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Bellis van den Berg, MA; Linda Grievink, PhD; Rebecca K. Stellato, MS; C. Joris Yzermans, PhD; Erik Lebret, PhD

Arch Intern Med. 2005;165:2402-2407.

Background  Traumatic events are described as precipitating factors for medically unexplained symptoms. The aim of this study was to examine the prevalence and course of symptoms reported by disaster survivors and to assess whether the symptoms have features similar to those of medically unexplained symptoms.

Methods  A 3-wave longitudinal study was performed after an explosion of a fireworks depot. As a result of the explosion, 23 people were killed, more than 900 people were injured, and about 500 homes were damaged or destroyed. Respondents completed a set of validated questionnaires measuring their health problems 3 weeks (wave 1), 18 months (wave 2), and 4 years (wave 3) after the disaster. A comparison group was included at waves 2 and 3.

Results  The study population included 815 survivors who participated in the 3 waves. The mean number of symptoms was higher among survivors compared with control subjects at wave 2 (7.5 vs 5.8 symptoms) and at wave 3 (6.1 vs 4.9 symptoms) (P<.001 for both). Survivors and control subjects with more symptoms reported significantly lower mean scores on all scales of the Dutch version of the RAND 36-item health survey. Illness behavior and depression and anxiety were associated with the number of symptoms. For example, more than 60% of survivors with 10 or more symptoms reported depression and anxiety, compared with 2.4% of survivors with 0 to 1 symptoms (P<.001).

Conclusions  Up to 4 years after the disaster, symptoms were more prevalent among survivors than controls. Although medical disorders cannot be excluded, the reported symptoms showed several features similar to those of medically unexplained symptoms in the general population.

Author Affiliations: National Institute for Public Health and the Environment, Bilthoven (Mss van den Berg and Stellato and Drs Grievink and Lebret), and Institute of Risk Assessment Sciences, Utrecht University (Ms van den Berg), and Institute for Health Services Research (Dr Yzermans), Utrecht, the Netherlands.

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