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33.62 · Center for Crisis Psychology, Bergen, Norway+ 1Show
more authorsAbstractFindings from a study of 563 adolescents' reactions following a discotheque fire that killed 63 young people in G?teborg in October 1998 are presented. The group answered a questionnaire seven months following the disaster. The questionnaire included the Impact of Event Scale (IES) and the Birleson Depression Self-Rating Scale (DSRS). The level of trauma was found to be very high, while depression scores were less elevated. A little under a third of the students scored above a clinical cut-off point (& 35) on the IES, indicating high posttraumatic stress levels. Girls evidenced more depression and traumatic stress reactions than boys. Levels of reactions increased with more closeness (knowing victims personally) and if the adolescents were of non-Swedish origin.Discover the world's research13+ million members100+ million publications700k+ research projects
Scandinavian Journal of Psychology, 9–457 (C) 2003 The Scandinavian Psychological Associations. Published by Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UKand 350 Main Street, Malden, MA 02148, USA. ISSN . Blackwell Publishing Ltd The G?teborg discothèque fire, 1998 ATLE DYREGROV 1 , ANN-MARGRET FRYKHOLM 2 , LARS LILLED 2 , ANDERS G. BROBERG 3
and INGVAR HOLMBERG 41 Center for Crisis Psychology, Bergen, Norway 2 The City Office, G?teborg, Sweden 3 Child and Adolescent Psychiatry Centre, Queen Silvia Children’s Hospital, G?teborg, Sweden 4 Department of Statistics, School of Economics and Commercial Law, G?teborg, Sweden Dyregrov, A., Frykholm, A.-M., Lilled, L., Broberg, A. G. & Holmberg, I. (2003). The G?teborg discothèque fire, 1998.
Scandinavian Journalof Psychology ,
44 , 449–457.Findings from a study of 563 adolescents’ reactions following a discotheque fire that killed 63 young people in G?teborg in October 1998 arepresented. The group answered a questionnaire seven months following the disaster. The questionnaire included the Impact of Event Scale(IES) and the Birleson Depression Self-Rating Scale (DSRS). The level of trauma was found to be very high, while depression scores wereless elevated. A little under a third of the students scored above a clinical cut-off point ( &
35) on the IES, indicating high posttraumatic stresslevels. Girls evidenced more depression and traumatic stress reactions than boys. Levels of reactions increased with more closeness (knowingvictims personally) and if the adolescents were of non-Swedish origin. Key words:
Disaster, adolescents, Impact of Event Scale, Birleson Depression Self-Rating Scale. Atle Dyregrov, Center for Crisis Psychology, Fabrikkgaten 5, 5059. Bergen, Norway . E-mail: atle@uib.no INTRODUCTION The event 1 Three hundred and ninety-nine people were inside a two-storey building, gathered at a discothèque party, in G?teborg,when a fire erupted just before midnight on Thursday29 October 1998. The fire inspector had agreed to allow 150people in the building, with regard to the emergency exits’position and width. The room used was on the second floorof the building, with the entrance located at one end and thedance floor and emergency exits at the other.The fire started in the corridor behind the emergency exitand had lasted 20–60 minutes before it penetrated to theroom. The smoke fumes ignited and fire quickly blastedthrough the room. This started a rush, but as the room nar-rowed at the entrance, people got squeezed together, startedto fall and fastened in the exit door. A hundred youngsterswere
trapped in the room with no other exit other thanthrough windows 10 feet above the floor. Horrible experi-ences took place inside and outside the building. A combina-tion of lack of trust of the authorities before the disasterand an altered perception of time, with an experience that ittook “forever” for rescuers to respond to this disaster, led tohigh dissatisfaction with the rescuers.A total of 63 people were killed and 213 others weretreated at different hospitals, many of them severely injuredand requiring care at specialty units. The dead were agedbetween 12 and 19 years, and came from 19 different nations.Survivors were exposed to extreme sensory impressions.Parents and friends experienced a tremendous amount ofstress while waiting outside or searching through differenthospitals to learn whether their loved ones had died orsurvived. As news of the event spread, many young peoplegathered outside the building and were exposed to the situ-ation and the grief and misery of others (including bereavedpeople). For several days and weeks, many young peoplegathered at the disaster site to place flowers, pictures, poems,candles and other memorabilia to ritualize their grief andtalk about their lost friends. Throughout the first weeks, themedia coverage was enormous, with interviews of survivorsand bereaved alike, as well as a search for scapegoats. Latein 1999, the prosecutor’s office arrested four young adultsfor arson. The four had been asked to leave the party. Theywere sentenced to prison for three to eight years. Crisis intervention A massive crisis intervention was instigated at the varioushospitals that received dead and injured youths. The differ-ent child and adolescents outpatient clinics throughoutG?teborg used about 2200 working hours during the first14 days (Schütz, 1999). In addition, most schools set inaction their crisis contingency plans, offering a variety ofdifferent services or activities to help the students. For thosewho were injured, a variety of services were available at thedifferent hospitals that took part in the medical follow-up.The different municipalities within the city, churchesand voluntary organizations established about 60 differentcrisis centres throughout the city. Although the immediateresponse was rapid and comprehensive, the follow-up of themany people involved has been more problematic. Within
