title: Health problems of victims before and after disaster: a longitudinal study in general practice.
abstract: BACKGROUND
  We aimed to quantify the health problems and to assess the possible risk factors for developing health problems in persons affected by the explosion of a firework depot at Enschede, The Netherlands, on May 13, 2000. The explosion considerably damaged buildings in the local neighbourhood and caused 22 immediate deaths and injuries in over 1000 people.
  
  
  METHODS
  A longitudinal study of (89% of all) victims (n = 9329) and controls (n = 7392) with pre-disaster baseline morbidity for 16 months and post-disaster data for 2.5 years was conducted using the electronic medical records of general practitioners. Symptoms and diagnoses were recorded using the International Classification of Primary Care (ICPC). Prevalence rates for clusters of symptoms were compared between victim and control groups pre- and post-disaster. Risk factors for developing health problems were examined in hierarchical linear models.
  
  
  RESULTS
  Two and a half years post-disaster, the prevalence of psychological problems in victims who had to relocate was about double and in the non-relocated victims one-third more than controls. Victims with pre-disaster psychological problems were at a greater risk for post-disaster psychological problems. Relocated victims showed an excess of medically unexplained physical symptoms (MUPS) especially in a period of increased media attention. Both groups of victims showed some increase of gastrointestinal (GI) morbidity 2.5 years post-disaster compared with their pre-disaster rate, and compared with the control group.
  
  
  CONCLUSIONS
  Two and a half years post-disaster an excess of psychological problems, MUPS, and gastrointestinal morbidity was observed. Pre-disaster psychological problems and inevitable relocation were predictors of more post-disaster psychological problems.
authors.affiliation: NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Kerssens
authors.forename: Anja J E
authors.initials: AJ
authors.lastname: Dirkzwager
authors.forename: Rik J H
authors.initials: RJ
authors.lastname: Soeteman
authors.forename: Petra M H
authors.initials: PM
authors.lastname: ten Veen
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005107:Explosions; D005194:Family Practice; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000523:psychology; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D017741:Survivors / Q000523:psychology