on the assumption that life issues are an important aspect of long-term follow-up after a disaster. The term 'life issues' refers to the following: existential questioning of life's content, values and priorities; people's relationships with each other; and the importance of health, suffering, love and death. Life issues also refer to the way in which survivors form a new understanding of life after a disaster experience. Existential care is based on a charitable attitude of compassion and mercy towards one's fellows, be they professionals, families or wider society. By presenting eight theses, the model provides an approach based on compassion that works as an existential dressing for survivors of disaster. The model gives a knowledge base and approach for the long-term care of survivors, including practical advice.

The SE-Asian Tsunami Appeal: disclosure of contributions by corporate Australia

Purpose – The purpose of this paper is a quantitative exploration of the annual report disclosure of contributions by Australian corporations to the relief appeal following the South-East Asian tsunami of 26 December 2004. Design/methodology/approach – Hypotheses are developed from legitimacy and media agenda setting perspectives, predicting relationships between financial characteristics of the corporations and of their contributions with respect to presence and volume of content and extent of disclosure of cash amounts. The effect of public awareness of contributions on disclosure variables is also examined. Hypotheses not supported are re-examined from an agency perspective. Findings – Most correlations, such as company size and volume of content, are found to be consistent with a legitimacy perspective, while those not supported, such as company profit disclosure of cash amounts, can readily be explained from an accountability perspective. Overall, the results indicate a strong relationship between public awareness of the contributions and disclosing behaviour. Size of company and profit were related to some aspects of disclosure, while no relationship was detected between the size of the cash donation and disclosing behaviour. Research limitations/implications – The findings have important implications for studies of the way in which corporations communicate with their shareholders and other stakeholders when conflicting interests exist and when media exposure has been positive. The results cannot be extrapolated to situations beyond the Tsunami Appeal. Originality/value – Empirical research into the disclosure of corporate philanthropy by Australian corporations. Consideration of appropriate theoretical frameworks for study of corporate philanthropy disclosure.

Prevalence of psychiatric disorders and functional impairment after loss of a family member: a longitudinal study after the 2004 Tsunami.

Bereavement following disasters is a devastating experience for family members. The aim of this study was to examine the long-term mental health effects of losing a loved one in a natural disaster. Ninety-four Norwegians aged 18-80 years who lost close family members in the 2004 Southeast Asian tsunami were evaluated 2 and 6 years after the disaster. The participants were either staying in an affected area at the time of the disaster (i.e., directly exposed) or not (i.e., not directly exposed). The prevalence of psychiatric disorders was assessed by the MINI International Neuropsychiatric Interview (M.I.N.I). Prolonged grief disorder (PGD) was self-reported using the Inventory of Complicated Grief (ICG), and functional impairment was self-reported using the Work and Social Adjustment Scale (WSAS). We did not identify a significant decrease in the prevalence of PGD, posttraumatic stress disorder (PTSD), or major depressive disorder (MDD) from 2 to 6 years. Approximately, one-third of the bereaved (36%) had a psychiatric disorder 6 years after the tsunami. The most common disorder was PGD (12%) followed by general anxiety disorder (GAD, 11%), agoraphobia (11%), and MDD (10%). The prevalence of PTSD and MDD was higher among family members who were directly exposed to the disaster compared to those who were not (21 vs. 0%, and 25 vs. 3%). PGD was associated with functional impairment independent of other disorders. Loss of a close family member in a natural disaster can have a substantial adverse long-term effect on mental health and everyday functioning.

The global standardization of regional disaster risk management

Natural disasters have become a heightened security issue in the last decade. Mitigating and responding to disasters, such as the 2004 tsunami in Southeast Asia and the 2011 earthquake in Japan, reflect a new security agenda that has spread across the globe and infiltrated most regional organizations. At first glance, the creation of regional programmes on disaster risk management (DRM) appears to be driven by the functional preferences of states. However, a comparison of ten regional organizations reveals some curious ambiguities. Despite different threat perceptions, financial budgets and geographical environments of regional organizations, a majority of states have formed DRM programmes that exhibit highly standardized features in terms of language, the referent points of protection and the apparent motivations for cooperation. World society theory is used to explain these striking similarities with reference to the global cultural system. This article also illustrates the analytical purchase of world society theory in understanding cooperation through regional organizations.

