title: Physical symptoms 14 months after a natural disaster in individuals with or without injury are associated with different types of exposure.
abstract: OBJECTIVE
  To investigate whether different types of exposure to the 2004 tsunami were associated with physical symptoms 14 months after the disaster and to study correlations between survivors' physical and psychological symptoms.
  
  
  METHODS
  Using a cross-sectional design, 1505 survivors from the 2004 Indian Ocean Tsunami, tourists from Stockholm, who had been present in the disaster areas, responded to a postal questionnaire. Eight groups based on type of exposure were created. Physical symptoms occurring on a daily or weekly basis over the past year were investigated in four indices: musculoskeletal, cardiorespiratory, neurological, and gastrointestinal. Mental health symptoms (General Health Questionnaire-12) and posttraumatic stress symptoms (Impact of Event Scale-Revised) were also investigated. Multiple logistic regression analyses were conducted with controls for background variables and exposure, with physical symptoms as outcome variables. The association between physical and psychological symptoms was studied with the Spearman Rank Order Correlation.
  
  
  RESULTS
  Different types of exposure during the disaster were associated with physical symptoms 14 months later for survivors both with and without severe physical injury. The single exposure of life threat, also in combination with other exposures, was associated with a higher risk for reporting of physical symptoms. Physical symptoms showed modest yet significant correlation with psychological symptoms.
  
  
  CONCLUSIONS
  It is important to pay attention to both physical and psychological symptoms among disaster survivors whether they have been injured or not. A relatively simple questionnaire about physical symptoms may be a good complement to the scales used to assess psychological problems after disaster.
authors.affiliation: Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden. riitta.keskinen-rosenqvist@sll.se
authors.forename: Riitta
authors.initials: R
authors.lastname: Keskinen-Rosenqvist
authors.forename: Hans
authors.initials: H
authors.lastname: Michélsen
authors.forename: Abbe
authors.initials: A
authors.lastname: Schulman
authors.forename: Lars
authors.initials: L
authors.lastname: Wahlström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004190:Disasters; D005260:Female; D006801:Humans; D019156:Indian Ocean; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D057192:Tsunamis; D014947:Wounds and Injuries / Q000503:physiopathology* / Q000523:psychology; D055815:Young Adult