title: Disaster exposure as a risk factor for mental health problems, eighteen months, four and ten years post-disaster--a longitudinal study.
abstract: BACKGROUND
  Disaster experiences have been associated with higher prevalence rates of (mental) health problems. The objective of this study was to examine the independent relation between a series of single disaster experiences versus the independent predictive value of a accumulation of disaster experiences, i.e. a sum score of experiences and symptoms of distress and post-traumatic stress disorder (PTSD).
  
  
  METHODS
  Survivors of a fireworks disaster participated in a longitudinal study and completed a questionnaire three weeks (wave 1), eighteen months (wave 2) and four years post-disaster (wave 3). Ten years post-disaster (wave 4) the respondents consisted of native Dutch survivors only. Main outcome measures were general distress and symptoms of PTSD.
  
  
  RESULTS
  Degree of disaster exposure (sum score) and some disaster-related experiences (such as house destroyed, injured, confusion) were related to distress at waves 2 and 3. This relation was mediated by distress at an earlier point in time. None of the individual disaster-related experiences was independently related to symptoms of distress. The association between the degree of disaster exposure and symptoms of PTSD at waves 2 and 3 was still statistically significant after controlling for symptoms of distress and PTSD at earlier point in time. The variable 'house destroyed' was the only factor that was independently related to symptoms of PTSD at wave 2. Ten years after the disaster, disaster exposure was mediated by symptoms of PTSD at waves 2 and 3. Disaster exposure was not independently related to symptoms of PTSD ten years post-disaster.
  
  
  CONCLUSIONS
  Until 4 years after the disaster, degree of exposure (a sum score) was a risk factor for PTSD symptoms while none of the individual disaster experiences could be identified as an independent risk factor. Ten years post-disaster, disaster exposure was no longer an independent risk factor for symptoms of PTSD. Since symptoms of PTSD and distress at earlier waves perpetuate the symptoms at later waves, health care workers should aim their resources at those who still have symptoms after one and a half year post-disaster, to prevent health problems at medium and long-term.
authors.affiliation: Regioplan Policy Research, Nieuwezijds Voorburgwal 35, Amsterdam, RD, 1012, the Netherlands.
authors.forename: Bellis
authors.initials: B
authors.lastname: van den Berg
authors.forename: Albert
authors.initials: A
authors.lastname: Wong
authors.forename: Peter G
authors.initials: PG
authors.lastname: van der Velden
authors.forename: Hendriek C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: Linda
authors.initials: L
authors.lastname: Grievink
mesh_terms: D000328:Adult; D004190:Disasters; D005107:Explosions; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008960:Models, Psychological; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology*; D017741:Survivors / Q000523:psychology*; D013997:Time Factors