title: Social support barriers and mental health in terrorist attack survivors.
abstract: BACKGROUND
  To expand our understanding of social support and mental health, we introduce a measure of social support barriers and investigate the relationship between these barriers, social support, mental health and gender in survivors of the terrorist attack on Utøya Island, Norway.
  
  
  METHODS
  Survivors (N=285) were interviewed face to face. We used confirmatory factor analysis (CFA) to assess the latent factor structure of the Social Support Barriers Scale and perceived social support (FSSQ), and linear regression analyses to investigate the associations between social support variables and mental health (PTSD-RI and HSCL-8).
  
  
  RESULTS
  The CFA indicated that social support barriers and perceived social support were two separable latent constructs. Social support barriers were highly associated with posttraumatic stress reactions (adjusted regression coefficient=0.38, 95% CI=0.29-0.47. p<0.001) as well as with psychological distress (adjusted regression coefficient=0.35, 95% CI=0.26-0.43, p<0.001). In contrast, neither perceived social support nor gender was associated with mental health after adjustment for barriers.
  
  
  CONCLUSIONS
  Most analyses were based on cross-sectional data. This is the first study to use a quantitative measure of social support barriers.
  
  
  CONCLUSIONS
  Social support barriers may be a new opening to understand the relationship between social support and mental health and may have a role in explaining why women are at increased risk for mental health problems. Clinicians should explore not only perceived social support but also barriers to making use of these resources when consulting young people facing major life adversities.
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Postbox 181 Nydalen, 0409 Oslo, Norway. Electronic address: siri.thoresen@nkvts.unirand.no.
authors.forename: Siri
authors.initials: S
authors.lastname: Thoresen
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Postbox 181 Nydalen, 0409 Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway.
authors.forename: Tine K
authors.initials: TK
authors.lastname: Jensen
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Postbox 181 Nydalen, 0409 Oslo, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway.
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Postbox 181 Nydalen, 0409 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Grete
authors.initials: G
authors.lastname: Dyb
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009664:Norway; D012737:Sex Factors; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D017741:Survivors / Q000523:psychology*; D023481:Terrorism / Q000523:psychology*; D055815:Young Adult
keywords: Adolescent; Post-traumatic stress disorder; Social support; Social support barriers; Terrorism