Abstract
BackgroundThe 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).MethodsSanté 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.ResultsTwo-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.ConclusionOur 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.
Highlights
The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care
With regard to the other types of mental health supports (MHSu), 17% had consulted their general practitioner (GP), 16% had met a person from an association providing support for psychological problems, and 39% had consulted a specialist in a structure belonging to the peacetime health care system (Table 2)
Provided that the ethical rules for the protection and security of personal data are respected, systems to monitor the mental health of exposed people as well as their use of MHSu should be put in place
Summary
The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. Terrorist attacks take a heavy psychosocial toll on the lives of people who have been directly threatened, witnesses, and those indirectly exposed (i.e., who learn that a loved one has been threatened, injured or killed) This is reflected in a high prevalence of acute stress and mental health disorders (MHD) – post-traumatic stress disorder (PTSD), major depressive disorder and anxiety-based disorders - in the months, and even years, following the attack [1,2,3,4]. Access to MHSu is important for people directly affected by a collective massive attack [17,18,19], as they represent the exposure group with the highest risk of psychological sequelae [18] This access may differ depending on whether the person was directly threatened, was a witness during the attack, or learned that a loved one was threatened, injured or killed
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