title: Disaster-related injury and predictors of health complaints after exposure to a natural disaster: an online survey.
abstract: Objectives To study short- and long-term effects of experiencing a disaster in repatriated injured survivors and the differential effect of injury, need for medical treatment, loss of loved ones and danger to life on both physical and mental health.  Design Prospective online study.  Setting Open online survey among Dutch survivors of the 2004 Asian tsunami.  Participants Of the estimated total of 464 Dutch survivors, the authors recruited 144 unique respondents (59 men and 85 women) with a total of 175 assessments made in various time periods.  Main outcome measures Health outcomes were Symptom Checklist 90 (SCL-90), Impact of Event Scale (original version, in Dutch) and Beck Depression Inventory II. Correlations were calculated with socio-demographic as well as disaster-related factors: physical injury, medical care, loss of loved ones and duration of threat to life. Assessments were clustered in four post-disaster time periods (0-3, 4-6, 7-30 and 31-48 months).  Results Across these periods, SCL-90 scores were significantly higher than the reference population (p<0.001), with a significant linear downward trend between the groups over time (p=0.001). The same pattern occurred for the Impact of Event Scale (p<0.001) and the Beck Depression Inventory II (p=0.002). Physical injury, medical care or loss of loved ones was not associated with higher total SCL-90 scores or somatic subscores. Both duration of threat to life and female sex were correlated with all measured outcome parameters.  Conclusions Exposure to the 2004 Asian tsunami had significant short- and long-term impacts on health complaints in a group of repatriated Dutch tsunami victims. Cross-sectionally, there was a trend towards recovery over 4 years, although 22% still reported high psychological and physical distress 4 years post-disaster. Duration of danger to life and female sex were associated with more physical and mental health complaints. In this study, neither disaster-related injury nor loss of loved ones resulted in negative health outcomes.
authors.affiliation: University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Geertruid M H
authors.initials: GM
authors.lastname: Marres
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
authors.forename: Jolanda
authors.initials: J
authors.lastname: de Vries
authors.forename: Paul G H
authors.initials: PG
authors.lastname: Mulder
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten