Psychological distress could take months to manifest itself
Trauma fears for Thai boys rescued from cave
The dramatic rescue of a dozen boys from a flooded Thai cave ended a harrowing two-week ordeal that most seem to have weathered with astonishing mental and physical resilience - at least for the moment.
Despite days trapped in the gloom of a cramped, part-submerged chamber the youngsters' psychological state is "very good", Thongchai Lertwilairatanapong, Inspector General of the Public Health Ministry, told reporters on Wednesday, adding that they were now "free from stress".
The upbeat assessments were surprising given that the boys and their football coach initially survived for more than a week in pitch darkness on a narrow ledge - with the passing days marked by hunger and fear that they might never be found.
When they eventually were rescued it involved an extremely hazardous extraction - guided one-by-one, using underwater breathing equipment, through a series of long, flooded sections of narrow tunnel.
Despite the positive health assessments so far experts said they would all need to be monitored closely for signs of psychological distress that could take months to manifest itself.
"Their journey is not over yet," said Jennifer Wild, a clinical psychologist at the Oxford Centre for Anxiety Disorders and Trauma.
"It's possible after an ordeal such as this that similar cues will bring back feelings or memories from the trauma ... being in the dark, being in rooms when the doors are closed, having a scan such as an MRI and possibly swimming," Ms Wild said via the expert database Science Media Centre.
"In the weeks after such an ordeal, it is common for people to have unwanted memories, feelings and flashbacks," Ms Wild said, adding that while such symptoms usually clear up after a month, any longer could indicate post-traumatic stress disorder (PTSD).
The boys are expected to spend a week in hospital in Chiang Rai and six months of psychological monitoring.
Doctors said the weeklong quarantine period was necessary to ensure they had not contracted any infections from inside the cave, but parents were allowed to visit the first group wearing protective gear on Tuesday.
But even after they are fully reunited with their families and discharged, their recovery will remain an ongoing process - especially in the short term.
"They may become fearful, clingy, or jumpy," said Andrea Danese, a psychologist at king' College London.
"They may fear for their safety; they may become very moody or easily upset - or, in contrast, become detached or numb," he added.
The boys - all members of the same football team - may have been helped during their ordeal by the fact that they were already a unit rather than a group of strangers.
"The important things will be helping each other, returning to school and getting back into their community," said Boonruang Triruangworawat, director-general of the Thai Heath Ministry's Mental Health Department.
Ms Wild stressed that the boy's youth and collective spirit could also play to their advantage in terms of processing what they had been through.
"If they can view the ordeal as an unusual adventure rather than dwelling on how the event could have cost their lives, they will be more likely to have a good emotional outcome," Ms Wild said.
"If they focus and dwell on what could have happened, they'll have a harder time," she added.