Psychological Medicine

Original Articles

Stress sensitization following a disaster: a prospective study

G. E. Smida1 c1, P. G. van der Veldena2a3, G. J. L. M. Lensvelt-Muldersa4, J. W. Knipscheera1a5, B. P. R. Gersonsa1a6 and R. J. Klebera1a2a5

a1 Foundation Centrum ‘45/Arq, Diemen, The Netherlands

a2 Institute for Psychotrauma, Diemen, The Netherlands

a3 INTERVICT/Tilburg University, Tilburg, The Netherlands

a4 University for Humanistics, Utrecht, The Netherlands

a5 Utrecht University, Utrecht, The Netherlands

a6 Academic Medical Center, Amsterdam, The Netherlands


Background 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.

Method 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.

Results 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.

Conclusions 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.

(Received April 19 2011)

(Revised August 07 2011)

(Accepted November 01 2011)

(Online publication November 30 2011)


c1 Address for correspondence: Dr G. E. Smid, Foundation Centrum ‘45, Nienoord 5, 1112 XE Diemen, The Netherlands. (Email: