Viswashkumar Ramesh, a British citizen returning from a trip to India, has been confirmed as the only survivor of Thursday’s deadly Air India crash.

“I don’t know how I am alive,” Ramesh told family, according to his brother Nayan, in a video call moments after emerging from the wreckage. Another brother Ajay, seated elswhere on the plane, was killed.

The Boeing 787-7 Dreamliner crashed into a medical college less than a minute after taking off in the city of Ahmedabad, killing the other 229 passengers and 12 crew. At least five people were killed on the ground.

Surviving a mass disaster of this kind may be hailed as a kind of “miracle”. But what is it like to survive – especially as the only one?

Surviving a disaster

Past research has shown disaster survivors may experience an intense range of emotions, from grief and anxiety to feelings of loss and uncertainty.

These are common reactions to an extraordinary situation.

Some people may develop post-traumatic stress disorder (PTSD) and have difficulty adjusting to a new reality after bearing witness to immense loss. They may also be dealing with physical recovery from injuries sustained in the disaster.

Most people recover after disasters by drawing on their own strengths and the support of others. Recovery rates are high: generally less than one in ten of those affected by disasters develop chronic, long-term problems.

However, being a sole survivor of a mass casualty may have its own complex psychological challenges.

Survivor’s guilt

Survivors can experience guilt they lived when others died.

My friend, Gill Hicks, spoke to me for this article about the ongoing guilt she still feels, years after surviving the 2005 bombings of the London underground.

Lying trapped in a smoke-filled train carriage, she was the last living person to be rescued after the attack. Gill lost both her legs.

Yet she still wonders, “Why me? Why did I get to go home, when so many others didn’t?”

In the case of a sole survivor, this guilt may be particularly acute. However, research addressing the impact of sole survivorship is limited. Most research that looks at the psychological impact of disaster focuses on the impact of disasters more broadly.

Those interviewed for a 2013 documentary about surviving large plane crashes, Sole Survivor, express complex feelings – wanting to share their stories, but fearing being judged by others.

Being the lone survivor can be a heavy burden.

“I didn’t think I was worthy of the gift of being alive,” George Lamson Jr. told the documentary, after surviving a 1985 plane crash in Nevada that killed all others on board.

Looking for meaning

People who survive a disaster may also be under pressure to explain what happened and relive the trauma for the benefit of others.

Vishwashkumar Ramesh was filmed and interviewed by media in the minutes and hours following the Air India crash. But as he told his brother: “I have no idea how I exited the plane”.

It can be common for survivors themselves to be plagued by unanswerable questions. Did they live for a reason? Why did they live, when so many others died?

These kinds of unaswerable questions reflect our natural inclination to look for meaning in experiences, and to have our life stories make sense.

For some people, sharing a traumatic experience with others who’ve been through it or something similar can be a beneficial part of the recovery process, helping to process emotions and regain some agency and control.

However, this may not always be possible for sole survivors, potentially compounding feelings of guilt and isolation.

Coping with survivor guilt

Survivor guilt can be an expression of grief and loss.

Studies indicate guilt is notably widespread among individuals who have experienced traumatic events, and it is associated with heightened psychopathological symptoms (such as severe anxiety, insomnia or flashbacks) and thoughts of suicide.

Taking time to process the traumatic event can help survivors cope, and seeking support from friends, family and community or faith leaders can help an individual work through difficult feelings.

My friend Gill says the anxiety rises as the anniversary of the disaster approaches each year. Trauma reminders such as anniversaries are different to unexpected trauma triggers, but can still cause distress.

Media attention around collectively experienced dates can also amplify trauma-related distress, contributing to a cycle of media consumption and increased worry about future events.

On the 7th of July each year, Gill holds a private remembrance ritual. This allows her to express her grief and sense of loss, and to honour those who did not survive. These types of rituals can be a valuable tool in processing feelings of grief and guilt, offering a sense of control and meaning and facilitating the expression and acceptance of loss.

But lingering guilt and anxiety – especially when it interferes with day-to-day life – should not be ignored. Ongoing survivor guilt is associated with significantly higher levels of post-traumatic symptoms.

Survivors may need support from psychologists or mental health professionals in the short and long term.

Erin Smith, Associate Professor and Discipline Lead (Paramedicine), La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.

Vegan and vegetarian diets are plant-based diets. Both include plant foods, such as fruits, vegetables, legumes and whole grains.

