Longitudinal Psychological Effects of the Garuda Indonesia Air Disaster in Japan
Total Page：16
File Type：pdf, Size：1020Kb
Kurume Medical Journal, 55, 1-6, 2008 Original Contribution Longitudinal Psychological Effects of the Garuda Indonesia Air Disaster in Japan MISARI OE, MASAHARU MAEDA AND NAOHISA UCHIMURA Department of Neuropsychiatry, Kurume University School of Medicine, Kurume 830-0011, Japan Received 4 December 2007, accepted 31 January 2008 Summary: We examined the general health and psychological symptoms among survivors of the 1996 Garuda Indonesia air disaster in Japan. We conducted a prospective study 6 months and 1 year (Study 1) after the disaster. A retrospective follow-up study was performed ten years after the disaster (Study 2). The mean score on the 28-Item General Health Questionnaire was 6.5 (SD=6.9) 1 year after the disaster. Those who witnessed the death of an acquaintance in the disaster were classified into the high risk group. In Study 2, more than one-third of respondents complained of a flying phobia. These findings indicate that the psychological burdens of air disasters may last as long as 10 years. Key words air disasters, coping behavior, flying phobia, general health questionnaire, longitudinal study The Garuda Indonesia air disaster in Japan oc- INTRODUCTION curred in 1996. Three passengers died and 108 were Transportation accidents on land, in the air, or at sea injured. A mental health care service team was organ- form an important class of technological disasters ized after the disaster in cooperation with mental [1,2]. Air disasters in particular can produce a greater health experts (i.e., psychiatrists, clinical psycholo- number of victims at one time than other forms of gist, nurses, and social workers) of Fukuoka Prefec- transportation. Because air disasters often have a high ture and the Department of Psychiatry at Kurume Uni- mortality rate, there are few systemic studies on the versity. We planned a prospective study of general psychosocial consequences of air disaster survival on health and psychological symptoms related to the dis- passengers, in contrast to rescue workers [3-5] or aster among the survivors. This study was carried out community residents [6,7]. One of the most systemat- at six months (first examination) and one year (second ic surveys of surviving passengers was conducted af- examination) after the disaster. Members of the study ter the Kegworth air disaster, in which 47 people team visited the homes or offices of survivors, and in- died. Gregg et al. [8] assessed 68 of the 79 survivors terviews were conducted in an outreach setting. This at a clinical interview within one year after the disas- was the first psychological intervention study of the ter. Twenty-seven survivors had posttraumatic stress survivors of an air accident in Japan. Initially we as- disorder (PTSD) in the first year, and 9 of this group sumed that psychological effects would decrease at also met DSM-III-R criteria for major depression. one year after the disaster. However, there was no im- Those who saw injured or dead people at the scene, provement in symptoms, such as vehicle phobias or sustained less severe injuries, or were under 35 years mental health, at the time of the second examination. of age were significantly more likely to develop A retrospective follow-up study was conducted ten PTSD. Sloan [9] followed-up 30 survivors of a non- years after the disaster, consisting of a mail survey on fatal airplane crash and found high levels of stress in general health and psychological symptoms that was the following months. almost identical to the one used in the first examina- Editorial correspondence: Misari Oe, Department of Neuropsychiatry, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan. Tel: 0942-31-7564 Fax: 0942-35-6041 E-mail: [email protected] Abbreviations: GHQ-28, 28-Item General Health Questionnaire; PTSD, posttraumatic stress disorder. 2 OE ET AL. Fig. 1. Schedule of Study 1 and Study 2. Study1, 1st exam was held at 6 months after the accident. Study 1, 2nd exam was held at 1 year after the accident. Study 2 was held 10 years after the accident. tion, as well as an interview session to further eluci- health problems (physical or mental) or on request. date psychological effects. In this article, we report the After the second examination, conducted one year af- initial two-part prospective study as Study 1, and the ter the disaster, a single session of group psychoeduca- retrospective follow-up as Study 2. tion was provided at one company where more than This study had two aims. One was to elucidate the ten survivors worked. After the second examination, psychological effects of the Garuda Indonesia on the survivors received only individual care or treatment survivors. The other was to consider the necessity of