Study of Bali Bombing survivors points way to new support programs

A decade after the 2002 Bali Bombing a landmark study has found Australians directly affected by the terrorist attack had relatively good physical health but high rates of psychological distress with 20 percent of those in the study experiencing high levels of distress – twice the rate of the general population.

The study by University of Western Sydney researchers and colleagues is one of the first in the world to examine the long term psychological impact of terrorism. The results are published today in the Medical Journal of Australia.

Lead author and clinical psychologist, Garry Stevens from the University of Western Sydney's School of Medicine says the ability to 'make sense' of a loved one's death is considered a central process of grieving. However, the irrational or meaningless nature of violent death, particularly through terrorism, can interfere with this cognitive process for many survivors.

The research found that compared with the wider NSW population participants reported greater rates of high psychological distress (12.7 percent versus 8.2 percent) and very high psychological distress (9.1 percent versus 2.9 percent). However, those in the study that reported strong social connections did appear to be faring better.

"Deaths involving deliberate violence are associated with higher incidence of depression and prolonged or 'complicated' grief and a slower rate of recovery. But our study found being in a married or de facto relationship and a perception of strong family support were key protective factors against long-term distress," says Mr Stevens, a PhD candidate with the UWS Disaster Response and Resilience Research Group.

The 2002 Bali Bombing killed over 200 people, including 88 Australians and 35 Indonesians.  It remains the most deadly single act of terrorism to have affected either country. 209 people were physically injured, including 66 Australians.

All 55 people who participated in the phone survey in late 2010 had experienced personal exposure and/or loss related to the attack and were part of the NSW Ministry of Health's Bali Recovery Program - a therapeutic support program.

Co-author and a senior psychologist in the NSW Ministry of Health Julie Dunsmore says eight years down the track many people in the study reported frequent unwelcome thoughts about the tragedy.

"Half of the group interviewed reported that, in the previous month, they had experienced upsetting thoughts, dreams or 're-experiences' related to the Bali bombing or the need to avoid such thoughts and feelings," says Ms Dunsmore.

While the attack wasn't far from the thoughts of the study participants, their ability to cope with current stresses and adapt to difficulties remains similar to the wider community. More than half the group (56 percent) were within the highest level of 'personal resilience' - the ability to cope with stressful situations or high levels of background stress.

Mr Stevens says this ' complex picture' of the Bali survivors' shows that the health and daily functioning of the group is generally good, but that a significant number continue to experience high levels of distress and trauma, with these being consistently linked with complicated grief symptoms.

"The findings have implications for how we should respond to and support the survivors of acts of terrorism and other violent events," he says.

"Future post disaster screening programs should incorporate checks for 'complicated grief' and both screening programs and treatment options should be available in the longer-term as the psychological impacts are not limited to the first few years after the event," says Mr Stevens.

The study was funded by the Australian Research Council and approved by the ethics committees of the Northern Sydney Local Health District and the University of Western Sydney (H7143).