Le Centre Régional de Psychotraumatisme Paris Centre et Sud : quel profil psychotraumatique pour les victimes appelant sa plateforme téléphonique ?

Abstract

ContextPsychotrauma is a public health issue. Prior to 1995 in France, support for victims of psychotrauma was mainly provided by associations. Following the terrorist bombing in the Paris metro at the Saint-Michel station on 25 July 1995, a new emergency care unit, the Cellule d’Urgence Médico-Psychologique (CUMP), was created. Its main mission is to provide immediate and post-traumatic event care to victims of disasters or events involving a large number of victims and likely to result in significant psychological repercussions. Following the 2015 attacks in Paris and Saint-Denis, the creation of the National Resource and Resilience Center and the Regional Psychotrauma Centers in 2018, represented a major step forward in the field of victim care and resilience. The Regional Psychotrauma Center for Central and Southern Paris (CRPPCS), which covers an area that consists of several departments (including Paris and the south of the Île-de-France region), is organized on a model of the federation of several care and associative structures. The originality of the CRPPCS system lies in the establishment of a call center, assessment, and referral platform. Three state-certified nurses trained in psychotraumatology engage callers in a semi-structured interview, explaining the course and purpose of the interview; noting the reason for the call, then evaluating any psychotraumatic symptoms according to a grid inspired by the Posttraumatic Stress Disorder Checklist version DSM-5. They also evaluate potential comorbidities (associated depression, addictions, suicidal behaviors, somatoform disorders, etc.). The callers’ psychiatric and addictological history are explored. ObjectivesThe aim of this study is to establish the profiles of callers, studying the different types of trauma, addictive comorbidity, treatment approaches and demographic data. Materials and methodsThis is a descriptive and retrospective observational study that was carried out from September 2020 to the end of June 2021. Our sample comprised 502 people, 75% of whom were women, 70% of whom were aged between 25 and 60, and the majority of whom were from the Île-de-France region (98%). ResultsPsychotrauma was diagnosed in 411 out of the 502 individuals. The main causes of trauma, in descending order of importance, were: domestic violence (32%), rape, physical assault, psychological assault, sexual assault other than rape, traumatic bereavement, confrontation with death, traffic accidents, verbal aggression/psychological violence/harassment at work, fire/explosion, traumatic migration path, assistance provided to a loved one in danger, and serious medical problems. For 24% of the sample, a previous history of traumatic events was reported. Among, these callers, 289 were redirected to a specialized structure for further treatment, and 20% of them also had an addictive comorbidity. Of the 52 people with a substance use disorder, 20 % reported a sexual assault as a child, 31% had been the victim of a rape, 26% of a sexual assault in adulthood and 43% of a traumatic migration journey. Of the 289 calls involving psychotrauma in the network, the distribution between the different subtypes was as follows: 137 people experienced a simple psychotrauma (47%) and 152 people were suffering from a complex psychotrauma (52%). ConclusionThe high prevalence of psychotrauma as well as the medical and social cost of its chronicity and associated frequent comorbidities illustrate the urgency to act in order to establish coherent public health strategies. The CRPPCS telephone platform provides direct access to specially trained staff. It contributes to an improvement in mental health by identifying disorders at an early stage and by referring patients for appropriate specialized care for psychotrauma and associated comorbidities. Our study highlights the significant addictive comorbidity associated with PTSD, which is often secondary to the onset of PTSD, as well as the risk of developing complex trauma if early treatment is not provided. These conclusions stress the need for simultaneous joint care of both the psychotrauma and the comorbidity of addiction.