a until the follow-up study. Schedule of the studies was long-term mental health care system for victims of shown in Fig. 1. transportation disasters. The incident and the interventions METHODS On 13 June 1996, Garuda Indonesia Airways Flight 865 (260 passengers, 15 crew members) failed Study 1 to take off and crashed at the Fukuoka Airport in Ja- Study 1 was a prospective survey. Of the 87 survi- pan. The entire fuselage of the plane went up in flames. vors (all Japanese), excluding children under 11 years Despite the great efforts of rescue teams, three pas- of age, living in Fukuoka Prefecture, study respond- sengers died and 108 were injured. All of the dead pas- ents comprised 84 at the first examination and 83 at sengers were seated in the rear of the plane, on the the second. The response rate reached approximately right side. Most of the passengers lived in Fukuoka 95%. Unfortunately, due to our own methodological and were going on a trip to Bali Island with their col- errors, only 57 survivors responded to the self-rating leagues from work. One survivor described the inci- questionnaire at the second examination. Table 1 sum- dent thus: “I felt frightened when the airplane started marizes the number of respondents. slipping on the runaway. Fire came from the floor, and Assessments were conducted in December 1996 I could not see through the clouds of smoke. I desper- for the first examination and in June 1997 for the sec- ately tried to remove my seat belt, but it would not ond. Subjects were evaluated using the 28-item Gen- move. I thought it was the end. I wanted to cry out for eral Health Questionnaire (GHQ-28 [10]; the cut-off help; but I don’t know if I did. I don’t remember any- score of the Japanese version is 6/7) and a self-rating thing after that.” (author’s translation) questionnaire on psychological symptoms. The latter Fukuoka Prefecture’s mental health team planned questionnaire consisted of 6 items (flying phobia, pho- an outreach program and prospective mental health bia of other vehicles, difficulty in concentrating, hy- survey (Study 1) in September 1996, three months af- persensibility to noise or vibration, irritability and in- ter the disaster. The first outreach and the first exami- somnia). Each item was rated in terms of its severity nations were conducted by 50 experts, in pairs. Some (rated on a 0-3 scale). We considered scores over 2 to survivors received continuous outreach service due to confirm the existence of a symptom. Kurume Medical Journal Vol. 55, No. 1, 2, 2008 EFFECTS OF THE GARUDA AIR DISASTER 3 Study 2 For Study 2, Questions on Useful Coping Behav- Study 2 was constructed as a retrospective follow- ior [11] were added to the GHQ-28 and self-question- up survey 10 years after the disaster. The self-rating naire on psychological symptoms to assess the coping questionnaire and the interview by a psychiatrist or behaviors which survivors considered useful for their clinical psychologist were administered separately. recovery. There were 6 categories in this question- Only 21 survivors (16 males, 5 females) responded to naire: 1) talking and gathering with others, 2) obtain- the self-rating questionnaire. The response rate of 24% ing information on health problems from public or- was partially due to the fact that 22 survivors could ganizations, 3) leisure activities, 4) work, 5) avoidance not be contacted. We interviewed nine survivors (including sleeping) and 6) humor. For each category, among the respondents to the self-rating question- we asked survivors whether or not these behaviors had naire, after obtaining written informed consent. been useful for their recovery. In interview sessions, we focused on 4 themes: 1) TABLE 1. psychological symptoms, 2) duration of recovery, 3) Study 1 variables useful coping behaviors and 4) views on post-disaster Variables Number of Respondents mental health services. The main purpose of the inter- Exam First Second view sessions was to obtain survivors’ narratives after Demographic characteristics 83 83 ten years. GHQ-28 83 82 Self-rating questionnaire 75 57 Statistical analysis (Data missing for some subjects) Statistical analysis employed SPSS, version 14.0 for Windows. Fisher’s exact tests were used for com- paring the different groups and a Wilcoxon signed- TABLE 2. rank test were used for comparing GHQ-28 scores. General Health Questionnaire (28 items) scores for Study 1 The significance level was less 5%. First exam Second exam Variables S.D. S.D. Average Average Ethical issues GHQ-28 total score 5.7 6.1 6.5 6.9 This research received approval from the ethics Subscales of GHQ-28 review board at Kurume University. Written informed Somatic concern 2.1 2.2 2.2 2.3 consent was obtained from all the respondents and Anxiety/insomnia 2.2 2.3 2.5 2.4 confidentiality of ratings was assured.