Analysis Of Inhibitory Effect Of Transcriptional Regulatory Protein (Sty 4289) Of Salmonella Typhi Ct18by Homology Modelling.

BACKGROUND: Salmonella typhi cause typhoid fever which is life threatening disease. It affects approximately 600,000 people per annum around the world. Food and water are the integral components through which this disease is transmitted and becomes base of typhoid. It spreads widely where cleanliness is very poor. Objective was to analyse three-dimensional structure of transcriptional regulator of Salmonella typhi CT18 by homology modelling to inhibit virulent effect of Salmonella typhi. METHODS: Bioinformatics tools and programs like comprehensive Microbial resource (CMR). Interproscan, Basic Local Alignment Search tool (BLAST), Modeller 9.10, Procheck and Prosa were used as bioinformatic tools for effective study of protein. RESULTS: Homology modelling is an appropriate and precise method to find three-dimensional transcriptional regulator to stop its virulency. CONCLUSIONS: Homology modelling is computational and accurate method to find 3D structure of transcriptional regulator to inhibit its virulence effect of causing disease.

Coping, Social Support and Loneliness during the COVID-19 Pandemic and Their Effect on Depression and Anxiety: Patients' Experiences in Community Mental Health Centers in Norway.

Background: Little is known about psychiatric patients' experiences during the COVID-19 pandemic. The purpose of this study was to investigate associations of coping strategies, social support and loneliness with mental health symptoms among these patients. Methods: We recruited 164 patients from Community Mental Health Centers in June-July 2020. Participants responded to an online questionnaire on corona-related questions, Brief Coping Orientation to Problems Experience, Crisis Support Scale, a 3-item Loneliness Scale, and Hopkins Symptom Checklist-25. We used linear regression models to investigate associations between these and symptoms of depression and anxiety. Results: Almost 51% were aged 31-50 years and 77% were females. Forty-six (28%) participants reported worsened overall mental health due to the pandemic. The reported rates of clinical depression and anxiety were 84% and 76%, respectively. Maladaptive coping was independently associated with both depression and anxiety symptoms. Loneliness was independently associated with depression symptoms. Conclusions: Patients in Community Mental Health Centers in Norway reported high rates of depression and anxiety symptoms. Many of them reported worsening of their mental health due to the pandemic, even at a time when COVID-19 infections and restrictive measures were relatively low. Maladaptive coping strategies and loneliness may be possible explanations for more distress.

Double-Edged Nanobiotic Platform with Protean Functionality: Leveraging the Synergistic Antibacterial Activity of a Food-Grade Peptide to Mitigate Multidrug-Resistant Bacterial Pathogens.

While persistent efforts are being made to develop a novel arsenal against bacterial pathogens, the development of such materials remains a formidable challenge. One such strategy is to develop a multimodel antibacterial agent which will synergistically combat bacterial pathogens, including multidrug-resistant bacteria. Herein, we used pediocin, a class IIa bacteriocin, to decorate Ag° and developed a double-edged nanoplatform (Pd-SNPs) that inherits intrinsic properties of both antibacterial moieties, which engenders strikingly high antibacterial potency against a broad spectrum of bacterial pathogens including the ESKAPE category without displaying adverse cytotoxicity. The enhanced antimicrobial activity of Pd-SNPs is due to their higher affinity with the bacterial cell wall, which allows Pd-SNPs to penetrate the outer membrane, inducing membrane depolarization and the disruption of membrane integrity. Bioreporter assays revealed the upregulation of cpxP, degP, and sosX genes, triggering the burst of reactive oxygen species which eventually cause bacterial cell death. Pd-SNPs prevented biofilm formation, eradicated established biofilms, and inhibited persister cells. Pd-SNPs display unprecedented advantages because they are heat-resistant, retain antibacterial activity in human serum, and alleviate vancomycin intermediate Staphylococcus aureus (VISA) infection in the mouse model. In addition, Pd-SNPs wrapped in biodegradable nanofibers mitigated Listeria monocytogenes in cheese samples. Collectively, Pd-SNPs exhibited excellent biocompatibility and in vivo therapeutic potency without allowing foreseeable resistance acquisition by pathogens. These findings underscore new avenues for using a potent biocompatible nanobiotic platform to combat a wide range of bacterial pathogens.

An explorative study of factors associated with treatment in specialized mental health care centers among GP patients in Norway.

