title: Tsunami-affected Scandinavian tourists: disaster exposure and post-traumatic stress symptoms.
abstract: BACKGROUND
  Studies of short- and long-term mental effects of natural disasters have reported a high prevalence of post-traumatic stress. Less is known about disaster-exposed tourists repatriated to stable societies.
  
  
  OBJECTIVE
  To examine the association between exposure to the 2004 Southeast Asian tsunami and symptoms of post-traumatic stress in three Scandinavian tourist populations.
  
  
  METHODS
  Postal survey of Norwegian, Danish and Swedish Southeast Asia tourists registered by the police when arriving at national airports. Follow-up time was 6 (Norway), 10 (Denmark) and 14 months (Sweden) post-disaster; 6772 individuals were included and categorized according to disaster exposure: danger exposed (caught or chased by the waves), non-danger exposed (other disaster-related stressors) and non-exposed. Outcome measures were the Impact of Event Scale-Revised (IES-R) and Post Traumatic Stress Disorder Check List (PCL).
  
  
  RESULTS
  Danger exposed reported more post-traumatic stress than non-danger exposed, and the latter reported more symptoms than non-exposed (each P<0.001). Comparison of the Norwegian and Swedish data suggested that symptoms were attenuated at 14 months follow-up (P<0.001). Female gender and low education, but not age, predicted higher levels of symptoms.
  
  
  CONCLUSIONS
  Disaster-exposed tourists repatriated to unaffected home environments show long-term post-traumatic stress disorder symptoms related to the severity of exposure.
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, Oslo, Norway. trond.heir@medisin.uio.no
authors.forename: Trond
authors.initials: T
authors.lastname: Heir
authors.forename: Susanne
authors.initials: S
authors.lastname: Rosendal
authors.forename: Kerstin
authors.initials: K
authors.lastname: Bergh-Johannesson
authors.forename: Per-Olof
authors.initials: PO
authors.lastname: Michel
authors.forename: Erik L
authors.initials: EL
authors.lastname: Mortensen
authors.forename: Lars
authors.initials: L
authors.lastname: Weisaeth
authors.forename: Henrik S
authors.initials: HS
authors.lastname: Andersen
authors.forename: Christina M
authors.initials: CM
authors.lastname: Hultman
mesh_terms: D000328:Adult; D001210:Asia, Southeastern; D004190:Disasters; D004522:Educational Status; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D012537:Scandinavian and Nordic Countries; D012720:Severity of Illness Index; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014187:Transportation of Patients; D014195:Travel / Q000523:psychology; D057192:Tsunamis