Trauma and traumatic bereavement have well-known consequences for mental health, but little is known about long-term adjustment, particularly with respect to health-protective factors.

To assess the levels of anxiety/depression and perceived social support among the survivors and the bereaved 26 years after the Scandinavian Star ferry disaster compared with expected levels from the general population.

Anxiety/depression and social support were assessed in face-to-face interviews with the survivors and the bereaved (N = 165, response rate 58%). Expected scores were calculated for each participant based on the means and proportions for each age and gender combination from a general population sample. We computed the ratio between expected and observed scores, standardised mean differences with 95% confidence intervals and standardised effect sizes.

We found an elevated level of anxiety/depression symptoms in the victims (Mdiff = 0.28, 95% CI 0.18, 0.38; effect size 0.43, 95% CI 0.31, 0.55) and a significant excess of individuals with a clinically significant level of symptoms. The observed level of perceived social support was significantly lower than that expected (Mdiff = −0.57, 95% CI −0.70, −0.44; effect size −0.73, 95% CI −0.89, −0.57). This was the case for both survivors and those who were bereaved and for both men and women.

This study reveals that disaster survivors and the bereaved reported elevated levels of anxiety and depression symptoms 26 years after the event. They also reported a markedly reduced level of social support. Traumas and post-traumatic responses may thus cause lasting harm to interpersonal relationships.

None.

Although youths in many countries have been exposed to terrorism, few studies have examined early risk and protective factors for the subsequent development of mental health problems.

To investigate the levels of post-traumatic stress in survivors of the 2011 massacre on Ut⊘ya Island compared with the general population in Norway, and to identify predictive factors.

Four hundred and ninety survivors were invited to participate. Structured face-to-face interviews were performed 4–5 months after the attack.

There were 325 study participants (response rate 66%). Survivors had been highly exposed to danger and loss. Post-traumatic stress levels were more than six times higher in survivors than in the general population. Predictors were female gender, minority ethnic status, high level of trauma exposure, pain, the loss of someone close and social support.

Survivor characteristics that can be assessed in the early aftermath of a terrorist attack strongly predict the subsequent mental health problems of exposed youths. The highly elevated symptoms observed were largely attributable to the traumatic experience and reflect the mental health costs of the terrorist attack.