BACKGROUND: Effectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers. METHODS: In this retrospective cohort study, we looked at 12 months of data from electronic health records from six GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency. RESULTS: We found that 4.6% of all GP patients and 18.4% of the GP patients with a mental health problems were treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers. CONCLUSIONS: Men were more likely to be treated in SMHC centers than women, which may imply that they have different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care.

Delayed post-traumatic stress and memory inflation of life-threatening events following a natural disaster: prospective study.

BACKGROUND: The causes of delayed post-traumatic stress disorder (PTSD) are debated, and the validity of late-onset PTSD has been questioned. AIMS: We aimed to examine predictors of delayed PTSD in a community sample of survivors of a natural disaster. METHOD: Norwegian survivors of the 2004 Indian Ocean tsunami (n = 532) responded to a questionnaire at 6 and 24 months post-disaster. The questionnaire measured PTSD symptoms, recalled exposure and immediate stress responses to the disaster, recalled perceived life threat, personality dimensions, social support and other subsequent adverse life events. RESULTS: When dichotomising PTSD symptom scores, 331 participants had low and 194 had high PTSD scores (early-onset PTSD) at 6 months. Of those with initially low scores, 43 (13.0%) had high symptom scores (delayed PTSD) at 24 months. The delayed PTSD group had a lower degree of initially assessed threat and witness experiences of death or suffering, lower immediate stress response and higher degree of memory inflation of perceived threat than the early-onset PTSD group. Among those with low PTSD scores at 6 months, onset of delayed PTSD was associated with neuroticism and memory inflation of life threat, but not with the degree of initially assessed disaster exposure or reports of subsequent adverse life events. CONCLUSIONS: Lack of association between trauma exposure and delayed onset of PTSD symptoms casts doubt on whether the traumatic event is actually the primary causative factor for delayed PTSD. Our findings suggest that delayed PTSD may be a manifestation of personality factors and memory inflation of the severity of an event.

Homogentisic Acid-Based Whole-Cell Biosensor for Detection of Alkaptonuria Disease.

Clinicians require simple quantitative tools for the detection of homogentisic acid in alkaptonuria patients, a rare inherited disorder of amino acid metabolism. In this study, we report a whole-cell biosensor for homogentisic acid to detect alkaptonuria disease through the expression of green fluorescence protein. The assay system utilizes a promoter sequence (hmgA) isolated from the Pseudomonas aeruginosa genome. To increase the sensitivity, the sensor module harboring phmgA::GFP was further transformed into various transposon mutants debilitated in steps involved in the metabolism of phenylalanine and tyrosine via homogentisic acid as a central intermediate. The proposed biosensor was further checked for analytical features such as sensitivity, selectivity, linearity, and precision for the quantification of homogentisic acid in spiked urine samples. The limit of detection for the developed biosensor was calculated to be 3.9 µM, which is comparable to that of the various analytical techniques currently in use. The sensor construct showed no interference from all of the amino acids and its homolog molecules. The accuracy and precision of the proposed biosensor were validated using high-performance liquid chromatography (HPLC) with satisfactory results.

Collaborative care for mental health: a qualitative study of the experiences of patients and health professionals.

BACKGROUND: Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment. METHODS: We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis. RESULTS: Participants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients' access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5-10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable. CONCLUSIONS: Participants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03624829.

Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-analysis.

OBJECTIVE: To summarize evidence for the prevalence of posttraumatic stress disorder (PTSD) among persons with chronic pain (CP). METHODS: We searched databases for studies published between January 1995 and December 2016, reporting the prevalence of PTSD in persons with CP. Two reviewers independently extracted data and assessed the risk of bias. We calculated the pooled prevalence using a random-effects model and performed subgroup analyses according to pain location, the population and assessment method. RESULTS: Twenty-one studies were included and the PTSD prevalence varied from 0-57%, with a pooled mean prevalence of 9.7%, 95% CI (5.2-17.1). In subgroup analysis, the PTSD prevalence was 20.5%, 95% CI (9.5-39.0) among persons with chronic widespread pain, 11.2%, 95% CI (5.7-22.8) among persons with headache, and 0.3%, 95% CI (0.0-2.4) among persons with back pain. The prevalence in clinical populations was 11.7%, 95% CI (6.0-21.5) and in non-clinical populations 5.1%, 95% CI (0.01-17.2). In studies of self-reported PTSD symptoms, PTSD prevalence was 20.4%, 95% CI (10.6-35.5), and in studies where structured clinical interviews had been used to assess PTSD its prevalence was 4.5%, 95% (CI 2.1-9.3). The risk of bias was medium for most studies and the heterogeneity was high (I2 = 98.6). CONCLUSION: PTSD is overall more prevalent in clinical cohorts of persons with CP and particularly in those with widespread pain, but may not always be more prevalent in non-clinical samples of persons with CP, compared to the general population. There is a large heterogeneity in prevalence across studies. Future research should identify sources of heterogeneity and the mechanisms underlying the comorbidity of the two conditions.

