title: Posttraumatic Stress among Not-Exposed Traumatically Bereaved Relatives after the MS Estonia Disaster.
abstract: BACKGROUND
  Little is known about posttraumatic stress (PTS) reactions in bereaved individuals following loss in disaster who were not directly exposed to disaster. The aim of the present study was to examine the course of PTS up to three years after losing relatives in the MS Estonia ferry disaster, one of the worst maritime disasters in modern times.
  
  
  METHODS
  Seven postal surveys were sent out over three years post-disaster. The respondents were invited and added consecutively during the three years and 938 relatives participated in one or more of the surveys, representing 89% of the MS Estonia's Swedish victims. The survey included the Impact of Event Scale (IES) to measure PTS. Latent growth curve modeling was used to analyze PTS over time.
  
  
  RESULTS
  The majority of bereaved individuals had high levels of PTS. At three years post-loss, 62% of the respondents scored above the recommended cut-off value on the IES. Over time, PTS symptoms declined, but initially high symptoms of PTS were associated with a slower recovery rate.
  
  
  CONCLUSIONS
  The present finding suggests that being an indirectly-exposed disaster-bereaved close-relative can lead to very high levels of PTS which are sustained for several years.
authors.affiliation: Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.|Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
authors.forename: Josefin
authors.identifier: http://orcid.org/0000-0002-5523-8126
authors.initials: J
authors.lastname: Sveen
authors.affiliation: Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.|Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lilian
authors.initials: L
authors.lastname: Pohlkamp
authors.affiliation: Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.|Institute of Health and Care Sciences, and University of Gothenburg Centre for Person-Centered Care, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Öhlén
authors.affiliation: Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.|Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Sandberg
authors.affiliation: Department of Psychiatry, Ersta Hospital, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Brandänge
authors.affiliation: Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Petter
authors.initials: P
authors.lastname: Gustavsson
mesh_terms: D000328:Adult; D004190:Disasters; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D012767:Ships; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000473:pathology; D011795:Surveys and Questionnaires