Psychiatric disorders and suicide attempts in Swedish survivors of the 2004 southeast Asia tsunami: a 5 year matched cohort study

Abstract

Background Survivors of natural disasters are thought to be at an increased risk of psychiatric disorders, however the extent of this risk, and whether it is linked to preexisting psychopathology, is not known. We aimed to establish whether Swedish survivors of tsunamis from the 2004 Sumatra-Andaman earthquake had increased risks of psychiatric disorders and suicide attempts 5 years after repatriation. MethodsWe identified Swedish survivors repatriated from southeast Asia (8762 adults and 3742 children) and 864 088 unexposed adults and 320 828 unexposed children matched for sex, age, and socioeconomic status. We retrieved psychiatric diagnoses and suicide attempts from the Swedish patient register for the 5 years after the tsunami (from Dec 26, 2004, to Jan 31, 2010 and estimated hazard ratios (HRs), then adjusted for pre-tsunami psychiatric disorders, and, for children, for parental pretsunami disorders. 0.86-1.11), although exposed children and adolescents had a higher risk for suicide attempts with uncertain intent (1.43; 1.01-2.02) and stress-related disorders (1.79; 1.30-2.46), mainly during the first 3 months after the tsunami. FindingsInterpretation The 2004 tsunami was, independently of previous psychiatric morbidity, associated with an increased risk of severe psychopathology, mainly stress-related disorders and suicide attempts, in children and adults. Survivors of natural disasters should be targeted with early interventions and active long-term follow-up to prevent, detect, and alleviate psychiatric disorders that might follow. 3 IntroductionIn the last decade, natural disasters afflicted more than 200 million people each year, 1 resulting in loss of lives, property destruction, and psychological suffering worldwide. Literature reviews suggest that survivors are at increased risk of psychiatric disorders, particularly posttraumatic stress disorder (PTSD). [2][3][4][5] As noted previously, [6][7][8] percentile). We matched children and adolescents for sex, birth year, parental cohabitation status, disposable family income, education, and employment of both parents as defined above.The final cohort included 8762 exposed and 864088 unexposed adults and 3742 exposed and 320 828 unexposed children and adolescents. We followed the exposed and matched cohorts from Dec 26, 2004, until emigration, death, or end of follow-up (Jan 31, 2010), whichever came first. The study was approved by the Regional Ethics Committees of Karolinska Institutet and Uppsala University. After register-linkage on national identifiers, unique for every Swedish resident, data analyses were done on deidentified datasets. OutcomesOur assessed outcomes were first presentation of a psychiatric disorder (diagnostic codes F00-F99), a definite suicide attempt based on a diagnosis of intentional selfharm (X60-X84), or an uncertain suicide attempt based on a diagnosis of events of undetermined intent (Y10-Y34). For the sake of precision we report mainly diagnoses in the category of disorders related to stress and adjustment disorder...

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