Longitudinal Relationship between Self-efficacy and Posttraumatic Stress Symptoms 8 Years after a Violent Assault: An Autoregressive Cross-Lagged Model.

Self-efficacy is assumed to promote posttraumatic adaption, and several cross-sectional studies support this notion. However, there is a lack of prospective longitudinal studies to further illuminate the temporal relationship between self-efficacy and posttraumatic stress symptoms. Thus, an important unresolved research question is whether posttraumatic stress disorder (PTSD) symptoms affect the level of self-efficacy or vice versa or whether they mutually influence each other. The present prospective longitudinal study investigated the reciprocal relationship between general self-efficacy (GSE) and posttraumatic stress symptoms in 143 physical assault victims. We used an autoregressive cross-lagged model across four assessment waves: within 4 months after the assault (T1) and then 3 months (T2), 12 months (T3) and 8 years (T4) after the first assessment. Stress symptoms at T1 and T2 predicted subsequent self-efficacy, while self-efficacy at T1 and T2 was not related to subsequent stress symptoms. These relationships were reversed after T3; higher levels of self-efficacy at T3 predicted lower levels of posttraumatic stress symptoms at T4, while posttraumatic tress symptoms at T3 did not predict self-efficacy at T4. In conclusion, posttraumatic stress symptoms may have a deteriorating effect on self-efficacy in the early phase after physical assault, whereas self-efficacy may promote recovery from posttraumatic stress symptoms over the long term.

The relationship between psychiatric morbidity and quality of life: interview study of Norwegian tsunami survivors 2 and 6 years post-disaster.

BACKGROUND: The study investigated the impact of psychiatric disorders on Quality of Life (QOL) cross-sectionally and longitudinally in a group of Norwegian tourists severely exposed to the 2004 tsunami. METHODS: Sixty-two adult Norwegian tsunami survivors were interviewed face to face 2 years post-tsunami (T1) and 58 were interviewed again by telephone 6 years post-tsunami (T2). The majority (81 %) reported direct exposure to the waves, and 14 participants (23 %) lost a close family member in the tsunami. Psychiatric morbidity was measured by structured clinical interviews and QOL was assessed with WHO's Quality of Life-Bref scale. Multiple linear regression analyses were performed to assess the independent effects of psychiatric disorders on QOL 2 and 6 years after the tsunami. RESULTS: Psychiatric disorders, especially depression, but also PTSD and other anxiety disorders, were associated with reduced QOL. Psychiatric disorders were more strongly related to QOL at 6 years after the tsunami than at 2 years. CONCLUSIONS: Psychiatric disorders, and especially depression, is related to reduced QOL in a disaster exposed population. Post-disaster psychiatric disorders, such as PTSD and especially depression, should be addressed properly in the aftermath of disasters.

General self-efficacy and posttraumatic stress after a natural disaster: a longitudinal study.

BACKGROUND: Self-efficacy may be an important factor in individuals' recovery from posttraumatic stress reactions after a natural disaster. However, few longitudinal studies have investigated whether self-efficacy predicts the course of posttraumatic recovery beyond lower initial levels of distress. The purpose of the present study was to investigate whether general self-efficacy is related to recovery from posttraumatic stress reactions from a longitudinal perspective. METHODS: A total of 617 Norwegians exposed to the 2004 Southeast Asian tsunami completed self-report questionnaires measuring their level of disaster exposure and general self-efficacy at 6 months and posttraumatic stress reactions 6 months and 2 years post-disaster. Predictors of changes in posttraumatic stress reactions were analyzed with multivariate mixed effects models. RESULTS: Self-efficacy at 6 months post-disaster was unrelated to trauma exposure and inversely related to posttraumatic stress reactions at 6 months and 2 years post-disaster. However, self-efficacy was not related to recovery from posttraumatic stress reactions between 6 months and 2 years post-disaster. CONCLUSIONS: In conclusion, general self-efficacy is related to lower levels of posttraumatic stress reactions in the first months after a disaster but does not appear to be related to improved recovery rates over the longer term.

