Media perception and trust among disaster survivors: Tsunami survivors' interaction with journalists, media exposure, and associations with trust in media and authorities.

A critical part of disaster communication is media coverage in the interface of the afflicted, media, and authorities. One communication key is building trust. Disaster survivors encounter journalists in a high-stress context, but little is known about their perceptions of these interactions and the subsequent media exposure. The aim of this study is to explore how survivors 6 years after a major disaster perceived their encounters with journalists and exposure in the media, as well as their level of trust in the media, compared with government and authorities. Data were used from a longitudinal study of Swedish tourists, repatriated from the 2004 Indian Ocean tsunami, surveyed up to 6 years after the tsunami to assess posttraumatic stress (PTS) and effects on mental health. At 6 years after, the survey included questions about survivors' perceptions of journalist interactions (reported by n = 311), of their own media exposure (n = 177), and survivors' trust in media organizations and public authorities (n = 1,181). Tsunami survivors mainly perceived interactions with journalists as being professional. There were 14% who reported that the interactions were supportive and 17% that the interactions were a strain. Similarly, most participants had a neutral view concerning the subsequent media coverage or exposure, although 12% experienced media exposure as stressful and 12% reported that it had been involuntary. Finally, the survivors indicated higher confidence and trust in Swedish radio and TV as compared to the Swedish authorities, and the participants' level of trust in the media was associated with their perceptions of journalists, r = 0.34, p < 0.001, and media coverage, r = 0.47, p < 0.001. Disaster survivors mainly agreed with emotionally neutral statements about interacting with the media, the performance of journalists on site, and their own media exposure. Nonetheless, a substantial minority found the encounters and exposure to be negative, and the results suggest a link between personal experiences or perceptions and trust in the media.

Trajectories of prolonged grief one to six years after a natural disaster.

BACKGROUND: The long-term trajectories of prolonged grief are poorly understood. The aims were to examine the course of grief among bereaved disaster survivors up to six years post loss and factors predicting worse bereavement outcome. A third aim was to explore differences in grief indicators between trajectories. METHODS: Bereaved Swedish tourists who survived the 2004 Indian Ocean tsunamis responded to surveys including the Inventory of Complicated Grief 1 to 6 years after the disaster. Latent growth mixture modeling was used to identify longitudinal trajectories of grief. Multinomial logistic regression analysis was used to examine predictors of class membership. RESULTS: Three trajectories were identified: resilient (41% of the sample), recovering (48%), and chronic (11%). The strongest predictor of chronic grief was the loss of one's child. When examining grief indicators, the chronic trajectory was characterized by not accepting the loss, while yearning was common in all trajectories. CONCLUSIONS: This study highlights the importance of considering how traumatically bereaved individuals can be affected by loss for several years after a disaster, especially after losing one's child. An inability to accept the loss, more so than yearning, appears to characterize bereaved survivors at risk of a chronic trajectory of grief.

A pilot study of user satisfaction and perceived helpfulness of the Swedish version of the mobile app PTSD Coach.

Background: There is a need for accessible interventions in the aftermath of traumatic events with documented efficacy for preventing or reducing negative mental health consequences. The PTSD Coach is a mobile app that has shown to be effective in reducing symptoms of posttraumatic stress (PTSS). Objective: The purpose of the current study was to evaluate the user satisfaction, perceived helpfulness and potential reductions of PTSS and symptoms of depression among participants using the Swedish version of the PTSD Coach. Method: This was an uncontrolled pre-test post-test open trial including participants recruited from the community via advertisement and from an ongoing observational study who had experienced a potentially traumatic event in the last five years. Participants had access to the Swedish PTSD Coach app for four weeks. Results: Eleven participants (mean age = 38.6, female = 8) completed the study. Nine of the participants met criteria for full or partial PTSD. Results from the PTSD Coach Survey indicated that participants found the app slightly to moderately helpful and were slightly to moderately satisfied with the app. Nominal but not statistically significant reductions of medium effect sizes in PTSS (PCL-5) and depression (PHQ-9) from pre- to post-assessment were found. In interviews, participants indicated that they found elements such as learning about PTSD, breathing exercises and monitoring symptoms helpful in managing symptoms. However, several participants indicated that they had not used the app as much as they had intended to. Participants also had suggestions for improvements such as enhanced app structure and better guidance regarding how to use the app. Conclusions: The perceived helpfulness and user satisfaction were slightly lower compared to research on the original version of the app. Experiences from the study are discussed and a future controlled study of the Swedish version of the PTSD Coach is suggested.