450 A. Dyregrov
et al. Scand J Psychol 44 (2003)(C) 2003 The Scandinavian Psychological Associations. the psychiatric services, the tradition for outreach waslimited, and adolescents rarely sought out psychiatric facil-ities on their own. When traditional services were soughtout, some help-seekers dropped out following the first visit,as they found that the services provided were not helpful.Within the school system, the response varied enormously.While some schools had a management well aware of theneeds of the students, other principals saw it as their role tohave their school return to normal (i.e. stop devoting time tothe disaster and its consequences) after the first acute inter-ventions. The overall aim of the study is to look at how anevent of this magnitude influenced students throughout thecity of G?teborg. Relevant previous studies It is hard to find comparable events for this disaster, whichwas triggered by a deliberate malicious human act. Terroristattacks and wartime events are more similar to this eventthan natural disasters and large accidents. Following terror-ist attacks like the Oklahoma bombing (Pfefferbaum
et al. ,2000) and war situations (Ahmad, Mohamed & Ameen,1998; Dyregrov, Gupta, Gjestad & Mukanoheli, 2000) chil-dren and adolescents react with posttraumatic stress symp-toms. Reactions are not only short-term, but continue overtime (Dyregrov, Gjestad & Raundalen, 2002).It is not only those in close proximity to danger who areat risk of experiencing reactions over time. Certain disasters,especially disasters that receive intense media coverage, canaffect children and adolescents far removed from the sceneof events, even across a whole nation, as Terr
(1997)have shown following the explosion of the space shuttle Challenger
in 1986. Terr
(1999) use the term “distanttrauma” to describe the experience of a disastrous eventfrom a safe distance. When a community suffers a disaster,widespread effects can be found among students throughouta district, as following the 1995 Oklahoma City bombing(Pfefferbaum
et al. , 1999). When close personal con-sequences may be relatively limited, Pfefferbaum
foundthe media played a role in sustaining posttraumatic stresssymptoms. Following the Oklahoma bombing, those wholost a friend had significantly more posttraumatic stresssymptoms than those who lost an acquaintance (Pfeffer-baum
et al. , 2000). Also, among children with no physical oremotional exposure, the degree of television exposure wasdirectly related to posttraumatic stress symptomatology(Pfefferbaum
et al. , 2001). Pynoos, Frederick
(1987), intheir study of students in a school following a sniper attack,showed a positive correlation between symptoms of post-traumatic stress disorder (PTSD) and level of acquaintancewith the child who was killed, and advocated the need foran intervention strategy aimed particularly at friends andacquaintances of those who are killed or injured.Research on both adults (Maes, Mylle, Delmeire & Janca,2001) and adolescents (Bolton, O’Ryan, Udwin, Boyle &Yule, 2000) has documented high rates of comorbid anxietyand depression in persons with PTSD. The relationshipbetween PTSD and these comorbid conditions is complex,however, as PTSD may have a causal role in the develop-ment of the comorbid condition, or the existence of acomorbid condition may increase the person’s vulnerabilityto the development of PTSD after exposure to trauma.There is mounting evidence that girls report more reac-tions following death and trauma than boys do (Balmer, 1992,reported in Fleming & Balmer, 1996; Bolton
et al. , 2000;Burke, Moccia, Borus & Burns, 1986; Curle & Williams,1996; Dyregrov, Matthiesen, Kristoffersen & Mitchell, 1994;Dyregrov, Gjestad, Bie Wikander & Vigerust, 1999; Giaconia et al. , 1995; Green
et al. , 1991; Khoury
et al. , 1997; Vernberg,La Greca, Silverman & Prinstein, 1996). Higher rates ofPTSD in women than men has been found to be a functionof higher probability of PTSD development in women, notthe prevalence or type of exposure (Breslau, Davis, Andreski,Peterson & Schultz, 1997), a finding supported in a study ofolder adolescents (Giaconia
et al. , 1995).This article focuses on the dramatic discothèque firedescribed above and addresses the following hypotheses:1. Such an event will be associated with depressive or post-traumatic stress reactions in students throughout the city.2. Reactions will differ depending on psychological “close-ness” to the fire or the victims.3. Girls are expected to evidence higher scores than boys onmeasures of depression and posttraumatic stress.METHOD Sample Out of a total of 672 students enrolled in the study classes, 569students were present at school on the day the study took place andanswered the questionnaire (a response rate of 85%), 265 girls and298 boys (six students had failed to indicate their gender). Absencewas primarily due to illness, but some had left the school since theclass lists last were updated, and still others were having lessonsseparate from their class. They were aged between 13 and 19, witha mean of 15.4 years. They attended junior and senior high school.Sixty-nine percent of the children were born in Sweden, while 31%had immigrant backgrounds. Questionnaire and inventories The first part of the questionnaire concerned a few demographicquestions, and questions regarding activities at the school followingthe disaster, and about support from the school, family and friends.Students were asked to state how well they knew the injured anddead, their closeness to the fire, and how they learned about theevent. The questions were partly based on the study by McNeil,Silliman and Swihart (1991), and that by Dyregrov
(1999).The last part of the questionnaire consisted of two inventories. The Impact of Event Scale (IES) (Horowitz, Wilner & Alvarez,1979) was used to assess the degree of intrusive thoughts and
