Posttraumatic stress disorder and depression after the 2018 Strasbourg Christmas Market terrorist attack: a comparison of exposed and non-exposed police personnel

Abstract

Background: Police personnel are among the first responders exposed to terrorist attacks, raising in number in the late decades. Due to their profession, they are also exposed to repetitive violence, increasing their vulnerability to PTSD and depression. Objective: Our study aims at comparing the prevalence of PTSD and depression, and the risk factors associated with these conditions among directly and indirectly exposed versus non-exposed police personnel during the Strasbourg Christmas Market terrorist attack. Method: Three months after the attack, participants completed a survey assessing their sociodemographic characteristics, occupational data, degree of exposure, sleep debt around the event, event centrality (CES), and three mental health conditions: PTSD (PCL-5), depression (PHQ-9), and suicide risk (yes/no questions). Results: A total of 475 police personnel responded to the questionnaire: 263 were exposed to the attack (182 of them directly) and 212 were non-exposed. Among directly exposed participants, the prevalences of partial and complete PTSD were 12.6 and 6.6%, and the prevalence of moderate-to-severe depression was 11.5%. Multivariate analysis revealed that direct exposure was associated with a higher risk of PTSD (OR = 2.98 [1.10–8.12], p = .03). Direct exposure was not associated with a higher risk of depression (OR = 0.40 [0.10–1.10], p = .08). A significant sleep debt after the event was not associated with a higher risk of later PTSD (OR = 2.18 [0.81–5.91], p = .13) but was associated with depression (OR = 7.92 [2.40–26.5], p < .001). A higher event centrality was associated with both PTSD and depression ( p < .001). Conclusions: Police personnel directly exposed to the Strasbourg Christmas Market terrorist attack were at higher risk of PTSD but not depression. Efforts to prevent and treat PTSD should focus on directly exposed police personnel. However, general mental health should be monitored for every personnel member.

Comment on ‘Posttraumatic stress disorder and depression after the 2018 Strasbourg Christmas Market terrorist attack: a comparison of exposed and non-exposed police personnel’: moving towards shared methodology in terrorism-research

“…As the name suggests, partial PTSD refers to individuals who exhibit some symptoms of PTSD but do not meet all the criteria for a positive screening. More specifically, the authors define partial PTSD as: ‘Partial PTSD was considered when a participant met two or three of the diagnostic criteria B, C, D, or E’ (Nourry et al, 2023 ). These diagnostic criteria B to E are based on the DSM-5 definition of PTSD (American Psychiatric Association, 2013 ).…”

“…So, by grouping both partial and full PTSD together, it defeats the purpose of examining risk factors for partial PTSD and for PTSD, as it is unclear whether or not the risk factors are associated more for those with partial PTSD, or with those with PTSD. For example, the authors state ‘The participants with partial or complete PTSD used mental health care services significantly more than those with no PTSD (33% and 6%)’ (Nourry et al, 2023 ), without distinguishing partial and full PTSD. Yet, it would have been interesting to know if those with partial PTSD seek out mental health care services more than those with PTSD, as some studies suggest that symptom severity after terrorist attacks is associated with unmet mental health aid needs (Ghuman et al, 2014 ).…”

“…The second methodologic issue is related to criterion A, which might not be met for some participants. Nourry et al ( 2023 ) state that: ‘All respondents were asked to refer to the Christmas Market terrorist attack as a potentially traumatic event’, thus implying an adjustment of the PCL-5 by solely focusing on the specific terrorist attack. This raises doubts about the validity of the scale, as respondents who may have had PTSD prior to the attacks are forced to attribute their symptoms exclusively to that specific event.…”

“…According to the study's inclusion criteria, all police personnel employed by the Strasbourg police departments in December 2018 were eligible for participation, including administrative, technical, and scientific staff. The authors even state, ‘We expected that at least half the police personnel in our sample would have been unexposed to the attack, either because they were not working on the day of the attack or because of their assignment’ (Nourry et al, 2023 ). This raises questions about whether criterion A of PTSD is fulfilled for all participants in the study.…”

“…We read the study by Nourry et al ( 2023 ) with great interest. However, we would like to address two methodological issues that are recurring challenges in the field of terrorism studies (Durodié & Wainwright, 2019 ).…”