Scandinavian Star

In 2015, The Norwegian Parliament appointed an independentcommission with the mandate to evaluate several aspects of theScandinavian Star case. As part of their work, the commission gavethe Norwegian Centre for Violence and Traumatic Stress Studies theassignment to perform a systematic investigation of the survivorsand the bereaved, focusing on traumatic exposure, what types ofassistance they had received and their evaluation of this assistance,as well as current health, work participation, and well-being.

The direct victims of this tragedy, both the survivors from the shipand the bereaved families, were involved in an extremely traumaticevent. Exposure to adverse and traumatic events increases the riskfor later health problems.

In this report, we will describe theexperiences of the survivors and the bereaved, with a focus on theirrecollection of what happened during the event, how they haveperceived the support from the public health care system, what theirown situation was like following the disaster, and their views on thepolitical aftermath. We have also investigated health consequencesas well as factors associated with current health.

Methods

Information letters with a description of the study and an invitationto participate were sent to the survivors and the bereaved. Weperformed face-to-face interviews during the autumn of 2016, 26years after the fire. The survivors included both passengers and employees at the ship.

Some survivors also lost someone they knew in the fire. The bereaved included individuals who were not present on the ship, but who lost someone close. In total, 193 individualsparticipated in the study, including 98 survivors and 95 bereaved, resulting in a response rate of 60% for both groups.

Results

Exposure

• Many of the 98 survivors were exposed to danger during the fire. Three out of four survivors reported that they had been in areas of the ship with heavy smoke, and about half had experienced dangerous situations in the lifeboats. One out of five thought they were going to die. More than one third heardcries for help or saw someone seriously injured or killed. One in four survivors lost someone they knew to the fire.
• Among the 95 bereaved participants, who were not on boardthe ship, 81 had lost a close family member: a spouse, one orseveral children, one or both parents, or siblings. The majoritylost more than one close person to the fire. About one out of four bereaved participants also had surviving relatives or
  friends on board the ship.

Memories and centrality

• Participants’ memories of this event were experienced as vividand many could easily re-experience what happened.• For many participants the fire had become highly central totheir life story. The fire was also central for theirunderstanding of the world and their personal identity. For example, one out of four survivors and more than half of the bereaved “fully agreed” that the fire changed their life forever.

The aftermath

• Looking back to the first two years following the event, fourout of ten reported that they had mental health problems andone out of four that they had somatic problems related to thefire. Almost half had accompanying difficulties with their dailylife level of functioning. Among those who reported impairedfunctioning, one in four perceived that they never hadregained their pre-fire level of functioning.

• The majority of the participants reported a lack of trust in thepolice investigations, and felt that the Norwegian authoritieshad shown little interest or support for those affected by thefire. Most participants reported satisfaction with the supportthey had received from their local communities.

• The general trust in the police and the justice system wassignificantly lower in the participants, compared to a generalpopulation sample. Trust in the police and the justice systemwas associated with the degree of trust in the authorities’handling of the Scandinavian Star tragedy, and was alsorelated to current mental health and perceived social support.

Shame and guilt

• About one out of four reported that they had been worriedabout what others might think about them, and that they havehad bothersome thoughts that they should have donesomething differently when it happened or to prevent it fromhappening.

Support systems

• Overall, negative opinions about the support were moreprevalent than positive ones. The majority did not receiveassistance without requesting it themselves, and they did not feel that they were taken good care of. About half felt theywere not given sufficient time to talk with professionals.
• The most positive evaluations concerned the arrangement of acommemoration trip to Copenhagen and the ScandinavianStar Support group’s outreach program.
• Concerning the overall experience with the public health andsupport systems, negative evaluations were predominantamong participants. More than half considered the supportand treatment not at all or hardly satisfactory.
• One in three reported that they missed proactive outreach. Many participants underlined the need for long-term follow-upas well as assistance to children or support in parental roles.

Work absence and current level of functioning

• About half of the participants reported to have had at leastone lengthy absence from work during the years following thefire. Many participants attributed this absence to theconsequences of the fire.
• About one in four had minor or major problems with theircurrent level of daily functioning, which they attributed to theconsequences of the fire.

The participants’ self-rated mental health trajectories

• When looking back, participants reported to have had a lowlevel of mental health problems in the period preceding thefire, which had increased dramatically at one month after thefire. From that time, the participants described a gradualprocess of recovery. Bereaved described a slowerimprovement compared to survivors. The current level ofmental health problems remained higher than the low levelreported before the fire.

The participants’ evaluation of long-term mental health problemsrelated to the fire

• More than one third of the survivors, and almost half of thebereaved, reported that the fire had resulted in long-termmental health problems.

Current health and life satisfaction

• More than one out of four scored above a clinical cutoff foreither posttraumatic stress reactions or anxiety/depression.
• One in five bereaved reported a current impairment in social,occupational or other important areas of functioning due togrief reactions. Only a few fulfilled the criteria for complicatedgrief.
• Participants had an increased level of anxiety/depression, anda lower level of social support, compared to a generalpopulation sample.
• About half of the participants had a high level of lifesatisfaction, yet one in five had a low or very low lifesatisfaction.

Factors associated with mental and physical health

• Social support and barriers to social support were stronglyassociated with current mental and physical health. That is,individuals with a high level of perceived social support, andlow barriers to seeking social support, had less mental andsomatic health problems.
• Shame and guilt feelings related to what had happened, aswell as centrality of the event, were also associated withcurrent mental health.

Conclusions and implications

26 years after the disaster, the majority of survivors and bereavedhad good health and a high level of life satisfaction. However, formany, the fire has had severe consequences. Even today, theaffected group shows a disproportional burden of psychologicalhealth problems. Social factors, such as high perceived socialsupport and a low level of social support barriers, seemed to be ofparticular importance for current mental health.

The lack of confidence in the Norwegian authorities’ handling of thedisaster might have contributed to a reduced general trust in thepolice and the justice system. This low level of trust was associatedwith impaired mental health and social relationships.

Negative experiences or views regarding the early support and latertreatment were predominant. Proactive outreach services arenecessary post disaster, and these should last longer than haspreviously been assumed. Because social factors are of importancefor mental health, interventions should target social relationships.For outreach services to be useful, specialized mental health caremust be available when needed.

Time does not heal all wounds. Despite all the years that havepassed, many participants still remembered the event as if ithappened yesterday. After a while, there is often an expectation thatlife should move on. But for some, life will never be the same, and itwill take time to adjust to a new reality.