Posttraumatic growth, depression and posttraumatic stress in relation to quality of life in tsunami survivors: a longitudinal study.

BACKGROUND: Quality of life (QoL) may often be reduced in survivors of a natural disaster. This paper investigated how posttraumatic growth (PTG), depression and posttraumatic stress interact and independently predict QoL in a longitudinal study of disaster survivors. METHODS: A total of 58 Norwegian adults who were present in Khao Lak, Thailand at the time of the 2004 Southeast Asia Tsunami completed self-report questionnaires 2 and 6 years after the disaster. The participants reported symptoms of depression and posttraumatic stress as well as PTG and QoL. Multiple mixed effects regression analyses were used to determine the independent effects of PTG, depression and posttraumatic stress on QoL measured 2 and 6 years after the disaster. RESULTS: Posttraumatic stress and depression were negatively related to QoL. PTG was not significantly related to QoL in a bivariate analysis. However, considerable interaction effects were found. Six years after the tsunami, high levels of posttraumatic stress were related to lower QoL in those participants with low levels of PTG, whereas lower levels of depression were related to higher QoL in those participants with high levels of PTG. CONCLUSIONS: Posttraumatic stress and depression are negatively associated with QoL after a natural disaster. PTG may serve as a moderating factor in this relationship.

Prevalence of psychiatric disorders and functional impairment after loss of a family member: a longitudinal study after the 2004 Tsunami.

BACKGROUND: Bereavement following disasters is a devastating experience for family members. The aim of this study was to examine the long-term mental health effects of losing a loved one in a natural disaster. METHODS: Ninety-four Norwegians aged 18-80 years who lost close family members in the 2004 Southeast Asian tsunami were evaluated 2 and 6 years after the disaster. The participants were either staying in an affected area at the time of the disaster (i.e., directly exposed) or not (i.e., not directly exposed). The prevalence of psychiatric disorders was assessed by the MINI International Neuropsychiatric Interview (M.I.N.I). Prolonged grief disorder (PGD) was self-reported using the Inventory of Complicated Grief (ICG), and functional impairment was self-reported using the Work and Social Adjustment Scale (WSAS). RESULTS: We did not identify a significant decrease in the prevalence of PGD, posttraumatic stress disorder (PTSD), or major depressive disorder (MDD) from 2 to 6 years. Approximately, one-third of the bereaved (36%) had a psychiatric disorder 6 years after the tsunami. The most common disorder was PGD (12%) followed by general anxiety disorder (GAD, 11%), agoraphobia (11%), and MDD (10%). The prevalence of PTSD and MDD was higher among family members who were directly exposed to the disaster compared to those who were not (21 vs. 0%, and 25 vs. 3%). PGD was associated with functional impairment independent of other disorders. CONCLUSIONS: Loss of a close family member in a natural disaster can have a substantial adverse long-term effect on mental health and everyday functioning.

Posttraumatic stress and symptom improvement in Norwegian tourists exposed to the 2004 tsunami--a longitudinal study.

BACKGROUND: Mental health consequences of disasters are frequently studied. However, few studies have investigated symptom improvement in victims after natural disasters. This study aimed to identify predictors of 6 months post-disaster stress symptoms and to study 6 months and 24 months course of symptoms among Norwegian tourists who experienced the 2004 tsunami. METHODS: Norwegian tourists (≥ 18 years) who experienced the 2004 tsunami (n = 2468) were invited to return a postal questionnaire at two points of time. The first data set was collected at 6 months (T1, n = 899) and the second data set at 24 months post-disaster (T2, n = 1180). The population studied consisted of those who responded at both assessments (n = 674). Impact of Event Scale Revised (IES-R) was used to measure posttraumatic stress symptoms. IES-R score ≥ 33 (caseness) was used to identify various symptom trajectories from T1 to T2. Multiple linear regression was used to determine predictors of posttraumatic stress at T1 and to identify variables associated with symptom improvement from T1 to T2. RESULTS: The majority was identified as non-case at both assessments (57.7%), while 20.8% of the respondents were identified as case at both assessments. Symptoms at T1 were positively related to female gender, older age, unemployment, being chased or caught by the waves, witnessing death or suffering, loss of loved ones, experiencing intense fear during the disaster, low conscientiousness, neuroticism and low levels of social support. The IES-R sum score declined from 24.6 (SD = 18.5) at T1 to 22.9 (SD = 18.3) at T2, p < 0.001. Emotional stability and high IES-R scores at T1 were positively related to symptom improvement, while received social support was not. Being referred to a mental health specialist was negatively related to symptom improvement. CONCLUSIONS: A significant minority (20-30%) among Norwegian tourists developed enduring posttraumatic stress symptoms in the aftermath of the 2004 tsunami. Tsunami exposure, peritraumatic fear, neuroticism and low levels of social support were the strongest predictors of posttraumatic stress at 6 months post-disaster. Decrease in posttraumatic stress was related to emotional stability and higher symptom levels at T1. Being referred to a mental health specialist did not facilitate symptom improvement.

