To be a child and survive a natural disaster

Sammanfattning: Introduction: Despite the fact that children or adolescents often are exposed to disasters, we do not know what happens to these children or adolescents in the end. Much of the international research has been concerned with the effect of disasters on children or adolescents soon after the event and that research shows that adverse psychological reactions can be very strong in this group. We became interested in learning if there are longer-term effects, perhaps even when children or adolescents who experienced disaster reach adulthood. Only a few studies have addressed that question. Many children in the Swedish families vacationing in Southeast Asia, when the Indian Ocean tsunami struck in 2004 and we wondered if the experience left its mark on them years later, even when they have become young adults. Aim: The overall aim of our study was to investigate the long-term effects on Swedish individuals, eight to nine years after the Indian Ocean tsunami that they experienced when they were between 10 and 15 years of age. The specific aims were to examine, whether there was an association between different types of exposures and levels of social support and the adverse effects even after eight years. Another aim was to compare exposed children or adolescents with non-exposed children or adolescents as young adults. Did respondents individual experience produced late reminders of the experience nine years later and, if so, how do they handle them in young adulthood. We also wanted to compare respondents who had lost someone close to them with those who had not lost someone close during the tsunami 2004. To describe the bereaved as young adults was another specific aim. Methods: A questionnaire was distributed in 2013 to young adults who were residents in Stockholm County in 2004 and had been in South East Asia during the Indian Ocean tsunami. The questionnaire consisted of questions about background factors, exposures, the time up to six mounts post disaster and the present time. The respondents also could agree to be interviewed, and 17 respondents who had been seriously exposed to the tsunami were randomly selected for the interview. All the semi-structured interviews were done by telephone with the interviewer following an interview guide prepared for this study. Nine of the 17 had lost someone close to them, and the interviews with them were used as the basis for describing the group experience of loss. Results: The result showed that the percentage of respondents with associations between exposures and studied outcomes variables eight years post disaster increased for every additional exposure studied, indicating that the greater the number of different exposures, the greater the total impact. The most exposed respondents, compared with a population based matched sample, had significantly higher odds ratios that indicated higher psychological distress, lower self-rated health and more thoughts about suicide eight years post disaster. The least expose had less psychological distress than the matched sample. The level of perceived social support up to six months post disaster as well as perceived social support as young adults was associated with the outcomes variables studied. All 17 interviewed stated that they had experienced different late reminders of the 2004 tsunami. The respondents said they could try to make plans in advance to keep late reminders from occurring and they reported different strategies they could use to strive for balance. These included thinking, talking, letting their feelings out, doing something else, or actively trying to avoid the hurtful feelings. Compared, with those who had not lost someone close, those who had lost someone close experienced psychological distress, more posttraumatic stress symptoms and lower self-rated health as young adults. They also described inner feelings that did not follow what others might think they could see as outside observers. Conclusions: The negative psychological impacts on these young adults can still be observed eight or nine years after their exposure to the Indian Ocean tsunami in childhood or adolescence, and were associated with the exposures a certain child or adolescent have experienced and the social support they perceived after the natural disaster. These results also show that the respondents experience external and internal reminders nine years post disaster. Anyone who has lost a closely connected person, for example a parent or a sibling, can have more associations with negative outcomes, than respondents who did not lose someone close. The bereaved also had inner feelings of the loss that did not follow what others might think they could see as outside observers.