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. 2022 Dec;13(2):2152930.
doi: 10.1080/20008066.2022.2152930. Epub 2022 Dec 13.

Prolonged grief, post-traumatic stress, and functional impairment in parents and siblings 8 years after the 2011 Utøya terror attack

Erik-Edwin Leonard Nordström  1   2 , Jens C Thimm  1   3 , Riittakerttu Kaltiala  4   5   6 , Pål Kristensen  1
Affiliations

Prolonged grief, post-traumatic stress, and functional impairment in parents and siblings 8 years after the 2011 Utøya terror attack

Erik-Edwin Leonard Nordström et al. Eur J Psychotraumatol. 2022 Dec.

Abstract
in English, Spanish, Chinese

Background: Research on bereavement after terrorism is limited and primarily aiming on short-term consequences.Objective: To better understand the long-term health consequences of terrorism, we studied bereaved parents and siblings eight years after the Utøya terrorist attack in Norway. We examined the participants' symptom levels of prolonged grief (PG) and post-traumatic stress (PTS), as well as their psychosocial functioning and employment status.Method: Bereaved parents (n = 88) and siblings (n = 34) aged 19 and above (mean age = 49.7 years, SD = 13.8 years, 59.8% female) completed the Inventory of Complicated Grief (ICG), the Impact of Event Scale-Revised (IES-R), and the Work and Social Adjustment Scale (WSAS) to assess PG, PTS, and functional impairment, respectively. In addition, information about employment status was obtained. The proportion of participants scoring above recommended thresholds on the ICG, IES-R, and WSAS was calculated. Differences between parents and siblings and gender differences on these measures were examined.Results: In total, 62.3% of the participants had scores on the ICG indicating a risk for prolonged grief, while 45.9% scored over cutoff on the IES. There was a high overlap between symptoms of PG and PTS. Females had significantly higher scores on both the ICG and the IES compared to males. There were no differences between parents and siblings regarding PG and PTS symptoms. One out of three showed severe functional impairment on the WSAS. Approximately 30% of all the bereaved were outside the labour force, and one third of the parents had become unable to work after the terrorist attack.Conclusion: Many bereaved parents and siblings, following the Utøya terror attack, report long-lasting health consequences with symptoms of PG and PTS and functional impairment. The results suggest a need for follow up of bereaved after a terror attack and identify family members in need of health services.

Antecedentes: La investigación sobre el duelo después del terrorismo es limitada y apunta principalmente a las consecuencias a corto plazo.

Objetivo: Para comprender mejor las consecuencias del terrorismo en la salud a largo plazo, estudiamos a padres y hermanos en duelo, ocho años después del ataque terrorista de Utøya en Noruega. Examinamos los niveles de síntomas de duelo prolongado (DP) y estrés postraumático (EPT) de los participantes, así como su funcionamiento psicosocial y situación laboral.

Método: Los padres en duelo (n = 88) y los hermanos (n = 34) mayores de 19 años (edad media = 49,7 años, DE = 13,8 años, 59,8% mujeres) completaron el Inventario de Duelo Complicado (ICG, por sus siglas en inglés), la Escala revisada de Impacto del Evento (IES-R, por sus siglas en inglés) y la Escala de Adaptación Laboral y Social (WSAS, por sus siglas en inglés) para evaluar DP, EPT y deterioro funcional, respectivamente. Además, se obtuvo información sobre la situación laboral. Se calculó la proporción de participantes con puntajes superiores a los umbrales recomendados en ICG, IES-R y WSAS. Se examinaron las diferencias entre padres y hermanos, y las diferencias de género en estas medidas.

Resultados: En total, el 62,3% de los participantes obtuvo puntajes en el ICG que indicaban un riesgo de duelo prolongado, mientras que el 45,9% obtuvo puntajes superiores al límite en el IES. Hubo una alta superposición entre los síntomas de DP y EPT. Las mujeres obtuvieron puntajes significativamente más altos tanto en el ICG como en el IES en comparación con los hombres. No hubo diferencias entre padres y hermanos con respecto a los síntomas de DP y EPT. Uno de cada tres mostró un deterioro funcional severo en WSAS. Aproximadamente el 30% de todos los familiares en duelo estaban fuera de la fuerza laboral, y un tercio de los padres no pudieron trabajar después del ataque terrorista.

Conclusión: Muchos padres y hermanos en duelo, luego del ataque terrorista de Utøya, reportan consecuencias de salud duraderas con síntomas de DP y EPT y deterioro funcional. Los resultados sugieren la necesidad de un seguimiento de los dolientes después de un ataque terrorista e identificar a los miembros de la familia que necesitan servicios de salud.

目的：为了更好地了解恐怖主义对健康的长期影响，我们在挪威于特岛恐怖袭击发生八年后研究了丧亲的父母和兄弟姐妹。我们考查了参与者的延长哀伤 (PG) 和创伤后应激 (PTS) 症状水平，及其社会心理功能和就业状况。

方法：19 岁及以上（平均年龄 = 49.7 岁，SD = 13.8 岁，59.8% 为女性）的丧亲父母 (n = 88) 和兄弟姐妹 (n = 34) 完成复杂性哀伤量表 (ICG)、事件影响量表修订版 (IES-R) 和工作与社会适应量表 (WSAS) 分别用于评估 PG、PTS 和功能受损。此外，还获得了就业状况相关信息。计算了 ICG、IES-R 和 WSAS 得分高于推荐阈值的参与者比例。考查了这些测量的父母和兄弟姐妹间差异以及性别差异。

结果：共有 62.3% 的参与者的 ICG 得分表明有延长哀伤风险，而 45.9% 的参与者的 IES 得分超过临界值。 PG 和 PTS 的症状之间存在高度重叠。与男性相比，女性的 ICG 和 IES得分显著更高。父母和兄弟姐妹在 PG 和 PTS 症状上没有差异。三分之一的人在 WSAS 上表现出严重的功能受损。大约 30% 的丧亲者不在劳动力市场，三分之一的父母在恐怖袭击后无法工作。

结论：在于特岛恐怖袭击后，许多丧亲的父母和兄弟姐妹报告了长期健康后果，包括 PG 和 PTS 症状以及功能受损。结果表明需要在恐怖袭击后对丧亲者追踪，识别需要医疗服务的家庭成员。

Keywords: Bereavement; Deterioro funcional; Duelo; Duelo prolongado; Duelo traumático; Estrés postraumático; Hermanos; Padres; Situación laboral; Terrorismo; employment status; functional impairment; parents; post-traumatic stress; prolonged grief; siblings; terrorism; traumatic grief; 丧亲; 兄弟姐妹; 创伤后应激; 创伤性哀伤; 功能受损; 就业状况; 延长哀伤; 恐怖主义; 父母.

Plain language summary

Eight years after the Utøya terrorist attack bereaved parents and siblings still report high levels of prolonged grief and post-traumatic stress symptoms.There were no differences between parents and siblings regarding prolonged grief and post-traumatic stress symptoms.Many bereaved are still suffering functional impairments. Post-traumatic stress symptoms are found to be an important predictor for functional impairments.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

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