title: Six years after the wave. Trajectories of posttraumatic stress following a natural disaster.
abstract: BACKGROUND
  The characteristics of long-term trajectories of distress after disasters are unclear, since few studies include a comparison group. This study examines trajectories of recovery among survivors in comparison to individuals with indirect exposure.
  
  
  METHODS
  Postal surveys were sent to Swedish tourists, repatriated from the 2004 Indian Ocean tsunami (n=2268), at 1, 3, and 6 years after the tsunami to assess posttraumatic stress (PTS) and poor mental health. Items were used to ascertain high and moderate disaster exposure groups and an indirect exposure comparison group.
  
  
  RESULTS
  Long-term PTS trajectories were best characterized by a resilient (72.3%), a severe chronic (4.6%), a moderate chronic (11.2%) and a recovering (11.9%) trajectory. Trajectories reported higher levels of PTS than the comparison group. Exposure severity and bereavement were highly influential risk factors.
  
  
  CONCLUSIONS
  These findings have implications regarding anticipation of long-term psychological adjustment after natural disasters and need for interventions after a single traumatic event with few secondary stressors.
authors.affiliation: National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden. Electronic address: kerstin.bergh.johannesson@neuro.uu.se.
authors.forename: Kerstin Bergh
authors.initials: KB
authors.lastname: Johannesson
authors.affiliation: Department of Neuroscience, Psychiatry, Uppsala University, Akademiska Sjukhuset, Ing. 10, SE 751 85 Uppsala, Sweden. Electronic address: hans.arinell@neuro.uu.se.
authors.forename: Hans
authors.initials: H
authors.lastname: Arinell
authors.affiliation: National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden. Electronic address: filip.arnberg@neuro.uu.se.
authors.forename: Filip K
authors.initials: FK
authors.lastname: Arnberg
mesh_terms: D000704:Analysis of Variance; D001601:Bereavement; D004190:Disasters; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013548:Sweden / Q000453:epidemiology; D057192:Tsunamis
keywords: General mental health; Longitudinal study; Natural disaster; PTSD; Posttraumatic stress; Recovery; Trajectories