Mental Health Outcomes 27 Years After a Major Disaster

  • Are HolenEmail author
Reference work entry


In March 1980, an oil rig in the North Sea capsized with 212 men on board; 123 died and 89 survived. A research program followed up the 75 Norwegian survivors in 4 waves of data collections: shortly after the disaster (1980), after 1 year (1981), again after 5 years (1985), and eventually after 27 years (2007). In 1985, a matched comparison group was included and followed up until 2007. The comparison group was matched for age, gender, profession, and domicile. So far, this disaster study has the longest follow-up period that is combined with a comparison group.

In this chapter, a description of the disaster itself is given together with a brief introduction of disaster psychiatry, i.e., the study of civilian disasters as a part of the larger research field that is addressing post-traumatic stress.

After 27 years, no significant difference in the general symptom severity or in the number of screened cases was found between the survivors and those from the comparison group when using inventories such as PTSS and GHQ. The same was also found regarding the annual number of weeks in sick leave or disability pension; annually, there was a significant difference between the survivors and the comparison group during the first 12 years, but after that time the annual significant difference disappeared and did not return.

However, when using the SCID I interview in 2007, significant differences were found with regard to diagnoses. The risks were more than three times higher of survivors having one or more psychiatric diagnoses at that time than for those in the comparison group. The biggest difference was found for anxiety disorders, but depressive disorders also demonstrated significant differences. The most prevalent of the lifetime diagnoses was the depressive disorders, about one third of the survivors, while less than one fifth in the comparison group had faced this kind of mental health problems. Lifetime somatoform disorders were only found among the survivors. Lifetime substance misuse was significantly more prevalent among the survivors. About a quarter of the survivors had an early-onset PTSD, but the occurrence dwindled over the decades. Anxiety and depression seemed to become more common, rendering support to the suggestion that post-traumatic symptomatology in the long run may serve as a transitional psychopathology. Comorbidity was far more common among the survivors. Those reporting residual PTSD symptoms were more likely to experience reactivated PTSD later in the post-traumatic course. The reported post-traumatic growth after 27 years was highly correlated with the concurrent symptom severity, and not with higher levels of post-traumatic burden of the past. This indicates that self-reported post-traumatic growth may serve as a means of coping rather than an expression of richer and fuller lives.


Stressor Adverse events Civilian disaster Oil rig disaster PTSD Post-traumatic stress disorder Sub-syndromal PTSD Post-traumatic growth Sick leave Disability Transitional psychopathology 

List of abbreviations


Diagnostic and statistical manual


General health questionnaire


Impact of event scale


Mean value


NEO personality inventory


Post-traumatic growth


Post-traumatic growth inventory


Post-traumatic stress


Post-traumatic stress disorder


Post-traumatic stress scale (previously called Post-traumatic symptom scale)


