title: Post-traumatic stress reactions in survivors of the 2011 massacre on Utøya Island, Norway.
abstract: BACKGROUND
  Although youths in many countries have been exposed to terrorism, few studies have examined early risk and protective factors for the subsequent development of mental health problems.
  
  
  OBJECTIVE
  To investigate the levels of post-traumatic stress in survivors of the 2011 massacre on Utøya Island compared with the general population in Norway, and to identify predictive factors.
  
  
  METHODS
  Four hundred and ninety survivors were invited to participate. Structured face-to-face interviews were performed 4-5 months after the attack.
  
  
  RESULTS
  There were 325 study participants (response rate 66%). Survivors had been highly exposed to danger and loss. Post-traumatic stress levels were more than six times higher in survivors than in the general population. Predictors were female gender, minority ethnic status, high level of trauma exposure, pain, the loss of someone close and social support.
  
  
  CONCLUSIONS
  Survivor characteristics that can be assessed in the early aftermath of a terrorist attack strongly predict the subsequent mental health problems of exposed youths. The highly elevated symptoms observed were largely attributable to the traumatic experience and reflect the mental health costs of the terrorist attack.
authors.affiliation: Grete Dyb, MD, PhD, Norwegian Centre for Violence and Traumatic Stress Studies, and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Tine K. Jensen, PhD, Egil Nygaard, PhD, Norwegian Centre for Violence and Traumatic Stress Studies, and Department of Psychology, Faculty of Social Sciences, University of Oslo; Øivind Ekeberg, MD, PhD, Department of Acute Medicine, Oslo University Hospital, and Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo; Trond H. Diseth, MD, PhD, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, and Department of Clinical Neurosciences for Children, Women and Children's Division, Oslo University Hospital; Tore Wentzel-Larsen, MSc, Norwegian Centre for Violence and Traumatic Stress Studies, and Center for Child and Adolescent Mental Health, Eastern and Southern Norway; Siri Thoresen, PhD, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Grete
authors.initials: G
authors.lastname: Dyb
authors.forename: Tine K
authors.initials: TK
authors.lastname: Jensen
authors.forename: Egil
authors.initials: E
authors.lastname: Nygaard
authors.forename: Oivind
authors.initials: O
authors.lastname: Ekeberg
authors.forename: Trond H
authors.initials: TH
authors.lastname: Diseth
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.forename: Siri
authors.initials: S
authors.lastname: Thoresen
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009664:Norway; D010549:Personal Satisfaction; D012737:Sex Factors; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D023481:Terrorism / Q000523:psychology*; D055815:Young Adult