The Norwegian version of the PTSD Checklist (PCL): construct validity in a community sample of 2004 tsunami survivors.

BACKGROUND: The PTSD Checklist (PCL) is a widely used self-administered measure of post-traumatic stress disorder (PTSD) and it has been validated in a variety of languages and cultures. AIM: Evaluate the diagnostic validity of the Norwegian version of a specific PCL (PCL-S) for detecting PTSD in epidemiological research. METHODS: Participants were severely exposed Norwegian survivors from the 2004 South-East Asian tsunami. Of 75 individuals asked to participate, 63 responded (84%). PTSD was assessed by PCL-S and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). These instruments were compared to evaluate the diagnostic validity of the PCL. We used two different scoring methods to diagnose PTSD based on PCL. The first method was based on the dichotomized sum score (cut-off ≥ 50) and the second was based on the flowchart method following DSM-IV symptom criteria. Area under the curve (AUC), Cohen's kappa, sensitivity and specificity were used to evaluate the agreement between the PCL and SCID-I. RESULTS: According to the clinical interview, 11.3% of the participants met the diagnostic criteria for PTSD. The two scoring methods of PCL-S revealed similar results: according to both methods, 14.5% were categorized with PTSD. AUC was 0.98 (95% CI 0.93-1.00). For Cohen's kappa, the agreement was 0.71. Sensitivity was 0.86 and specificity 0.95. Agreement between PCL and SCID-I investigated for each of the three symptom clusters of PTSD and for the 17 individual items showed mostly a moderate to substantial agreement. CONCLUSIONS: The Norwegian version of the PCL-S performed well as a diagnostic instrument for detecting PTSD in epidemiological research.

Family structure and posttraumatic stress reactions: a longitudinal study using multilevel analyses.

BACKGROUND: There is limited research on the relevance of family structures to the development and maintenance of posttraumatic stress following disasters. We longitudinally studied the effects of marital and parental statuses on posttraumatic stress reactions after the 2004 Southeast Asian tsunami and whether persons in the same households had more shared stress reactions than others. METHOD: The study included a tourist population of 641 Norwegian adult citizens, many of them from families with children. We measured posttraumatic stress symptoms with the Impact of Event Scale-Revised at 6 months and 2 years post-disaster. Analyses included multilevel methods with mixed effects models. RESULTS: Results showed that neither marital nor parental status was significantly related to posttraumatic stress. At both assessments, adults living in the same household reported levels of posttraumatic stress that were more similar to one another than adults who were not living together. Between households, disaster experiences were closely related to the variance in posttraumatic stress symptom levels at both assessments. Within households, however, disaster experiences were less related to the variance in symptom level at 2 years than at 6 months. CONCLUSIONS: These results indicate that adult household members may influence one another's posttraumatic stress reactions as well as their interpretations of the disaster experiences over time. Our findings suggest that multilevel methods may provide important information about family processes after disasters.

Psychiatric disorders and functional impairment among disaster victims after exposure to a natural disaster: a population based study.

