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The Aberfan Disaster: 33-Year Follow-Up of Survivors School but Different Junior Schools: 326 Were Traced in the Same Way As the Sur- Vivors

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The Aberfan Disaster: 33-Year Follow-Up of Survivors School but Different Junior Schools: 326 Were Traced in the Same Way As the Sur- Vivors BRITISH JOURNAL OF PSYCHIATRY (2003), 182, 532^536 The Aberfan disaster: 33-year follow-up of survivors school but different junior schools: 326 were traced in the same way as the sur- vivors. This group was chosen to be as LOUISE MORGAN, JANE SCOURFIELD, DAVID WILLIAMS, ANNE JASPER similar as possible to those living in and GLYN LEWIS Aberfan. It was intended to obtain a ratio of 2 comparisons to 1 survivor in order to improve the statistical power of the study. Instruments All participants were interviewed using a computerised version of the Composite Background Experiencing life- At 09.15 h on 21 October 1966, a coal slag International Diagnostic Interview (CIDI; World Health Organization, 1997), a fully threatening events often contributes to the heap collapsed on to a primary school in the mining village of Aberfan, South Wales, structured, standardised interview that onset of such psychiatric conditions as killing 116 children; 145 children survived. generates ICD–10 diagnoses. Disorders post-traumatic stress disorder (PTSD). Subsequently a large proportion of the were then grouped into depressive, anxiety Children can develop PTSD; however, survivors suffered from sleeping difficulties, and substance misuse disorders (World Health Organization, 1992). Depressive there is controversy over whether PTSD nervousness, lack of friends, unwillingness disorders included F32.0, F32.1, F32.10, symptoms decrease or persistover time. to go to school and enuresis. Lacey (1972) commented that ‘it seems very likely that F32.11, F32.2, F33.10, F33.11, F33.2 and F34.1. Anxiety disorders included F40.0, Aims Toexamine the long-term effects many of the Aberfan children may F40.00, F40.01, F40.1, F40.21, F40.22, of surviving the1966 Aberfan disasterin experience psychiatric problems in later life’.life’. F40.23, F40.24, F41.0, F41.01, F41.1 and childhood. Studies suggest that children can de- F42.1. Substance misuse included F10.1, velop post-traumatic stress disorder (PTSD) F10.2 and F11.2. The diagnostic code for MethodMethod Survivors (nn¼41) werewere41) and other psychological problems follow- PTSD was F43.1. compared with controls (nn¼72) matched ing traumatic events (e.g. Terr, 1983; for age and background. AllAllwere were inter- McFarlane, 1987; Yule et aletal, 1990; Green Lifetime incidence of PTSD viewed using the Composite International et aletal, 1991, 1992; Bolton et aletal, 2000; Bre- In the PTSD section of the CIDI, the Diagnostic Interview, measures of current slauslau et aletal, 2000). However, there is some survivors were questioned with specific controversy over the persistence of PTSD health and social satisfaction, and the reference to the Aberfan disaster. This that started in childhood. The aim of this General Health Questionnaire.The section provides a diagnosis of lifetime study was to examine the long-term psy- PTSD; that is, whether participants have survivor group also completed the Impact chological impact of the Aberfan disaster experienced PTSD as a direct result of the of Event Scale to assess current levels of on the children (aged 4–11 years) who disaster at some time in their subsequent PTSD.PTSD. had attended the junior school, survived lives. The comparison group were asked its engulfing and who were, at follow-up, which traumatic events, from a specific list, ResultsResults Nineteen (46%; 95% CI 31^61) adults in their late thirties and early forties. they had experienced in their lifetime. They survivors had had PTSD at some point were then questioned in relation to the one since the disaster, compared with12 (20%; that they felt was the most traumatic of METHOD these experiences. Survivors were not asked 95% CI10^30) controls (OR¼3.38 (95%(95%3.38 SampleSample about other traumatic experiences because CI1.40^8.47)).Ofthe survivors,12 (29%; the PTSD questions within the CIDI relate 95% CI15^43) metdiagnosticcriteria for A register of 145 survivors from the only to a single specific incident, and as primary school, aged 4–11 years at the time current PTSD.SurvivorsPTSD. Survivors were not at a the Aberfan disaster was the main focus of the disaster, was compiled using the significantly increased risk of anxiety, of the study, it was decided to restrict admission records of the Afon Taf com- questions to this incident. depression or substance misuse. prehensive school in Aberfan, which almost all of the survivors subsequently attended. Conclusions Tr a u m a i n c h il d h o o d c a n Of those survivors, 115 were traced to their Current levels of PTSD lead to PTSD, and PTSD symptoms can current addresses with the help of the Bro To assess current PTSD levels, the survivors persist for asaslong long as 33 yearsintoyears into adult life. Taf Family Health Services Authority and completed the 15-item Impact of Event current general practitioners. The latter Scale (Horowitz et aletal, 1979). A score of Rates of other psychopathological forwarded a letter requesting an interview 35 or above on this scale was used to define disorders are not necessarilyraised after to the survivors. Those giving consent to a case. This threshold was chosen on the life-threatening childhood trauma. participate were interviewed in their basis of an existing data-set that used the homes, places of work or a clinical setting. same measure. All participants also com- Declaration of interest None. The comparison group consisted of 379 pleted the 28-item General Health Ques- persons who attended the same secondary tionnaire (GHQ), and questionnaire 532 Downloaded from https://www.cambridge.org/core. 28 Sep 2021 at 11:27:29, subject to the Cambridge Core terms of use. PTSD IN ABERFAN SURVIVORS measures of current health and social satis- Representativeness of the 1.40–8.17. The traumas suffered by the faction. A score of 5 or above on the GHQ survivor group comparison group included witnessing was used to define a case (Goldberg & The majority of the survivors did not want someone being badly injured or killed Hillier, 1979; Goldberg & Williams, to take part in the study, so it is important (20%), being seriously attacked or as- 1988). The interviews were carried out by to know how representative our subgroup saulted (14%) and being involved in a fire, experienced health care professionals and was. Unfortunately, definitive claims about flood or other natural disaster (14%). academically trained researchers. the group’s representativeness cannot be There was no statistically significant differ- made. Ethical restrictions prevented us ence in the prevalence of anxiety disorders, from obtaining any information about the depressive disorders or substance misuse survivors who had not consented to take disorders.disorders. Analyses part in the research. However, some of Table 3 shows the odds ratios for PTSD Odds ratios were calculated for all outcome the survivors were seen by a psychiatrist after adjustment for gender, marital status, measures, namely GHQ scores, PTSD, after the disaster at the request of solicitors age, current employment, ‘ever unemployed’ anxiety disorders, depressive disorders, requiring medico-legal reports. As these and level of education. After adjustment for substance misuse, and any psycho- records are now in the public domain, gender, there was a slight reduction in the pathological disorder. The risk of PTSD we were granted access to them. Of the odds. However, after adjustment for was then assessed taking into account the 41 survivors who did agree to take part, marital status and education, there was a possible effects of gender, marital status, 24 (59%) had been referred to the slight increase. age, employment and education, using the psychiatrist (11 men, 13 women). Of Mantel–Haenszel method and performed the 74 who did not take part in the Current psychiatric morbidity using STATA 6 software. The Mantel– study, 28 (38%) had been referred (13 When assessed with the GHQ, 23% of the Haenszel method assesses relative risk and men, 15 women) (odds ratio 2.22, 95% survivors (95% CI 10–37) and 21% of the adjusts for the confounding effects of other CI 1.73–2.84). comparisons (95% CI 12–30) were desig- variables (see Breslow & Day, 1987). nated as cases. The odds ratio was 1.21 (95% CI 0.45–3.22). This was not sub- Lifetime psychopathology stantially altered after adjustment for RESULTSRESULTS The survivors were more likely than the confounding variables. comparison group to have suffered from The data from the CIDI assessment Response rate PTSD (Table 2): odds ratio 3.38, 95% CI showed that 25 (61%) of the survivors From a total of 145 survivors, 115 were traced and 41 agreed to take part in the study (36%; 28% of total). Of the 115 Ta b l e 11Tab Socio-demographic characteristics of participants who were invited to take part, 25 declined, 1 had died and 48 did not reply. From 379 people identified as potential comparisons, Survivors (nn¼41) Comparisons (nn¼73) 326 were traced and invited to take part: Age (years)(years)Age 72 agreed (22%; 19% of total), 85 declined, 5 had died and 163 did not reply. At disaster: Mean (s.d.) 7.73 (3.71)(3.71)7.73 7.98 (3.54)(3.54)7.98 RangeRange 4^114^11 4^114^11 At follow-up: Demographic data Mean (s.d.) 40.24 (1.61)(1.61)40.24 40.67 (1.66)(1.66)40.67 Table 1 shows, for both survivor and RangeRange 37^44 38^44 comparison groups, the mean age at the Time of follow-up after disaster32 years 7 m to 34 years 1 m33 years 1 m to 34 years 2 m time of the disaster and at follow-up, Gender: male nn (%) 21(51) 24 (33)(33) the range of time of follow-up after the Marital status: nn (%) disaster, the gender of the participants, Married/cohabiting 31(76) 52(71) marital status, education, current employ- Single 5(12)5 (12) 9(12)9 (12) ment status and prevalence of unemploy- Divorced/separated/widowed5(12) 5 (12) 12(16) ment.
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