Health care needs, experiences, and satisfaction after terrorism: a longitudinal study of parents of survivors of the Utøya attack.

BACKGROUND: There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up. METHODS: Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up. RESULTS: Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported "very high/high" needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received. CONCLUSIONS: Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.

The psychosocial aid response after the 22/03/2016 attacks in Belgium: a community case study.

Introduction: After the terrorist attacks, early psychosocial care is provided to people considered at risk of developing mental health issues due to the attacks. Despite the clear importance of such early intervention, there is very few data on how this is registered, who is targeted, and whether target-recipients accept such aid. Methods: Using registry data from the Centre General Wellbeingwork (CAW), a collection of centers in the regions Brussels and Flanders that provide psychosocial care, we examined the early psychosocial care response after the terrorist attacks of 22/03/2016 in Belgium. Results: In total, 327 people were listed to be contacted by the CAW, while only 205 were reached out to (62.7%). Most were contacted within a month (84.9%), and were victims of the attacks (69.8%). Overall, the majority was female (55.6%). Conclusion: Overall, target recipients were witnesses and survivors of the attacks, though a large proportion of people were not reached by the early outreach.

Significance Quest: A Meta-Analysis on the Association Between the Variables of the 3N Model and Violent Extremism.

Given the pervasiveness of violent extremism all over the globe, understanding its psychological underpinnings is key in the fight against it. According to the Significance Quest Theory and its 3N model, violent extremism (i.e., violent and deviant behavior) is a function of three elements: need, narrative, and network. In the present meta-analysis, to put into test the theory and its model, we aimed to establish the strength of the association between these three elements, as well as the quest for significance itself, and violent extremism; and investigate if these associations are influenced by methodological decisions (i.e., sampling and measurements/manipulations). A literature search was performed through electronic platforms, a call for unpublished or in-press data, and backward snowballing. Seventeen reports, comprising 42 studies, met full inclusion criteria: quantitative studies based on primary data assessing for the association of at least one of the 3Ns, or quest for significance, and violent extremism, and providing sufficient data for effect size extraction. Findings are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines. Random-effect meta-analyses rendered statistically significant pooled effect sizes in all the investigated associations. The association is strong for quest for significance, moderate for narrative and network, and low for need for significance. Subgroup analyses demonstrate that the detection of these associations is influenced by methodological decisions concerning the measurements and manipulations, but not by those concerning the sampling. We discuss these findings and suggest future research directions aiming to improve the predictive power of the theory and its model.

Contextualizing involvement in terrorist violence by considering non-significant findings: Using null results and temporal perspectives to better understand radicalization outcomes.

Irrespective of discipline, the publication of null or non-significant findings is rare in the social sciences. For burgeoning fields like terrorism research, this is particularly problematic. As well as increasing the likelihood of Type II errors, the selective reporting of significant findings ultimately impedes progression, hindering comprehensive syntheses of evidence and enabling ill-supported lines of scientific enquiry to persist. This manuscript discusses several structural and individual-level variables which failed to produce significant, linear associations with involvement in terrorist violence in a dataset (N = 206) of right-wing and jihadist extremists active in Europe and North America. After considering methodological factors such as non-random distributions of missing data, we illustrate how certain variables are significantly associated with involvement in terrorist violence at particular periods in a radicalizing individual's lifespan, but not others (i.e., pre- or post-radicalization onset). Moreover, we demonstrate that while some static, binary constructs (such as whether or not a radicalizing individual was exposed to diverse viewpoints) are not associated with terrorist violence, their influence over time produces different associations. We conclude that radicalization may be less about individuals having pre-disposing risk factors, such as biographical stressors, and more about cognitive changes that allow individuals to re-evaluate their lives through the lens of an extremist ideology. We also underline the importance of taking a temporal, rather than static, perspective to better understand the variables associated with the outcomes of radicalization trajectories.

The short-term impact of terrorism on public mental health: an emergency primary care approach.