Scand J Psychol 44 (2003) G?teborg discothèque fire 451 (C) 2003 The Scandinavian Psychological Associations.images (IES-I) and the degree of avoidance of thoughts andreminders of the event (IES-A). This inventory consists of 15 itemswith four answer categories, 0
Not at all, 1
Some-times and 5
Often. This scale is one of the most widely used scalesto measure posttraumatic distress following critical events (Paton,1990). Cronbach’s alpha was 0.89 for IES-I, 0.85 for IES-A and 0.92for IES-Total. For the IES, the clinical cut-off point is usually set at30, with those who score above 30 comprising those at high risk forhaving PTSD (Yule, ). However, Stallard and Law (1993),Yule and Udwin (1991) and Lundin (personal correspondence,1997) have used 40 as a cut-off point. A cut-off score of 35 has beenfound to correctly identify 89% of those with diagnosable PTSD,and this cut-off level will be used in this study (Neal
et al. , 1994). The Birleson Depression Self-Rating Scale (DSRS) (Birleson, 1981)was used to assess the degree of depression. This inventory consistsof 25 items with three answer categories, 0
Sometimesand 2
Most of the time. Cronbach’s alpha for the DSRS was 0.81.Birleson (1981) suggested that the clinical cut-off point for depres-sion should be set at 15. Procedure The study was approved by the National Agency for Education andquestionnaires were administered in the classroom at differentschools in May 1999. Six junior and five senior high schools rep-resenting all different city regions were represented by two classesfrom each school at junior level and one from each school at seniorlevel (17 classes in all). On the junior level, the aim was to have 50students fr on the senior level, the aim was to have50 students from each year, level 1 and 2. As classes varied in size,the number of classes from each school varied. The principals ateach school were responsible for the distribution of the question-naires to the class teachers. The principals were informed about therationale behind the study, that is, learning more about adolescents’reactions and how they perceived the help they received, in order toplan the continuing support in the best possible way. The principalswere
informed through letters, e-mail and by telephone. At theG?teborg City Education Authority, one of the authors of the study(A-MF) was present to answer questions about the study. Theprincipal of each school decided whether to inform parents aboutthe study. An information letter was made available to the principalfor this purpose.The students were informed that the rationale behind the studywas to learn more about adolescents’ reactions and how theyperceived the help they received, in order to plan the continuingsupport in the best possible way. The students answered the ques-tionnaire individually and anonymously during one lesson. At leastthree adults (teachers and support personnel) were present in eachclass to provide support if any reactions arose and to answer anyquestions, but they did not in any way lead the students in how toanswer the questions. Some students not present on the day thequestionnaire was administered were offered an opportunity to fillthem in later, with support personnel at hand. RESULTS Relation to the fire Most students (41%) learned about the fire through televi-sion or radio, or through their parents telling them (26%).Some heard about it through friends (11%) or through others(9%), while 5% read about it in the papers and 4% wereinformed through other sources of information. Twenty-two(4%) were present at the scene of the fire.A fifth of the students (20%) knew none of the dead orinjured. Nineteen percent had best friends who lost one ormore of their best friends, while 44% had lost or had oneor more of their own friends injured. Only 2% of the sampleexperienced the loss or injury of some of their family. Four-teen percent (14%) had some other relationship to a victim. General scores on the inventories Table 1 lists the mean scores on the DSRS and the IES.Nineteen percent scored above the clinical cut-off point of15 on the DSRS. A little under a third of the students (27%)scored above the recommended clinical cut-off point of 35on the IES. Pearson product–moment correlations betweenthe DSRS and the IES scores revealed a statistically sig-nificant relationship ( r
0.05). For the subscales,more depression was paralleled by more intrusion ( r
0.05), and avoidance ( r
0.05). Using Horowitz’s(1982) criteria, 20% evidenced high distress, 28% mediumdistress and 52% low distress on the IES intrusion subscale.For avoidance, the percentages were 27, 29 and 44 for high,medium and low distress. Closeness to the victims and scores The students were asked to rate how well they knew any ofthe victims. The scores on the IES in relation to their close-ness to the victims are reported in Table 2. Those who knewnone of the injured or deceased are listed as “distant”; thosewho reported that some of their best friends had lost one ormore of their best friends are listed as “fairly distant”; thosewho reported that some of their best friends were badlyinjured or died are listed as “close”; and lastly those whoreported that one or more of their own family died are listedas “very close”.Table 2 show that the mean scores increase as the level ofcloseness increases, reflecting more depressive symptoms andTable 1. Total scores and gender differences on the Birleson Depression Self-Rating Scale(DSRS) and the Impact of Event Scale (IES)Number of girls/boys Total M (SD) Girls M (SD)Boys M (SD) tDSRS 255/283 9.7 (5.5) 10.8 (5.6) 8.5 (5.0) 4.95***IES Total 263/282 10.1 (9.1) 25.6 (17.6) 18.7 (16.6) 4.69**IES Intrusion 263/282 11.9 (9.7) 12.0 (9.4) 8.4 (8.5) 4.75**IES Avoidance 264/282 22.0 (17.4) 13.6 (9.7) 10.3 (9.4) 4.05**Note: **p & 0.000004, ***p & 0.000002.
452 A. Dyregrov
et al. Scand J Psychol 44 (2003)(C) 2003 The Scandinavian Psychological Associations. more intrusion and avoidance as their personal closeness tothose injured or killed in the fire increases. Girls reportedmore closeness than boys,
F (1, 535)
0.01.The fire happened to a group with a very mixed culturalbackground. A
t -test was performed to see whether therewere any differences between those who were Swedish bornand those born outside Sweden. The
t -tests for both theDSRS and IES (with its subscales) showed that those bornoutside Sweden had significantly higher scores than thoseborn in Sweden (for brevity only DSRS and IES total arereported here: DSRS,
0.001; IES total, t
0.001). As the people present at thefire had a multicultural background, tests were undertakento see whether this relationship held up with “closeness” asa covariate. It did, probably reflecting that many of theyoung people with a non-Swedish background had experi-enced trauma before the fire (many of these young peoplehave fled from war). Exposure to the fire Twenty-two of the adolescents were present inside or out-side the discothèque when the fire started. A comparison ofthese 22 with the rest of the sample showed them to havesignificantly higher depression scores ( t
3.89, d.f.
0.001) and IES scores (IES total,
5.67, d.f.
0.001; IES intrusion,
5.99, d.f.
0.001;IES avoidance,
4.53, d.f.
0.001) than thosenot present at the fire. Gender differences The scores for the two genders were compared (see Table 1).Girls were significantly more depressed and evidenced higherscores than boys on IES total score as well as on the IESsubscales. Analyses of variance showed that girls had talkedsignificantly more with their friends,
0.01,and their parents,
0.001, than boys had.Girls also significantly more than boys had close friends inwhom they could confide and whom they found to be ofgreat help following the fire,
F (1, 556)
0.001.More girls than boys scored above the cut-off score ( &
15)on the DSRS (23% vs. 15%) and on the IES ( &
35) (33%vs. 22%). More than half the girls (54%) wished that teachershad talked more about the fire, compared with 38% of theboys,
0.001. Although there were no dif-ferences between boys and girls regarding having receivedenough information about the fire in general, boys perceivedthe school as not having provided them with enoughinformation regarding usual reactions during and followinga crisis situation,
5.11, p & 0.05.Predicting reactionsMultiple regression (forward stepwise) was used to analyzethe relationship between the dependent variables – IESintrusion, IES avoidance and DSRS – and the followingindependent variables:1. gender,2. place of birth (Sweden – outside of Sweden),3. psychological distance to the victims (knowledge, friend-ship or family relation),4. talking with friends about the fire,5. having a friend to confide in,6. talking with parents.In addition, three new variables were constructed. Thefirst variable, termed “rituals”, was constructed from variableswhere the students acknowledged participation in rituals ashelpful following an event such as the fire. The second one,termed “cognitive coping”, was made up of variables suchas writing about the event and using time to think about theevent. The third one, termed “communication”, concernsattitudes to talking with others. Variables that had nosignificant effect were removed step by step. The results fromthe tolerance levels in the multiple regression analysis indic-ated a low degree of colinearity (range 0.63 to 0.94).The first dependent variable studied was IES intrusion.The result of the regression analysis is presented in Table 3.The included variables explained 43% of the variance inintrusion. Adolescents with the highest intrusion scores werethose born outside Sweden, who had confided in a closefriend, who described a close psychological relationship tothe victims, and who were female. Higher intrusion scoreswere
also found among those who had talked much withtheir friends and their parents about the fire, and those whofound that rituals and use of cognitive coping were of littlehelp and made things worse. The beta coefficients indicatethat having confided in a close friend and reporting a closepsychological relationship to the victims had the strongestinfluence on intrusion.Regression analysis with avoidance as the dependentvariable resulted in seven significant independent variables(see Table 4). The included variables explained 38% of thevariance in avoidance. Adolescents with the highest avoid-ance scores were those born outside Sweden, who hadTable 2. Mean scores and SD (in parentheses) for DSRS and IES(with subscales) in relation to how well subjects knew victimsaDistant Fairly distant Close Very closeDSRS 7.7 (4.0) 9.0 (5.0) 11.0 (5.8) 14.0 (6.4)IES Intrusion 3.7 (5.4) 7.9 (7.1) 14.3 (9.2) 16.5 (10.6)IES Avoidance 6.0 (7.5) 10.8 (8.9) 15.5 (9.5) 19.5 (12.2)IES Total 9.7 (11.6) 18.7 (14.8) 29.8 (16.9) 36.1 (20.0)Note: a Number of respondents: distant, n = 104–105; fairly distant, n = 98; close, n = 229–233; very close, n = 10–11; 77–78 persons checked a category of “other alternatives”.
Scand J Psychol 44 (2003) G?teborg discothèque fire 453(C) 2003 The Scandinavian Psychological Associations.confided in a close friend, who described a close psycholo-gical relationship to the victims, and who were female. Higheravoidance scores were also found among those who hadtalked much with their parents about the fire, and amongthose who found that rituals were of little help and madethings worse. The beta coefficients indicate that place ofbirth had the strongest influence on avoidance, followed byhaving confided in a close friend and having a close psycho-logical relationship to the victims.Regression analysis with depression (DSRS) as thedependent variable resulted in four significant independentvariables (see Table 5). The included variables explained 22%of the variance in depression. Adolescents with the highestdepression scores were females, those born outside Sweden,Table 3. Multiple regression with IES intrusion as the dependent variableVariablesIntrusion (correlation with dependent variable)Regression coefficient, Bβ coefficientSemipartialcorrelationGender -0.21 -1.81 -0.10 -0.10Place of birth 0.36 3.45 0.18 0.17Psychological closeness 0.50 2.41 0.24 0.20Talking with friends -0.37 -0.79 -0.10 -0.09Having confided in a close friend - 0.54 -2.57 -0.28 -0.22Talking with parents -0.34 -0.72 -0.10 -0.09Positive towards use of rituals 0.00 0.30 0.09 0.09Intercept 5.56R2 = 0.43F(7/370) = 39.72, p & 0.0001Note: All regression parameters were statistically significant at p & 0.05.Table 4. Multiple regression with IES avoidance as the dependent variableVariablesAvoidance (correlation with dependent variable)Regression coefficient, Bβ coefficientSemipartialcorrelationGender -0.20 -3.73 -0.16 -0.15Place of birth 0.41 5.69 0.25 0.23Psychological closeness 0.42 2.23 0.20 0.17Having confided in a close friend - 0.44 -2.15 -0.21 -0.17Talking with parents -0.28 -0.75 -0.09 -0.09Positive towards use of rituals 0.07 0.36 0.10 0.09Use of cognitive coping 0.21 0.61 0.15 0.13Intercept 2.17R2 = 0.38F(7/370) = 32.51, p & 0.0001Note: All regression parameters were statistically significant at p & 0.05.Table 5. Multiple regression with DSRS (depression) as the dependent variableVariablesDepression (correlation with dependent variable)Regression coefficient, Bβ coefficientSemipartialcorrelationGender -0.20 -2.69 -0.25 -0.24Place of birth 0.29 2.66 0.23 0.22Psychological closeness 0.27 1.10 0.18 0.17Negative towards open communication 0.22 1.30 0.25 -0.24Intercept 3.21R2 = 0.22F(4/369) = 25.95, p & 0.0001Note: All regression parameters were statistically significant at p & 0.02.
454 A. Dyregrov et al. Scand J Psychol 44 (2003)(C) 2003 The Scandinavian Psychological Associations.those who described a close psychological relationship to thevictims, and those who found that open communicationmade things worse. The beta coefficients indicate that beingfemale and being negative towards communication had thestrongest influence on depression, but the other two vari-ables had similar beta coefficients.DISCUSSIONNo formal diagnostic interview was undertaken and there isno corroborative information from parents or teachers. Thestudy addresses trauma and depressive reactions as meas-ured by a few instruments on only one occasion followingthe disaster, and suffers from the same limitations as othercross-sectional studies. It does not address changes that havetaken place prior to the first seven months in the recoveryprocesses, nor does it encompass the dynamic process thattakes place over time.Subjectively, the students in this sample evidenced fairlystrong and intense posttraumatic stress reactions to this fire,thus partly supporting hypothesis 1. Most of them hadreacted with shock and a sense of unreality when it hap-pened. Traumatic reactions in the form of intrusion andavoidance, as measured by the IES, were common at themeasuring point, with a little under one-third of the groupevidencing scores reflecting high levels of posttraumaticstress. Using the cut-off levels suggested by Neal et al. (1994),they score at a level indicative of a posttraumatic stressdisorder.The depression scores were not elevated in a similar man-ner. The Birleson scale does not tap grief in the manner asthe Pynoos grief scale (Pynoos, Nader, Frederick, Gonda &Stuber, 1987) or the Hogan Grief Inventory (Hogan, 1990),and it is not possible to know how many of the studentswere grieving. Compared with normative data (see Ivarsson,1998) on the DSRS from comparable age groups of Swedishchildren from the same city (Gothenburg), both girls andboys scored higher following the fire (normative M for girls= 7.8 vs. 10.8 following the fire, and normative M for boys6.1 vs. 8.5 following the fire). The results do indicate that thefire group primarily responded with an elevation in the post-traumatic area, and less with depressive reactions.The scores on the IES indicate that the group in generalexperienced a relatively high degree of intrusive images andthoughts following the fire. Avoidance levels were somewhathigher than intrusion levels, indicating a cognitive struggleto keep the disaster out of their mind. The high avoidancelevel might also reflect a process where the group at this time(seven months after the fire) used avoidance strategies toregulate the intrusive images and thoughts. The mean IESlevels were lower than those of adolescents surviving thesinking of a cruise ship (Yule & Udwin, 1991) and adoles-cents surviving a minibus accident (Stallard & Law, 1993).In previous studies the tendency to suppress thoughts andfeelings has been associated with later PTSD (Aaron, Zaglul& Emery, 1999; Warda & Bryant, 1998). Lonigan, Anthonyand Shannon (1998) have found that children reportingsymptoms associated with behavioral and emotional avoid-ance were the most likely to experience a severe posttrau-matic reaction, particularly when these symptoms werecombined with symptoms associated with re-experiencingphenomena. Other studies also point to unsuccessful avoid-ance activity as a characteristic of chronic emotional pro-cessing (Joseph et al., 1996), often leading to more intrusivethoughts and imagery than in those who allow themselves toremember and process their experience (Aaron et al., 1999).The high level of avoidance found among the students in thisstudy may therefore warrant attention, as it may be associ-ated with suffering over time.Previous studies have shown that PTSD symptoms ingeneral are associated with the level of exposure to the trau-matic event (Lonigan et al., 1991; Tyano et al., 1996). Thisstudy shows that both traumatic reactions and depressionincrease with the closeness to those dead or injured in adisaster, supporting hypothesis 2, and corroborating Pynoos,Frederick
(1987). It is not only the level of physicalthreat or the exposure to strong sensory impressions thatlead to a form of dose relationship to the traumatic reac-tions, but also the “psychological” closeness to those directlyinvolved in the disaster. The importance of this variable isemphasized by its importance in all three multiple regressionanalyses. It is meaningful to look at a form of subjective“closeness hierarchy” following a disaster of this magnitude.By broadening one’s focus from direct exposure to emo-tional exposure in the form of the “felt” distance to thoseinvolved, people in need of more follow-up can be identified.In view of the fact that many of the students in this sam-ple personally did not know anyone who died or survivedthe fire, the level of depression and traumatic reactions issurprisingly high. It seems evident that a disaster of this sizein some ways is affecting all young people in the same agerange as those who were present at the fire. The extensivemedia coverage made this an event that almost every studentcould identify with and share in, an event that was the sub-ject of conversation among children, adolescents and adultsalike. The media were on the scene within minutes and fordays news stories described the tragedy and the ensuingreactions in minute detail. By being exposed to the extensiveloss and tragedy through the media or having friends andacquaintances who were more directly affected by the fire,other, more distant adolescents were “exposed” too. Thesituation created a form of psychological closeness and theterm “distant trauma” or “trauma by identification” or aform of emotional contagion may describe the situation forthose who developed posttraumatic reactions. Pfefferbaumand Pfefferbaum (1998) have used the term “communitycontamination” to describe the wide-reaching impact thattraumatic events can have on entire communities, and con-tagion may account for the magnitude of distress evidencedby so many.
Scand J Psychol 44 (2003) G?teborg discothèque fire 455(C) 2003 The Scandinavian Psychological Associations.The “contagion” hypothesis may further be supported bythe fact that the variables “having talked much with theirfriends and parents” and “having confided in a close friend”held up in the multiple regression analyses as being relatedto elevated scores on the IES and DSRS.As a majority of the direct victims of the fire had a non-Swedish family or origin, we may expect that those not bornin Sweden would feel somewhat more “psychologicallyclose” than would the Swedish born. This conclusion wassupported by analyses. However, the raised depressive levelsand higher IES scores of non-Swedish adolescents may alsoreflect that many of these young people had experiencedtrauma before leaving their country of origin to come andlive as refugees in Sweden, and a more difficult life situationin Sweden as exiles. Without good measurement of levels oftraumatization prior to the fire, it is difficult to draw firmconclusions.Another factor that could explain the high level of distressexperienced by so many is the fact that going to dances atdiscothèques is among the activities almost all young peopletake part in. They socialize, meet friends, start to date andrelax from their schoolwork by going out to dances, moviesand discothèques. They easily can identify with the victimsand “know” that this could have happened to them. Goingto a discothèque suddenly changed from an activity filledwith fun and excitement to an activity that meant fear andapprehension. If something could happen there, it couldhappen anywhere.The significant gender differences on both the DSRS andthe IES scale and the results from the multiple regressionanalyses add to the mounting evidence that females reactmore to traumatic events than males (Breslau et al., 1991,1997; Davidson, Hughes, Blazer & George, 1991; Dyregrov,Gjestad
et al., 1999; Helzer, Robins & McEvoy, 1987;Kessler, Sonnega, Bromet, Hughes & Nelson, 1995), andsupports hypothesis 3. Previous studies have indicated thatadolescent girls define themselves through connections andinterpersonal ties, while boys seek self-definition throughseparateness and independence (Douvan & Aldelson, 1966;McDermott et al., 1983). The fact that females are likely toexperience more concern over other’s distress than males(Trobst, Collins & Embree, 1994), and the consistent findingthat women have relatively high levels of dispositional em-pathy in comparison with men (Eisenberg & Lennon, 1983),may partly explain why girls evidenced more reactions bothon the IES and on the DSRS, and why they perceived morecloseness to the victims. More girls than boys also reportedthe wish for more discussion in the class, a finding that mayimplicate gender-differentiated responses in the follow-up.Implications for interventionThe level of reactions more than half a year following thedisaster should lead teachers and support personnel to bewell prepared to respond to such events, not only imme-diately but over time. The intensity and duration of trau-matic distress following a disaster may be greater than mostteachers and support staff imagine.Based on the results from the follow-up at seven months,it seems likely that many students would have benefittedfrom more mental health assistance over time. However,traditional psychiatric services were not sought out to alarge degree: many adolescents came for only one or a fewvisits (Wiberg & Broberg, 2001). New ways of meeting theneeds of these adolescents have to be established. Outreachmodels using more activity-based methods may be a way ofdoing so. In the summer after the fire, summer camps werearranged by the city of G?teborg, with fire rescue personnelparticipating in each of them. In these camps, activities likecanoeing, swimming and tent building were used to create a“meeting room” for adolescents. During the activities theadolescents could talk about their traumas and losses.In summary, some of the important clinical implicationsfrom this study worth considering when helping following adisaster are as follows.1. For students who directly or indirectly are exposed to adisaster of this magnitude, follow-up may be needed formore than the first month after the event. Both depressiveand traumatic reactions may persist over time.2. Particular attention should be given to those who perceivethemselves to be “psychologically close” to the victimsof the disaster, as suggested by Pynoos, Frederick et al.(1987). Grief or trauma groups would allow for continuedhelp in this respect (Lohnes & Kalter, 1994; Quarmby,1993; Tonkins, 1996).3. Having a detailed crisis contingency plan in place andactivated shortly following a disaster situation will increasethe chance of securing good follow-up for affected groups.School management need to validate students’ reactionsover time.4. Teaching and support staff need to be aware of possibledifferences between the two genders regarding how theyexperience and react to such events and how they seeksupport from friends, family and others following suchlosses.NOTES1The description of the event is based on the keynote presentationthat Per Hassling of the Fire/Rescue Department of G?teborg city madeat the Fifth World Congress on Stress, Trauma and Coping in theEmergency Services Professions, Baltimore, April 1999, entitled “Discodeath trap in Sweden”.REFERENCESAaron, J., Zaglul, H. & Emery, R. E. (1999). Posttraumatic stress inchildren following acute psychical injury. Journal of PediatricPsychology, 24, 335–343.Ahmad, A., Mohamed, H. T. & Ameen, N. M. (1998). A 26-monthfollow-up of posttraumatic stress symptoms in children after
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CitationsCitations15ReferencesReferences67It serves as a general early intervention to reduce psychological consequences of mass violence or disasters (APA, 2004). Youth exposed to a larger scale disaster need follow-up for more than the first month after the event (Dyregrov et al., 2003). If untreated, adolescents exposed to severe trauma may develop chronic PTSD and mood disorders (Goenjian et al., 2005). ABSTRACT: Background: In November 2007, a student shot and killed eight people and himself at Jokela High School, Finland.
Method: Availability and experiences of psychosocial support were investigated using data (N=231) collected with a questionnaire 4 months after the event.
Results: Female gender, severity of trauma, psychiatric disturbance and post-traumatic distress were associated with receiving psychosocial support. Over half of the students with a high level of trauma-related symptoms reported immediate support as having been helpful. Additionally, support from family and friends was available to a majority of students.
Conclusions: The factors associated with not receiving support or not feeling helped should be studied further for possible implications on crisis interventions. Full-text · Article · Feb 2012 The associations between psychological outcomes and risk and protective factors for posttraumatic and psychiatric disturbance appeared to be similar in the comparison group. Our finding, that posttraumatic stress was strongly associated with the severity of exposure to the disaster and that females were especially vulnerable, is concurrent with previous findings [5,11,42]. Even though a significantly greater number of exposed females suffered from posttraumatic distress as compared to exposed males, exposed males were also found to suffer significantly more from posttraumatic distress and probable PTSD than males in comparison school. ABSTRACT: In November 2007, a student shot eight people and himself at Jokela High School, Finland. This study aims to evaluate the long-term effects of exposure to a school shooting among adolescents.
Associations between psychological outcomes and background factors were analysed and compared with &comparison students& four months after the incident. A questionnaire including Impact of Event Scale (IES) and General Health Questionnaire (GHQ-36) was used.
Half of the females and a third of the males suffered from posttraumatic distress. High level of posttraumatic distress (IES≥35), predicting PTSD, was observed in 27% of the females and 7% of the males. The odds ratio was 6.4 (95% confidence interval 3.5-10.5) for having high levels of posttraumatic distress. Severe or extreme exposure and female gender were found to increase the risk. Forty-two percent of the females and 16% of the males had psychiatric disturbance (GHQ≥9). Severe or extreme exposure, older age and female gender increased the risk. Perceived support from family and friends was found to be protective.
The observed risk and protective factors were similar to earlier studies. Follow-up will be essential in identifying factors predicting persisting trauma-related symptoms in adolescence. Full-text · Article · Oct 2010 +1 more author...A background questionnaire, based on a previous investigation of the aftermath of the G?teborg discotheque fire (Dyregrov, Frykholm, Lilled, Broberg, & Holmberg, 2003), contained demographic questions, and questions regarding activities at the school following the fire, as well as support from the school, family and friends. The Impact of Event Scale Revised (IES-R) (Weiss & Marmar, 1997) assesses the degree of arousal (IES-Ar) in addition to the IES-scales' intrusive thoughts and images (IES-I), and avoidance of thoughts and reminders of the event (IES-A). ABSTRACT: On October 29, 1998, around 400 young people were gathered in an old warehouse in G?teborg, Sweden, for a discotheque party. A fire erupted and spread explosively. Adolescents were exposed to dreadful scenes inside and outside the building. In all, 63 young people were killed and 213 physically injured. An 18-month follow-up with 275 adolescents (126 girls) who survived the fire, regarding the effects of the fire on symptoms of posttraumatic stress, school adjustment and performance, is reported.
Impact of Events Scale (IES), Clinician Administered Posttraumatic Stress Scale (CAPS) and an interview concerning background factors and issues of public and personal support.
The level of posttraumatic stress was generally high, and highest among adolescents with an immigrant background. In all, 25% of the participants met DSM-IV criteria for PTSD. Twenty-three percent of the participants reported having either dropped out of school or repeated a class because of the fire. Students' ratings of how their own school handled the situation, and school absenteeism, were related to ratings of their own performance in school as well as to the level of posttraumatic stress.
Traditional talking cures were more sought out by girls than boys. Broad-scale interventions must be complemented with special treatment opportunities for the most severely afflicted. Victims who suffer from high levels of posttraumatic stress need special support for a long period of time to minimise the effects on scholastic achievement and adjustment. Studies of the effects of traumatic events on child and adolescent development should measure school-related effects better than has hitherto been the case. Full-text · Article · Jan 2006
Full-text · Article · Journal of Child Psychology and PsychiatryABSTRACT: Not AvailableConference Paper · Jul 1991 · Journal of Child Psychology and PsychiatryABSTRACT: Playing Nicely in the Sandbox: The Monumental Task of Multi-Agency Coordination in Preparing for the United States Presidential Inauguration in the Nation's Capital - Volume 20 Issue S1 - C. CatlettArticle · Apr 2005 Project[...]Project[...]maria erikssonDet ?vergripande syftet med f?religgande studie ?r att pr?va anv?ndbar- och genomf?rbarheten av intervjuerna inom ramen f?r barnav?rdsutredningar avseende barn som varit utsatta f?r v?ld direkt och…& ProjectArticleJanuary 2006 · Journal of Child Psychology and Psychiatry · Impact Factor: 6.46On October 29, 1998, around 400 young people were gathered in an old warehouse in G?teborg, Sweden, for a discotheque party. A fire erupted and spread explosively. Adolescents were exposed to dreadful scenes inside and outside the building. In all, 63 young people were killed and 213 physically injured. An 18-month follow-up with 275 adolescents (126 girls) who survived the fire, regarding the... ArticleFebruary 2003 · New Directions for Youth DevelopmentGiven the magnitude of the possible exposure and duration of distress evidenced by Iraqi children, there is strong reason to expect that this, in combination with malnutrition and reduced school attendance, will dramatically reduce their learning potential. ArticleJanuary 2004Many children are deeply affected by loss and trauma. Although some studies mention the educational consequences of such situations, this is an aspect often overlooked. Results from different studies show that survivors of disasters, violence and death tend to be more absent from school and some drop out of school prematurely. In addition, school performance may deteriorate, especially in... ArticleJanuary 2002 · TraumatologyRecently there has been a critique of the use of western models in the trauma field. In this article it is discussed whether some of this critique reflects a continuation of a denial of trauma and PTSD that has been evident in psychology and psychiatry for a number of years. Although the critique has rightfully pointed out the importance of social and political dimensions in the understanding... ArticleJune 2002 · Journal of the American Academy of Child & Adolescent Psychiatry · Impact Factor: 7.26Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.This publication is from a journal that may support self archiving.Last Updated: 28 Aug 17}