The Great Belt Bridge railway accident: Post-traumatic stress reactions among passengers and bereaved family members




train disaster, prospective study, PTSD, anxiety and depression rates, comparison DSM-IV and ICD-11


Objective: To identify the trauma sequelae after a major train disaster on the Great Belt Bridge in 2019 and to compare two different trauma measures.

Design: Five (T1) and 13 (T2) months after the disaster, a questionnaire included both the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the new The International Classifications of Diseases (ICD-11) criterion standards for post-traumatic stress disorder (PTSD). Also, anxiety and depression were measured on both occasions.

Participants: All surviving passengers (N = 133) and the bereaved families (N = 8) were invited to participate through an electronic mailbox. At T1, 58 and 46 at T2 filled out all the questionnaires.

Main outcome measures: The primary study outcome measures were the Harvard Trauma Questionnaire (HTQ) and the International Trauma Questionnaire (ITQ).

Results: At T1, the HTQ screened 19 percent positive for PTSD, while the ITQ screened 15.5 percent. At T2, the numbers were 26 percent for the HTQ and 10.9 percent for the ITQ. At T1, 22.8 percent were screened positive for moderate or severe depression and 8.6 percent fulfilled the criteria for an anxiety diagnosis. The numbers at T2 were 19.5 percent for depression and 10.9 percent for anxiety.

Conclusions: There is a remarkable lack of train accident/disaster passenger studies. A large subgroup suffered from several psychological disorders both 5 and 13 months after the disaster. The two diagnostic systems used (DSM-IV and ICD-11) both identified a considerable number of passengers in need of treatment; the latter identifying fewer than the former. Effective outreach procedures are recommended in the future.

Author Biographies

Ask Elklit, Cand Psych

National Danish Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark

Lea Katrine Jørgensen, Cand Psych

National Danish Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark


Railway safety statistics in the EU: Eurostat statistics explained. 2023. Available at Accessed May 28, 2022.

Theorell T, Leymann H, Jodko M, et al.: ‘Person under train’ incidents: Medical consequences for subway drivers. Psychosom Med. 1992; 54(4): 480-488. DOI: 10.1097/00006842-199207000-00010.

Theorell T, Leymann H, Jodko M, et al.: Person under train’ incidents from the subway driver’s point of view—A prospective 1-year follow-up study: The design, and medical and psychiatric data. Soc Sci Med. 1994; 38(3): 471-475. DOI: 10.1016/0277-9536(94)90449-9.

Cothereau C, de Beaurepaire C, Payan C, et al.: Professional and medical outcomes for French train drivers after “person under train” accidents: Three year follow up study. Occup Environ Med. 2004; 61(6): 488-494. DOI: 10.1136/oem.2003.007922.

Limosin F, Loze J, Cothereau C, et al.: A prospective study of the psychological effects of “person under train” incidents on drivers. J Psychiatr Res. 2006; 40(8): 755-761. DOI: 10.1016/j.jpsychires.2005.04.007.

Généreux M, Maltais D, Petit G, et al.: Monitoring adverse psychosocial outcomes one and two years after the lac-mégantic train derailment tragedy (Eastern Townships, Quebec, Canada). Prehosp Disaster Med. 2019; 34(3): 251-259. DOI: 10.1017/s1049023x19004321.

Maltais D, Lavoie-Trudeau É, Labra O, et al.: Medium-term effects of a train derailment on the physical and psychological health of men. Am J Mens Health. 2019; 13(4): 1557988319865363. DOI: 10.1177/1557988319865363.

Miniati M, Petracca A, Carmassi C, et al.: Risk of post-traumatic stress disorder in 111 survivors the 2009 Viareggio (Italy) Rail Crash: The role of mood spectrum comorbidity. J Psychopathol. 2017; 23(1): 12-18.

Chung MC, Farmer S, Werrett J, et al.: Traumatic stress and ways of coping of community residents exposed to a train disaster. Aust N Z J Psychiatry. 2001; 35(4): 528-534. DOI: 10.1046/j.1440-1614.2001.00922.x.

Chung MC, Werrett J, Easthope Y, et al.: Traumatic stress and death anxiety among community residents exposed to a train crash. Omega (Westport). 2002; 45(2): 133-147. DOI: 10.2190/JGK9-QB71-5QP4-56G5.

Engelhard I, van den Hout M, Arntz A, et al.: A longitudinal study of “intrusion-based reasoning” and post-traumatic stress disorder after exposure to a train disaster. Behav Res Ther. 2002; 40(12): 1415-1434. DOI: 10.1016/S0005-7967(02)00018-9.

Andersen HS, Christensen AK, Petersen GO: Post-traumatic stress reactions amongst rescue workers after a major rail accident. Anxiety Res. 1991; 4(3): 245-251. DOI: 10.1080/08917779108248778.

Ben-Ezra M, Palgi Y, Essar N, et al.: Acute stress symptoms, dissociation, and depression among rescue personnel 24 hours after the Bet-Yehoshua train crash: The effects of exposure to dead bodies. Prehosp Disaster Med. 2008; 23(5): 461-465. DOI: 10.1017/s1049023x00006208.

Palgi Y, Ben-Ezra M, Essar N, et al.: Acute stress symptoms, dissociation, and depression among rescue personnel 24 hours after the Bet-Yehoshua train crash in Israel: The effect of gender. Prehosp Disaster Med. 2009; 24(5): 433-437. DOI: 10.1017/s1049023x00007275.