But there are important differences, and knowing what you can and can’t eat when it comes to a vegan and vegetarian diet can be confusing.

So, what’s the main difference?

What’s a vegan diet?

A vegan diet is an entirely plant-based diet. It doesn’t include any meat and animal products. So, no meat, poultry, fish, seafood, eggs, dairy or honey.

What’s a vegetarian diet?

A vegetarian diet is a plant-based diet that generally excludes meat, poultry, fish and seafood, but can include animal products. So, unlike a vegan diet, a vegetarian diet can include eggs, dairy and honey.

But you may be wondering why you’ve heard of vegetarians who eat fish, vegetarians who don’t eat eggs, vegetarians who don’t eat dairy, and even vegetarians who eat some meat. Well, it’s because there are variations on a vegetarian diet:

• a lacto-ovo vegetarian diet excludes meat, poultry, fish and seafood, but includes eggs, dairy and honey
• an ovo-vegetarian diet excludes meat, poultry, fish, seafood and dairy, but includes eggs and honey
• a lacto-vegetarian diet excludes meat, poultry, fish, seafood and eggs, but includes dairy and honey
• a pescatarian diet excludes meat and poultry, but includes eggs, dairy, honey, fish and seafood
• a flexitarian, or semi-vegetarian diet, includes eggs, dairy and honey and may include small amounts of meat, poultry, fish and seafood.

Are these diets healthy?

A 2023 review looked at the health effects of vegetarian and vegan diets from two types of study.

Observational studies followed people over the years to see how their diets were linked to their health. In these studies, eating a vegetarian diet was associated with a lower risk of developing cardiovascular disease (such as heart disease or a stroke), diabetes, hypertension (high blood pressure), dementia and cancer.

For example, in a study of 44,561 participants, the risk of heart disease was 32% lower in vegetarians than non-vegetarians after an average follow-up of nearly 12 years.

Further evidence came from randomised controlled trials. These instruct study participants to eat a specific diet for a specific period of time and monitor their health throughout. These studies showed eating a vegetarian or vegan diet led to reductions in weight, blood pressure, and levels of unhealthy cholesterol.

For example, one analysis combined data from seven randomised controlled trials. This so-called meta-analysis included data from 311 participants. It showed eating a vegetarian diet was associated with a systolic blood pressure (the first number in your blood pressure reading) an average 5 mmHg lower compared with non-vegetarian diets.

It seems vegetarian diets are more likely to be healthier, across a number of measures.

For example, a 2022 meta-analysis combined the results of several observational studies. It concluded a vegetarian diet, rather than vegan diet, was recommended to prevent heart disease.

There is also evidence vegans are more likely to have bone fractures than vegetarians. This could be partly due to a lower body-mass index and a lower intake of nutrients such as calcium, vitamin D and protein.

But it can be about more than just food

Many vegans, where possible, do not use products that directly or indirectly involve using animals.

So vegans would not wear leather, wool or silk clothing, for example. And they would not use soaps or candles made from beeswax, or use products tested on animals.

The motivation for following a vegan or vegetarian diet can vary from person to person. Common motivations include health, environmental, ethical, religious or economic reasons.

And for many people who follow a vegan or vegetarian diet, this forms a central part of their identity.

So, should I adopt a vegan or vegetarian diet?

If you are thinking about a vegan or vegetarian diet, here are some things to consider:

• eating more plant foods does not automatically mean you are eating a healthier diet. Hot chips, biscuits and soft drinks can all be vegan or vegetarian foods. And many plant-based alternatives, such as plant-based sausages, can be high in added salt
• meeting the nutrient intake targets for vitamin B12, iron, calcium, and iodine requires more careful planning while on a vegan or vegetarian diet. This is because meat, seafood and animal products are good sources of these vitamins and minerals
• eating a plant-based diet doesn’t necessarily mean excluding all meat and animal products. A healthy flexitarian diet prioritises eating more whole plant-foods, such as vegetables and beans, and less processed meat, such as bacon and sausages
• the Australian Dietary Guidelines recommend eating a wide variety of foods from the five food groups (fruit, vegetables, cereals, lean meat and/or their alternatives and reduced-fat dairy products and/or their alternatives). So if you are eating animal products, choose lean, reduced-fat meats and dairy products and limit processed meats.

Katherine Livingstone, NHMRC Emerging Leadership Fellow and Senior Research Fellow at the Institute for Physical Activity and Nutrition, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.