Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-28T05:03:29.673Z Has data issue: false hasContentIssue false
  • English
  • Français

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: [email protected])
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaronson, NK, Muller, M, Cohen, PD, Essink-Bot, ML, Fekkes, M, Sanderman, R, Sprangers, MA, te Velde, A, Verrips, E (1998). Translation, validation, and norming of the Dutch language version of the SF-36 health survey in community and chronic disease populations. Clinical Epidemiology 51, 1055–1068.CrossRefGoogle ScholarPubMed
Aggarwal, VR, McBeth, J, Zakrzewska, JM, Lunt, M, Macfarlane, GJ (2006). The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? International Journal of Epidemiology 35, 468–476.CrossRefGoogle ScholarPubMed
Arrindell, WA, Ettema, JHM (1986). SCL-90: Manual for a Multidimensional Psychopathology Indicator [in Dutch]. Swets & Zeitlinger: Lisse, The Netherlands.Google Scholar
Candy, B, Chalder, T, Cleare, AJ, Peakman, A, Skowera, A, Wessely, S, Weinman, J, Zuckerman, M, Hotopf, M (2003). Predictors of fatigue following the onset of infectious mononucleosis. Psychological Medicine 33, 847–855.CrossRefGoogle ScholarPubMed
Derogatis, LR, Lipman, RS, Covi, L (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin 9, 13–28.Google ScholarPubMed
Donker, GA, Yzermans, CJ, Spreeuwenberg, P, van der Zee, J (2002). Symptom attribution after a plan crash: comparison between self-reported symptoms and GP record. British Journal of General Practice 52, 917–922.Google Scholar
Engel, CC (2003). Somatization and multiple idiopathic physical symptoms: relationship to traumatic events and posttraumatic stress disorder. In Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress (ed. Schnurr, P. P. and Green, B. L.), pp. 191–215. American Psychological Association: Washington, DC.Google Scholar
Escobar, JI, Canino, G, Rubio-Stipec, M, Bravo, M (1992). Somatic symptoms alter a natural disaster: a prospective study. American Journal of Psychiatry 149, 965–967.Google Scholar
Escobar, JI, Hoyos-Nervi, C, Gara, H (2002). Medically unexplained physical symptoms in medical practice: a psychiatric perspective. Environmental Health Perspectives 110, 631–636.CrossRefGoogle ScholarPubMed
Feder, A, Olfson, M, Gameroff, M, Fuentes, M, Shea, S, Lantigua, RA, Weissman, MM (2001). Medically unexplained symptoms in urban general medicine practice. Psychosomatics 43, 261–268.CrossRefGoogle Scholar
Gray, GC, Reed, RJ, Kaiser, KS, Smith, TC, Gastanaga, VM (2002). Self-reported symptoms and medical conditions among 11868 Gulf War-era veterans: The Seabee Health Study. American Journal of Epidemiology 155, 1033–1044.CrossRefGoogle Scholar
Green, LA, Fryer, GE, Yawn, BP, Lanier, D, Dovey, SM (2001). The ecology of medical care revisited. New England Journal of Medicine 344, 2021–2025.CrossRefGoogle ScholarPubMed
Grievink, L, van der Velden, PG, Stellato, RK, Dusseldorp, A, Gersons, BPR, Kleber, RJ, Lebret, E (2007). A longitudinal comparative study of the physical and mental health problems of affected residents of the firework disaster Enschede, the Netherlands. Public Health 121, 367–374.CrossRefGoogle ScholarPubMed
Grievink, L, van der Velden, PG, Yzermans, CJ, Roorda, J, Stellato, RK (2006). The importance of estimating selection bias on prevalence estimates shortly after a disaster. Annals of Epidemiology 16, 782–788.CrossRefGoogle ScholarPubMed
Hassett, AL, Sigal, LH (2002). Unforeseen consequences of terrorism: medically unexplained symptoms in time of fear. Archives of Internal Medicine 162, 1809–1813.CrossRefGoogle ScholarPubMed