Use of Health Care Services Before and After a Natural Disaster Among Survivors With and Without PTSD

This study used a questionnaire to identify individuals who met criteria for posttraumatic stress disorder (PTSD) ten months after surviving a disaster and compared their use of health care services before and after the disaster with that of survivors who did not meet criteria for PTSD. Ten months after the December 26, 2004, Southeast Asian tsunami, Danish tourists who had been in areas exposed to the disaster were mailed a questionnaire asking about demographic characteristics and exposure to the tsunami. The questionnaire included the PTSD Checklist, which measures symptoms of posttraumatic stress. Individuals who met DSM-IV PTSD criterion A1--in this case, being caught, touched, or chased by the waves or having witnessed the death, serious injury, or suffering of others--were included in the analyses (N=635). The Danish National Health Service Register provided longitudinal data on annual number of contacts with health care services before (2002-2004) and after (2005-2007) the tsunami. Survivors with PTSD or partial PTSD used health care services more than survivors without PTSD before and after the tsunami. The severity of posttraumatic stress symptoms was positively correlated with postdisaster use of health care services. However, when adjusted for predisaster health care use, this association was not significant. Postdisaster health care service utilization was predicted by predisaster health care service utilization and was hardly affected by the onset of PTSD itself. Associations between PTSD and subsequent health problems must be interpreted with caution.

Familial searching: A specialist forensic DNA profiling service utilising the National DNA Database® to identify unknown offenders via their relatives—The UK experience

The National DNA Database (NDNAD) of England and Wales was established on April 10th 1995. The NDNAD is governed by a variety of legislative instruments that mean that DNA samples can be taken if an individual is arrested and detained in a police station. The biological samples and the DNA profiles derived from them can be used for purposes related to the prevention and detection of crime, the investigation of an offence and for the conduct of a prosecution. Following the South East Asian Tsunami of December 2004, the legislation was amended to allow the use of the NDNAD to assist in the identification of a deceased person or of a body part where death has occurred from natural causes or from a natural disaster. The UK NDNAD now contains the DNA profiles of approximately 6 million individuals representing 9.6% of the UK population. As the science of DNA profiling advanced, the National DNA Database provided a potential resource for increased intelligence beyond the direct matching for which it was originally created. The familial searching service offered to the police by several UK forensic science providers exploits the size and geographic coverage of the NDNAD and the fact that close relatives of an offender may share a significant proportion of that offender's DNA profile and will often reside in close geographic proximity to him or her. Between 2002 and 2011 Forensic Science Service Ltd. (FSS) provided familial search services to support 188 police investigations, 70 of which are still active cases. This technique, which may be used in serious crime cases or in 'cold case' reviews when there are few or no investigative leads, has led to the identification of 41 perpetrators or suspects. In this paper we discuss the processes, utility, and governance of the familial search service in which the NDNAD is searched for close genetic relatives of an offender who has left DNA evidence at a crime scene, but whose DNA profile is not represented within the NDNAD. We discuss the scientific basis of the familial search approach, other DNA-based methods for eliminating individuals from the candidate lists generated by these NDNAD searches, the value of filtering these lists by age, ethnic appearance and geography and the governance required by the NDNAD Strategy Board when a police force commissions a familial search. We present the FSS data in relation to the utility of the familial searching service and demonstrate the power of the technique by reference to casework examples. We comment on the uptake of familial searching of DNA databases in the USA, the Netherlands, Australia, and New Zealand. Finally, following the adverse ruling by the European Court of Human Rights against the UK in regard to the S & Marper cases and the consequent introduction of the Protection of Freedoms Act (2012), we discuss the impact that changes to regulations concerning the storage of DNA samples will have on the continuing provision of familial searching of the National DNA Database in England and Wales.

The Soft Power Currencies of US Navy Hospital Ship Missions

The Tsunami in South-East Asia in 2004 prompted the largest military disaster response in history. Encouraged by the success, increasing attention has been paid to the various humanitarian assistance and disaster relief activities conducted by US armed forces. Since 2006, the US Navy deploys one of its two large hospital ships in annual missions to either Central and South America or the Asia-Pacific region to provide people in need with free care. These missions offer many opportunities to increase the soft power capital of the United States by forging ties with host nation governments and improving the image of the United States within the local population. However, this article argues that we need more research on the impact of humanitarian assistance to justify a continuation in a fiscally constrained environment.

