The Impact of a Workplace Terrorist Attack on the Psychosocial Work Environment: A Longitudinal Study From Pre- to Post-disaster.

The psychosocial work environment is of great importance for regaining health and productivity after a workplace disaster. Still, there is a lack of knowledge about the impact of a disaster on the psychosocial work environment. The purpose of this study was to examine whether employees' perceptions of role clarity, role conflicts, and predictability in their work situation changed from before to after a workplace terrorist attack. We combined data from two prospective work environment surveys of employees in three governmental ministries that were the target of the 2011 Oslo terrorist attack. A first two-wave survey was conducted 4-5 years and 2-3 years before the attack, and a second three-wave survey took place 10 months, 2 years, and 3 years after the attack. Of 504 individuals who were employed at the time of the bombing, 220 were employed in both pre- and post-disaster periods, participated in both the first and the second survey, and consented to the linking of data from the two surveys. We found no significant changes in levels of role clarity, role conflict, and predictability from before to after the terrorist attack. Adjusting for sex, age and education had no effect on the results. The findings suggest that perceptions of the psychosocial working environment are likely to be maintained at previous levels in the aftermath of a workplace disaster. Considering the importance of the psychosocial work environment for regaining health and productivity, the findings are important for the preparation for, and management of, future crises.

Is perceived safety and threat after workplace terrorism linked to employee sick-leave? A registry-based longitudinal study of governmental employees in Norway.

BACKGROUND: A large body of research has shown that terrorism enhances fears and undermines perceived safety in a high proportion of both directly exposed individuals and individuals without any form of direct exposure (i.e. no geographical proximity to an attack). Some studies have further suggested that fear of terrorism may adversely affect health in those without direct exposure and that this may constitute an important public health burden because of the number who are indirectly exposed. Limited studies have investigated threat and safety perception after workplace terrorism and the possible consequences for employee health. OBJECTIVE: To explore whether perceived safety and threat in employees whose workplace was subjected to a terrorist attack are associated with subsequent sick-leave. METHOD: A longitudinal questionnaire survey on governmental employees' perceived safety and threat at work one (T1) and two (T2) years after the 2011 terrorist attack on the Norwegian ministries was linked to registry data on doctor-certified sick-leave for two 9-month periods following T1 and T2 (N = 1703). RESULTS: There was fairly strong evidence (0.004 < p < 0.034) that higher perceived safety was associated with a close to 30% reduction in sick-leave in fully adjusted models which included terror exposure and symptom-based PTSD. There was inconclusive evidence that lower perceived threat was associated with reduced sick-leave in the full models. CONCLUSIONS: Reduced perceived safety in employees following workplace terrorism may have adverse health consequences of public health significance given how prevalent this perception seems to be. The study supports that post-terrorism response plans should include strategies on how to address the potentially large number of individuals suffering ill health after terror even if they were not directly exposed and do not meet criteria for PTSD.

Antecedentes: Una gran cuerpo de investigación ha mostrado que el terrorismo incrementa el miedo y disminuye la percepción de seguridad en gran proporción tanto en individuos directamente expuestos como también en individuos sin ninguna forma de exposición directa (es decir, sin ninguna proximidad geográfica al ataque). Algunos estudios han sugerido que el miedo al terrorismo puede afectar en forma negativa la salud de aquellos sin exposición directa y que esto puede constituir una importante carga en la salud pública, debido al número de personas expuestas indirectamente. Un limitado número de estudios han investigado la percepción de amenaza y seguridad después de terrorismo en el lugar de trabajo y sus posibles consecuencias para la salud de los empleados.Objetivo: Explorar si es que la seguridad y amenaza percibida en empleados en los cuales su lugar de trabajo fue sujeto a un acto terrorista están asociadas con permiso de ausencia por enfermedad.Método: Se conectaron los resultados de un cuestionario longitudinal sobre la seguridad y amenaza percibida en empleados gubernamentales al primer (T1) y segundo (T2) año posterior al ataque terrorista de los ministerios noruegos del año 2011 con los datos registrados de permiso de ausencia por enfermedad certificados por un médico en dos períodos de nueve meses posteriores a T1 y T2 (N=1703)Resultados: Se encontró evidencia bastante fuerte (0.004< p < 0.034) que mayor seguridad percibida se asoció con una reducción cercana al 30 por ciento en permiso por enfermedad en modelos completamente ajustados que incluían exposición al terror y TEPT basado en síntomas. Hubo evidencia poco concluyente de que menos percepción de la amenaza fue asociada con disminución en permiso por enfermedad en los modelos completos.Conclusiones: La percepción reducida de seguridad en empleados posterior a terrorismo en el lugar de trabajo puede tener consecuencias de salud adversas de relevancia para la salud pública, debido a lo prevalente que es esta percepción. Este estudio apoya la tesis de que los planes de respuesta post-terrorista debiesen incluir estrategias sobre cómo lidiar con el número potencialmente grande de personas que sufren problemas de salud después del terror, incluso si no estuvieron expuestos directamente y no cumplen con los criterios para TEPT.

