Peter G. van der Velden

Construct Validation of the Dutch Version of the Impact of Event Scale

The Impact of Event Scale (ES; M. J. Horowitz, N. Wilner, & W. Alvarez, 1979) is a worldwide-used self-report measure to assess the frequency of intrusive and avoidant phenomena after a variety of traumatic experiences. The purpose of this article is to assess the psychometric value of the Dutch version of the IES (D. Brom & R. J. Kleber, 1985) in several samples of individuals who had experienced various traumatic stressors. The reliability and structure of the IES were evaluated in 3 different samples (total N = 1.588). The reliability of the Dutch version of the IES was adequate across the various stressors. The construct validity was assessed by using confirmatory factor analyses. Outcomes revealed a robust structure over the various samples, generally supporting the composition of the original IES.

Multigenerational Perspectives on Coping with the Holocaust Experience: An Attachment Perspective for Understanding the Developmental Sequelae of Trauma across Generations

In this paper, we advance a new approach to the intergenerational transmission of Holocaust experiences, by focusing on attachment theory. The approach is used as a framework for interpretation of the results of three studies on Holocaust survivors and their offspring, from different countries (The Netherlands, Canada, and Israel), and based on different conceptual approaches and methods of data collection (quantitative as well as qualitative). The literature is divided with regard to the extent and depth of long-term effects of the Holocaust. Attachment theory allows the integration of the phenomena of attachment, separation, and loss, which appear to be core concepts in the three studies presented here. The notion of insecure-ambivalent attachment sheds some light on the observed preoccupation with issues of attachment and separation in the second generation. Furthermore, the theme of “the conspiracy of silence” is discussed in the context of attachment disorganisation. Attachment theory transcends the traditional boundaries between clinical and nonclinical interpretations, in stressing the continuous and cumulative nature of favourable and unfavourable child-rearing circumstances. In this context, insecure attachment should be regarded as coping with suboptimal child-rearing environments.

Police officers: a high-risk group for the development of mental health disturbances? A cohort study.

Objectives Policing is generally considered a high-risk profession for the development of mental health problems, but this assumption lacks empirical evidence. Research question of the present study is to what extent mental health disturbances, such as (very) severe symptoms of anxiety, depression and hostility are more prevalent among police officers than among other occupational groups. Design Multicomparative cross-sectional study using the data of several cross-sectional and longitudinal studies in the Netherlands. Participants Two samples of police officers (N=144 and 503), employees of banks (N=1113) and employees of banks who were robbed (N=144); employees of supermarkets (N=335), and a psychiatric hospital (N=219), employees of a governmental social welfare organisation (N=76), employees who followed a training based on rational-motive therapy to strengthen their assertiveness (N=710), soldiers before deployment (N=278) and before redeployment (N=236) and firefighters (N=123). The numbers refer to respondents with complete data. Primary outcomes Prevalence of severe (subclinical level) and very severe symptoms (clinical level) were computed using the Dutch norm tables (80th percentile and 95th percentile, respectively) of the Symptom Check List Revised (SCL-90-R). All comparisons were controlled for age, gender and education. Results Multivariate logistic regression and analyses showed that the prevalence of clinical and subclinical levels of symptoms of anxiety, depression and hostility among police officers were not significantly higher than among comparison groups. The same pattern was found for the other SCL-90-R subscales. Conclusions We found no indications that self-reported mental health disturbances were more prevalent among police officers than among groups of employees that are not considered high-risk groups, such as employees of banks, supermarkets, psychiatric hospital and soldiers before deployment.

Mental health problems among search and rescue workers deployed in the Haïti earthquake 2010: A pre-post comparison

Search and rescue workers play an important role in rescuing trapped disaster victims. However, it is unclear whether they are at risk for post-disaster mental health problems. For this purpose we prospectively examined pre- and post-deployment health among Dutch search and rescue workers (USAR NL) deployed in the devastating Haiti earthquake disaster (2010). The evening before departure (T1, response=100%) and 3 months post-deployment (T2, response=91%), Search and rescue workers were administered standardized questionnaires assessing health (SCL-90-R, RAND-36), including use of substances and mental health services utilization (N=51). At T2 event-related PTSD-symptoms (IES) and coping self-efficacy (CSE), and experiences during and after deployment were examined. At both surveys health problems were almost absent and no significant increases in health problems and use of substances were found. PTSD-symptomatology was very low and coping self-efficacy rather high. Protective factors such as good team functioning, recognition and job satisfaction were clearly present, while risk factors such as sustained injuries or death of a co-worker were absent. Findings suggest that post-disaster health problems may (partly) be prevented by enhancing or restoring protective factors.

Persistent mental health disturbances during the 10 years after a disaster: Four-wave longitudinal comparative study

Although some studies have examined the long‐term effects of disasters, very little is known about severe persistent symptoms following disasters. The aim of the present study was to examine persistent mental health problems and to what extent disaster exposure predicts long‐term persistent disturbances.

