Journal of Anxiety Disorders 32 (2015) 103–111 Contents lists available at ScienceDirect Journal of Anxiety Disorders Posttraumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors Edda Bjork Thordardottir a,b,* , Unnur Anna Valdimarsdottir a,c , Ingunn Hansdottir b , Heidi Resnick d , Jillian C. Shipherd e,f , Berglind Gudmundsdottir a,b,g a Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland b Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland c Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA d Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA e National Center for PTSD, VA Boston Healthcare System, USA f Department of Psychiatry, Boston University School of Medicine, USA g Mental Health Services, Landspitali – The National University Hospital of Iceland, Iceland a r t i c l e i n f o Article history: Received 24 September 2014 Received in revised form 19 February 2015 Accepted 9 March 2015 Available online 28 March 2015 Keywords: Disaster Avalanche Posttraumatic stress disorder Mental health Physical health a b s t r a c t To date, no study has investigated the effects of avalanches on survivor’s health beyond the first years. The aim of this study was to examine long-term health status 16 years after exposure to avalanches using a matched cohort design. Mental health, sleep quality and somatic symptoms among avalanche survivors (n = 286) and non-exposed controls (n = 357) were examined. Results showed that 16% of sur- vivors currently experience avalanche-specific PTSD symptoms (PDS score > 14). In addition, survivors presented with increased risk of PTSD hyperarousal symptoms (>85th percentile) (aRR = 1.83; 98.3% CI [1.23–2.74]); sleep-related problems (PSQI score > 5) (aRR = 1.34; 95% CI [1.05–1.70]); PTSD-related sleep disturbances (PSQI-A score ≥ 4) (aRR = 1.86; 95% CI [1.30–2.67]); musculoskeletal and nervous system problems (aRR 1.43; 99% CI 1.06–1.93) and gastrointestinal problems (aRR 2.16; 99% CI 1.21–3.86) com- pared to the unexposed group. Results highlight the need for treatment for long-term PTSD symptoms and sleep disruption in disaster communities. © 2015 Elsevier Ltd. All rights reserved. Disasters can have a significant effect on survivors’ mental and physical health. In a growing body of research on disaster survivors, a majority of studies have found that survivors suffer from psycho- logical disorders and following exposure to disaster (Norris et al., 2002). These findings in general are however limited to the first year following exposure (Norris, Galea, Friedman, & Watson, 2006). Although limited in number, research on the long-term effect of disasters indicates that survivors may suffer from a range of adverse mental health symptoms, up to decades later such as PTSD (Arnberg, Eriksson, Hultman, & Lundin, 2011; Green et al., 1990), major depression (Zaetta, Santonastaso, & Favaro, 2011), chronic anxiety and sleep-related disturbances (van der Velden, Wong, Boshuizen, & Grievink, 2013). Furthermore, trauma expo- sure has been shown to be strongly associated with increased physical health problems; such as cardiovascular, gastrointestinal, * Corresponding author at: Centre of Public Health Sciences, University of Iceland, Stapi v/ Hringbraut, 101 Reykjavik, Iceland. Tel.: +354 525 5486; fax: +354 552 1331. E-mail address: eddat@hi.is (E.B. Thordardottir). respiratory and musculoskeletal disorders including chronic pain (Afari et al., 2014; Boscarino, 2004; Green & Kimerling, 2004; McFarlane, 2010; Shipherd, Clum, Suvak, & Resick, 2013; Spitzer et al., 2009; Wachen et al., 2013). The literature on long-term survivorship after exposure to avalanche is indeed scarce. Two studies have assessed PTSD preva- lence in soldiers who survived avalanches in Norway (Herlofsen, 1994; Johnsen, Eid, Lovstad, & Michelsen, 1997), both indicat- ing that survivors suffered from symptoms of PTSD up to four months post-disaster. The other studies, examining two avalanche- exposed communities in small fishing villages in Iceland found that ten weeks post-disaster survivors in one of the communi- ties were twice as likely to meet criteria for psychiatric caseness based on the General Health Questionnaire compared to population controls and further follow-up on both samples showed that ten weeks to 14 months after the two avalanches, approximately 40% of survivors were suffering from PTSD (Asmundsson & Oddsson, 2000; Finnsdottir & Elklit, 2002). These high rates of PTSD merit further investigation and the current study follows up on these samples of avalanche survivors to assess the long-term health of survivors. http://dx.doi.org/10.1016/j.janxdis.2015.03.005 0887-6185/© 2015 Elsevier Ltd. All rights reserved.