For Tsunami Survivors, Higher Exposure to Trauma Delays Recovery

Study Shows Lingering Mental Health Effects for Tourists Affected by Indian Ocean Disaster

Newswise — Philadelphia, Pa. (April 14, 2011) – Follow-up on a group of Swedish tourists who survived the 2004 Indian Ocean tsunami shows slower psychological recovery for those exposed to more severe trauma, according to a report in The Journal of Nervous and Mental Disease. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"Exposure was associated with increased levels of post-traumatic stress reactions even three years after the disaster," according to a study led by Kerstin Bergh Johannesson, Ph.D., of Uppsala University Hospital. Recovery appears delayed for survivors more directly affected by the tsunami—especially those who lost a loved one in the disaster.

Study Tracks Course of Mental Health Recovery in Tsunami SurvivorsThe researchers monitored the mental health impact of trauma exposure in a group of nearly 3,500 Swedish survivors of the 2004 Indian Ocean tsunami. The disaster was one of the world's deadliest, causing nearly 230,000 deaths in 14 countries in South Asia and East Africa. Most of the survivors were vacationing in Southeast Asia at the time of the disaster.

Follow-up surveys showed "a general pattern of resilience and recovery" within the three years after the tsunami. The higher the degree of traumatic exposure, the slower the recovery. (Exposure ranged from "high" for those who were caught in the wave to "low" for those who were only indirectly affected.)

For example, a "resilient" recovery pattern was observed for 98 percent of subjects with low exposure, 91 percent with medium exposure, and 77 percent with high exposure. For those who lost a loved one in the tsunami, the rate of "resilient" recovery was just 52 percent.

Scores for psychological distress showed a similar pattern. After three years, scores indicating general mental health effects were seen in 28 percent of the high-exposure group and 43 percent of the bereaved group, compared to 20 percent of the medium-exposure group.

Other factors associated with slower recovery included female sex, lower education, previous psychiatric illness, and further traumatic experiences after the tsunami. Younger survivors were also more likely to show general mental health effects at follow-up.

As in previous studies, survivors with good social support had better recovery. The fact that the survivors were tourists, who returned to an "intact domestic society" unaffected by the disaster, was a unique feature of the study.

The study was coincidentally published at a time of continued rescue and recovery efforts after the devastating earthquake and tsunami in Japan. The results show a general pattern of recovery from the mental health impact over time in disaster survivors. However, recovery follows a predictably slower pattern for survivors more directly exposed to the traumatic event, and in those dealing with the death of a loved one.

Dr. Johannesson and co-authors conclude, "This study highlights the long-term negative effects of severe exposure and traumatic loss, which appear to slow down recovery." They believe their results may help in identifying and treating survivors at high risk of delayed recovery: "Identification of symptoms and subsequent support or trauma-focused psychotherapy might facilitate optimal recovery."

About The Journal of Nervous and Mental DiseaseFounded in 1874, The Journal of Nervous and Mental Disease is the world's oldest independent scientific monthly in the field of human behavior. Articles cover theory, etiology, therapy, social impact of illness, and research methods.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.5 billion ($4.7 billion).