Effects of exposure to workplace terrorism on subsequent doctor certified sickness absence, and the modifying role of psychological and social work factors: a combined survey and register study.

BACKGROUND: Studies have shown that terrorist attacks affect the mental and physical health of persons exposed to terrorism. When terror strikes at the workplace where people spend much time, and should feel safe, the health consequences for those affected might be severe. The aim of the study was to determine whether psychological and social work factors moderates effects of exposure to a workplace terrorist attack on subsequent doctor-certified sickness absence. METHODS: The study design combined survey data with register data on sickness absence. Data on exposure to the attack, and psychosocial working conditions were collected by a web-based questionnaire 10 months after the attack. Survey data was linked to registry data on doctor-certified sickness absence over the one-year time period following baseline. The survey response rate was 56% (n = 1974), where 80.6% (1591) gave consent to link survey data to data on sickness absence. Exposure to the attack was assessed as "Directly-", or "Indirectly exposed". Psychological and social work factors were measured by the General Questionnaire for Psychological and Social factors at Work (QPSNordic). Data were analyzed with negative binominal hurdle regressions. RESULTS: Direct exposure to the attack increased the odds of becoming sick-listed if role clarity was average (OR = 1.50) or high (OR = 2.13), but not if low (OR = 1.17). Direct exposure was associated with higher sickness absence rates if control over work pace was low (RR = 1.61). Role conflict, support from co-workers, and -superior showed weaker evidence of moderating effects of exposure on sickness absence. CONCLUSIONS: Exposure to the bomb explosion, as well as psychosocial working conditions affect the risk of employee sickness absence. Psychosocial working conditions seems to moderate effects of exposure to workplace terrorism on subsequent sickness absence. Organizations would benefit from striving for good psychological and social working conditions both as preventions against illness and sickness absence, and as measures in the aftermath of a workplace terrorist attack.

Employee safety perception following workplace terrorism: a longitudinal study.

Terrorism at the workplace represents an extreme form of workplace violence potentially affecting large numbers of individuals. Evidence suggests that workplace violence adversely affects employees' health and work functioning by increasing perceived threat and decreasing perceived safety. The objective of this study was to explore longitudinal associations between perceived safety at work among employees exposed to a workplace terrorist attack and their views on security measures and emergency preparedness. The study comprised a three-wave follow-up of earlier cross-sectional studies on perceived safety at work in ministerial employees exposed to a terrorist attack in Oslo, Norway, in 2011 (N = 3065). Linear mixed-effects modelling was used to explore how perceived safety at work was associated with employees' perceptions on the prioritization of security measures at work, their knowledge of evacuation procedures, and the extent of escape and evacuation training. The more employees believed security measures were sufficiently prioritized at work and the better their knowledge of evacuation procedures, the higher they rated perceived safety at work. These findings applied both across employees (between-subject effects) and within employees across time (within-subject effects). Employees' views on the extent of escape and evacuation training were not strongly associated with perceived safety at work. Secondary analysis showed that post-traumatic stress reactions were negatively associated with perceived safety at work, and that the positive association between knowledge of evacuation procedures and perceived safety at work was weaker in women and more educated employees. In conclusion, following terrorism at the workplace, employees' perceived safety at work might be increased if employers prioritize security measures and provide good information on evacuation procedures. For employees with high levels of post-traumatic stress reactions, adequate treatment of these reactions will be likely to lead to enhanced perceived safety at work.