BACKGROUND: Terrorist attacks commonly have mental health consequences for those directly affected. Existing research is, however, divided when it comes to how and whether terrorist attacks affect the general population's mental health. There is a need for studies investigating a broader range of mental health reactions to understand more about how different groups of the population are affected by terrorist attacks, while also illuminating important systemic factors. METHODS: In this study we investigated whether there was any change in the number of consultations with out-of-hours emergency primary care for psychological reactions in association with the 2011 terrorist attacks in Norway. Data covering the entire Norwegian population's primary care contacts in 2008-2013, where the reason for encounter was coded as psychological concerns or psychiatric disorders, were studied. A time series intervention analysis, using ARIMA modelling, was used to estimate whether there was indeed a change in healthcare utilisation associated with the terrorist attacks. RESULTS: The analysis uncovered an increase in contacts with emergency primary care by the overall population for mental health concerns associated with the terrorist attacks. When divided into groups according to geographical proximity to attacks, no significant change was found in the area closest to the attack in Oslo, whereas an increase was found for the rest of the country. There was also heterogeneity across different age groups. An increase was found among youths, young adults, and middle-aged people, but not the other age groups, and an increase was found for both men and women. CONCLUSIONS: These findings highlight the need for primary care services to be prepared to meet mental health reactions in the general population when planning for healthcare provision in the aftermath of terrorism. Simultaneously, it should be noted that needs may vary across different groups of the population.

[Attitudes of Healthcare Professionals to Extremism and Treatment Options]. / Einstellung von Fachkräften aus den Heilberufen zum Thema Extremismus und zu Behandlungsoptionen.

OBJECTIVE: In view of the cruelty of acts of terrorism and violent extremism, it is often inconceivable what the underlying motives are. Analyzes of the attacks in Ansbach (2016), Halle (2019) and Hanau (2020) showed a picture of different psychological conspicuities among the perpetrators, which highlights the need to involve health care professionals in the prevention of extremism. Against this background, the treatment of people with extremist attitudes appears to be crucial in order to prevent negative consequences for those affected, but also for society. METHODS: Within the framework of an anonymous online survey, physicians and psychological psychotherapists were asked about previous experiences, attitudes and wishes regarding the treatment of patients with extremist attitudes. Furthermore, data on their own work was collected. RESULTS: A total of 364 physicians (18%), psychological psychotherapists (72%) and participants with other job descriptions (10%) took part in the study. Only one fifth state that they felt well trained in the subject. About half of the respondents would offer a place in therapy (if they could decide on the patients themselves), likewise about half have already dealt with the topic of extremism and the majority see a need to deal with the topic more in the future and indicate a need for further training. The analyses show that physicians have so far dealt with the topic somewhat more than those with psychological psychotherapeutic training, and professionals in private practive are more likely to see a connection between extremism and psychiatric illnesses than professionals in hospitals, but would be less willing to offer patients with extremist attitudes a place in therapy. DISCUSSION: Physicians and psychotherapists need further training on extremisms and should be better prepared fo the challenges of treating patients in this context. CONCLUSION: In order to increase the chances of providing adequate care for mentally ill people with extremist attitutdes, health professionals should be better prepared for the topic in the future, for example through further training or opportunities for cooperation.

[The social traces of the trauma of the 13 November 2015 terrorist attacks: Five years and seven months after]. / Les traces sociales du traumatisme des attentats du 13 novembre 2015 : cinq ans et sept mois après.