Antecedentes: Existe una necesidad por intervenciones accesibles en el periodo subsiguiente a los eventos traumáticos que presenten una eficacia documentada en prevenir o reducir las consecuencias negativas de salud mental. El entrenador TEPT (PTSD Coach en sus siglas en inglés) es una aplicación de teléfono celular que ha mostrado ser efectiva en reducir los síntomas de estrés postraumático (SEPT). Objetivo: El propósito del presente estudio fue evaluar la satisfacción del usuario, la utilidad percibida, y las potenciales reducciones de los SEPT y síntomas de depresión entre los participantes de una versión sueca del Entrenador TEPT. Método: Este fue un ensayo abierto no-controlado de evaluación pre y post-intervención, incluyendo participantes que fueron reclutados desde la comunidad usando anuncios y desde un estudio observacional en proceso con quienes han experimentado un evento potencialmente traumático en los últimos cinco años. Los participantes tuvieron acceso a la aplicación móvil Entrenador TEPT sueca durante 4 semanas. Resultados: 11 participantes (edad media = 38.6, mujeres = 8) completaron el estudio. Nueve de los participantes cumplieron los criterios completa o parcialmente para TEPT. Los resultados de la Encuesta de Entrenador TEPT indicó que los participantes encontraron que la aplicación móvil fue desde ligera a moderadamente útil y estuvieron desde ligera a moderadamente satisfechos con la aplicación. Reducciones significativas nominales, pero no estadísticamente significativas, y de efecto de tamaño mediano en TEPT (PCL-5) y depresión (PHQ-9) fueron encontradas desde pre a post-evaluación. En entrevistas, los participantes indicaron que encontraron que elementos tales como aprender sobre TEPT, ejercicios de respiración, y monitorear síntomas; fueron útiles en manejar los síntomas. Sin embargo, varios participantes indicaron que ellos no habían usado la aplicación tanto como ellos habían intentado hacerlo. Los participantes también tuvieron algunas sugerencias para realizar mejoras, tales como una estructura mejorada de la aplicación y mejor guía en cuanto a cómo usar la aplicación. Conclusiones: La utilidad percibida y la satisfacción del usuario fueron levemente más bajas en comparación a la investigación de la versión original de la aplicación. Las experiencias a partir de este estudio son discutidas, y un estudio controlado futuro de la versión sueca del Entrenador TEPT es sugerido.

Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study.

BACKGROUND: The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence). OBJECTIVE: To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints. DESIGN: Cross-sectional survey. PARTICIPANTS: Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG). METHODS: A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression. RESULTS: The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient. CONCLUSIONS: A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.

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.

Post-disaster psychosocial services across Europe: the TENTS project.

At present post-disaster activities and plans seem to vary widely. An adequate estimation of the availability of post-disaster psychosocial services across Europe is needed in order to compare them with recently developed evidence-informed psychosocial care guidelines. Here we report on the results of a cross-sectional web-based survey completed in 2008 by two hundred and eighty-six representatives of organizations involved in psychosocial responses to trauma and disaster from thirty-three different countries across Europe. The survey addressed planning and delivery of psychosocial care after disaster, methods of screening and diagnosis, types of interventions used, and other aspects of psychosocial care after trauma. The findings showed that planning and delivery of psychosocial care was inconsistent across Europe. Countries in East Europe seemed to have less central coordination of the post-disaster psychosocial response and fewer post-disaster guidelines that were integrated into specific disaster or contingency plans. Several forms of psychological debriefing, for which there is no evidence of efficacy to date, were still used in several areas particularly in North Europe. East European countries delivered evidence-based interventions for PTSD less frequently, whilst in South- and South-Eastern European countries anxiety suppressing medication such as benzodiazepines were prescribed more frequently to disaster victims than in other areas. Countries across Europe are currently providing sub-optimal psychosocial care for disaster victims. This short report shows that there is an urgent need for some countries to abandon non-effective interventions and others to develop more evidence based and effective services to facilitate the care of those involved in future disasters.

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.