Hatcher, S, House, A (2003). Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study. Psychological Medicine 33, 1185–1192.CrossRefGoogle ScholarPubMed
Haug, TT, Mykletun, A, Dahl, AA (2004). The association between anxiety, depression and somatic symptoms in a large population: the HUNT-II study. Psychosomatic Medicine 66, 845–851.CrossRefGoogle Scholar
Hiller, W, Rief, W, Brahler, E (2006). Somatization in the population: from mild bodily misperceptions to disabling symptoms. Social Psychiatry and Psychiatric Epidemiology 41, 704–712.CrossRefGoogle ScholarPubMed
Horowitz, MJ, Wilner, N, Alvarez, W (1979). The impact of event scale: a measure of subjective stress. Psychosomatic Medicine 41, 209–218.CrossRefGoogle Scholar
Hotopf, M, David, A, Hull, L, Nikalaou, V, Unwin, C, Wessely, S (2004). Risk factors for continued illness among Gulf War veterans: a cohort study. Psychological Medicine 34, 747–754.CrossRefGoogle ScholarPubMed
Hotopf, M, Mayou, R, Wadsworth, M, Wessely, S (1999). Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study. American Journal of Psychiatry 156, 1796–1800.CrossRefGoogle ScholarPubMed
Katon, WJ, Walker, EA (1998). Medically unexplained symptoms in primary care. Journal of Clinical Psychiatry 59, 15–21.Google ScholarPubMed
Kroenke, K, Price, RK (1993). Symptoms in the community: prevalence, classification and psychiatric comorbidity. Archives of Internal Medicine 153, 2474–2480.CrossRefGoogle ScholarPubMed
Lazzeroni, LG, Schenker, N, Taylor, JMG (1990). Robustness of multiple imputation techniques to model misspecification. Proceedings of the Survey Research Methods, pp. 260–265.Google Scholar
Marmar, CR, Weiss, DS, Metzler, TJ (1997). The peritraumatic dissociation experiences questionnaire. In Assessing Psychological Trauma and PTSD (ed. Wilson, J. P. and Keane, T. M.), pp. 412–428. Guilford Press: New York.Google Scholar
Mayou, R, Farmer, A. (2002). Functional somatic symptoms and syndromes. British Medical Journal 325, 265–268.CrossRefGoogle ScholarPubMed
Meijman, TF, de Vries-Griever, AHG, de Vries, G, Kampman, R (1985). The Construction and Evaluation of a One-dimensional Scale Measuring Subjective Sleep Quality. State University Groningen: Groningen.Google Scholar
Mooren, T, Kleber, RJ (2001). The Impact of War: Studies on the Psychological Consequences of War and Migration. Eburon: Delft.Google Scholar
Norris, RL, Maguen, S, Litz, BT, Adler, AB, Britt, TW (2005). Physical health symptoms in peacekeepers: has the role of deployment stress been overrated? Stress, Trauma, and Crisis 8, 1–15.Google Scholar
Petersen, I, Thomas, JM, Hamilton, WT, White, PD (2006). Risk and predictors of fatigue after infectious mononucleosis in a large primary-care cohort. Quarterly Journal of Medicine 99, 49–55.CrossRefGoogle Scholar
Roorda, J, Van Stiphout, WA, Huijsman-Rubingh, RRR (2004). Post-disaster health effects: strategies for investigation and data collection. Experiences from the Enschede firework disaster. Journal of Epidemiology and Community Health 58, 982–987.CrossRefGoogle ScholarPubMed
Rubin, DB (1987). Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons: New York.CrossRefGoogle Scholar
Schafer, JL, Graham, JW (2002). Missing data: our view of the state of the art. Psychological Methods 7, 147–177.CrossRefGoogle ScholarPubMed
Scheier, MF, Carver, CS, Bridges, MW (1994). Distinguishing optimism from neuroticism and trait anxiety, self-mastery and self-esteem: a re-evaluation of the life orientation test. Journal of Personality and Social Psychology 67, 1063–1078.CrossRefGoogle Scholar
Schnurr, PP, Green, BL (2003). Understanding relationships among trauma, posttraumatic stress disorder, and health outcomes. In Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress (ed. Schnurr, P. P. and Green, B. L.), pp. 247–275. American Psychological Association: Washington, DC.Google Scholar