The monitoring of how public opinion memorizes the terrorist attacks from 13th November 2015, and moreover the terrorist attacks since the early 2000s, provides new material for understanding the evolution over time and the mechanisms of the construction of collective memory. Data collected to date show that these attacks had a greater impact on the population than other tragic events that have occurred in recent history in France, or even a greater impact than other and much more recent attacks. In the long term, the precise memory of the factual aspects and the memories of the personal circumstances in which people learned about the events begin to vanish. While imprecision is gaining ground, collective memory now crystallizes on very significant and overdetermined markers such as emblematic places or locations such as the "Bataclan". As a matter of fact, this imprecision of memory goes hand-in-hand with a much stronger symbolic and emotional investment of the event as a whole and leads to an overestimation of the number of terrorists or victims. The special place given to the terrorist attacks of 13th November in the collective memory is due to the unprecedented number of victims, the fact that the attacks took place in the heart of the capital city, the reaction of the public authorities who declared a long lasting state of emergency, the discursive framing of the war on terrorism in all major media, and the feeling that the Islamist threat can kill indiscriminately without targeting specific categories of the population. The study also reveals the influence of value systems (political opinions, views of the republican model) and social characteristics of individuals on the way people memorize such experiences. It is part of a fundamentally multidisciplinary research around "Memory and trauma" that includes neuroscience, biological and clinical investigations.

Title: Les traces sociales du traumatisme des attentats du 13 novembre 2015 : cinq ans et sept mois après. Abstract: Le suivi de la mémoire des attentats du 13 novembre, et plus généralement des attaques terroristes depuis l'an 2000, auprès de la population générale offre un matériau inédit pour comprendre l'évolution dans le temps et la construction de la mémoire collective. L'étude montre que ces attaques ont davantage marqué la population que d'autres événements tragiques survenus dans l'Hexagone dans une période de temps proche, ou même que d'autres attentats beaucoup plus récents. Avec le temps, la mémorisation précise des faits et les souvenirs des circonstances dans lesquelles les personnes ont appris les faits s'érodent, et se concentrent notamment autour du lieu du Bataclan. Mais, cette imprécision fait place à un investissement symbolique plus fort, qui conduit notamment à une surestimation du nombre de terroristes ou de victimes. Les raisons de la place particulière dévolue aux attaques du 13 novembre dans la mémoire collective tiennent à la fois au nombre inégalé de victimes, à l'attaque de lieux situés dans la capitale, à la réaction des pouvoirs publics qui instaurent l'état d'urgence, au cadrage discursif de la guerre contre le terrorisme amplifié par les médias télévisuels et au sentiment que la menace islamiste peut tuer aveuglément sans viser des catégories précises de population. L'étude met également à jour l'influence des systèmes de valeur (couleur politique, regard sur le modèle républicain) et des caractéristiques sociales des individus sur la mémoire. Elle s'inscrit dans une recherche fondamentalement pluridisciplinaire autour de la « Mémoire et traumatisme ¼ intégrant des travaux en biologie, neurosciences et médecine.

Cultural threat perceptions predict violent extremism via need for cognitive closure.

Understanding the psychological processes that drive violent extremism is a pressing global issue. Across six studies, we demonstrate that perceived cultural threats lead to violent extremism because they increase people's need for cognitive closure (NFC). In general population samples (from Denmark, Afghanistan, Pakistan, France, and an international sample) and a sample of former Mujahideen in Afghanistan, single-level and multilevel mediation analyses revealed that NFC mediated the association between perceived cultural threats and violent extremist outcomes. Further, in comparisons between the sample of former Afghan Mujahideen and the general population sample from Afghanistan following the known-group paradigm, the former Mujahideen scored significantly higher on cultural threat, NFC, and violent extremist outcomes. Moreover, the proposed model successfully differentiated former Afghan Mujahideen participants from the general Afghan participants. Next, two preregistered experiments provided causal support for the model. Experimentally manipulating the predictor (cultural threat) in Pakistan led to higher scores on the mediator (NFC) and dependent variables (violent extremist outcomes). Finally, an experiment conducted in France demonstrated the causal effect of the mediator (NFC) on violent extremist outcomes. Two internal meta-analyses using state-of-the-art methods (i.e., meta-analytic structural equation modeling and pooled indirect effects analyses) further demonstrated the robustness of our results across the different extremist outcomes, designs, populations, and settings. Cultural threat perceptions seem to drive violent extremism by eliciting a need for cognitive closure.

