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Risk factors for physical symptoms after a disaster: a longitudinal study

Published online by Cambridge University Press:  25 September 2007

B. van den Berg ,
L. Grievink ,
P. G. van der Velden ,
C. J. Yzermans ,
R. K. Stellato ,
E. Lebret  and
B. Brunekreef
B. van den Berg*
Affiliation:
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
L. Grievink
Affiliation:
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
P. G. van der Velden
Affiliation:
Institute for Psychotrauma (IvP), Zaltbommel, The Netherlands
C. J. Yzermans
Affiliation:
Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
R. K. Stellato
Affiliation:
Centre for Biostatistics, Utrecht University, Utrecht, The Netherlands
E. Lebret
Affiliation:
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
B. Brunekreef
Affiliation:
Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands Julius Centre, Utrecht University, Utrecht, the Netherlands
*
*Address for correspondence: B. van den Berg, M.A., National Institute for Public Health and the Environment (RIVM), PO Box 1 (postbox 10), 3720 BA Bilthoven, The Netherlands. (Email: bellis.van.den.berg@rivm.nl)
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Abstract

Background

Although symptoms such as fatigue, headache and pain in bones and muscles are common after disasters, risk factors for these symptoms among disaster survivors have rarely been studied. We examined predisposing, precipitating and perpetuating factors for these physical symptoms among survivors of a man-made disaster. In addition, we examined whether risk factors for physical symptoms differ between survivors and controls.

Method

Survivors completed a questionnaire 3 weeks (n=1567), 18 months and 4 years after the disaster. Symptoms and risk factors were measured using validated questionnaires. A comparison group was included at waves 2 and 3 (n=821). Random coefficient analysis (RCA) was used to study risk factors for symptoms.

Results

Female gender [beta (β)=1.0, 95% confidence interval (CI) 0.6–1.4], immigrant status (β=1.0, 95% CI 0.6–1.4) and pre-disaster psychological problems (β=0.8, 95% CI 0.1–1.4) were predisposing factors for symptoms. Although disaster-related factors were predictors, the relationship between symptoms and disaster-related factors was not very strong and the magnitude of this association was reduced when perpetuating factors were added. Intrusions and avoidance, depression, anxiety and sleeping problems were important perpetuating factors for physical symptoms among survivors and mediated the association between traumatic stress and physical symptoms. Risk factors for symptoms were comparable between survivors and controls.

Conclusions

The results indicate that health-care workers should be alert for physical symptoms among female survivors, immigrant survivors and individuals with a high level of psychological problems both before and after a disaster.

Keywords

Disasterlongitudinal studiesphysical symptomspsychological problemsrisk factors
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 4 , April 2008 , pp. 499 - 510
Copyright
Copyright © Cambridge University Press 2007

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