Antecedentes: El terrorismo en el lugar de trabajo representa una forma extrema de violencia en el lugar de trabajo y puede, potencialmente, afectar a un gran número de personas. La evidencia sugiere que la violencia en el lugar de trabajo afecta negativamente la salud y el funcionamiento laboral de los empleados al aumentar la amenaza percibida y disminuir la seguridad percibida.Objetivo: Explorar las asociaciones longitudinales entre la seguridad percibida en el trabajo de los empleados expuestos a un ataque terrorista en el lugar de trabajo y sus puntos de vista sobre las medidas de seguridad y la preparación para emergencias.Método: Seguimiento de tres momentos de estudios transversales anteriores sobre la seguridad percibida en el trabajo en empleados ministeriales expuestos a un ataque terrorista en Oslo, Noruega, 2011 (N = 3065). El modelado lineal de efectos mixtos se utilizó para explorar cómo la seguridad percibida en el trabajo estaba asociada con las percepciones de los empleados sobre (i) la priorización de las medidas de seguridad en el trabajo; (ii) sus conocimientos de los procedimientos de evacuación; y (iii) el grado de entrenamiento de escape y evacuación.Resultados: Cuanto más los empleados creyeron que las medidas de seguridad se priorizaron suficientemente en el trabajo y cuanto mejor conocían los procedimientos de evacuación, más alto calificaban la seguridad percibida en el trabajo. Estos hallazgos se aplicaron tanto entre los empleados (efectos entre sujetos) como dentro de los mismos empleados a lo largo del tiempo (efectos dentro del sujeto). Los puntos de vista de los empleados sobre el alcance del entrenamiento de escape y evacuación no estaban fuertemente asociados con la percepción de seguridad en el trabajo. El análisis secundario mostró que las reacciones de estrés postraumático se asociaron negativamente con la percepción de seguridad en el trabajo, y que la asociación positiva entre el conocimiento de los procedimientos de evacuación y la seguridad percibida en el trabajo fue más débil en las mujeres y los empleados con más educación.Conclusión: Tras el terrorismo en el lugar de trabajo, la seguridad percibida de los empleados en el trabajo podría aumentar si los empleadores priorizan las medidas de seguridad y aseguran buena información sobre los procedimientos de evacuación. Para empleados con altos niveles de reacciones de estrés postraumático, el tratamiento adecuado de estas reacciones probablemente conducirá a una mayor seguridad percibida en el trabajo.

Sick leave before and after a work-place targeted terror attack.

OBJECTIVES: To estimate the rate of sick leave and sick leave diagnosis among employees before and after a work-place targeted terror attack, and to compare sick leave in subgroups of employees based on gender and trauma exposure. METHODS: Data on sick leave and diagnosis in ministerial employees from the period 3 years before to 3 years after the 2011 bombing in the governmental district of Oslo was retrieved from the Norwegian Social Insurance Administration Registries. RESULTS: Prior to the attack, sick leave was twice as high in women as in men. Compared to the period prior to the attack, sick leave increased the first year after the attack, for both women and men that were directly exposed to the event. Sick leave stabilized to the initial level 3 years after the incident. For indirectly exposed employees, i.e., those who were not present at the site of the attack, there was no significant increase in sick leave from before to after the attack. There were no statistical significant changes in diagnoses applied before and after the terrorist attack. However, there was a tendency towards an increase in sick leave due to psychological diagnoses among the directly exposed women. CONCLUSIONS: After a work-place terrorist attack a transient increase in sick leave may occur among employees who were present at the site of the attack. The increase may seem relatively modest and last for 1-3 years.

Prevalence and Course of Symptom-Defined PTSD in Individuals Directly or Indirectly Exposed to Terror: A Longitudinal Study.

OBJECTIVE: It is well established that direct exposure to terrorism can result in posttraumatic stress disorder (PTSD). However, individuals indirectly exposed to terrorism may also develop symptoms of PTSD. This study examined the prevalence and course of symptom-defined PTSD in employees who were present and not present at the site of a workplace terror attack. METHODS: Survey data from ministerial employees were collected 10, 22, and 34 months after the 2011 bombing in the government district of Oslo. A total of 3,520 employees were initially invited to the study. Response rates of eligible participants were 56% (N = 1,974) at T1, 55% (N = 1,780) at T2, and 54% (N = 1,578) at T3. PTSD was measured using the Post-traumatic Stress Disorder Checklist-Specific (PCL-S). Symptom-defined PTSD was specified as meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), B, C, and D criteria. RESULTS: Our findings showed a low and declining prevalence of symptom-defined PTSD in employees indirectly exposed to a workplace terror attack (4%, 3%, and 2% at the three respective times). In employees present at the site of the explosion, PTSD was six- to eightfold more prevalent (24%, 17%, and 17%). CONCLUSIONS: Individuals indirectly exposed to terrorism may develop long-lasting posttraumatic stress reactions fulfilling PTSD symptom criteria. Due to the large number of individuals that may be indirectly exposed to terrorism, even a low risk of PTSD may result in high numbers of individuals with substantial posttraumatic stress. Our findings have implications for the planning and implementation of health care services beyond those directly exposed after large-scale terror events.

Like a bridge over troubled water? A longitudinal study of general social support, colleague support, and leader support as recovery factors after a traumatic event.

Background: Whereas the association between social support and psychological distress has been well-established through both cross-sectional and longitudinal studies, less is known about whether social support influences rate of change in psychological distress over time. Nor is it clear whether social support predicts baseline psychological distress, or, more importantly, whether social support may contribute to more rapid recovery following trauma exposure. Objective: This study aimed to determine the extent to which social support contributed to the recovery process among individuals with psychological distress after being exposed to trauma. Methods: Prospective survey data from ministry employees were collected 10, 22, and 34 months after the 2011 Oslo bombing that targeted the governmental quarters. We explored recovery in a clinical subsample (N = 238) of individuals with elevated levels of psychological distress (defined as mean 10-item Hopkins symptom checklist score > 1.85) one year after the event. A linear latent growth curve of psychological distress with general social support from friends and family, colleague support, and leader support as predictors was examined. Results: High levels of general social support and leader support were independently associated with a more rapid decline in psychological distress over time. Conclusions: General social support, as well as support from a leader in one's working life, may facilitate recovery from psychological distress after exposure to a traumatic event. Enhancing social support from family and friends, as well as in work settings, may benefit those with psychological distress following a traumatic workplace event.

Victimization from workplace bullying after a traumatic event: time-lagged relationships with symptoms of posttraumatic stress.

OBJECTIVE: This study examined relationships between victimization from bullying and symptoms of posttraumatic stress (PTSS) after exposure to a terror attack at the workplace. It was hypothesized that (1) victims of bullying report higher and more stable levels of PTSS over time compared to their non-bullied colleagues and (2) that PTSS provides an increased risk of subsequent victimization from bullying. METHODS: The hypotheses were tested in a two-wave prospective sample comprising 2337 employees from Norwegian governmental ministries who were exposed to the 2011 Oslo terror attack. The two waves of data collection were conducted 10 and 22 months after the terror attack. RESULTS: Hypothesis 1 was partially supported: victims of bullying reported significantly higher levels of PTSS than non-bullied employees at both measurement points, but bullying was not related to the stability in PTSS over time. In support of hypothesis 2, PTSS at 10 months was significantly associated with an increased risk of feeling victimized by bullying 1 year later. CONCLUSIONS: The results indicate that victimization from bullying is associated with elevated levels of PTSS in the aftermath of a workplace terror attack, but that bullying does not have any impact on the long-term development of PTSS. PTSS may be a potential antecedent of bullying. These findings suggest that organizations must give high priority to the psychosocial work environment of traumatized employees to prevent further detrimental health consequences.