Terror leaves adolescents behind: Identifying risk and protective factors for high-school completion among survivors of terrorism.

Terror exposure increases the risk of somatic and psychological health problems in survivors. Yet, knowledge of how such exposure affects survivors' ability to stay in school is lacking. This study examined whether exposure to the 2011 Utøya terrorist attack in Norway impacted survivors' ability to complete high school. Further, it aimed to identify important peri- and posttraumatic risk and protective factors. Interview data from the Utøya study, collected 4-5 months postterror, were linked to individual educational registry data for 265 survivors. Chi-square tests and ordinal logistic regression analyses were used to examine (a) high school completion among younger survivors (n = 185, age range: 13-18 years, 52.4% female) compared to both older survivors (i.e., who had the possibility of completing high school before the terror attacks; n = 80, age range: 19-21 years, 40.0% female) and the national average and (b) associations between high school completion and physical injury, posttraumatic stress symptoms (PTSS), somatic symptoms, and social support among younger survivors. Younger survivors were significantly less likely to complete high school on time. Among younger adolescents, physical injury, aOR = 0.36, 95% CI [0.16, 0.81]; higher-level PTSS, aOR = 0.54, 95% CI [0.33, 0.88]; and somatic symptoms, aOR = 0.51, 95% CI [0.29, 0.91], lowered the likelihood of on-time completion. Terror exposure in adolescence adversely affects long-term educational functioning in young survivors, which can severely hamper their future prospects. These findings reinforce the need for trauma-sensitive teaching and educator-provided support for adolescents exposed to trauma.

Post-traumatic stress disorder among civilians 6 and 18 months after the January 2015 terrorist attacks in the Paris region.

In the literature, the association between medium and long-term PTSD (post-traumatic stress disorder) after terrorist attack has rarely been described. The objective of our study was to identify the factors associated with PTSD in the medium and longer term among people exposed to a terrorist attack in France. We used data from a longitudinal survey of 123 terror-exposed people interviewed 6-10 (medium term) and 18-22 (long term) months after. Mental health was assessed by the Mini Neuropsychiatric Interview. PTSD in the medium term was associated with history of traumatic events, low levels of social support and severe peri-traumatic reactions, which were in turn associated with high levels of terror exposure. PTSD in the medium term was linked in turn to the presence of anxiety and depressive disorders, which was also linked to PTSD in the longer term. The factors leading to PTSD are different in the medium and long term. In order to improve future support for people exposed to distressing events, it is important to follow up people with intense peri-traumatic reactions, high levels of anxiety and depression and to measure reactions.

Analysis of Psychiatric Disorders by Age Among Children Following a Mass Terrorist Attack in Nice, France, on Bastille Day, 2016.

This cross-sectional study examines psychiatric disorders among children after a mass terrorist attack in Nice, France, in 2016.

Continuous Exposure to Terrorism during the COVID-19 Pandemic: A Moderated Mediation Model in the Israeli Context.

This study tested the role of perceived social support as a moderating factor in the mediation of COVID-19-related concerns in the association between continuous traumatic stress (CTS) and depression. The study participants were 499 college students who responded to an anonymous online questionnaire. Measures included the assessment of prior continuous exposure to threats of terrorism, COVID-19-related distress, perceived social support and depressive symptoms. The results demonstrated that COVID-19-related concerns mediated the relationship between continuous exposure to threats of terrorism and depression symptoms, and that perceived social support moderated the association between COVID-19-related concerns and depression. The implications of the study highlight the role of prior exposure to traumatic stress as a risk factor for depression and the role of social support as a protective factor. These results point to the need to develop accessible and non-stigmatic mental health services for populations exposed to other types of continuous traumatic stress.

Under the veil of tolerance: A justification-suppression approach to anti-Islamic implicit bias in reaction to terrorist attacks.

