232
G. Månum et al.
Since the physical functioning and somatic health
problems were heterogeneous, the results of the cur-
rent study regarding healthcare needs might reflect the
importance of considering even minor physical trauma
as potentially complex due to the stressful conditions
under which it was obtained, and thereby the multitude
of factors determining functional outcome. O’Donnell
et al. (40) found that the development and maintenance
of disability occurs via a complex interaction of phy-
sical factors, pain, and psychological symptoms over
time. These authors concluded that, while physical and
painful consequences of injury contribute significantly
to long-term disability after injury, psychological
symptoms play a larger role. In light of increasing
awareness of the adverse physical health effects of
chronic stress (35), both previous publications and our
results highlight the need to address somatic health in
terror survivors.
In our sample, more participants reported unsatis-
factory physical than psychological health. An obvious
explanation is that all the individuals had been phy-
sically injured and several were physically restricted.
The current study also found an association between
SF-36 PF and LSS physical and psychological health.
The authors of the life satisfaction outcome used in this
study suggested that life satisfaction should be defined
as “reaching your own goals” (34). Our finding of
unsatisfactory physical health might be explained by
the expectation of having long-standing psychological
symptoms, but not physical complaints, after being a
victim of terror. In addition, our results of PF-SF 36 and
LSS seem to be comparable to the results of Li et al.
and Gao et al., who studied people who were physically
injured by the 2008 Sichuan earthquake (14, 15).
Limitations
Some limitations of this study require consideration.
The study approvals did not allow us to compare re-
sponders and non-responders. Due to the study design
and sample size, only descriptive statistics and some
exploratory analyses were conducted, leaving the
study exploratory. However, the study design and the
integrated research and clinical practice setting allo-
wed for a thorough clinical examination and a detailed
description of health characteristics, functioning, and
healthcare needs. The response rate is a strength of the
current study, and the registration of injury characteris-
tics was highly structured and well-documented. The
integrated research and clinical practice setting might
have biased the results by recruiting those with the
most health problems. Because the study population
consisted of victims of gunshot and bomb explosion,
which are the most common causes of trauma after
terror attacks (4, 5), we assume that the health condi-
www.medicaljournals.se/jrm
tions described herein reflect the traumas that occur
after terror attacks in general. However, the external
validity of this study might be restricted to countries
with universal healthcare coverage and similar levels
of health services.
Conclusion
This study demonstrates that many hospitalized per-
sons following a terror attack need long-term follow-
up, both for their physical and their psychological
health. The hospitalized individuals reported more
unsatisfying physical than psychological health, high-
lighting the need to address physical health issues in
populations being injured under traumatic psycholo-
gical circumstances. Since terror attacks account for
increasing numbers of disability also in Europe, this
study is considered relevant to the field of medical
rehabilitation in Europe.
ACKNOWLEDGEMENTS
The authors would like to thank all participants, collaborators at
the Norwegian Centre for Violence and Traumatic Stress Studies
(NKVTS), Vestre Viken Hospital trust and Oslo University
Hospital. Particular thanks are extended to Thomas Glott and
Gro E. Paulsboe at Sunnaas Rehabilitation hospital and to Knut
Magne Kolstadbråten and Nada Andelic at OUHU.
This study has been funded by the institutions noted in affiliations,
and by The South-Eastern Norway Regional Health Authority.
The authors have no conflicts of interest to declare.
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