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Train disaster survivors: Long‐term effects on mental health and well‐being
Abstract
Disastrous train accidents have been relatively common in Sweden during the last three decades. Between the years 1970 and 1978 more than 20 serious accidents occurred. In total 70 persons were killed and 396 were officially registered as somatically injured. This article presents a retrospective follow-up study using questionnaires. Both the somatic injuries and the different psychological stressors and stress effects are presented. The need for psychological support together with a low rate of drug usage was prominent. The two main stressors for survivors after a train accident seemed to be personal bereavement and somatic injuries.
... As was mentioned, literature on the coping strate- gies that elderly people use to deal with the effects of traumatic events is few and far between. A few studies showed that elderly people used religion and helping others as their primary strategies to cope with the effects of flood ( Green et al., 1996), that they used drugs to cope with the effects of train disasters (as opposed to younger people who used counselling and support services) (Lundin, 1991), and that they used behavioural and avoidance coping strategies, rather than seek support services, more than younger people, following an earthquake. These elderly peo- ple tended to cope less well and were thus more at risk of experiencing post-traumatic stress reactions (Ticehurst et al., 1996). ...
... Neither did the three groups vary much on the extent to which they used coping strategies to deal with the effects of the disasters. This finding was not consistent with literature which suggested that dif- ferent coping strategies are used by young and elderly people (Aldwin, 1990;Lundin, 1991;Aldwin, 1992;Ticehurst et al., 1996). The present study suggested that the more they used both emotion-focused (i.e. ...
Debate persists about whether people of different ages react similarly to traumatic events, and whether elderly people are more vulnerable to such events, or better able to cope with them. The first aim of this paper was to shed light on this debate by comparing the post-traumatic responses of young, middle-aged and elderly community residents who had been exposed to technological disasters. The second aim was to differentiate between these three age groups in terms of coping strategies.
One hundred and forty-eight community residents, who were exposed to two technological disasters, participated in the study. They were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC).
The results showed that in terms of IES, GHQ and WOC scores, no significant differences were found across the three age groups. However, main effects were found according to type of disaster and intensity of exposure to disaster. One significant interaction effect was that residents exposed to the aircraft crash used significantly more confrontive coping than those exposed to the train collision, in all three age groups. Correlation coefficients results showed that for all three age groups, on the whole, the more they experienced intrusive thoughts and avoidance behaviour, the more they experienced general health problems.
Following exposure to technological disasters, young, middle-aged and elderly community residents could display similar post-traumatic responses and employ similar coping strategies, which contradicts the vulnerability hypothesis and the inoculation hypothesis.
... A railroad accident in the early 19th century injured a large number of people, opening the public's eyes and evoking society's interest in traumatic disasters (1). This event led to a number of findings about disease, anniversary reactions after the accident, and a tendency for symptoms to be prolonged due to a lack of social support (2) ; the presence of intrusive memories, nightmares, and avoidance symptoms, more pronounced in cases of life-threatening situations (3) ; and physical and mental disease that may persist nearly 20 years later (4). ...
Objective : The purpose of this study was to examine the relationship between peritraumatic reactions, posttraumatic stress disorder (PTSD) symptoms, and pain in people injured in train disasters. Methods : The participants were injured in a train crash in Japan that left more than 100 dead. There were 218 participants in the analysis, with a mean age of 37.50 ± 14.67 years. Peritraumatic reactions were assessed using the Peritraumatic Distress Inventory. PTSD symptoms were evaluated using the Impact of Event Scale-Revised Japanese-language version. Pain was measured using the Visual Analog Scale. Results : Peritraumatic reactions did not directly affect PTSD symptoms but were found to be associated via latent variables. Regarding pain and PTSD symptoms, intrusive memories were more associated with pain than other symptoms were. There was an associative path from intrusion to pain, but no such path from pain to intrusion. Conclusions : Our results suggest that a therapeutic approach to intrusion may be effective in ameliorating the pain caused by injury. Future research should examine integrated treatment approaches for both PTSD and pain, rather than just for aspects of PTSD. J. Med. Invest. 68 : 85-89, February, 2021
... The most salient signs of distress were identified among those who had lost children, which corresponded to findings from other studies (Bergh Johannesson et al., 2006;Dyregrov, Nordanger, & Dyregrov, 2003;Neria et al., 2007). Signs of complicated grief are reported among 50% of parents after sudden unexpected deaths (Lundin, 1991), and parents who have lost a child appear to cope worse than widows do (Lundin, 1984b). There was a tendency for increased psychological distress among those who lost younger children. ...