Singer, JD, Willett, JB (2003). Applied Longitudinal Data Analysis. Modeling Change and Event Occurrence. Oxford University Press: New York.CrossRefGoogle Scholar
Terheggen, MA, Stroebe, MS, Kleber, RJ (2001). Western conceptualizations and Eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India. Journal of Traumatic Stress 14, 391–403.CrossRefGoogle ScholarPubMed
Thomas, HV, Stimpson, NJ, Weightman, AL, Dustan, F, Lewis, G (2006). Systematic review of multi-symptom conditions in Gulf War veterans. Psychological Medicine 36, 735–747.CrossRefGoogle ScholarPubMed
Unwin, C, Blatchley, N, Coker, W, Ferry, S, Hotopf, M, Hull, L, Ismail, K, Palmer, I, David, A, Wessely, S (1999). Health of UK servicemen who served in the Persian Gulf War. Lancet 353, 169–178.CrossRefGoogle ScholarPubMed
Van den Berg, B, Grievink, L, Stellato, RK, Yzermans, CJ, Lebret, E (2005 b). Symptoms and related functioning in a traumatized community. Archives of Internal Medicine 165, 2402–2407.CrossRefGoogle Scholar
Van den Berg, B, Grievink, L, Yzermans, CJ, Lebret, E (2005 a). Medically unexplained physical symptoms in the aftermath of disasters. Epidemiologic Reviews 27, 92–106.CrossRefGoogle ScholarPubMed
Van den Berg, B, van der Velden, P, Stellato, R, Grievink, L (2007). Selective attrition and bias in a longitudinal health survey among survivors of a disaster. BMC Medical Research Methodology 7, 8.CrossRefGoogle Scholar
Van der Ploeg, E, Mooren, TT, Kleber, RJ, van der Velden, PG, Brom, D (2004). Construct validation of the Dutch version of the impact of event scale. Psychological Assessment 16, 16–26.CrossRefGoogle ScholarPubMed
Van der Ploeg, HM, Defares, PB, Spielberger, CK (1982). Manual of the State Anxiety Inventory [in Dutch]. Swets & Zeitlinger: Lisse.Google Scholar
Van der Velden, PG, Kleber, RJ, Christiaanse, B, Gersons, BP, Marcelissen, FG, Drogendijk, AN, Grievink, L, Olff, M, Meewisse, ML (2006). The independent predictive value of peritraumatic dissociation of post-disaster intrusions, avoidance reactions and PTSD symptom severity: a four-year prospective study. Journal of Traumatic Stress 19, 493–506.CrossRefGoogle Scholar
Van der Zee, KI, Sanderman, R (1993). Measuring General Health with the RAND-36: A Manual [in Dutch]. Noordelijk Centrum voor Gezondheidsvraagstukken: Groningen.Google Scholar
Van Kamp, I, van der Velden, PG, Stellato, RK, Roorda, J, van Loon, J, Kleber, RJ, Gersons, BB, Lebret, E. (2006). Physical and mental health shortly after a disaster: first results from the Enschede firework disaster study. European Journal of Public Health 16, 252–258.CrossRefGoogle ScholarPubMed
Van Sonderen, E (1993). Measuring Social Support with the Social Support Questionnaire – Interaction (SSL-I) and the Social Support Questionnaire – Discrepancies (SSL-D) [in Dutch]. Noordelijke Centrum voor Gezondheidsvraagstukken: Groningen.Google Scholar
Van Sonsbeek, LJA (1990). The VOEG: A List of Subjective Health Complaints (Statistical Reports M37) [in Dutch]. Dutch Office for Statistics: Heerlen/The Hague.Google Scholar
Wolfe, J, Proctor, SP, Davis, JD, Borgos, MS, Friedman, MJ (1998). Health symptoms reported by Persian Gulf War veterans two years after return. American Journal of Industrial Medicine 33, 104–113.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Yzermans, CJ, Donker, GA, Kerssens, JJ, Dirkzwager, AJ, Soeteman, RJ, ten Veen, PM (2005). Health problems of victims before and after disaster: a longitudinal study in general practice. International Journal of Epidemiology 34, 820–826.CrossRefGoogle ScholarPubMed