1. Post-traumatic Stress and Preventive Interventions in Journalists Lars Weisæth, MD, Ph D Professor, Senior Research Supervisor Norwegian Centre for Violence and Traumatic Stress Studies University of Oslo Journalism. The Global Investigative Conference Lillehammer, 14. September 2008

4. Various approaches to prevention: Selection of personnel Training / preparing Organizing Early interventions and appropriate and sufficient follow up.

5. The role of experience

6. The COPE study: Coping and stressors in Norwegian disaster response personnel mobilized for the 2004 tsunami disaster Siri Thoresen, Arnfinn Tønnessen, Camilla Vibe Lindgaard, Anne Lie Andreassen & Lars Weisæth

7. The Sumatra-Andaman earthquake 26. December 2004 triggered a series of tsunamies - affecting most of the landmasses bordering the Indian Ocean.

8. The Tsunami disaster caused the death of more than 230,000 people (CRED, 2006). Many of them were children.

9. The disaster caused the death of 2,448 tourists from 37 different countries (WHO, 2008). 84 Norwegians died in the disaster

10. Authorities from several countries mobilized personnel for a support and rescue operation 3 large personnel groups mobilized for the Tsunami disaster: Non-governmental organisations Police Journalists Others, including air force, health personnel, chaplains, Foreign Ministry personnel, travel agencies, and more.

11. Aim of the COPE study To investigate risk factors and protective factors for stress reactions in Norwegian personnel mobilized for the tsunami disaster.

12. Methods Cross-sectional Questionnaire study 9-10 months post Tsunami Web and postal

13. Subjects Total Journalists Disaster area personnel 63% 63% Response Rate (N = 335)(N = 56) Home base personnel 48% 32% Response Rate (N = 246)(N= 33)

14. Results (Disaster area only)

15. Demographics NGO’s (N=111) Police (N=89) Journalists (N=56) Age (mean)48 år46 år41 år Male gender60%73%80% Married / cohabitating66%81%66%

16. Experience and training NGO’s (N=111) Police (N=89) Journalists (N=56) Relevant work experience95%84%77% Relevant training81%67%48% Mass casualty exercises67%48%43% Specific preparation59%52%32% Demographics NGO’s (N=111) Police (N=89) Journalists (N=56) Age (mean)48 år46 år41 år Male gender60%73%80% Married / cohabitating66%81%66%

17. Stressful experiences, examples NGO’s (N=111) Police (N=89) Journalists (N=56) Strong smells/other sensory perceptions of the disaster scene 74%95%98% Witnessing disaster victims searching for next of kin 61%46%93% Seeing children separated from next of kin 68%3%34% Witnessing disaster victims with major physical injuries 61%10%62% Seeing dead bodies 48%70%83% Seeing body parts 21%69%40% Witnessing disaster victims in despair 94%44%94% Having to reject victims in need 69%10%50%

18. Exposure to stressful stimuli, sum scores NGO’s (N=111) Police (N=89) Journalists (N=56) Witnessing experiences (mean) 5.0 (SD 2.2) 4.5 (SD 1.6) 6.0 1,2 (SD 1.6) Personal contact with disaster victims (mean) 3.0 (SD 0.9) 1.7 (SD 1.5) 3.2 1 (SD 1.2) 1 Jour > pol, p hum, p<0.05

19. NGO’s (N=111) Police (N=89) Journalists (N=56) Stress reactions (IES-22, mean score) 10.37.112.9 1 Exposure to stressful stimuli, sum scores NGO’s (N=111) Police (N=89) Journalists (N=56) Witnessing experiences (mean) 5.0 (SD 2.2) 4.5 (SD 1.6) 6.0 1,2 (SD 1.6) Personal contact with disaster victims (mean) 3.0 (SD 0.9) 1.7 (SD 1.5) 3.2 1 (SD 1.2) 1 Jour > pol, p hum, p<0.05 1 Jour > pol, p<0.05 Note: None of the groups were highly traumatized – the vast majority do well

20. Politiet (n=89) Hum.org (n=111) Journ. (n=56) Experience/trainingMiddleMostLeast Being well preparedMiddleBestLeast Witnessing exp.LowestMiddleHighest Rejecting victimsLowestHigher Clear work tasksMost clear Less clear Possibility for restBestMiddleLowest Support from peersBestLowerLowest Stress reactionsLowestMiddleHighest Summing up – differences between groups

21. For All Disaster Area Personnel (N = 335): A low level of stress reactions was associated with: Low level of - WitnessingBeing well prepared experiences Possibilities to rest and ”time-out” Personal contact with Not ”over achieving” disaster victims Low level of avoidant coping Having to reject disasterLow level of restlessness or victims sadness following mission High social support after mission

22. Predictors for stress reactions in the three groups: Police Secondary stressors Avoidanct coping Recognition for mission Social support after mission NGOs Being well prepared for mission Rejecting victims in need of help and witnessing experiences Possiblities for necessary rest during mission Recognition for mission Avoidant coping Journalists Being well prepared for mission Support from superior during mission Social support after mission Avoidant coping

23. ”Take home”: Possible implications Journalists were less trained, more exposed, and had higher stress reactions than the other groups Possible interventions: Specific preparation for the mission Preparations for exposure, and having to reject victims in need Organizing rests and time-outs Strengthen work structure and peer support/ support from superior during mission First weeks after mission: Important period (identify needs for follow-up)

24. Limitations Cross-sectional Retrospective Self-report Lower response rate in home base personnel compared to disaster area personnel

25. Principles of intervention: A sense of safety Calming A sense of self- and community efficacy Connectedness Hope

26. Textbook of Disaster Psychiatry Cambridge University Press 2007 Edited by: Robert J. Ursano Carol S. Fullerton Lars Weisaeth Beverley Raphael

27. Thank you for listening