Fourteen months after the 2004 tsunami, mental health outcome was assessed in 187 bereaved relatives, 308 bereaved friends, and in 3,020 nonbereaved Swedish survivors. Of the bereaved relatives, 41% reported posttraumatic stress reactions and 62% reported impaired general mental health. Having been caught or chased by the tsunami in combination with bereavement was associated with increased posttraumatic stress reactions. Complicated grief reactions among relatives were almost as frequent as posttraumatic stress reactions. The highest levels of psychological distress were found among those who had lost children. Traumatic bereavement, in combination with exposure to life danger, is probably a risk factor for mental health sequelae after a natural disaster.
Rarely described are people's lived experiences from severe injury events such as train crashes. The number of train crashes named disasters with ≥10 killed and/or ≥100 nonfatally injured grows globally and the trend shows that more people survive these disasters today than did so in the past. This results in an increased number of survivors needing care. The aim of the study was to explore survivors’ experiences from a train crash. Narrative interviews were performed with 14 passengers 4 years after a train crash event. Qualitative content analysis was used to analyse the interviews. Experiences were captured in three main themes: (1) Living in the mode of existential threat describes how the survivors first lost control, then were thrown into a state of unimaginable chaos as they faced death. (2) Dealing with the unthinkable described how survivors restored control, the central role of others, and the importance of reconstructing the event to move forward in their processing. (3) Having cheated death shows how some became shackled by their history, whereas others overcame the haunting of unforgettable memories. Furthermore, the result shows how all experienced a second chance in life. Experiencing a train crash meant that the passengers experienced severe vulnerability and a threat to life and interdependence turned out to play a crucial role. Focusing on helping other passengers on site was one way to regain the loss of control and kept the chaos at bay. Family, friends, and fellow passengers turned out to be extremely important during the recovery process why such closeness should be promoted and facilitated.
Post-traumatic stress disorder is a well recognised condition which can have long-term consequences. A rail accident to commuter trains in south London provided an opportunity, within the context of a Psychological Therapies Service, to study the prevalence and associations of the condition in a follow-up study.
Postal questionnaires were completed by 187 survivors (52% response rate) 10 to 22 months after the accident, and their symptoms were compared with a commuter control group.
The accident group scored significantly higher on the Impact of Events scale (IES) than the control group. Severity of physical injury was significantly associated with high IES scores. Thirty per cent of those moderately or severely injured showed high levels of intrusion or avoidance symptoms (sub-scores of 20 or more). Thirty per cent of those nearest the accident focus had high sub-scores, associated variables being the accident experience of risk of death, feeling trapped and seeing death. For those less directly involved the proportions with symptoms were similar to those of controls.
It is recommended that disaster services should provide for long-term psychological effects, particularly for those survivors who are injured, who experience risk of death, feeling trapped or who witness death.
This study aimed to differentiate between the posttraumatic stress responses of elderly and younger community residents who had been exposed to two technological disasters (a train collision and an aircraft crash). One hundred and forty-eight community residents were assessed using the Impact of Event Scale (IES) and the General Health Questionnaire (GHQ-28). The results showed that age differences were not affected by impact of disaster (IES), suggesting that elderly and younger community residents responded to the disasters similarly. Instead, the community residents exposed to the aircraft crash experienced significantly more intrusion and avoidance than those exposed to the train collision. Also, the community residents who had experienced high exposure to the disasters had significantly more intrusive thoughts and exhibited significantly more avoidance behavior than the low/medium exposure group. The results also showed no main effects in general health between the elderly and younger community residents, suggesting that their health status was similar. Instead, the community residents exposed to the aircraft crash had significantly more general health problems than the train disaster residents and the control group. Also, the community residents in either the low/medium or the high exposure group experienced more general health problems than the control group. Correlation coefficients showed that intrusion, avoidance, and the total impact of the disasters were significantly correlated with all general health subscales for both elderly and younger groups.
