Academic journal article European Journal of Psychotraumatology

Longitudinal Course of Physical and Psychological Symptoms after a Natural Disaster

Academic journal article European Journal of Psychotraumatology

Longitudinal Course of Physical and Psychological Symptoms after a Natural Disaster

Article excerpt


Longitudinal course of physical and psychological symptoms after a natural disaster

Lars Wahlström*, Hans Michélsen, Abbe Schulman, Hans Backheden and Riitta Keskinen-Rosenqvist

Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden


Background : After disaster, physical symptoms are common although seldom recognized due to lack of knowledge of the course of symptoms and relation to more studied psychological symptoms.

Objective : This study aimed to investigate the change in the reporting of different physical symptoms after a disaster, including possible factors for change, and whether psychological symptoms predict physical symptoms reporting at a later point in time.

Method : A longitudinal study of citizens of Stockholm who survived the 2004 Indian Ocean tsunami. A total of 1,101 participants completed questionnaires on somatic symptoms, general distress, posttraumatic stress, exposure, and demographic details 14 months and 3 years after the disaster. Physical symptoms occurring daily or weekly during the last year were investigated in four symptom indices: neurological, cardiorespiratory, gastrointestinal, and musculoskeletal. We used generalized estimating equations (GEE) analysis to determine odds ratios for a change in symptoms, and pathway analysis to predict the influence of psychological symptoms on physical symptoms.

Results : There was a general decrease of reporting in all physical symptom indices except the musculoskeletal symptom index. The change in the neurological symptom index showed the strongest association with exposure, and for women. General distress and posttraumatic stress at 14 months postdisaster predicted physical symptoms at 3 years.

Conclusion : Physical symptoms were predicted by psychological symptoms at an earlier time point, but in a considerable proportion of respondents, physical symptoms existed independently from psychological symptoms. Physicians should be observant on the possible connection of particular pseudoneurological symptoms with prior adversities.

Keywords: Physical symptoms; mental health; natural disaster; longitudinal studies; pseudoneurological symptoms

*Correspondence to: Lars Wahlström, Alfred Nobels allé 12, SE-141 83 Huddinge, Sweden, Tel: +46 8524 88906, Mobile: +46 739 627710, Fax: +46 8524 88706, Email:

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Received: 3 July 2013; Revised: 22 November 2013; Accepted: 30 November 2013; Published: 27 December 2013

European Journal of Psychotraumatology 2013. © 2013 Lars Wahlström et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: European Journal of Psychotraumatology 2013, 4 : 21892 -

Physical health problems are common after a disaster (Yzermans, Van den Berg, & Dirkzwager, 2009). In some cases these problems result from direct physical injury, such as burns from fires, or fractures and cuts after earthquakes (Catchpole & Morgan, 2010). Even without injury, experiencing a disaster may be associated with subsequent medical conditions if the hormonal stress response is not downregulated when safety is restored (Dirkzwager, Van der Velden, Grievink, & Yzermans, 2007; Zaetta, Santonastaso & Favaro, 2012). In addition, it is a commonly held belief that disaster, like other types of trauma, results in increased perceptions of somatic distress. …

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