Structured clinical interview for DSM-IV


Standard deviation


  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-III. Washington, DC: American Psychiatric Association; 1980.Google Scholar
  2. Boe HJ, Holgersen KH, Holen A. Reactivation of posttraumatic stress in male disaster survivors: the role of residual symptoms. J Anxiety Disord. 2010;24:397–402.CrossRefPubMedGoogle Scholar
  3. Boe HJ, Holgersen KH, Holen A. Mental health outcomes and predictors of chronic disorders after the North Sea Oil Rig Disaster: 27-year longitudinal follow-up study. J Nerv Ment Dis. 2011;199(1):49–54.CrossRefPubMedGoogle Scholar
  4. Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59:2–28.CrossRefGoogle Scholar
  5. Brady K, Killeen T, Brewerton T, Lucerini S. Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatry. 2000;61 Suppl 7:22–32.PubMedGoogle Scholar
  6. Brown G, Harris T. Social origins of depression. London: Tavistock; 1978.Google Scholar
  7. Calhoun LG, Tedeschi RG. The foundation of posttraumatic growth: an expanded framework. In: Calhoun LG, Tedeschi RG, editors. Handbook of posttraumatic growth – research and practice. Mahwah: Erlbaum; 2006. p. 3–23.Google Scholar
  8. Eid J, Thayer JF, Johnsen BH. Measuring post-traumatic stress: a psychometric evaluation of symptom- and coping questionnaires based on a Norwegian sample. Scand J Psychol. 1999;40:101–8.CrossRefPubMedGoogle Scholar
  9. Finley-Jones R, Brown G. Types of stressful life events and the onset of anxiety and depressive disorders. Psychol Med. 1981;11:803–15.CrossRefGoogle Scholar
  10. Gleser GC, Green B, Winget C. Prolonged psychosocial effects of disaster: a study of Buffalo Creek. New York: Academic; 1981.Google Scholar
  11. Helgeson VS, Reynolds KA, Tomich PL. A meta-analytic review of benefit finding and growth. J Consult Clin Psychol. 2006;74:797–816.CrossRefPubMedGoogle Scholar
  12. Holen A. A longitudinal study of the occurrence and persistence of post-traumatic health problems in disaster survivors. Stress Med. 1991;7:11–7.CrossRefGoogle Scholar
  13. Holen A. Posttraumatic stress disorder, delayed. In: Fink G, editor. Encyclopedia of stress, vol. 3. 2nd ed. Oxford: Academic; 2007. p. 150–2.CrossRefGoogle Scholar
  14. Holen A. A long-term outcome study of survivors from a disaster: the Alexander L Kielland disaster in perspective. Doctoral dissertation, University of Oslo, Oslo. 1990a.Google Scholar
  15. Holen A. Post-traumatic symptom scale. In: Holen A, editor. A long-term outcome study of survivors from a disaster: the Alexander L Kielland disaster in perspective. Doctoral dissertation, University of Oslo, Oslo, 1990b. p. 59–78.Google Scholar
  16. Holgersen KH, Boe HJ, Holen A. Long-term perspectives on posttraumatic growth in disaster survivors. J Trauma Stress. 2010a;23(3):413–6.PubMedGoogle Scholar
  17. Holgersen KH, Boe HJ, Klöckner CA, Weisæth L, Holen A. Initial stress response in relation to outcome after three decades. J Nerv Ment Dis. 2010b;198(3):230–3.CrossRefPubMedGoogle Scholar
  18. Holgersen KH, Klöckner CA, Boe HJ, Weisæth L, Holen A. Disaster survivors in their third decade: trajectories of initial stress responses and long-term course of mental health. J Trauma Stress. 2011;24(3):334–41.CrossRefPubMedGoogle Scholar
  19. Holgersen KH, Klöckner CA, Boe HJ, Holen A. Sick leave and disability across three decades after a major disaster. J Nerv Ment Dis. 2016. (in press).Google Scholar
  20. Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11(2):213–8.CrossRefPubMedGoogle Scholar
  21. Horowitz MJ. Stress response syndromes. New York: Jason Aronson; 1976.Google Scholar
  22. Horowitz MJ, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18.CrossRefPubMedGoogle Scholar
  23. Hull AM, Alexander DA, Klein S. Survivors of the Piper Alpha platform disaster: long-term follow up study. Br J Psychiatry. 2002;181:433–8.CrossRefPubMedGoogle Scholar
  24. Maercker A, Zoellner T. The Janus face of self-perceived growth: toward a two-component model of posttraumatic growth. Psychol Inq. 2004;15:41–8.Google Scholar
  25. Muthèn B. Second-generation structural equation modeling with a combination of categorical and continuous latent variables: new opportunities for latent class/latent growth modeling. In: Collins LM, Sayer A, editors. New methods for the analysis of change. Washington, DC: American Psychological Association; 2001. p. 291–322.CrossRefGoogle Scholar
  26. Muthèn LK, Muthèn BO. Mplus user’s guide. 5th ed. Los Angeles: Muthèn, L. K. & Muthèn; 2007.Google Scholar
  27. Nolen-Hoeksema S, Davis CG. Theoretical and methodological issues in the assessment and interpretation of posttraumtic growth. Psychol Inq. 2004;15:60–4.Google Scholar
  28. Norris FH. Disaster research methods: post progress and future directions. J Trauma Stress. 2006;19:173–84.CrossRefPubMedGoogle Scholar
  29. Norris FH, Slone L. The epidemiology of trauma and PTSD. In: Friedman M, Keane T, Resick P, editors. Handbook of PTSD science and practice. New York: Guildford Press; 2007. p. 78–98.Google Scholar
  30. Norris FH, Friedman M, Watson P. 60,000 disaster victims speak: part II. Summary and implications of the disaster mental health research. Psychiatry. 2002a;65(3):240–60.CrossRefPubMedGoogle Scholar
  31. Norris FH, Friedman M, Watson P, Byrne C, Diaz E, Kaniasty K. 60,000 disaster victims speak: part I. An empirical review of the empirical literature. Psychiatry. 2002b;65(3):207–39.CrossRefPubMedGoogle Scholar
  32. Paykel E, Prusoff B, Uhlenhuth E. Scaling life events. Arch Gen Psychiatry. 1971;25:340–7.CrossRefPubMedGoogle Scholar
  33. Raphael B. When disaster strikes: a handbook for the caring professions. London: Unwin Hyman; 1986a.Google Scholar
  34. Raphael B. When disaster strikes: how individuals and communities cope with catastrophe. New York: Basic Books; 1986b.Google Scholar
  35. Raphael B, Middleton W. Mental health responses in a decade of disasters: Australia, 1974–1983. Hosp Community Psychiatry. 1987;38(12):1331–7.PubMedGoogle Scholar
  36. Solomon Z, Mikulincer M. Trajectories of PTSD: a 20-year longitudinal study. Am J Psychiatry. 2006;163(4):659–66.CrossRefPubMedGoogle Scholar
  37. Stein M, Walker J, Hazan A, Forde D. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry. 1997;154:1114–9.CrossRefPubMedGoogle Scholar
  38. Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9:455–71.CrossRefPubMedGoogle Scholar
  39. Tedeschi RG, Calhoun LG. Posttraumatic growth: conceptual foundations and empirical evidence. Psychol Inq. 2004;15:1–18.CrossRefGoogle Scholar
  40. Titchner JL, Kapp F. Disaster at Buffalo Creek. Family and character change at Buffalo Creek. Am J Psychiatry. 1976;133(3):295–9.CrossRefGoogle Scholar
  41. Weisæth L. Stress reactions to an industrial disaster: an investigation of disaster behaviour and acute post-traumatic stress reactions, and a prospective, controlled, clinical and interventive study of sub-acute and long-term post-traumatic stress reactions. Doctoral dissertation, University of Oslo, Oslo.Google Scholar
  42. Weisæth L, Mehlum L. Mennesker, traumer og kriser [People, trauma and crisis]. Oslo: Universitetsforlaget; 1993.Google Scholar
  43. Wortman C. Posttraumatic growth: progress and problems. Psychol Inq. 2004;15:81–90.Google Scholar
  44. Zoellner T, Maercker A. Posttraumatic growth in clinical psychology – a critical review and introduction of a two component model. Clin Psychol Rev. 2006;26:626–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Faculty of Medicine, Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway

Personalised recommendations