The present study used a model of individual response to catastrophic events to guide the analysis of data collected from survivors of the Beverly Hills Supper Club fire of 1977. One hundred seventeen subjects were seen 1-year postfire, and 67 subjects were reinterviewed a year later. Hierarchical regression analyses for multiple outcome measures showed that the most predictable symptoms at 1 year were those associated with stress disorders. The independent variables contributing most to that prediction were aspects of the individual’s fire experience (e.g., bereavement and injury). Predictability shifted somewhat in the second year for the outcome measures: Secondary measures (those with a Hostility component) became more predictable. Overall, up to 45% of outcome variance 1-year postfire could be explained by the individual’s experiences surrounding the fire. The role of mediating variables was also addressed.
117 individuals (mean age 37.77 yrs) who were at the fire and 30 individuals (mean age 40.72 yrs) who were not at the fire (bereaved families and rescue workers) were assessed regarding objective stressfulness of their fire experience, subjective stressfulness, and intensity of psychological symptoms (the Psychiatric Evaluation Form, PEF) in a structured clinical interview approximately 1 yr after the fire. Ss also filled out the Symptom Checklist-90, Revised Version (SCL-90R). 88 Ss were followed-up at 2 yrs. The group as a whole was more impaired than comparison samples of normals but less impaired than outpatients. Ss at the fire were less impaired than those not at the fire, who were similar to outpatients on the PEF. The latter group improved significantly on several measures from 1 to 2 yrs postfire, whereas the group at the fire showed little change. Results are discussed in the context of the specific instruments and methodology used in the present study, impairment levels of other samples, and the nature of the particular disaster. (19 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Examined the chronic responses of survivors of a 1977 supper club fire, in which 165 people died, from the standpoint of linking individual differences in aspects of the fire experience to differential outcome. 117 Ss were interviewed on stress, life events, coping, social supports, psychopathology, and symptoms 1 yr postfire. 67 Ss were reinterviewed a year later. Hierarchical regression analyses for multiple outcome measures showed that the most predictable symptoms at 1 yr were those associated with stress disorders. The independent variables contributing most to that prediction were aspects of the S's experience (e.g., bereavement, injury). Predictability shifted somewhat in the 2nd yr for the outcome measures: Secondary measures (those with a hostility component) became more predictable. Overall, up to 45% of outcome variance 1-yr postfire could be explained by the individual's experiences surrounding the fire. (17 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is virtually no literature detailing the effects of a disaster on the rescue workers. This paper reports the results of a questionnaire survey conducted one month after the Granville rail disaster on ninety-five of the personnel involved in the rescue work and a follow-up on thirteen of them one year later. Seventy-seven of the ninety-five found the experience stressful; in particular, the feelings of helplessness engendered by the disaster, the magnitude of the destruction, the sight and smell of mutilated bodies, the anguish of relatives, and the need to work under pressure were items highlighted by the respondents. While only about 20 percent experienced specific psychological sequelae as a result of the disaster (depression, anxiety, insomnia), approximately 70 percent of the helpers showed evidence of being temporarily strained (half of them being over this by the end of one week). Thirty-five percent felt more positive about their own lives as a result of their involvement. The utility of debriefing sessions to assist workers to come to terms with and assimilate their experiences is discussed.
Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.
A primary prevention program implemented immediately following a major rail disaster is described. Because of the high mortality, services were oriented towards the provisions of preventive counselling for bereaved families as well as support for the injured. Emergency counselling services were provided at the City Morque. Subsequently, coordinating consultative and educative programmes were instituted in the affected health region. Counselling bereaved families was continued through appropriate specialised community services. High-risk groups of bereaved were delineated and special emphasis given to individual care of these persons. Recommendations are made concerning the relevance of such a programme to the personal disasters of life.
