title: Physical injury and posttraumatic stress reactions. A study of the survivors of the 2011 shooting massacre on Utøya Island, Norway.
abstract: OBJECTIVE
  The objective of the study was to investigate the relationship between physical injury (no, moderate and severe) and posttraumatic stress reactions (PTSR) at 4-5 months after the attack in survivors of the terror attack at Utøya Island, Norway, 22 July 2011, adjusting for sociodemographic, psychosocial and trauma-related factors.
  
  
  METHODS
  Overall, 325 young survivors (47% women, mean age 19.4 years) were interviewed 4-5 months (T1) and 14-15 months (T2) after the attack. Variables concerning physical injury, PTSR (UCLA PTSD-RI scale, 0-4), peritraumatic exposure, sociodemographic and psychosocial backgrounds were measured. To evaluate the role of injury, multiple linear regression analyses were conducted.
  
  
  RESULTS
  The physically injured (n=60) reported higher levels of PTSR than did the non-injured. The difference was statistically significant between the moderately injured (n=37, mean 1.9) and the non-injured (n=265, mean 1.5). No significant differences were found between the moderately and the severely (n=23, mean 1.8) injured. Higher levels of peritraumatic events, peritraumatic reactions and loss of close, female sex and non-Norwegian ethnicity were significantly related to higher levels of PTSR in the full regression model.
  
  
  CONCLUSIONS
  Physical injury was associated with higher PTSR after the terror attack. Moderately injured survivors may, as those severely injured, exhibit high levels of PTSR, and this should be taken into account when targeting early psychosocial health care after terror.
authors.affiliation: Section for Psychosomatics and CL-child Psychiatry, Department of Clinical Neurosciences for Children, Women and Children's Division, Oslo University Hospital, Norway; Norwegian Centre for Violence and Traumatic stress Studies, Norway. Electronic address: ingrid.bugge@medisin.uio.no.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Bugge
authors.affiliation: Norwegian Centre for Violence and Traumatic stress Studies, Norway.
authors.forename: Grete
authors.initials: G
authors.lastname: Dyb
authors.affiliation: Norwegian Centre for Violence and Traumatic stress Studies, Norway.
authors.forename: Synne Øien
authors.initials: SØ
authors.lastname: Stensland
authors.affiliation: Division of Mental Health and Addiction, Oslo University Hospital, Norway; Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Ekeberg
authors.affiliation: Norwegian Centre for Violence and Traumatic stress Studies, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway.
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.affiliation: Section for Psychosomatics and CL-child Psychiatry, Department of Clinical Neurosciences for Children, Women and Children's Division, Oslo University Hospital, Norway; Department of Paediatrics, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Trond H
authors.initials: TH
authors.lastname: Diseth
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology / Q000208:ethnology; D012737:Sex Factors; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D023481:Terrorism / Q000523:psychology* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000523:psychology*; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
keywords: Adolescents; Physical injury; Posttraumatic stress reaction (PTSR); Shooting; Terrorism