Skip to main content Accessibility help
Hostname: page-component-768dbb666b-ptlz9 Total loading time: 0.459 Render date: 2023-02-06T15:45:13.236Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Stress sensitization following a disaster: a prospective study

Published online by Cambridge University Press:  30 November 2011

G. E. Smid*
Foundation Centrum ‘45/Arq, Diemen, The Netherlands
P. G. van der Velden
Institute for Psychotrauma, Diemen, The Netherlands INTERVICT/Tilburg University, Tilburg, The Netherlands
G. J. L. M. Lensvelt-Mulders
University for Humanistics, Utrecht, The Netherlands
J. W. Knipscheer
Foundation Centrum ‘45/Arq, Diemen, The Netherlands Utrecht University, Utrecht, The Netherlands
B. P. R. Gersons
Foundation Centrum ‘45/Arq, Diemen, The Netherlands Academic Medical Center, Amsterdam, The Netherlands
R. J. Kleber
Foundation Centrum ‘45/Arq, Diemen, The Netherlands Institute for Psychotrauma, Diemen, The Netherlands Utrecht University, Utrecht, The Netherlands
*Address for correspondence: Dr G. E. Smid, Foundation Centrum ‘45, Nienoord 5, 1112 XE Diemen, The Netherlands. (Email:



According to the stress sensitization hypothesis, prior exposure to extreme stressors may lead to increased responsiveness to subsequent stressors. It is unclear whether disaster exposure is associated with stress sensitization and, if so, whether this effect is lasting or temporary. This study aimed to investigate the occurrence and duration of stress sensitization prospectively following a major disaster.


Residents affected by a fireworks disaster (n=1083) participated in surveys 2–3 weeks (T1), 18–20 months (T2) and almost 4 years (T3) after the disaster. Participants reported disaster exposure, including direct exposure, injury and damage to their home at T1, and also stressful life events (SLEs) at T2 and T3. Feelings of anxiety and depression, concentration difficulty, hostility, sleep disturbance, and intrusion and avoidance of disaster-related memories were used as indicators of distress.


Residents whose home was completely destroyed responded with greater distress to SLEs reported 18–20 months following the disaster than residents whose home was less damaged. There were no differences in stress responsiveness almost 4 years after the disaster.


During the first years after a disaster, stress sensitization may occur in disaster survivors who experienced extreme disaster exposure. Stress sensitization may explain the persistence or progression of distress over time following extreme stressor exposure.

Original Articles
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Antelman, SM, Eichler, AJ, Black, CA, Kocan, D (1980). Interchangeability of stress and amphetamine in sensitization. Science 207, 329331.CrossRefGoogle ScholarPubMed
Arrindell, WA, Ettema, JHM (2003). SCL-90: Manual for a Multidimensional Psychopathology Indicator [in Dutch]. Swets and Zeitlinger: Lisse.Google Scholar
Bland, SH, O'Leary, ES, Farinaro, E, Jossa, F, Trevisan, M (1996). Long-term psychological effects of natural disasters. Psychosomatic Medicine 58, 1824.CrossRefGoogle ScholarPubMed
Blaney, PH (1986). Affect and memory: a review. Psychological Bulletin 99, 229246.CrossRefGoogle ScholarPubMed
Bollen, KA, Davis, WR (2009). Two rules of identification for structural equation models. Structural Equation Modeling 16, 523536.CrossRefGoogle Scholar
Bonanno, GA, Brewin, CR, Kaniasty, K, Greca, AML (2010). Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest 11, 149.CrossRefGoogle ScholarPubMed
Boscarino, J, Adams, R (2009). PTSD onset and course following the World Trade Center disaster: findings and implications for future research. Social Psychiatry and Psychiatric Epidemiology 44, 887898.CrossRefGoogle ScholarPubMed
Breslau, N, Chilcoat, HD, Kessler, RC, Davis, GC (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. American Journal of Psychiatry 156, 902907.CrossRefGoogle ScholarPubMed
Breslau, N, Peterson, EL, Schultz, LR (2008). A second look at prior trauma and the posttraumatic stress disorder effects of subsequent trauma: a prospective epidemiological study. Archives of General Psychiatry 65, 431437.CrossRefGoogle ScholarPubMed
Brom, D, Kleber, RJ (1985). Impact of Event Scale [in Dutch]. Nederlands Tijdschrift voor Psychologie 40, 164168.Google Scholar
Derogatis, LR (1979). SCL-90-R: Administration, Scoring and Procedures Manual-I for the R(evised) Version. Johns Hopkins University School of Medicine, Clinical Psychometrics Research Unit: Baltimore.Google Scholar
DiGrande, L, Neria, Y, Brackbill, RM, Pulliam, P, Galea, S (2011). Long-term posttraumatic stress symptoms among 3,271 civilian survivors of the September 11, 2001, terrorist attacks on the World Trade Center. American Journal of Epidemiology 173, 271281.CrossRefGoogle ScholarPubMed
Dirkzwager, AJ, Grievink, L, van der Velden, PG, Yzermans, CJ (2006). Risk factors for psychological and physical health problems after a man-made disaster. Prospective study. British Journal of Psychiatry 189, 144149.CrossRefGoogle ScholarPubMed
Dougall, AL, Herberman, HB, Delahanty, DL, Inslicht, SS, Baum, A (2000). Similarity of prior trauma exposure as a determinant of chronic stress responding to an airline disaster. Journal of Consulting and Clinical Psychology 68, 290295.CrossRefGoogle Scholar
Edwards, JR, Bagozzi, RP (2000). On the nature and direction of relationships between constructs and measures. Psychological Methods 5, 155174.CrossRefGoogle ScholarPubMed
Enders, CK, Bandalos, DL (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling 8, 430457.CrossRefGoogle Scholar
Galea, S, Ahern, J, Resnick, H, Kilpatrick, D, Bucuvalas, M, Gold, J, Vlahov, D (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine 346, 982987.CrossRefGoogle ScholarPubMed
Galea, S, Ahern, J, Tracy, M, Hubbard, A, Cerda, M, Goldmann, E, Vlahov, D (2008). Longitudinal determinants of posttraumatic stress in a population-based cohort study. Epidemiology 19, 4754.CrossRefGoogle Scholar
Grievink, L, van der Velden, PG, Yzermans, CJ, Roorda, J, Stellato, RK (2006). The importance of estimating selection bias on prevalence estimates shortly after a disaster. Annals of Epidemiology 16, 782788.CrossRefGoogle ScholarPubMed
Hammen, C, Henry, R, Daley, SE (2000). Depression and sensitization to stressors among young women as a function of childhood adversity. Journal of Consulting and Clinical Psychology 68, 782787.CrossRefGoogle ScholarPubMed
Hobfoll, SE (1989). Conservation of resources: a new attempt at conceptualizing stress. American Psychologist 44, 513524.CrossRefGoogle ScholarPubMed
Hobfoll, SE (2001). The influence of culture, community, and the nested-self in the stress process: advancing conservation of resources theory. Applied Psychology 50, 337421.CrossRefGoogle Scholar
Horowitz, MJ, Wilner, N, Alvarez, W (1979). Impact of Event Scale: a measure of subjective stress. Psychosomatic Medicine 41, 209218.CrossRefGoogle ScholarPubMed
Hu, LT, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 155.CrossRefGoogle Scholar
Jöreskog, K (1971). Simultaneous factor analysis in several populations. Psychometrika 36, 409426.CrossRefGoogle Scholar
Kandel, ER, Schwartz, JH (1982). Molecular biology of learning: modulation of transmitter release. Science 218, 433443.CrossRefGoogle ScholarPubMed
Kaniasty, K, Norris, FH (2008). Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. Journal of Traumatic Stress 21, 274281.CrossRefGoogle ScholarPubMed
