Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris

Abstract

Background The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD). Methods Santé publique France conducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use. Results Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps. Conclusion Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.

People’s experiences of distress and psychosocial care following a terrorist attack: interviews with survivors of the Manchester Arena bombing in 2017

“…This finding is consistent with recent research that shows that GPs are the primary or first healthcare provider to whom people turn in the immediate aftermath of terrorist attacks. 10 , 20 , 21 Our interviewees described variable responses. Some encountered limited knowledge of the psychosocial aspects of major incidents and available services, and inappropriate offers of help, including medication.…”

“…Apart from a few recent notable exceptions, there have been very few studies that reflect survivors’ voices. 10 , 11 , 20 , 21 Consequently, relatively little is known about survivors’ experiences of services. This is an important gap in the literature.…”

Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium

“…The fact that primary care services played a fundamental role generally in healthcare may have facilitated the organization of a primary care based follow-up also in the context of the terrorist attacks. Indeed, research indicates that the use of GPs was more common in survivors of the Utøya attack in Norway than in survivors of the 13 November attacks in France [ 87 – 89 ]. The psychosocial care response in Norway relied on multidisciplinary primary care services, including both health professionals and other professionals, in the local municipalities.…”

Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study

“…We can only speculate on the lack of recourse to psychological support among exposed staff: the setup of the psychological support resources provided by the hospital may not have been suited to staff expectations for various reasons; identification of staff members potentially exposed to a traumatic experience was not considered, hence the lack of a systematic approach to reach out to them and offer them a planned support meeting; on a more individual level, there may have been a fear of a lack of confidentiality when contacting a psychological support specialist in their own workplace [ 42 ]. These findings point to the need to dedicate adequate resources to organise early mental health support for exposed hospital staff, and to strongly recommend follow-up which can take on various forms [ 43 ].…”