Gertrud Sofie Hafstad

PTSD prevalence and symptom structure of DSM-5 criteria in adolescents and young adults surviving the 2011 shooting in Norway

BACKGROUND Diagnostic criteria for Posttraumatic Stress Disorder (PTSD) have been revised for DSM-5. Two key changes include alteration of the clustering of PTSD symptoms and new PTSD symptom criteria related to negative alterations in cognition and mood. In this study, we empirically investigated these changes. METHODS We interviewed 325 adolescents and young adults who survived the 2011 youth camp shooting at Utøya Island, Norway. The UCLA PTSD Reaction Index for DSM-IV was used to assess symptoms of PTSD. In addition, 11 questions were added to assess the four new symptom criteria within the new DSM-5 symptom categories. RESULTS PTSD prevalence did not differ significantly whether DSM-IV (11.1%) or DSM-5 (11.7%) criteria were used and the Cohen׳s Kappa for consistency between the diagnoses was 0.061. Confirmatory factor analyses showed that the four-factor structure of the DSM-5 fit the data adequately according to the conceptual model outlined. LIMITATIONS The homogeneity of this sample of highly exposed subjects may preclude generalization to less severely exposed groups. Also, we did not assess criterion G in regard to symptoms causing clinically significant distress and functional impairment. CONCLUSION The prevalence of PTSD was quite similar regardless of diagnostic system. The relatively low concordance between the diagnoses has implications for eligibility for a diagnosis of PTSD.

Parenting After a Natural Disaster: A Qualitative Study of Norwegian Families Surviving the 2004 Tsunami in Southeast Asia

How do parents support their children after a high-impact disaster? To answer this question, face-to-face interviews were conducted with 51 Norwegian parents. These parents and children were all severely exposed to the trauma of the tsunami disaster. The analyses show how parents interpret their children’s signs of distress, as well as their own strategies of support in the aftermath. The main strategies described by the parents were watchful waiting, careful monitoring of the children’s reactions and a sensitive timing when providing support. Such monitoring, and interpretation of signs of distress, served as an aid for the parents in determining what needs their children had and what support they therefore needed to provide. A range of support strategies were employed, including re-establishing a sense of safety, resuming normal roles and routines, and talking to their children. Parents who were themselves severely impacted by the disaster reported a reduced ability to assess their children’s reactions and thereby were unable to provide optimal care in the aftermath. Interestingly, the parents’ support strategies mirror the early intervention recommendations put forward in the NICE guidelines and in the Psychological First Aid guidelines which is a well accepted and promising practice for helping children after disasters.

PTSD or not PTSD? Comparing the proposed ICD-11 and the DSM-5 PTSD criteria among young survivors of the 2011 Norway attacks and their parents.

Background The conceptualization of post-traumatic stress disorder (PTSD) in the upcoming International Classification of Diseases (ICD)-11 differs in many respects from the diagnostic criteria in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The consequences of these differences for individuals and for estimation of prevalence rates are largely unknown. This study investigated the concordance of the two diagnostic systems in two separate samples at two separate waves. Method Young survivors of the 2011 Norway attacks (n = 325) and their parents (n = 451) were interviewed at 4–6 months (wave 1) and 15–18 months (wave 2) after the shooting. PTSD was assessed with the UCLA PTSD Reaction Index for DSM-IV adapted for DSM-5, and a subset was used as diagnostic criteria for ICD-11. Results In survivors, PTSD prevalence did not differ significantly at any time point, but in parents, the DSM-5 algorithm produced significantly higher prevalence rates than the ICD-11 criteria. The overlap was fair for survivors, but amongst parents a large proportion of individuals met the criteria for only one of the diagnostic systems. No systematic differences were found between ICD-11 and DSM-5 in predictive validity. Conclusions The proposed ICD-11 criteria and the DSM-5 criteria performed equally well when identifying individuals in distress. Nevertheless, the overlap between those meeting the PTSD diagnosis for both ICD-11 and DSM-5 was disturbingly low, with the ICD-11 criteria identifying fewer people than the DSM-5. This represents a major challenge in identifying individuals suffering from PTSD worldwide, possibly resulting in overtreatment or unmet needs for trauma-specific treatment, depending on the area of the world in which patients are being diagnosed.