Psychiatric evaluation teams used observations of family interaction and psychoanalytically oriented individual interviews to study the psychological aftereffects of the 1972 Buffalo Creek disaster, a tidal wave of sludge and black water released by the collapse of a slag waste dam. Traumatic neurotic reactions were found in 80% of the 625 survivors interviewed. Underlying the clinical picture were unresolved grief, survivor shame, and feelings of impotent rage and hopelessness. These clinical findings had persisted for the 2 yrs since the flood, and a definite symptom complex labeled the "Buffalo Creek syndrome" was pervasive. The methods used by the survivors to cope with the overwhelming impact of the disaster--1st-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A description of the behavioural responses of some of the survivors of the Granville train disaster in Sydney has been given covering the eighteen months since the accident. A high and persisting level of psychiatric morbidity was found mainly involving neurotic and psychosomatic symptoms. This has been followed by a review of the literature on stress and its relevance for psychiatry. Initial problems with terminology have been examined and a definition covering environmental, psychological and biological factors proposed. A relationship between stressful experience and a variety of phenomena including physical ill health, psychiatric disorders and accidents has been found. Much evidence is also present to highlight the value of a supportive and cohesive social network in enabling the individual to cope with events of a stressful nature. Conclusion and proposals for future work in the area have been given.
Distressed victims and their relatives have passed through the early days of horror and uncertainty, and for the most part they received the very best in comforting support, in psychological first aid for their distress. Such psychological first aid involved a caring empathy from concerned others that allowed those affected to express all feelings openly and safely, particularly the initial overwhelming anxiety and helplessness and the rage induced by impact of loss. However, the psychological effects of disasters extend well beyond this initial phase. They will affect not only those who have survived the disaster - the injured, and those who travelled on that train - but also the bereaved, the rescuers, those more peripherally connected with the disaster and the total community. Some important principles of understanding and managing the psychological sequelae of this tragic event are explained.
Psychiatric evaluation teams used observations of family interaction and psychoanalytically oriented individual interviews to study the psychological aftereffects of the 1972 Buffalo Creek disaster, a tidal wave of sludge and black water released by the collapse of a slag waste dam. Traumatic neurotic reactions were found in 80% of the survivors. Underlying the clinical picture were unresolved grief, survivor shame, and feelings of impotent rage and hopelessness. These clinical findings had persisted for the two years since the flood, and a definite symptom complex labeled the "Buffalo Creek syndrome" was pervasive. The methods used by the survivors to cope with the overwhelming impact of the disaster--first-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes.
In a study of 989 middle-aged men followed up for 9 years social influences, measured as persons per household unit, home activities, outside-home activities, and social activities at the baseline examination, were found to be significantly associated with mortality. The association between these variables (except for home activities) and mortality was significant even when age, risk factors for coronary heart disease, and health status measured at the baseline examination were taken into consideration. Social activities may have a modifying effect on life stresses and risk factors associated with mortality.
The psychological effects of bushfires that devastated areas of South Australia on Ash Wednesday 1983 are described. We emphasise the need to assess the various components of a disaster to understand its immediate and long-term impact. In the inventory phase, much of the symptomatic disturbance is different from that seen in psychiatric clinic populations and is best dealt with in the early stages using a consultation model. Providing information about the nature of these reactions is helpful for those affected and for service personnel managing disaster relief. In the reconstruction phase, it is important for relief agencies to be aware of the ways in which grief and psychological morbidity can interfere with people's ability to make decisions and carry out practical tasks.
117 individuals (mean age 37.77 yrs) who were at the fire and 30 individuals (mean age 40.72 yrs) who were not at the fire (bereaved families and rescue workers) were assessed regarding objective stressfulness of their fire experience, subjective stressfulness, and intensity of psychological symptoms (the Psychiatric Evaluation Form, PEF) in a structured clinical interview approximately 1 yr after the fire. Ss also filled out the Symptom Checklist-90, Revised Version (SCL-90R). 88 Ss were followed-up at 2 yrs. The group as a whole was more impaired than comparison samples of normals but less impaired than outpatients. Ss at the fire were less impaired than those not at the fire, who were similar to outpatients on the PEF. The latter group improved significantly on several measures from 1 to 2 yrs postfire, whereas the group at the fire showed little change. Results are discussed in the context of the specific instruments and methodology used in the present study, impairment levels of other samples, and the nature of the particular disaster. (19 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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