title: Symptoms and related functioning in a traumatized community.
abstract: BACKGROUND
  Traumatic events are described as precipitating factors for medically unexplained symptoms. The aim of this study was to examine the prevalence and course of symptoms reported by disaster survivors and to assess whether the symptoms have features similar to those of medically unexplained symptoms.
  
  
  METHODS
  A 3-wave longitudinal study was performed after an explosion of a fireworks depot. As a result of the explosion, 23 people were killed, more than 900 people were injured, and about 500 homes were damaged or destroyed. Respondents completed a set of validated questionnaires measuring their health problems 3 weeks (wave 1), 18 months (wave 2), and 4 years (wave 3) after the disaster. A comparison group was included at waves 2 and 3.
  
  
  RESULTS
  The study population included 815 survivors who participated in the 3 waves. The mean number of symptoms was higher among survivors compared with control subjects at wave 2 (7.5 vs 5.8 symptoms) and at wave 3 (6.1 vs 4.9 symptoms) (P < .001 for both). Survivors and control subjects with more symptoms reported significantly lower mean scores on all scales of the Dutch version of the RAND 36-item health survey. Illness behavior and depression and anxiety were associated with the number of symptoms. For example, more than 60% of survivors with 10 or more symptoms reported depression and anxiety, compared with 2.4% of survivors with 0 to 1 symptoms (P < .001).
  
  
  CONCLUSIONS
  Up to 4 years after the disaster, symptoms were more prevalent among survivors than controls. Although medical disorders cannot be excluded, the reported symptoms showed several features similar to those of medically unexplained symptoms in the general population.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, the Netherlands. bellis.van.den.berg@rivm.nl
authors.forename: Bellis
authors.initials: B
authors.lastname: van den Berg
authors.forename: Linda
authors.initials: L
authors.lastname: Grievink
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Stellato
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
authors.forename: Erik
authors.initials: E
authors.lastname: Lebret
mesh_terms: D001007:Anxiety / Q000453:epidemiology; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology; D005107:Explosions; D005390:Fires; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D009140:Musculoskeletal Diseases / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D018582:Sick Leave / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data*