2011 Norway attacks: Predictors of long-term physical and mental health in victims of the Utøya Island massacre.

The study The objective of this study was to assess the reactions of those who were exposed to the terror attack at Utøya the 22nd of July, 2011, and their parents. The effect of terror , the impact of coinciding injuries, and psychosocial adversities in the aftermath of the event was investigated. A better understanding of the longitudinal course of psychological and somatic reactions, and related risk, may be critical for planning early, effective interventions and treatment following future disasters and other traumatic events. The survey has a longitudinal design. Data collection was conducted at three time-points; 4-5 months, 14-15 months and 30-32 months after the disaster. All adolescents and adults (above age 12) who were on the Utøya islet at the time of the terror were invited to participate. In the first round of interviews, 325 survivors, with a mean age of about 19 years, and 463 caregivers participated. In the second round of interviews 285 survivors and 435 caregivers responded, whilst 261 survivors and 377 caregivers participated in the third round. Participation was voluntary and informants could withdraw from the study at any time. Trained personnel conducted semi-structured interviews with the survivors, including a validated headache interview. At the end of each session the interviewer assessed the participants` current needs for health services, and provided advice and support in contacting the appropriate health services if required. All interviewees were sent a summary report with some selected results from the study after each data collection. We asked all informants for consent to collect records from emergency teams, hospitals and GPs, as well as access to information from educational and health registries. Results The study has revealed that those who were directly affected by the terrorist attack at Utøya had significant psychological and physical reactions to the incident and the challenges they faced in the aftermath. At the first interview, almost half of those who had been at Utøya reported probable posttraumatic stress disorder (PTSD). The majority (7 out of 10) reported symptoms on clinical levels of anxiety and depression or somatic complaints. On both the second and third interview, the symptom load was somewhat alleviated, although still above the level of symptoms expected in the general population. The youth and parents' mental and physical reactions generated a considerable increase in need for assistance, over several years, both from the municipal - and the specialist health care services. The narratives To gain more knowledge about youths? personal experiences we investigated their trauma narratives in relation to post-traumatic stress reactions. Postdoctoral Fellow on the project (1.5 years funding), Petra Filkukova, has analyzed the narratives and found that there was a correlation between the way young people construct a trauma narrative and mental health 14 to 15 months after the terrorist attack at Utøya. The narratives of youth with few post-traumatic stress symptoms had a more internal focus in their narratives, with more descriptions referring to thoughts and feelings, than the narratives of those with a high symptom level. Filkukova also found that many survivors had experienced fear that prolonged far beyond the acute situation. The youth who experienced such "extended fear" also had significantly higher levels of post-traumatic stress symptoms. Headaches and other somatic health complaints Surprisingly little research is conducted on somatic complaints after exposure to terror attacks and other traumatic events. In this study we investigated the occurrence and etiology of young survivors who were exposed to the terrorist attack. Postdoctor Synne Øien Stensland (1.5 years funding) has done two studies on this issue; the first estimated the risk of headache after terror in a comparative cohort study. We found that the majority of survivors reported migraine or tension-type headaches in the early aftermath of the terror attack. Adolescent survivors were about three times more likely to experience severe and frequent headaches as compared to controls. The journal article describing this study is currently in print in the renowned (level 2) journal Neurology, and thus the knowledge will reach specialists in neurology and other medical specialties and help raise awareness and improve the treatment of this condition among trauma affected patients. The second study is in the final phase and will be submitted during summer 2018. In this work, the longitudinal course of mental and somatic health problems is analyzed over time (three times). The aim is to investigate early pain and other somatic disorders that go far beyond the acute phase and assess the possible impact of these complaints on every day functioning. The study uses advanced statistical analyzes and this type of knowledge is highly required in the field.

Background Societal response to terrorist attacks include care and support for the victims. Previous research has clearly demonstrated that victims of terrorism may carry a burden of posttraumatic stress disorder, depression, and somatic health problems f or years following a terrorist attack. However, predictors of long-term courses and the temporal development of symptoms are largely unknown. Objective The current study aims to identify predictors of long-term health development in adolescents and y oung adults following exposure to a terrorist attack. More specifically we will a) analyze aspects of trauma narratives and identify their relationship with long-term development of posttraumatic stress symptoms, b) examine the developmental trajectories of ill-health and resilience, and their predictors, and c) investigate comorbidity and the temporal development of mental health, somatic health problems and social support. Methods A unique opportunity for investigation of longitudinal health trajector ies following a terrorist attack is offered by our study of survivors and their parents following the 22. July terrorist attack at the Utøya Island in Norway. This interview study includes repeated measurements of several health outcomes, as well as narra tives bringing forward the survivors' own voices. We will use a mixed methods approach, mixed effects models, and structural equation modeling. Scientific importance This study will address scientific gaps in our understanding of long-term health develop ment following terrorism and disasters. This empirical investigation will guide theory development related to the longitudinal interplay of mental and somatic symptoms, social support and narratives. Identification of pathways of ill-health and factors re lated to resiliency will contribute to develop more evidence informed response programs to disasters and terror, including early outreach and treatment.