For Whom Does Time Heal Wounds? Individual Differences in Stability and Change in Posttraumatic Stress After the 2011 Oslo Bombing.

Prospective studies describing and predicting individual differences in the course of posttraumatic stress symptoms (PTSS) after disasters are scarce. The present study aimed to describe and predict individual differences in both the level and the rate of change in PTSS after the 2011 Oslo bombing, a terrorist attack directed at the Norwegian government. Survey data from ministerial employees (N = 256) were collected 10, 22, and 34 months after the bombing. We used latent growth modeling to examine the development of PTSS, and to identify the strength of predictor variables. High exposure, female sex, and high levels of neuroticism were associated with higher levels of PTSS 10 months after the traumatic event (ß ranged from .25 to .30, p < .001), whereas social support was associated with lower levels of PTSS (ß = -.30, p < .001). The combination of being female and high in neuroticism was associated with a faster decline in PTSS (ß range: -.20 to -.39, p = .010 < .05). High exposure seemed to have a lasting influence by maintaining high levels of PTSS. Our findings suggested that being female, being highly exposed, and having low levels of social support were risk markers for enduring PTSS.

Visually impaired individuals, safety perceptions and traumatic events: a qualitative study of hazards, reactions and coping.

PURPOSE: To explore the types of risks and hazards that visually impaired individuals face, how they manage potential threats and how reactions to traumatic events are manifested and coped with. METHOD: Participants were 17 visually impaired individuals who had experienced some kind of potentially traumatic event. Two focus groups and 13 individual interviews were conducted. RESULTS: The participants experienced a variety of hazards and potential threats in their daily life. Fear of daily accidents was more pronounced than fear of disasters. Some participants reported avoiding help-seeking in unsafe situations due to shame at not being able to cope. The ability to be independent was highlighted. Traumatic events were re-experienced through a variety of sense modalities. Fear of labelling and avoidance of potential risks were recurring topics, and the risks of social withdrawal and isolation were addressed. CONCLUSIONS: Visual impairment causes a need for predictability and adequate information to increase and prepare for coping and self-efficacy. The results from this study call for greater emphasis on universal design in order to ensure safety and predictability. Fear of being labelled may inhibit people from using assistive devices and adequate coping strategies and seeking professional help in the aftermath of a trauma. Implications for Rehabilitation Visual impairment entails a greater susceptibility to a variety of hazards and potential threats in daily life. This calls for a greater emphasis on universal design in public spaces to ensure confidence and safety. Visual impairment implies a need for predictability and adequate information to prepare for coping and self-efficacy. Rehabilitation professionals should be aware of the need for independence and self-reliance, the possible fear of labelling, avoidance of help-seeking or reluctance to use assistive devices. In rehabilitation after accidents or potential traumatizing events, professionals' knowledge about the needs for information, training and predictability is crucial. The possibility of social withdrawal or isolation should be considered.

Long-term relationships between perceived social support and posttraumatic stress after the 2011 Oslo bombing: A three-year longitudinal study.

BACKGROUND: After traumatic events, social support and posttraumatic stress are interrelated, but little is known about the underlying dynamics behind this association. Levels of social support and posttraumatic stress may change and affect each other over time, but there are also stable time-invariant individual differences in both constructs. The present study aimed to determine the amount of variance explained by stable individual differences in levels of social support and posttraumatic stress across three years, and to determine whether and to what extent social support and posttraumatic stress may affect one another when these stable individual differences are controlled for. METHODS: We used data from ministerial employees present in the Governmental district during the 2011 Oslo bombing attack (N=255). Data was collected ten months, two years, and three years after the terror attack. Using a random intercept cross lagged panel model (RI-CLPM), we tested the possible directional effects between social support and posttraumatic stress within persons when variance between persons was taken into account. RESULTS: The intraclass correlations of the three measures of posttraumatic stress and social support were.83 and.74, respectively. The remaining variation within persons could not be explained by change in either of these constructs. LIMITATION: We have no information on the processes that might have occurred before 10 months after the incident. CONCLUSIONS: Our findings indicate that the long-term longitudinal linkage between social support and posttraumatic stress may be best explained by stable individual differences rather than causal processes operating within persons.

