Symptom attribution and presentation in general practice after an extreme life event.
BACKGROUND
A serious life event is likely to shape attributions relating to symptoms experienced afterwards. While they may play an important role in prognosis and seeking care, such perceptions have hardly been studied among survivors of a disaster.


OBJECTIVE
To investigate the association between self-reported health problems that have been attributed to an extreme life event and the symptoms presented to GPs.


METHODS
A two-wave longitudinal survey (2-3 weeks and 18 months) among survivors of a fireworks disaster was combined with a continuous morbidity surveillance in general practice. Symptoms attributed to the disaster reported in an open-ended question in the two waves were analysed using descriptive statistics. Differences in presented symptoms over time were analysed using logistic multilevel analysis.


RESULTS
More than half of the respondents reported health problems, which were, in their opinion, related to the disaster. Psychological problems were most frequently reported in association with the disaster, and in contrast to physical attributed symptoms, presentation of these problems in general practice decreased over time. In the total sample, musculoskeletal symptoms were less frequently presented in the longer term. Survivors who attributed symptoms to the disaster at both waves or after 18 months only most often presented such symptoms to the GP.


CONCLUSIONS
Survivors attributed psychological problems and physical symptoms to the disaster at short-term and midterm post-disaster. Most of these survivors presented such symptoms to the GP. Attribution of symptoms to an extreme life event such as a disaster may therefore require special attention from the GP.
NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Iris
I
Nijrolder
Peter G
PG
van der Velden
Linda
L
Grievink
C Joris
CJ
Yzermans
D000328:Adult; D001294:Attitude to Health; D015984:Causality; D004190:Disasters; D005260:Female; D058006:General Practice; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D017741:Survivors / Q000523:psychology*