Academic journal article European Journal of Psychotraumatology

Does Posttraumatic Stress Predict Frequency of General Practitioner Visits in Parents of Terrorism Survivors? A Longitudinal Study

Academic journal article European Journal of Psychotraumatology

Does Posttraumatic Stress Predict Frequency of General Practitioner Visits in Parents of Terrorism Survivors? A Longitudinal Study

Article excerpt

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1. Background

Life threat to offspring may deeply affect their parents. Uncertainty of whether one's child will live or die, the sense of powerlessness to protect a loved one and the fear of what comes next may leave harsh, lasting impressions in mothers and fathers of children of all ages, including parents of teens and young adults. The relief of reunion following a traumatic event may be accompanied by a second wave of emotional turmoil in parents: the shock of reconnecting with an injured, distressed and poorly-functioning child. Numerous challenges lie ahead for the traumatized family. Great responsibilities fall on the shoulders of parents. First, parents need to learn how to cope with their own stress reactions. Second, parents need to learn how to support their child under difficult circumstances. Third, practical challenges may arise as family members resume their daily lives, return to school, work and social arenas (Røkholt, Schultz, & Langballe, 2016). Adequate healthcare services may be critical in this demanding situation.

Parent traumatization through life threat to their child has mainly been studied in contexts of child's chronic or acute illness (Cabizuca, Marques-Portella, Mendlowicz, Coutinho, & Figueira, 2009; Nelson & Gold, 2012) and sexual abuse (Dyb, Holen, Steinberg, Rodriguez, & Pynoos, 2003). High levels of parent posttraumatic stress reactions (PTSR) have consistently been reported. Few studies have addressed posttraumatic health in parents who learn that their offspring have been affected by disasters or terrorist attacks. One small study addressing 20 mothers of schoolchildren who survived the 2004 terrorist attack in Beslan reported high levels of PTSR, comparable to levels observed among the survivors themselves (Scrimin et al., 2006). A registry-based study of the aftermath of a pub fire in Holland in 2001 reported that mental and cardiovascular health problems, as recorded by the primary healthcare provider, were significantly more prevalent in parents of survivors with burns than in unaffected community controls (Dorn, Yzermans, Spreeuwenberg, & Van Der Zee, 2007). Thus, although limited, current evidence suggests that post-disaster ill-health in parents of disaster survivors may include both mental and somatic health problems that in turn may call for both mental and somatic post-disaster healthcare responses.

Our previous studies of the mothers and fathers of the 2011 Utøya terrorist attack survivors have demonstrated significantly elevated levels of early and lasting PTSR and depression/anxiety symptoms (Haga, Stene, Wentzel-Larsen, Thoresen, & Dyb, 2015; Thoresen, Jensen, Wentzel-Larsen, & Dyb, 2016). General practitioners (GPs) may play a key role in post-disaster management of parent mental and somatic healthcare needs, as a high number of individuals affected by a disaster may turn to their GP for help. Regardless of whether visits to the GP are related to the disaster or not, they allow GPs the opportunity to efficiently evaluate post-disaster healthcare needs.

Unmet healthcare needs are repeatedly reported following disasters (Brewin et al., 2010). A number of factors have been identified as barriers to postdisaster access to healthcare, including factors within the individuals in need (internal factors), as well as characteristics of the healthcare services or the community at large (external factors) (Kantor, Knefel, & Lueger-Schuster, 2016). Andersen's behavioural model of healthcare service utilization (Andersen, 1995) has shaped much of current thinking on access to healthcare. The model divides predictors of healthcare consumption into three groups: (1) predisposing factors, including sociodemographic characteristics of the individual; (2) illness-related needs factors, including symptom severity and perceived needs; and (3) enabling factors, including availability of services, patient attitude towards health seeking and financial resources. …

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