Support, opinion of support and psychological health among survivors of a natural disaster

Although formal intervention after disasters is recommended the evidence base for this is weak. Satisfaction with support after disasters is seldom investigated and the relation to psychological symptoms is unknown.


To investigate whether dissatisfaction with social and formalised support are associated with post-disaster psychological symptoms.


1505 Swedish survivors of the 2004 Indian Ocean tsunami responded to a questionnaire 14 months after the disaster, including General Health Questionnaire-12, Impact of Events Scale-Revised, Crisis Support Scale, and questions concerning the reception and appraisal of social and formalised support from health care, psychological services and insurance agencies. Disaster exposure and background factors were controlled for in the analyses.


Reception of formalised support, but not social support, was associated with both psychological distress and posttraumatic stress. Dissatisfaction with social but not formalised support, with the exception of support from insurance agencies, was associated with psychological distress.


Social support and formalised support should in future studies be differentiated in order to improve preventive intervention efforts after disasters. The reporting of dissatisfaction with social support merits special attention, since this may indicate increased risk for psychological symptoms.


  • Lars Wahlström, PhD, MD
  • Hans Michélsen, Ast Prof, PsyD
  • Abbe Schulman, PhD, MD
  • Magnus Backheden, MS