OBJECTIVE: We aimed to examine psychiatric morbidity and functional impairment after a natural disaster. METHOD: Norwegian tourists who survived the 2004 tsunami in Khao Lak (n = 63), a severely affected area in Thailand, were interviewed in person 2.5 years after the disaster. The examination included the Mini International Neuropsychiatric Interview, the PTSD module of the Structured Clinical Interview for DSM-IV Axis I disorders, the Work and Social Adjustment Scale (WSAS), the Global Assessment of Functioning function score (GAF-F), and questions covering background characteristics and disaster exposure. RESULTS: The most prevalent disorders were specific phobia (30.2%), agoraphobia (17.5%), social anxiety disorder (11.1%), PTSD (11.1%), major depressive disorder (MDD, 11.1%), and dysthymic disorder (DD, 11.1%). In 24 of the 40 respondents with a current psychiatric disorder, symptoms had originated after the tsunami. The post-tsunami 2.5 year incidence of PTSD and MDD was 36.5% and 28.6%, respectively. Multivariable regression analysis showed that the depressive disorders (MDD and DD) and PTSD were associated with self-reported functional impairment (WSAS), and the depressive disorders were associated with clinician assessed functional impairment (GAF-F). LIMITATIONS: Small sample size and high education may limit the generalizability of the results. CONCLUSIONS: Depression and anxiety disorders were common among disaster victims 2.5 years after the 2004 tsunami. Psychiatric disorders other than PTSD, especially depressive disorders, are of clinical importance when considering long-term mental health effect of disasters.

Changes in religious beliefs and the relation of religiosity to posttraumatic stress and life satisfaction after a natural disaster.

OBJECTIVE: To study changes in religious beliefs and predictors of such changes in a community sample exposed to a natural disaster, and to investigate whether religiosity was linked to post-disaster mental distress or life satisfaction. METHODS: An adult population of 1,180 Norwegian tourists who experienced the 2004 tsunami was surveyed by a postal questionnaire 2 years after the disaster. Data included religiosity, disaster exposure, general psychopathology, posttraumatic stress and life satisfaction. RESULTS: Among the respondents, 8% reported strengthening and 5% reported weakening of their religious beliefs. Strengthening was associated with pre-tsunami mental health problems (OR: 1.82, 95% CI: 1.12-2.95) and posttraumatic stress (OR: 1.62, 95% CI: 1.22-2.16). Weakening was associated with younger age (OR: 0.98, 95% CI: 0.96-1.00) and posttraumatic stress (OR: 1.72, 95% CI: 1.23-2.41). Two years after the tsunami, 11% of the sample considered themselves to be positively religious. There were no significant differences in posttraumatic stress, general psychopathology or life satisfaction between religious and non-religious groups. CONCLUSIONS: Religion did not play an important role in the lives of Norwegian tsunami survivors in general. Respondents who had the greatest disaster exposure were more likely to report changes in religious beliefs in both directions. Religious beliefs did not prevent post-disaster long-term mental distress, and religiosity was not related to higher levels of life satisfaction.

Brief measure of posttraumatic stress reactions: impact of Event Scale-6.

BACKGROUND: The Impact of Event Scale-revised (IES-R) is one of the most widely used measures of posttraumatic stress reactions. However, for some purposes, such as large epidemiological studies, there is a need for briefer instruments. The aim of this study was to develop and validate an abbreviated version of the IES-R that could capture the three current symptom clusters of posttraumatic stress disorder (PTSD). METHODS: Stepwise multiple regression was applied to abbreviate the IES-R in one sample. The abbreviated version was then tested in three separate samples of individuals exposed to different kinds of potentially traumatic events. Agreement with a reference measure of PTSD, the PTSD checklist (PCL), was calculated for the abbreviated and the full-scale versions of IES. RESULTS: The abbreviation procedure resulted in a subset of six items (the IES-6), which correlated highly (pooled correlation = 0.95) with the IES-R across samples. Correlations between the IES-6 and IES-R subscales were somewhat lower (r = 0.78-0.94). Both the IES-6 and IES-R were in high agreement with the PCL. CONCLUSION: The IES-6 appears to be a robust brief measure of posttraumatic stress reactions. It may be useful for research in epidemiological studies, and it may also have a role as a screening instrument in clinical practice.

Nonresponse to a population-based postdisaster postal questionnaire study.

We examined nonparticipation in a 2-year postdisaster mail survey of Norwegian tourists evacuated from countries affected by the 2004 tsunami. One hundred seventy-one persons out of a random sample of 330 nonparticipants were telephone interviewed concerning disaster exposure, current posttraumatic stress reactions, and reasons for not participating. Fewer nonparticipants than participants had been in a place directly affected by the tsunami. Nonparticipants reported less perceived threat of death and lower levels of posttraumatic stress reactions. Reasons for not participating were "lack of interest or time" (39.2%), "lack of relevant experiences" (32.2%), and "too personal or emotionally disturbing" (15.2%). Our findings suggest that postdisaster studies may be biased in the direction of more severe disaster exposure and pronounced posttraumatic stress reactions.