Per-Olof Michel

A comprehensive system for leader evaluation and development

The aim was to describe the development of a theoretical model for leader evaluation and development, an instrument based on this model, and a strategy for large scale implementation in the Swedish armed forces. The model rests on an interactional person by situation paradigm. It emphasises “developmental leadership”, which is inspired by transformational and functionalistic leadership approaches. The developmental leadership questionnaire (DLQ) was operationalised from the model and refined through structural equation modelling. The model and the DLQ will be used for three purposes: yearly evaluation of all personnel in the Swedish armed forces; yearly planning dialogues between each employee and his or her nearest supervisor; and a tool for leadership training. The implementation strategy includes an initial course in developmental leadership for all colonels. This is followed by the selection and training of local trainers, who, in turn, initiate the comprehensive programme locally. The system should be fully implemented by 2005.

Social Support Moderates Posttraumatic Stress and General Distress After Disaster

Social support buffers the negative impact of stressful events. Less, however, is known about the characteristics of this association in the context of disaster and findings have been discrepant regarding direct and buffering effects. This study tested whether the protective effects of social support differed across levels of exposure severity (i.e., buffered distress) and assessed whether the buffering effect differed between event-specific and general distress. Participants were 4,600 adult Swedish tourists (44% of invited; 55% women) repatriated within 3 weeks after the 2004 Indian Ocean tsunami. A survey 14 months after the disaster included the Crisis Support Scale, the Impact of Event Scale-Revised (IES-R), and the General Health Questionnaire (GHQ-12). Social support buffered the negative impact of exposure on both outcomes. The support and distress association ranged from very small in participants with low exposure to moderate in those with high exposure (η(p)(2) = .004 to .053). The buffering effect was not found to differ between the IES-R and GHQ-12, F(2, 4589) = 0.87, p = .42. The findings suggest that social support moderates the stressor-distress relationship after disasters. This study might help explain discrepant findings and point to refinements of postdisaster interventions.

Impact of Exposure to Trauma on Posttraumatic Stress Disorder Symptomatology in Swedish Tourist Tsunami Survivors

The aim was to examine long-term mental health and posttraumatic stress symptomatology in a Swedish tourist population after exposure to the 2004 Southeast Asian tsunami. Data from 4822 returned questionnaires 14 months after the disaster were analyzed. Respondents were categorized into 3 subgroups: (1) danger-to-life exposure group (having been caught or chased by the waves), (2) nondanger-to-life exposure group (exposed to other disaster-related stressors), and (3) low exposure group. Main outcome measures were General Health Questionnaire-12 and Impact of Event Scale-22-Revised. Danger-to-life exposure was an important factor in causing more severe posttraumatic stress symptoms and in affecting mental health. Female gender, single status, and former trauma experiences were associated with greater distress. Other factors related to more severe symptoms were loss of relatives, physical injuries, viewing many dead bodies, experiencing life threat, and showing signs of cognitive confusion. Disaster exposure has a substantial impact on survivors, which stresses the need for long-lasting support.

Tsunami-affected Scandinavian tourists : Disaster exposure and post-traumatic stress symptoms

Background: Studies of short- and long-term mental effects of natural disasters have reported a high prevalence of post-traumatic stress. Less is known about disaster-exposed tourists repatriated to stable societies. Aims: To examine the association between exposure to the 2004 Southeast Asian tsunami and symptoms of post-traumatic stress in three Scandinavian tourist populations. Methods: Postal survey of Norwegian, Danish and Swedish Southeast Asia tourists registered by the police when arriving at national airports. Follow-up time was 6 (Norway), 10 (Denmark) and 14 months (Sweden) post-disaster; 6772 individuals were included and categorized according to disaster exposure: danger exposed (caught or chased by the waves), non-danger exposed (other disaster-related stressors) and non-exposed. Outcome measures were the Impact of Event Scale—Revised (IES-R) and Post Traumatic Stress Disorder Check List (PCL). Results: Danger exposed reported more post-traumatic stress than non-danger exposed, and the latter reported more symptoms than non-exposed (each P<0.001). Comparison of the Norwegian and Swedish data suggested that symptoms were attenuated at 14 months follow-up (P<0.001). Female gender and low education, but not age, predicted higher levels of symptoms. Conclusions: Disaster-exposed tourists repatriated to unaffected home environments show long-term post-traumatic stress disorder symptoms related to the severity of exposure.

Tsunami-exposed Tourist Survivors: Signs of Recovery in a 3-year Perspective

Long-term follow-up after disaster exposure indicates increased rates of psychological distress. However, trajectories and rates of recovery in large samples of disaster-exposed survivors are largely lacking. A group of 3457 Swedish survivors temporarily on vacation in Southeast Asia during the 2004 tsunami were assessed by postal questionnaire at 14 months and 3 years after the tsunami regarding post-traumatic stress reactions (IES-R) and general mental health (GHQ-12). There was a general pattern of resilience and recovery 3 years postdisaster. Severe exposure and traumatic bereavement were associated with increased post-traumatic stress reactions and heightened risk for impaired mental health. The rate of recovery was lower among respondents exposed to life threat and among bereaved. Severe trauma exposure and bereavement seem to have considerable long-term impact on psychological distress and appear to slow down the recovery process. Readiness among health agencies for identification of symptoms and provision of interventions might facilitate optimal recovery.

The Effect of Traumatic Bereavement on Tsunami-Exposed Survivors

Fourteen months after the 2004 tsunami, mental health outcome was assessed in 187 bereaved relatives, 308 bereaved friends, and in 3,020 nonbereaved Swedish survivors. Of the bereaved relatives, 41% reported posttraumatic stress reactions and 62% reported impaired general mental health. Having been caught or chased by the tsunami in combination with bereavement was associated with increased posttraumatic stress reactions. Complicated grief reactions among relatives were almost as frequent as posttraumatic stress reactions. The highest levels of psychological distress were found among those who had lost children. Traumatic bereavement, in combination with exposure to life danger, is probably a risk factor for mental health sequelae after a natural disaster.

Stress reactions among Swedish peacekeeping soldiers serving in Bosnia: A longitudinal study

Assessments of mental health (GHQ-28) were performed on a Swedish battalion serving in Bosnia at 4 times: before deployment, immediately after deployment, 6 months after deployment, and 1 year after deployment. Complete responses were obtained from 316 participants (61% response rate). No significant change of mental health over time was noted. Individuals having experienced traumatic events in Bosnia, as well as stressful life events postdeployment, reported the poorest mental health. Logistic regression analysis showed that postdeployment stressors made the strongest contribution to registering a poor mental health score after one year.

Systematic Assessment of Mental Health Following Various Types of Posttrauma Support

In this study, we evaluated the influence of different forms of support (peer support, ventilation or defusing led by the ordinary group leader, and more formal debriefing sessions led by an external counselor) on mental health following traumatic experiences, using a prospective study design. The sample consisted of a Swedish battalion (N = 510), which was part of NATOs implementation force in Bosnia in 1996. Preservice assessment was made of personality, sense of coherence, and mental health. One third of the soldiers experienced traumatic situations during their service. Results showed that poor mental health after service was related more to preservice mental health and sense of coherence than to trauma exposure and posttrauma support. Peer support followed by a defusing session had a positive effect on postservice mental health, although this did not apply to the individuals with the worst preservice mental health. The value of formal debriefings could not be evaluated due to insufficient data.

Prevalence and duration of PTSD in survivors 6 years after a natural disaster

The present study aimed to examine the prevalence of posttraumatic stress disorder (PTSD) in survivors with low levels of risk factors for PTSD. The sample included 142 adults (58% women, 54% university education, 93% employed/students/retired) on vacation in Southeast Asia during the 2004 Indian Ocean disaster. Semi-structured clinical interviews (SCID-I) were performed after 6 years including PTSD, depression, specific phobia, and alcohol abuse. The 6-year prevalence of PTSD was 11.3% and the current prevalence was 4.2%, with onset mainly within 1 month and remission within 3 years post-disaster. Suicidal ideation and comorbidity were common in PTSD cases. Lifetime prevalence of depression was 19%, specific phobia 7%, and alcohol abuse 4%. The findings suggest elevated levels of PTSD but not other disorders as compared with general population samples, but still lower levels than other disaster samples. Despite benign circumstances, however, the course and burden of PTSD were comparable to similar studies.

Prolonged Grief Among Traumatically Bereaved Relatives Exposed and Not Exposed to a Tsunami

Numerous studies on the mental health consequences of traumatic exposure to a disaster compare those exposed to those not exposed. Relatively few focus on the effect of the death of a close relative caused by the disaster-suffering a traumatic bereavement. This study compared the impact on 345 participants who lost a close relative in the 2004 Indian Ocean tsunami, but who were themselves not present, to 141 who not only lost a relative, but also were themselves exposed to the tsunami. The focus was on psychological distress assessed during the second year after the sudden bereavement. Findings were that exposure to the tsunami was associated with prolonged grief (B = 3.81) and posttraumatic stress reactions (B = 6.65), and doubled the risk for impaired mental health. Loss of children increased the risk for psychological distress (prolonged grief: B = 6.92; The Impact of Event Scale-Revised: B = 6.10; General Health Questionnaire-12: OR = 2.34). Women had a higher frequency of prolonged grief. For men, loss of children presented a higher risk for prolonged grief in relation to other types of bereavement (B = 6.36 vs. loss of partner). Further long-term follow-up could deepen the understanding of how recovery after traumatic loss is facilitated.