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

Johannesson, Kerstin Bergh PsyD*; Michel, Per-Olof MD, PhD*; Hultman, Christina M. PsyD, PhD; Lindam, Anna MA*; Arnberg, Filip PsyD*; Lundin, Tom MD, PhD*

The Journal of Nervous and Mental Disease: May 2009 - Volume 197 - Issue 5 - p 316-323
doi: 10.1097/NMD.0b013e3181a206f7
Original Article

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.

*Department of Neuroscience, National Center for Disaster Psychiatry, Uppsala University, Uppsala, Sweden; and †Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

The study was financed by the Swedish Emergency Management Agency, the Swedish National Board of Health and Welfare, and Swedish Council for Working Life and Social Research.

Send reprint requests to Kerstin Bergh Johannesson, PsyD, Department of Neuroscience, National Center for Disaster Psychiatry, Uppsala University, Emmy Rappes väg 10, SE 750 17 Uppsala, Sweden. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.