Prevalence of increased alcohol use and alcohol use disorders in adult victims of terrorist attacks: a systematic and meta-analytic review.

Background: Previous studies have reviewed the evidence on the increase in alcohol consumption after a terrorist attack. However, an increase does not necessarily imply the presence of an alcohol use disorder.Objectives: To conduct a systematic and meta-analytic review of the literature on the prevalence of increased alcohol consumption and alcohol use disorders in adult exposed to terrorism.Methods: A search of PsycINFO, MEDLINE and PTSDpubs identified 29 studies published up to March 2023 in which 38 adult samples totaling 282,753 persons exposed to terrorism were assessed. Using inverse variance heterogeneity models, pooled prevalence rates of increased alcohol use and alcohol use disorders were calculated.Results: 6% (95% CI [2.9, 9.5]) of the adults exposed to a terrorist attack increased their alcohol consumption. The prevalence of increased alcohol use varied depending on the degree of exposure (p = .006, R2 = .18) and the procedure for measuring increases (p = .043, R2 = .37). The prevalence of alcohol use disorders in adults exposed to a terrorist attack was 5.5% (95% CI [3.7, 7.5]), a rate that was not higher than that obtained in the general population and varied depending on the type of alcohol disorder (p = .015, R2 = .30).Conclusions: A relevant number of adults exposed to terrorist attacks will subsequently increase their alcohol consumption, but this increase is not associated with an increase in the prevalence of alcohol use disorders. Effects of terrorism on people's health are potentially widespread, but concerns of excessive alcohol use after terrorist attacks may be unwarranted.

Provision of pre-hospital medical care for terrorist attacks.

The delivery of medical care to the severely injured during major incidents and mass casualty events has been a recurring challenge for decades across the world. From events in resource-poor developing countries, through richly funded military conflicts, to the most equipped of developed nations, the provision of rapid medical care to the severely injured during major incidents and mass casualty events has been a priority for healthcare providers. This is often under the most difficult of circumstances.1,2 Whilst mass casualty events are a persistent global challenge, it is clear in developed countries that patients and their families demand and expect a high standard of care from their rescuers, that this care should be delivered rapidly, and this should be of the highest quality possible.3 Whilst there is respect afforded to those who 'run towards danger' during a high-threat situation, first responders are subjected to a high degree of scrutiny for their actions, even when the circumstances they are presented with are considered to be extraordinary.4 Likewise, even for those who are catastrophically injured beyond salvage, society expects the response to be dignified, calculated, and thorough.3.

Army Public School Terrorist Attack - Perceptions and Experiences of school children of Karachi.

Objectives: To explore the experiences and perceptions of school children of Karachi after the Army Public School (APS) attack. Methods: It was a qualitative transcendental phenomenological study. Data collection started nine months after the attack, in September 2015, and continued till November 2019. Study participants were school children from Army, Government, and Private schools. The sampling strategy was convenience. Data collection of 53 students was done by focus group discussions and in depth interviews. Data analysis was performed using the phenomenological analytical techniques of Colaizzi. Results: Inductive analysis of the qualitative data gave rise to three themes - The journey beyond fear, Response of parents and schools and Role of media. Conclusion: The study concluded that the APS attack was the source of emotional distress and fear for the school children of Karachi as they personalized the event due to the nature of the attack. Immediately after the incident, they were in anger, grief, and fear, which altered their daily life activities and caused apprehensions in socializing and attending school. However, later they became highly motivated to study and gained courage. This motivation is revenge from terrorists as they wanted to keep children away from schools.

Non-participation and attrition in a longitudinal study of civilians exposed to the January 2015 terrorist attacks in Paris, France.