Twenty years after 9/11, the impact of terrorism on social and political attitudes remains unclear. Several large-scale surveys suggest that terrorism has no discernible effects on direct, self-report measures of prejudice toward Arab-Muslims. However, direct measures may lack the sensitivity to detect subtle underlying attitudes that are considered socially unacceptable to openly express. To tap these subtle reactions, we assessed more sensitive and implicit measures of the cognitive-affective aspects of prejudice. Building on the justification-suppression model of prejudice, we hypothesized that terrorist attacks increase implicit bias toward Arab-Muslims, especially among individuals who are unable to regulate automatic hostile reactions due to personality or situational variables. Study 1, using data from Project Implicit (N = 276,311), showed that terrorist attacks increased implicit bias but not expressed prejudice toward Arab-Muslims. Study 2, using data from Google Trends, showed that terrorist attacks increased anti-Islamic searches on the internet. Four studies that collected original data (total N = 851) showed that the effects of reminders of terrorism on anti-Islamic implicit bias are moderated by individual differences in prejudice and automaticity (Studies 3-4), by the strength of implicit Muslim-terrorist associations (Study 5), and by momentary self-control depletion (Study 6). Overall, the present research indicates that despite little evidence for elevated overt expression of prejudice against Arab-Muslims following terrorist attacks, terrorist attacks increase anti-Islamic implicit bias whenever individuals are unlikely to control automatic hostile reactions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Necessity to Recognize Processes of Radicalization from a Socio-cultural Perspective.

The current paper investigates Psychoanalytic, Cognitive, Behaviorist, and Socio-cultural theories and critiques how they have (or might have) contributed to the study of radicalization. The paper asserts two arguments that lack emphasis in the current radicalization research: 1) radicalization refers to a process, and does not always refer to violent behavior; 2) radicalization research needs to pay tribute to socio-cultural, political, and historical context while designing research and discussing findings. These two points are essential to extend the concept of radicalization and to be sensitive to different research contexts and populations. Currently, the conceptualization of radicalization appears to be generalized to violent action among minority groups (mainly Muslims) in limited contexts (mostly Western countries). The article claims that Psychology can better contribute to this diverse field of interest with its well-established theoretical contributions to the understanding of human beings and its compassion to seek differences amongst people across different contexts.

Distinguishing lone from group actor terrorists: A comparison of attitudes, ideologies, motivations, and risks.

The increasing recognition of the risks posed by lone-actor terrorists provides the impetus for understanding the psychosocial and ideological characteristics that distinguish lone from group actors. This study examines differences between lone and group actor terrorists in two domains: (i) attitudes toward terrorism, ideology, and motivation for terrorist acts; and (ii) empirically derived risk factors for terrorism. Using a cross-sectional research design and primary source data from 160 men convicted of terrorism in Iraq, this study applied bivariate and logistic regression analyses to assess group differences. It tested the hypothesis that there are no statistically significant differences between the groups. Bivariate analyses revealed that lone actors were less likely than group actors, to be unemployed, to cite personal or group benefit as the main motives for terrorist activity, and to believe that acts of terrorism achieved their goals. Regression analysis indicated that having an authoritarian father was the only factor that significantly predicted group membership, with group actors three times more likely to report this trait. Lone actors and group actors are almost indistinguishable except for certain differences in attitudes, motives, employment, and having an authoritarian father.

Why Is It so Difficult to Investigate Violent Radicalization?

Imagine that you are a researcher interested in disentangling the underlying mechanisms that motivate certain individuals to self-sacrifice for a group or an ideology. Now, visualize that you are one of a few privileged that have the possibility of interviewing people who have been involved in some of the most dramatic terrorist attacks in history. What should you do? Most investigations focused on terrorism do not include empirical data and just a handful of fortunate have made face-to-face interviews with these individuals. Therefore, we might conclude that most experts in the field have not directly met the challenge of experiencing studying violent radicalization in person. As members of a research team who have talked with individuals under risk of radicalization, current, and former terrorists, our main goal with this manuscript is to synopsize a series of ten potential barriers that those interested in the subject might find when making fieldwork, and alternatives to solve them. If all the efforts made by investigators could save the life of a potential victim, prevent an individual from becoming radicalized, or make him/her decide to abandon the violence associated with terrorism, all our work will have been worthwhile. (AU)

Exploring Pathways and Obstacles to Well-Being in Victims of Terrorism: A Qualitative Approach

On March 11, 2004, Madrid suffered one of the worst terrorist attacks in the history of Spain, leaving more than 190 dead and 2,000 injured. For years, the psychological consequences of the attacks have been studied; however, its long-term effects on symptomatology and especially on well-being remains unknown. This study aims to explore, through a qualitative approach, pathways and obstacles to the well-being of those affected directly or indirectly by the attacks of March 11 in Madrid. Two focus groups were held, one for indirect victims and one for direct victims. Subsequently, a thematic analysis of the materials obtained was carried out. More than 10 years after the attacks, most of the participants reported great difficulty in achieving well-being. Acceptance and victims’ associations seemed to act as key facilitators, while symptoms, political institutions and the media were the main obstacles. Direct and indirect victims presented similar data although aspects such as guilt and family relationships played a different role in their well-being. (AU)

Healthcare utilization after mass trauma: a register-based study of consultations with primary care and mental health services in survivors of terrorism.

BACKGROUND: Knowledge on healthcare utilization after mass trauma is needed to strengthen the public health preparedness to such incidents. Using register-based data, this study had a unique opportunity to investigate how young survivors' use of primary care physicians (PCP) and mental health services (MHS) changed after a terrorist attack. METHODS: We examined register-based data on PCP and MHS consultations among 255 survivors (52% male) of the 2011 Utøya youth camp attack in Norway 3 years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC- 2). RESULTS: The PCP and MHS consultation rates (CR) were higher in female than male survivors both acutely and at long-term. The mean yearly CRs increased from 2.25 to 4.41 for PCP and 1.77 to 13.59 for MHS the year before and after the attack in female survivors, and from 1.45 to 3.65 for PCP and 1.02 to 11.77 for MHS in male survivors. The third year post-attack CRs for PCP were 3.55 and 2.00; and CRs for MHS were 5.24 and 2.30 in female and male survivors, respectively. Among female survivors, 76% consulted PCP and 12% MHS the year preceding the attack; post-attack 93% consulted PCP and 73% MHS the first year; decreasing to 87 and 40% the third year. Among male survivors, 61% consulted PCP and 7% MHS the year preceding the attack; post-attack 86% consulted PCP and 61% MHS the first year, and 67 and 31% the third year. As for PCP consultations, there was a particular increase in psychological reasons for encounter following the attack. CONCLUSIONS: This study indicates that it is important to anticipate an increased healthcare utilization several years following mass trauma, particularly of MHS. Both PCP and MHS practitioners played important roles in providing healthcare for psychological problems in young survivors of terrorism in a country with universal and largely publicly financed healthcare and a gatekeeping system. The healthcare utilization could be different in countries with other health systems or psychosocial care responses to mass trauma.

Dissociation and psychopathology in Kenyan survivors of a terrorist bombing.

BACKGROUND: Dissociation is a serious psychological condition that is characterized as a pathological outcome of trauma-related experience. Thus, dissociation could be expected to develop in survivors of disaster trauma and to be associated with trauma exposure and psychopathology. METHODS: A sample of 278 disaster-affected Kenyans was assessed 8 to 10 months after the 1998 terrorist bombing of the US Embassy in Nairobi for a study of trauma-related psychopathology and dissociation in the context of personality and culture. Instruments of assessment were the Diagnostic Interview Schedule, the Dissociative Experiences Scale, and the Temperament and Character Inventory. RESULTS: Dissociation appeared to represent a largely nonpathological response to the disaster experience that reflected personality variables and a cultural context. CONCLUSIONS: These findings suggest that dissociation encountered in disaster-exposed groups in this cultural setting does not necessarily represent psychopathology, but attention to dissociative responses might help clinicians identify and provide interventions for individuals experiencing distressing intrusive and hyperarousal symptoms.