The Effects of Disaster Exposure and Post-Disaster Critical Incidents on Intrusions, Avoidance Reactions and Health Problems Among Firefighters: A Comparative Study

Firefighters are at risk to be confronted with critical incidents and disasters. This study focused on the predictive value of these variables and their interaction effect for intrusions, avoidance reactions, and health problems among firefighters 18 months post-disaster (N = 639). Furthermore, the course of intrusions, avoidance reactions, and health problems in the period 2–3 weeks to 18 months post-disaster was assessed. Health problems were compared with those of non-affected firefighters (N = 132). Results showed that only disaster exposure and critical incidents accounted for a significant but small proportion of the variance (R 2 < .07) of intrusions, avoidance reactions and health problems among the affected firefighters. Health problems among affected firefighters did not decline in the period 2–3 weeks–18 months post-disaster, in contrast to intrusions and avoidance reactions. Health problems of both groups were comparable at T2. Results suggest that resilience in firefighters is rather high.

Longitudinal interplay between posttraumatic stress symptoms and coping self-efficacy: A four-wave prospective study

Trauma-related coping self-efficacy (CSE), the perceived capability to manage ones personal functioning and the myriad environmental demands of the aftermath of potentially traumatic events (PTE), has been shown to affect psychological outcomes after these events. Aim of the present four-wave study was to examine the cross-lagged relationships between CSE and posttraumatic stress disorder (PTSD) symptoms following PTEs in order to examine direction of influence. Levels of CSE and PTSD symptoms were measured with 4-month intervals. In addition, prospectively assessed personality traits and general self-efficacy perceptions as well as peritraumatic distress were entered in the analyses. The study sample consists of adult respondents of a representative internet panel who experienced PTE in the six months before T1, and did not experience any new PTE or life event between T1 and T3 (N = 400). Respondents were administered the coping self-efficacy scale (CSE-7), impact of event scale (IES) and arousal items of IES-R at each wave (T1 through T3), as well as questions on peritraumatic stress and prospectively measured personality traits (T0). Results of structural equation modeling showed that the effect of CSE on subsequent PTSD symptom levels was dominant. CSE significantly predicted subsequent symptoms, over and above earlier symptom levels, with higher CSE associated with lower PTSD. Symptoms in turn, did not predict subsequent levels of CSE. Higher peritraumatic distress was associated with both higher initial PTSD symptoms and lower initial CSE levels. Higher levels of the personality traits of emotional stability and agreeableness were associated with higher initial CSE levels. This supports a model in which CSE perceptions play an important role in recovery from trauma.

Disaster exposure as a risk factor for mental health problems, eighteen months, four and ten years post-disaster--a longitudinal study.

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.

Lack of perceived social support among immigrants after a disaster: comparative study

BACKGROUND Disaster research suggests that immigrant groups who are affected by a disaster receive less emotional support than their native counterparts. However, it is unclear to what extent these differences can be attributed to post-disaster mental health problems or whether they were present before the event. AIMS To examine the association between lack of social support, immigration status and victim status, as well as differences in support between immigrants and Dutch natives with disaster-related post-traumatic stress disorder (PTSD). METHOD Social support and psychological distress were assessed among immigrants and Dutch natives, among affected and non-affected individuals 4 years post disaster. Post-traumatic stress disorder was examined in the affected groups. RESULTS Affected immigrants more often lacked various kinds of perceived social support compared with affected Dutch natives. Remarkably, we found no differences in support between affected immigrants and non-affected immigrants. Immigrants with PTSD differ on only two out of six aspects of support from the Dutch natives with PTSD. CONCLUSIONS Results clearly indicate that differences in support between immigrants and Dutch natives are not so much a consequence of the disaster but were largely present before the disaster.

Selective attrition and bias in a longitudinal health survey among survivors of a disaster

BackgroundLittle is known about the response mechanisms among survivors of disasters. We studied the selective attrition and possible bias in a longitudinal study among survivors of a fireworks disaster.MethodsSurvivors completed a questionnaire three weeks (wave 1), 18 months (wave 2) and four years post-disaster (wave 3). Demographic characteristics, disaster-related factors and health problems at wave 1 were compared between respondents and non-respondents at the follow-up surveys. Possible bias as a result of selective response was examined by comparing prevalence estimates resulting from multiple imputation and from complete case analysis. Analysis were stratified according to ethnic background (native Dutch and immigrant survivors).ResultsAmong both native Dutch and immigrant survivors, female survivors and survivors in the age categories 25–44 and 45–64 years old were more likely to respond to the follow-up surveys. In general, disasters exposure did not differ between respondents and non-respondents at follow-up. Response at follow-up differed between native Dutch and non-western immigrant survivors. For example, native Dutch who responded only to wave 1 reported more depressive feelings at wave 1 (59.7%; 95% CI 51.2–68.2) than Dutch survivors who responded to all three waves (45.4%; 95% CI 41.6–49.2, p < 0.05). Immigrants who responded only to wave 1 had fewer health problems three weeks post-disaster such as depressive feelings (M = 69.3%; 95% CI 60.9–77.6) and intrusions and avoidance reactions (82.7%; 95% CI 75.8–89.5) than immigrants who responded to all three waves (respectively 89.9%; 95% CI 83.4–96.9 and 96.3%; 95% CI 92.3–100, p < .01). Among Dutch survivors, the imputed prevalence estimates of wave 3 health problems tended to be higher than the complete case estimates. The imputed prevalence estimates of wave 3 health problems among immigrants were either unaffected or somewhat lower than the complete case estimates.ConclusionOur results indicate that despite selective response, the complete case prevalence estimates were only somewhat biased. Future studies, both among survivors of disasters and among the general population, should not only examine selective response, but should also investigate whether selective response has biased the complete case prevalence estimates of health problems by using statistical techniques such as multiple imputation.