After the flood: Resilience among tsunami-afflicted adolescents

Background: About 7000 Swedish citizens were on Christmas holiday in the disaster area at the time of the South-east Asian tsunami in 2004, in many cases with children and adolescents in their families. Aims: To investigate how adolescents experience a traumatic exposure to a natural disaster. Method: Twenty adolescents aged 16–19 years, who had experienced the 2004 tsunami and participated in a follow-up study 19 months post-disaster, were randomly selected and interviewed about their reactions, their life afterwards and their families. The study combines the face-to-face, semi-structured interviews with questionnaire data on mental health for 4910 Swedish adolescents and adults. Results: The themes that emerged inductively during the analysis of the interviews were psychological reactions during the catastrophe, the coping after, changes in self-image, worldview, role in the family, risk interpretation and altruism. The disaster had profound impact on family relations, social networks and plans for the future. Many felt strengthened by the experience and by their ability to cope in comparison with other family members, but also perceived isolation and lack of understanding. The general mental health status among the adolescents did not differ significantly from those of older age at the 19-month follow-up. Conclusions: According to the adolescents’, they experienced the tsunami-disaster differently than others around them. Their subjective interpretation of the event and its aftermath indicates resilience, especially among the young men. Future follow-up studies in larger samples of both symptoms and psychological functioning are warranted.

Posttraumatic Growth in Parents After a Natural Disaster

Posttraumatic growth (PTG) was examined in Norwegian parents 2.5 years after they were exposed, together with their children, to the 2004 Southeast Asian tsunami. Parents reported on their own and their children's disaster exposure and posttraumatic stress symptoms (PTSS) 10 months post-disaster. Children reported their own PTSS. Multiple regression analyses showed that children's distress 10 months post-disaster predicted parental PTG 1 year later, over and above the effects of parents’ own distress and disaster exposure. This study demonstrates that stress and vulnerability related to parenting in and after a disaster situation may contribute to PTG.

Visiting the Site of Death: Experiences of the Bereaved after the 2004 Southeast Asian Tsunami

The authors examined how many bereaved relatives of Norwegian tourists who perished in the 2004 Southeast Asian Tsunami had visited the site of death and the most important outcome from the visit. We conducted in-depth interviews (n = 110) and used self-report questionnaires (Impact of Event Scale—Revised, Inventory of Complicated Grief, and General Health Questionnaire) in a total of 130 first-degree family members 2 years post-disaster. Results showed that the majority of participants (n = 113; 87%) had visited the site of death. The most important outcome was gaining an increased understanding of what occurred (61%) and a feeling of closeness to the deceased (21%). Those who had visited the site of death reported lower avoidance behavior and higher degree of acceptance of the loss than non-visitors. Although this could be a cause as well as a consequence of the visit, visiting the site of death may be an important part of the support offered to bereaved families after experiencing a disaster loss.

The Norwegian version of the PTSD Checklist (PCL): Construct validity in a community sample of 2004 tsunami survivors

Background: The PTSD Checklist (PCL) is a widely used self-administered measure of post-traumatic stress disorder (PTSD) and it has been validated in a variety of languages and cultures. Aim: Evaluate the diagnostic validity of the Norwegian version of a specific PCL (PCL-S) for detecting PTSD in epidemiological research. Methods: Participants were severely exposed Norwegian survivors from the 2004 South-East Asian tsunami. Of 75 individuals asked to participate, 63 responded (84%). PTSD was assessed by PCL-S and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). These instruments were compared to evaluate the diagnostic validity of the PCL. We used two different scoring methods to diagnose PTSD based on PCL. The first method was based on the dichotomized sum score (cut-off ≥ 50) and the second was based on the flowchart method following DSM-IV symptom criteria. Area under the curve (AUC), Cohen's kappa, sensitivity and specificity were used to evaluate the agreement between the PCL and SCID-I. Results: According to the clinical interview, 11.3% of the participants met the diagnostic criteria for PTSD. The two scoring methods of PCL-S revealed similar results: according to both methods, 14.5% were categorized with PTSD. AUC was 0.98 (95% CI 0.93–1.00). For Cohen's kappa, the agreement was 0.71. Sensitivity was 0.86 and specificity 0.95. Agreement between PCL and SCID-I investigated for each of the three symptom clusters of PTSD and for the 17 individual items showed mostly a moderate to substantial agreement. Conclusions: The Norwegian version of the PCL-S performed well as a diagnostic instrument for detecting PTSD in epidemiological research.