Insomnia in survivors 8.5 years after the Utøya Island terrorist attack: transition from late adolescence to early adulthood - the Utøya study.

Background: Insomnia is a global health concern, associated with many mental and physical health conditions. Prevalence of insomnia is reported to increase during adolescence and early adulthood. High levels of insomnia are also reported in adolescents up to 2.5 years after a traumatic event. What is less well understood is the prevalence of insomnia in a trauma exposed population transitioning from adolescence to adulthood. Objective: To assess insomnia in the survivors in the 2011 Utøya Island terrorist attack, 2.5 years and 8.5 years after the attack when the majority of survivors were transitioning from late adolescence to early adulthood. Method: Participants were 336 survivors of the Utøya Island attack who completed the Utøya Study 2.5 years (T3) and 8.5 years (T4) after the attack. Participants completed a face-to-face interview including the Bergen Insomnia Scale (BIS), which was used to assess insomnia symptoms and prevalence of meeting diagnostic criteria for insomnia. Results: Insomnia was indicated in 47.7% of survivors 8.5 years after the attack. Insomnia prevalence did not significantly change from 2.5 to 8.5 years after the attack, though insomnia symptoms (BIS sum score) were found to increase. Age was negatively associated with insomnia at T4, with older age being associated with less insomnia. No significant sex difference was found in insomnia prevalence at T4. Conclusion: Almost a decade after the Utøya Island terrorist attack, nearly a half of the young survivors in our study reported insomnia and typical age- and sex-related differences in sleep were not always seen. This rate is almost double what is reported in the general population (20-30%) indicating a high level of unmet need in this population. The implications of such sleep disruption during a critical time for physical, mental, social and cognitive development are far reaching.

Antecedentes: el insomnio es un problema de salud mundial, asociado con muchas afecciones de salud mental y física. Se reporta que la prevalencia del insomnio aumenta durante la adolescencia y la edad adulta temprana. También se reportan niveles elevados de insomnio en adolescentes hasta 2,5 años después de un evento traumático. Lo que es menos comprendido es la prevalencia del insomnio en una población expuesta al trauma que pasa de la adolescencia a la edad adulta.Objetivo: Evaluar el insomnio en los sobrevivientes del ataque terrorista de la isla de Utøya en 2011, 2.5 años y 8.5 años después del ataque, cuando la mayoría de los sobrevivientes pasaban de la adolescencia tardía a la adultez temprana.Método: Los participantes fueron 336 supervivientes del ataque de la isla de Utøya que completaron el estudio de Utøya 2,5 años (T3) y 8,5 años (T4) después del ataque. Los participantes completaron una entrevista cara a cara que incluía la Escala de insomnio de Bergen (BIS), que se utilizó para evaluar los síntomas de insomnio y la prevalencia de cumplir con los criterios de diagnóstico para el insomnio.Resultados: Se descubrió insomnio en el 47,7% de los supervivientes 8,5 años después del ataque. La prevalencia del insomnio no cambió significativamente de 2,5 a 8,5 años después del ataque, aunque se encontró que los síntomas de insomnio (puntuación suma BIS) aumentaron. La edad se asoció negativamente con el insomnio en T4, y la edad avanzada se asoció con menos insomnio. No se encontraron diferencias de sexo significativas en la prevalencia de insomnio en T4.Conclusión: Casi una década después del ataque terrorista en la isla de Utøya, casi la mitad de los jóvenes supervivientes de nuestro estudio reportaron insomnio y no siempre se observaron diferencias típicas en el sueño relacionadas con la edad y el sexo. Esta tasa es casi el doble de lo que se informa en la población general (20­30%), lo que indica un alto nivel de necesidad insatisfecha en esta población. Las implicaciones de tal interrupción del sueño durante un momento crítico para el desarrollo físico, mental, social y cognitivo son de gran alcance.