Tom Lundin

Salivary cortisol and serum prolactin in relation to stress rating scales in a group of rescue workers

BACKGROUND Rescue service personnel are often exposed to traumatic events as part of their occupation, and higher prevalence rates of psychiatric illness have been found among this group. METHODS In 65 rescue workers, salivary cortisol at 8 AM and 10 PM and serum prolactin at 8 AM were related to the psychiatric self-rating scale General Health Questionnaire (GHQ-28) measuring psychiatric health, and the Impact of Events Scale (IES) and Post Traumatic Symptom Scale (PTSS) measuring posttraumatic symptoms. RESULTS Seventeen percent of the study population scored above the GHQ-28 cut-off limit but none scored beyond the cut-off limit in the IES and PTSS questionnaires. Salivary cortisol concentration at 10 PM correlated with statistical significance to anxiety (p < .005) and depressive symptoms (p < .01) measured with GHQ-28, as well as to posttraumatic symptoms, with avoidance behavior measured with IES (p < .01) and PTSS (p < .005). Two of the rescue workers were followed over time with the same sampling procedure after a major rescue commission. CONCLUSIONS The correlation between evening salivary cortisol and anxiety, depressiveness, and posttraumatic avoidance symptoms indicates that these parameters can be used in screening and follow-up after traumatic stress events.

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-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.

Traumatic bereavement, acute dissociation, and posttraumatic stress : 14 years after the MS Estonia disaster

This prospective longitudinal study aimed to examine posttraumatic stress in survivors 14 years after a ferry disaster, and estimate short- and long-term changes in stress associated with traumatic bereavement and acute dissociation. There were 852 people who perished in the disaster, 137 survived. The 51 Swedish survivors were surveyed with the Impact of Event Scale-Revised (IES-R) at 3 months, 1, 3, and 14 years (response rates 82%, 65%, 51%, and 69%). Symptoms decreased from 3 months to 1 year; no change was found thereafter. After 14 years, 27% reported significant symptoms. Traumatic bereavement, but not acute dissociation, was associated with long-term symptom elevation. Chronic posttraumatic stress can persist in a minority of survivors, and traumatic bereavement appears to hinder recovery.

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.

Traumatic impact of a fire disaster on survivors—A 25-year follow-up of the 1978 hotel fire in Borås, Sweden

The objective of this study was to investigate the long-term psychological and mental health outcomes among survivors of a disastrous hotel fire. A 25-year follow-up investigation among adolescent and young adult survivors of a fire disaster was conducted in Borås, Sweden. A self-evaluation questionnaire and four self-rating scales—the IES-22, PTSS-10, GHQ-28 and SoC—were sent by mail to the participants. The results from the self-reported data showed low levels of psychiatric illness. Moreover, the respondents reported a low level of traumatic stress symptoms. More than 50% of the participants stated that the fire had a determining effect on their lives. Sixteen (21.3%) respondents indicated that the fire still had an impact on their daily lives. Differences between men and women were reported in most of the self-rating scales. The results indicate that a traumatizing experience (such as a fire disaster) still had a small effect on psychological health in a long-term perspective.

The psychological impact of an earthquake on rescue workers: A follow-up study of the Swedish group of rescue workers in Armenia, 1988

After the disastrous earthquake in Amenia in December 1988, many international teams assisted in the rescue work in response to an official request from the Soviet authorities. On December 10th and 12th, 50 Swedish rescue workers were sent to Leninakan in Armenia. This group was recruited at very short notice and there was no opportunity for any briefing sessions before departure. Twenty persons were professionals, with various degrees of experience in disaster rescue operations. None of the group had previously worked with earthquake victims. These 50 rescue workers camped in the center of the area for 4 days and nights and thus closely observed the devastating effects on people and their homes and possessions and other buildings. The group was followed up with debriefing sessions and a prospective 9-month questionnaire study. Some significant differences in the psychological outcome were found between professionals and non-professionals both during the first month and in the further follow-up.