Kaplan, DW (2008). Structural Equation Modeling: Foundations and Extensions. Sage: Thousand Oaks, CA.Google Scholar
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060.CrossRefGoogle ScholarPubMed
King, DW, King, LA, Foy, DW, Gudanowski, DM (1996). Prewar factors in combat-related posttraumatic stress disorder: structural equation modeling with a national sample of female and male Vietnam veterans. Journal of Consulting and Clinical Psychology 64, 520531.CrossRefGoogle ScholarPubMed
Kline, RB (2004). Principles and Practice of Structural Equation Modeling. Guilford Press: New York.Google Scholar
McArdle, JJ (2009). Latent variable modeling of differences and changes with longitudinal data. Annual Review of Psychology 60, 577605.CrossRefGoogle ScholarPubMed
McLaughlin, KA, Conron, KJ, Koenen, KC, Gilman, SE (2010). Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults. Psychological Medicine 40, 16471658.CrossRefGoogle Scholar
Monroe, SM (2008). Modern approaches to conceptualizing and measuring human life stress. Annual Review of Clinical Psychology 4, 3352.CrossRefGoogle ScholarPubMed
Neria, Y, Nandi, A, Galea, S (2008). Post-traumatic stress disorder following disasters: a systematic review. Psychological Medicine 38, 467480.CrossRefGoogle ScholarPubMed
Norris, FH, Friedman, MJ, Watson, PJ, Byrne, CM, Diaz, E, Kaniasty, K (2002). 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65, 207239.CrossRefGoogle ScholarPubMed
Post, RM, Weiss, SRB (1998). Sensitization and kindling phenomena in mood, anxiety, and obsessive-compulsive disorders: the role of serotonergic mechanisms in illness progression. Biological Psychiatry 44, 193206.CrossRefGoogle Scholar
Scott, CK, Sonis, J, Creamer, M, Dennis, ML (2006). Maximizing follow-up in longitudinal studies of traumatized populations. Journal of Traumatic Stress 19, 757769.CrossRefGoogle Scholar
Smid, GE, van der Velden, PG, Gersons, BPR, Kleber, RJ (2011). Late-onset posttraumatic stress disorder following a disaster: a longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy. Published online: 23 May 2011. doi:10.1037/a0023868.Google Scholar
Sörbom, D (1974). A general method for studying differences in factor means and factor structure between groups. British Journal of Mathematical and Statistical Psychology 27, 229239.CrossRefGoogle Scholar
van der Ploeg, E, Mooren, T, Kleber, RJ, van der Velden, PG, Brom, D (2004). Construct validation of the Dutch version of the Impact of Event Scale. Psychological Assessment 16, 1626.CrossRefGoogle ScholarPubMed
van der Velden, PG, Kleber, RJ, Christiaanse, B, Gersons, BPR, Marcelissen, FH, Drogendijk, AN, Grievink, L, Olff, M, Meewisse, ML (2006). The independent predictive value of peritraumatic dissociation for postdisaster intrusions, avoidance reactions, and PTSD symptom severity: a 4-year prospective study. Journal of Traumatic Stress 19, 493506.CrossRefGoogle ScholarPubMed
van der Velden, PG, van der Burg, S, Steinmetz, CHD, van den Bout, J (1992). Victims of Bank Robberies [in Dutch]. Bohn Stafleu van Loghum: Houten.Google Scholar
van der Velden, PG, Yzermans, CJ, Grievink, L (2009). The Enschede fireworks disaster. In Mental Health and Disasters (ed. Neria, Y., Galea, S. and Norris, F. H.), pp. 473496. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
van der Velden, PG, Yzermans, CJ, Kleber, RJ, Gersons, BPR (2007). Correlates of mental health services utilization 18 months and almost 4 years postdisaster among adults with mental health problems. Journal of Traumatic Stress 20, 10291039.CrossRefGoogle ScholarPubMed
van Kamp, I, van der Velden, PG, Stellato, RK, Roorda, J, van Loon, J, Kleber, RJ, Gersons, BBR, Lebret, E (2006). Physical and mental health shortly after a disaster: first results from the Enschede firework disaster study. European Journal of Public Health 16, 252258.CrossRefGoogle ScholarPubMed
Weisaeth, L (1989). Importance of high response rates in traumatic stress research. Acta Psychiatrica Scandinavica. Supplementum 80, 131137.CrossRefGoogle Scholar
Wichers, M, Schrijvers, D, Geschwind, N, Jacobs, N, Myin-Germeys, I, Thiery, E, Derom, C, Sabbe, B, Peeters, F, Delespaul, P, van Os, J (2009). Mechanisms of gene-environment interactions in depression: evidence that genes potentiate multiple sources of adversity. Psychological Medicine 39, 10771086.CrossRefGoogle ScholarPubMed
Zwiebach, L, Rhodes, J, Roemer, L (2010). Resource loss, resource gain, and mental health among survivors of Hurricane Katrina. Journal of Traumatic Stress 23, 751758.CrossRefGoogle ScholarPubMed
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Stress sensitization following a disaster: a prospective study
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Stress sensitization following a disaster: a prospective study
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Stress sensitization following a disaster: a prospective study
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *