title: Early outreach to survivors of the shootings in Norway on the 22nd of July 2011.
abstract: BACKGROUND
  Under-treatment and unmet needs among survivors have been documented years after terror attacks. Improved early and proactive outreach strategies, including targeted interventions for individuals in need, are required. After the terrorist attacks in Norway on 22 July 2011, a national, proactive outreach strategy was developed and implemented to help those who were directly affected.
  
  
  OBJECTIVE
  THE AIMS OF THIS STUDY WERE THREEFOLD: (1) to investigate whether the survivors at the island of Utøya had received proactive outreach from the municipalities, (2) to examine the relationships between received health services and the survivors' level of exposure and post-trauma health problems, and (3) to explore the level of unmet needs among survivors 5 months post-terror.
  
  
  METHODS
  Three hundred and twenty five survivors (M age=19.4, SD=4.6, 47.1% females, response rate 66%) of the 2011 massacre on Utøya Island, Norway, were interviewed face-to-face 4-5 months post-terror. The survivors were asked if they had received proactive outreach from their municipality, and what type of health services they had received. Survivors' level of peri-trauma exposure, loss and injury, posttraumatic stress reactions, symptoms of anxiety and depression, somatic health problems, and sick leave, were assessed.
  
  
  RESULTS
  Most participants (87%) reported that they had received early and proactive outreach, and most (84%) had a contact person. In addition a majority of the survivors has received support from their general practitioner (63%), or other municipal help services (66%). Specialized mental health services by psychiatrists or psychologists had been provided to 73.1% of the survivors. Survivors who had been referred to specialized mental health services reported higher levels of exposure to trauma, posttraumatic stress reactions, depression and anxiety, and somatic health problems, compared to non-receivers of such services. Forty-three survivors (14%) reported unmet needs for services.
  
  
  CONCLUSIONS
  In accordance with the national strategy, the vast majority of the participants in this study had received an early and proactive outreach and targeted responses from specialized mental health services had been provided to survivors in need of more extensive help. However, an important minority of the participants had not been reached as planned. The knowledge from this study may guide professionals and decision makers in planning for future disasters and improve the levels of care.
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Grete
authors.initials: G
authors.lastname: Dyb
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
authors.forename: Tine
authors.initials: T
authors.lastname: Jensen
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Kristin Alve
authors.initials: KA
authors.lastname: Glad
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway ; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
authors.forename: Egil
authors.initials: E
authors.lastname: Nygaard
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
authors.forename: Siri
authors.initials: S
authors.lastname: Thoresen
keywords: PTSD; Posttraumatic stress reactions; early intervention; shootings; terror; youth