BACKGROUND: Non-participation and attrition are rarely studied despite being important methodological issues when performing post-disaster studies. A longitudinal survey of civilians exposed to the January 2015 terrorist attacks in Paris, France, was conducted 6 (Wave 1) and 18 months (Wave 2) after the attacks. We described non-participation in Wave 1 and determined the factors associated with attrition in Wave 2. METHODS: Multivariate logistic regression models were used to compare participants in both waves with those who participated in the first wave only. Analyses were performed taking the following factors into account: socio-demographic characteristics, exposure to terror, peri-traumatic reactions, psychological support, perceived social support, impact on work, social and family life, and mental health disorders. Characteristics of new participants in Wave 2 were compared with participants in both waves using a chi-square test. RESULTS: Of the 390 persons who were eligible to participate in the survey, 190 participated in Wave 1 (participation rate: 49%). The most frequently reported reason for non-participation was to avoid being reminded of the painful event (32%, n = 34/105). In Wave 2, 67 were lost to follow-up, 141 people participated, of whom 123 participated in Wave 1 (re-participation rate: 65%) and 18 were new. Attrition in Wave 2 was associated with socio-demographic characteristics (age, French origin) and location during the attacks, but not with terror exposure or mental health disorders. Compared with those who participated in both waves, new participants declared less social and psychological support since the attacks. CONCLUSIONS: Attrition at 6 months was not associated with exposure to terror or mental health disorders, which indicates that any bias in future analyses on IMPACTS on mental health outcomes will be limited. Our findings suggest the importance of adapting similar surveys for people of foreign origin and of improving strategies to avoid attrition of younger people, for example by using social media, peers, and the educational environment. The present study also revealed that a high level of exposure to terror and a lack of social and psychological support after a terrorist event could impede individuals' participation in similar surveys in the short term.

Forensic answers to the 14th of July 2016 terrorist attack in Nice.

The terrorist attack of July 14, 2016 in Nice (France) was a devastating event. A man voluntarily drove a truck into a crowd gathered for the fireworks display on the seaside "Promenade des Anglais," plowing pedestrians down over more than 2 km before being shot dead. At the time of this report, a total of 86 casualties and more than 1200 formal complaints for physical and psychological injuries have been recorded. The aim of this work is to describe the forensic management of this event and its immediate aftermath. This paper reaffirms the basic tenets of disaster management: a single place of work, teamwork in times of crisis, a single communication channel with families and the media, and the validation of the identifications by a multidisciplinary commission. This paper highlights other essential aspects of the organization of the forensic effort put in place after the Nice attack: the contribution of the police at the crime scene, the cooperation between the disaster victim identification (DVI) team, and the forensic pathologists at the morgue, applying the identification (ID) process to unconscious victims in the intensive care unit, the input of volunteers, and the logistics associated with the management of the aftermath of the event. All of the victims were positively identified within 4 and a half days. For the first time in such a paper, the central role of medical students in the immediate aftermath of the disaster is outlined. The need to address the possible psychological trauma of the non-medical and even the medical staff taking part in the forensic effort is also reaffirmed.

Health outcomes of the July 14, 2016 Nice terror attack among hospital-based professionals and students: the « ECHOS de Nice ¼ health survey protocol.

BACKGROUND: The terror attack of July 14, 2016, in Nice, France, resulted in 86 deaths, including children, and several hundred wounded, with a major psychological impact on the population. Hospital staff had to cope with exceptional circumstances which made them vulnerable to detrimental effects on their own health. This paper describes the method that was selected for the survey entitled "ECHOS de Nice 14 Juillet" which aimed to assess the impact of the attack on the psychological, psycho-traumatic and somatic health condition of the Nice University and Lenval hospital staff who were directly or indirectly exposed to the attack, and also to describe the support and care facilities they were offered. METHOD: ECHOS de Nice 14 juillet is an observational, cross-sectional, multicentre study focusing on all the hospital staff and students of both institutions, i.e. 10,100 persons in June 2017. A web-based questionnaire based on the model developed by Santé Publique France (IMPACTS and ESPA 13 novembre 2015) was adapted to the contexts of the healthcare professionals and students employed in these healthcare institutions in Nice and published on line from June 21 to October 30, 2017. The paper describes the tools that were used to meet the aims of the study, i.e. identification of exposure categories ('civilian' exposure for those present during the attack and/or 'professional' exposure); indicators of psychological impact (anxiety, depression, burnout, compassion fatigue, suicidal states, tobacco and alcohol use, self-medications), psycho-traumatic and somatic impact; professional and social impact. Lastly, awareness of availability and use of psychological support and care-follow-up facilities by professionals were investigated. Respondents could include extensive qualitative comments on the various themes explored in the questionnaire, with text analysis complementing that of quantitative data. DISCUSSION: The benefits and limitations of the selected methodology are discussed, in view of contributing useful information to help anticipate and manage health issues among hospital staff who have been victims of traumatic events.