Posttraumatic stress disorder and exposure to trauma reminders after a terrorist attack

ABSTRACT The aims of this study were twofold: (a) to systematically describe the type and frequency of trauma reminders reported after a terrorist attack and (b) to examine whether posttraumatic stress disorder (PTSD) is associated with frequency of exposure to trauma reminders. A total of 285 survivors (M age = 22.2, SD = 4.3, 53% males) of the 2011 massacre on Utøya Island, Norway, were interviewed face to face 14–15 months after the terror. Participants were asked how often they had experienced a range of different trauma reminders in the past month and which was most distressing. Current posttraumatic stress reactions were measured using the University of California at Los Angeles PTSD Reaction Index. In all, 33.3% of the survivors reported having experienced 1 or more trauma reminders often/very often in the past month. Auditory reminders were most frequently encountered and were reported to be the most distressing, especially sudden and sharp noises. Meeting the diagnostic criteria for PTSD was significantly associated with frequency of exposure to trauma reminders. The findings suggest that trauma reminders are common among survivors of a terrorist attack almost 1.5 years after the trauma and that PTSD is strongly related to the frequency of exposure to reminders. It is important that clinicians are aware of the significant role trauma reminders may play in maintaining PTSD and help trauma survivors recognize and manage reminders.

Survivors Report Back: Young people reflect on their media experiences after a terrorist attack

This study sought to systematically explore how young survivors of a terrorist attack perceive specific aspects of their contact with the media. We used data from a large-scale longitudinal study on health and coping among survivors of the terrorist attack at Utøya Island and their parents. Thirty to thirty-two months after the attack, 261 survivors (52.1 percent males, mean = 22.1, SD = 4.76) were asked to give a written description of their contact with the media post-terror, accentuating either a positive or a negative experience. Answers were systematically analyzed using the Consensual Qualitative Research method. Of the 261 youths who participated, 192 (73.6 percent) described an experience with the media’s approach, the interview, or the coverage. Experiences with the media’s approach were predominantly described as negative, including accounts of intrusive reporters who lacked respect and compassion. Interview experiences were predominantly described as positive; survivors had been met with respect and compassion, and on their own terms, by professional reporters. Descriptions of the media coverage were more evenly distributed between positive and negative experiences; the main themes were (dis)satisfaction with the coverage and personally beneficial/burdensome aspects of the coverage. Reporters and editors should take the presented results into account when they cover terrorism and disasters.

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.

A longitudinal study of psychological distress and exposure to trauma reminders after terrorism.

Objective: The aim of this study was threefold: (1) to examine the type and frequency of trauma reminders reported by survivors 2.5 years after a terrorist attack; (2) to examine whether frequency of exposure to trauma reminders is associated with psychological distress and level of functioning; and (3) to compare the worst trauma reminders reported by the same survivors at 2 different time points. Method: Participants were 261 survivors (52.1% male; Mage = 22.1 years, SD = 4.76) of the 2011 massacre on Utøya Island, Norway, who were interviewed face-to-face 14–15 and 30–32 months postterror. Participants were asked how often they had experienced various trauma reminders in the past month, which reminder was the worst, and how distressing it was. Current posttraumatic reactions were measured using the University of California at Los Angeles PTSD Reaction Index and an 8-item version of the Hopkins Symptom Checklist-25. Results: Auditory reminders were most frequently encountered and the most distressing. Frequency of exposure to trauma reminders was positively correlated with symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, as well as negatively correlated with level of functioning, over time. Almost 20% of the survivors reported being very distressed by their worst reminder 2.5 years postterror. Less than half reported the same worst reminder at both time points. Conclusion: Trauma reminders, especially auditory reminders, are prevalent and distressing for years after a terrorist attack. Exposure to reminders may be important not only in the development and maintenance of PTSD but also in a broader conceptualization of posttraumatic reactions and functioning. Which reminder survivors appraise as the worst may fluctuate over time. It is important to help survivors identify and cope with reminders.

Five reasons for using social media among young terror survivors: Results from the Utøya study

Abstract This study explores how young survivors experienced social media usage after the 2011 terror attack at Utoya, Norway. In total, 112 interviews with survivors were conducted 14–15 months post-terror, and analyzed using thematic analysis. Five reasons for social media usage were identified: 1) exchange of information, 2) giving and receiving social support, 3) mourning, 4) performing different symbolic actions, and 5) partaking in debates and discussions pertaining to the terror. Our informants described how their participation in online debates existed in a space between their personal stories and the public narrative surrounding the July 22 attacks. As unedited and easily accessible platforms, social media had characteristics that differentiated them from other arenas in which the survivors were communicating about the terror attack. The potential for receiving support was described as massive, because social media were perceived as platforms where the threshold for reaching out was low. However, participants felt that although social media usage enabled survivors to take control when presenting their own narratives, it also took some of their control away as their posts could be misinterpreted. They also felt that they were unable to protect themselves from information and opinions that they found distressing.