title: The day Norway cried: Proximity and distress in Norwegian citizens following the 22nd July 2011 terrorist attacks in Oslo and on Utøya Island.
abstract: BACKGROUND
  Terrorism may create fear and stress reactions not only in the direct victims, but also in the general population.
  
  
  OBJECTIVE
  This study investigated emotional responses in the Norwegian population following the 22nd July 2011 terrorist attacks. We hypothesized that Oslo residents would report a higher level of fear responses compared with people living outside Oslo and that proximity would be associated with early distress and later post-traumatic stress reactions.
  
  
  METHODS
  Representative samples were drawn from the Norwegian Population Registry. Telephone interviews were conducted 4-5 months after the attacks. The response rate for the Oslo sample (N=465) was 24% of the total sample, and 43% of those who were actually reached by phone and asked to participate. Corresponding figures for the sample living outside Oslo (N=716) were 19% and 30%.
  
  
  RESULTS
  Our results show strong immediate emotional responses, particularly sadness and a feeling of unreality, in both samples. Jumpiness and other fear responses were significantly higher among Oslo residents. Current level of risk perception was low 4-5 months after the attacks; however, a significant minority reported to feel less safe than before. Geographical and psychological proximity were associated with early emotional responses. Psychological proximity was significantly associated with post-traumatic stress reactions, while measures of geographical proximity were not. Immediate emotional responses, first-week reactions, and first-week jumpiness were uniquely and significantly associated with post-traumatic stress reactions. Post-traumatic stress reactions were elevated in ethnic minorities.
  
  
  CONCLUSIONS
  The terrorist attacks seem to have had a significant effect on the Norwegian population, creating sadness and insecurity, at least in the short term. Proximity to the terrorist attacks was strongly associated with distress in the population, and early distress was strongly related to later post-traumatic stress reactions. Our results indicate that psychological proximity is more strongly associated with post-traumatic stress reactions than geographical proximity, and underline the importance of differentiated measurements of various aspects of early distress.
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Thoresen
authors.forename: Helene Flood
authors.initials: HF
authors.lastname: Aakvaag
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.forename: Grete
authors.initials: G
authors.lastname: Dyb
authors.forename: Ole Kristian
authors.initials: OK
authors.lastname: Hjemdal