Hagström R: The acute psychological impact on survivors following a train accident. J Trauma Stress. 1995; 8(3): 391-402. DOI: 10.1007/BF02102965.

Selley C, King E, Peveler R, et al.: Post-traumatic stress disorder symptoms and the Clapham rail accident. Br J Psychiatry. 1997; 171: 478-482. DOI: 10.1192/bjp.171.5.478.

Lundin T: Train disaster survivors: Long-term effects on mental health and well-being. Stress Med. 1991; 7(2): 87-91. DOI: 10.1002/smi.2460070206.

Forsberg R, Saveman B: Survivors’ experiences from a train crash. Int J Qual Stud Health Well-Being. 2011; 6(4): 8401-8414. DOI: 10.3402/Qhw.V6i4.8401.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: Author.

WHO: International Classification of Diseases: 11th Revision. Available at Accessed June 2, 2022.

Heeke C, O’Donald A, Stammel N, et al.: Same but different? DSM-5 versus ICD-11 PTSD among traumatized refugees in Germany. J Psychosom Res. 2020; 134: 110129. DOI: 10.1016/j.jpsychores.2020.110129.

Hickling EJ, Barnett SD, Sheppard S: A comparison of ICD-11, DSM-IV, DSM-5 classifications of PTSD and comorbid conditions: An examination of two veteran/military samples. EC Orthop. 2019; 10(5): 315-321.

Hyland P, Murphy J, Shevlin M, et al.: Variation in post-traumatic response: The role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms. Soc Psychiatry Psychiatr Epidemiol. 2017; 52(6): 727-736. DOI: 10.1007/s00127-017-1350-8.

Mollica RF, Caspi-Yavin Y, Bollini P, et al.: The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and post-traumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992; 180(2): 111-116. DOI: 10.1097/00005053-199202000-00008.

Bach ME: En empirisk belysning og analyse af “emotional numbing” som eventuel selvstændig faktor i PTSD. Psykol Stud. 2003; 6(1): 1-199.

Cloitre M, Shevlin M, Brewin CR, et al.: The international trauma questionnaire: Development of a self-report measure of ICD-11 PTSD and Complex PTSD. Acta Psychiatr Scand. 2018; 138(6): 536-546. DOI: 10.1111/acps.12956.

Vang ML, Dokkedahl SB, Schandorph SL, et al.: Validation of ICD- 11 PTSD and DSO using the International Trauma Questionnaire in five clinical samples recruited in Denmark. Eur J Psychotraumatol. 2021; 12(1): 1894806. DOI: 10.1080/20008198.2021.1894806.

Bech P, Bille J, Møller SB, et al.: Psychometric validation of the Hopkins symptom checklist (SCL-90) subscales for depression, anxiety, and interpersonal sensitivity. J Affect Disord. 2014; 160: 98-103. DOI: 10.1016/j.jad.2013.12.005.

Joseph S, Andrews B, Williams R, et al.: Crisis support and psychiatric symptomatology in adult survivors of the Jupiter cruise ship disaster. Br J Clin Psychol. 1992; 31(1): 63-73. DOI: 10.1111/j.2044-8260.1992.tb00968.x.

Elklit A, Schmidt Pedersen S, Jind L: The crisis support scale: Psychometric qualities and further validation. Personal Individ Differ. 2001; 31(8): 1291-1302. DOI: 10.1016/S0191-8869(00)00220-8.

Carney DR, Harrigan JA: It takes one to know one: Interpersonal sensitivity is related to accurate assessments of others’ interpersonal sensitivity. Emotion. 2003; 3(2): 194-200. DOI: 10.1037/1528-3542.3.2.194.

Mushtaq A, Fatima B, Fatema A, et al.: Interpersonal sensitivity in the at-risk mental state for psychosis in Karachi, Pakistan. Eur Psychiatry. 2017; 41(563): S563. DOI: 10.1016/j.eurpsy.2017.01.819.

Passagerer og transportruter: Danmarks Statistik. 2022. Available at Accessed May 30, 2022.

Møller L, Augsburger M, Elklit A, et al.: Traumatic experiences ICD-11 PTSD & complex PTSD and the overlap with ICD-10 diagnoses. Acta Psychiatr Scand. 2020; 141(5): 421-431. DOI: 10.1111/acps.13161.

Wisco BE, Marx BP, Miller MW, et al.: A comparison of ICD-11 and DSM criteria for post-traumatic stress disorder in two national samples of US military veterans. J Affect Disord. 2017; 223(1): 17-19. DOI: 10.1016/j.jad.2017.07.006.

Brewin CR, Scragg P, Robertson M, et al.: Promoting mental health following the London bombings: A screen and treat approach. J Trauma Stress. 2008; 21(1): 3-8. DOI: 10.1002/jts.20310.

Dyb G, Jensen T, Glad KA, et al.: Early outreach to survivors of the shootings in Norway on the 22nd of July 2011. Eur J Psychotraumatol. 2014; 5: 23523-23402. DOI: 10.3402/ejpt.v5. 23523.



How to Cite

Elklit, Cand Psych, A., and L. K. Jørgensen, Cand Psych. “The Great Belt Bridge Railway Accident: Post-Traumatic Stress Reactions Among Passengers and Bereaved Family Members”. American Journal of Disaster Medicine, vol. 17, no. 2, Apr. 2022, pp. 153-61, doi:10.5055/ajdm.2022.0429.