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Articles   |    
Use of Health Care Services Before and After a Natural Disaster Among Survivors With and Without PTSD
Susanne Rosendal, M.D., Ph.D.; Erik Lykke Mortensen, M.D., M.Sc.; Henrik Steen Andersen, D.M.Sc.; Trond Heir, M.D., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200535
View Author and Article Information

Dr. Rosendal and Dr. Andersen are with the Centre for Crisis and Disaster Psychiatry, Psychiatric Centre Copenhagen, Copenhagen, Denmark (e-mail: rosendals@gmail.com). Mr. Mortensen is with the Department of Public Health, University of Copenhagen, Copenhagen. Dr. Heir is with the Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, Oslo, Norway.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study used a questionnaire to identify individuals who met criteria for posttraumatic stress disorder (PTSD) ten months after surviving a disaster and compared their use of health care services before and after the disaster with that of survivors who did not meet criteria for PTSD.

Methods  Ten months after the December 26, 2004, Southeast Asian tsunami, Danish tourists who had been in areas exposed to the disaster were mailed a questionnaire asking about demographic characteristics and exposure to the tsunami. The questionnaire included the PTSD Checklist, which measures symptoms of posttraumatic stress. Individuals who met DSM-IV PTSD criterion A1—in this case, being caught, touched, or chased by the waves or having witnessed the death, serious injury, or suffering of others—were included in the analyses (N=635). The Danish National Health Service Register provided longitudinal data on annual number of contacts with health care services before (2002–2004) and after (2005–2007) the tsunami.

Results  Survivors with PTSD or partial PTSD used health care services more than survivors without PTSD before and after the tsunami. The severity of posttraumatic stress symptoms was positively correlated with postdisaster use of health care services. However, when adjusted for predisaster health care use, this association was not significant.

Conclusions  Postdisaster health care service utilization was predicted by predisaster health care service utilization and was hardly affected by the onset of PTSD itself. Associations between PTSD and subsequent health problems must be interpreted with caution.

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Figure 1 Use of health care services before and after the 2004 Southeast Asian tsunami among survivors with PTSD, partial PTSD, or no PTSD
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Table 1Characteristics of Danish survivors of the 2004 Southeast Asian tsunami (N=635), by diagnosis of PTSDa
Table Footer Note

a The groups were compared by chi square (linear by linear) test.

Table Footer Note

*p<.01, **p<.001

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Table 2Contacts with health care services before and after the 2004 Southeast Asian tsunami among survivors with PTSD, partial PTSD, or no PTSDa
Table Footer Note

a The groups were compared by one-way ANOVA with subsidiary Bonferroni-corrected post hoc tests (reference: no PTSD; df=2 and 632). The use of all health care services by all groups increased significantly, with the exception of the use of psychiatrists.

Table Footer Note

*p<.05, **p<.01, ***p<.001

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Table 3Contacts with health care services before (2002–2004) the Southeast Asian tsunami among survivors with PTSD, partial PTSD, and no PTSD, by quartilea
Table Footer Note

a Contacts among participants with PTSD, partial PTSD, and no PTSD were compared by chi square (linear by linear) test.

Table Footer Note

b PTSD Checklist (PCL) scores are reported as means and 95% confidence intervals. Possible scores range from 17 to 85, with higher scores indicating greater symptoms severity. PCL scores were compared by one-way ANOVA (reference: no PTSD, df=3 and 631).

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Table 4Association between characteristics of survivors of the 2004 Southeast Asian tsunami and their use of health care services in 2006–2007
Table Footer Note

a Model 1 was a bivariate analysis (R2=.03, df=1 and 633, p<.001).

Table Footer Note

b Model 2 adjusted the results for age, gender, education, and marital status (R2=.14, df=5 and 553, p<.001).

Table Footer Note

c Model 3 made an additional adjustment for predisaster health care use (R2=.44, df=6 and 552, p<.001).

Table Footer Note

*p<.01, **p<.001

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