Effort-Reward Imbalance and Post-Traumatic Stress After a Workplace Terror Attack.

OBJECTIVE: Following adverse work conditions, health consequences can be explained by an imbalance between the effort made and the reward received. We investigated the association between extra effort, perceived reward, and post-traumatic stress disorder (PTSD). The Effort-Reward Imbalance Model was used to examine whether extra effort at work in the aftermath of a workplace-related terrorist attack affected the risk of PTSD and the effects of reward for extra effort from a leader or colleagues. METHODS: Cross-sectional data were collected 10 months after a terrorist attack in Norway in 2011. Out of 3520 Ministry employees invited, 1927 agreed to participate. Employees reported any extra effort performed as a result of the bomb explosion and any reward received from a leader or colleagues. PTSD was assessed with the PTSD Checklist. RESULTS: Employees who reported extra effort displayed increased risk for PTSD (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.15-2.55, P=0.008). Perceived reward for extra effort from a leader was associated with lower risk for PTSD (OR=0.39, 95% CI: 0.23-0.64, P<0.001) but not perceived reward from colleagues. CONCLUSIONS: Extra effort may increase the risk of PTSD, but reward from a leader may mitigate this effect. The Effort-Reward Imbalance Model appears to be an appropriate approach that may contribute to understanding of the etiology of work-related PTSD.

Posttraumatic growth and centrality of event: A longitudinal study in the aftermath of the 2011 Oslo bombing.

Previous studies have reported that construing a traumatic event as central to one's life story and identity are associated with posttraumatic growth (PTG). Due to cross-sectional designs, these studies provide only weak evidence of a causal relationship between event centrality and PTG. The main aim in the present study is to examine the longitudinal associations and directionality between centrality of event and PTG in ministerial employees who were present at work during the 2011 Oslo bombing attack (N = 229). By applying a cross-lagged autoregressive model, the present study investigates both stability across time, possible time-lagged effects, and the relationship between centrality of event and PTG at 1 and 2 years after the bombing. The results showed that levels of centrality of event and PTG were stable across time. There was a significant association between centrality of event and PTG both 1 and 2 years after the bombing; however, this relationship attenuated over time. No time-lagged effects in either direction were found. The present findings are in line with previous findings indicating that centrality of a traumatic event is related to PTG. However, the present longitudinal data do not support a hypothesis about a long-term causal effect of event centrality on PTG. Rather, the relationship between centrality of event and PTG are concurrent, and attenuates with time.

Posttraumatic growth, posttraumatic stress and psychological adjustment in the aftermath of the 2011 Oslo bombing attack.

BACKGROUND: Experiencing potentially traumatic events is associated with psychological distress. However, some survivors also experience positive personal and psychological changes in the aftermath of trauma. METHODS: The present study investigated perceived posttraumatic growth in 197 ministerial employees who were present at work during the 2011 Oslo bombing attack. The relationships between trauma-exposure, peritraumatic reactions and posttraumatic growth were studied. Moreover, the adaptive significance of posttraumatic growth was addressed. RESULTS: The results showed that higher levels of trauma-exposure and immediate reactions were significantly related to perceived posttraumatic growth. No support for an adaptive significance of posttraumatic growth was found. On the contrary, posttraumatic growth was associated with higher symptom levels of posttraumatic stress. After adjusting for posttraumatic stress symptoms no association was found between perceived growth and work and social adjustment. However, perceived growth was associated with higher levels of life satisfaction. CONCLUSION: The present results are in line with previous findings indicating that perceived growth may be unrelated to psychological adjustment, and suggest that the concept and significance of posttraumatic growth should be interpreted with caution.