Do terrorist attacks affect ethnic discrimination in the labour market? Evidence from two randomized field experiments.

Terrorist attacks are known to influence public opinion. But do they also change behaviour? We address this question by comparing the results of two identical randomized field experiments on ethnic discrimination in hiring that we conducted in Oslo. The first experiment was conducted before the 2011 terrorist attacks in Norway; the second experiment was conducted after the attacks. In both experiments, applicants with a typical Pakistani name were significantly less likely to get a job interview compared to those with a typical Norwegian name. But the ethnic gap in call-back rates were very similar in the two experiments. Thus, Pakistanis in Norway still experienced the same level of discrimination, despite claims that Norwegians have become more positive about migrants after the far-right, anti-migrant terrorist attacks of 2011.

Dynamic Forecasting Conditional Probability of Bombing Attacks Based on Time-Series and Intervention Analysis.

In recent years, various types of terrorist attacks occurred, causing worldwide catastrophes. According to the Global Terrorism Database (GTD), among all attack tactics, bombing attacks happened most frequently, followed by armed assaults. In this article, a model for analyzing and forecasting the conditional probability of bombing attacks (CPBAs) based on time-series methods is developed. In addition, intervention analysis is used to analyze the sudden increase in the time-series process. The results show that the CPBA increased dramatically at the end of 2011. During that time, the CPBA increased by 16.0% in a two-month period to reach the peak value, but still stays 9.0% greater than the predicted level after the temporary effect gradually decays. By contrast, no significant fluctuation can be found in the conditional probability process of armed assault. It can be inferred that some social unrest, such as America's troop withdrawal from Afghanistan and Iraq, could have led to the increase of the CPBA in Afghanistan, Iraq, and Pakistan. The integrated time-series and intervention model is used to forecast the monthly CPBA in 2014 and through 2064. The average relative error compared with the real data in 2014 is 3.5%. The model is also applied to the total number of attacks recorded by the GTD between 2004 and 2014.

[Homicide-suicide: Clinical review and psychological assumptions]. / Homicide-suicide : revue clinique et hypothèses psychologiques.

OBJECTIVES: Suicide-homicide could be defined as a "suicidal" behaviour, which also includes the death of at least one other individual and sometimes up to hundreds. This literature review intends to highlight some characteristic features that might be found amongst the various types of suicide-homicide. It is a complex phenomenon which can occur in different situations, from a familial and somehow intimate setting (filicide, uxoricide, marital homicide…) to a public one (workplace shooting, school shooting), including a wide range of victims, from a single victim in marital cases of suicide-homicide to hundreds of victims in certain types, such as suicide by aircraft or warrior-like multi-homicids in terrorist acts. This literature review offers a combination of data emanating from scientific publications and case studies from our practices in an attempt to insulate some common factors. A thorough examination of the offenses unravels complex processes, ideations, M.O and peculiar cognitive impairments in which the familial suicide-homicide could be rooted. Mass murders might be caused also by a psychopathological alloy, made of Grandiose Self and sub-depressive and even paranoid ideations. Concerning the terrorism and multi-homicide-suicide, this is far more complex phenomenon and is defined by a group-process enrolment and ideological conviction. Beyond epidemiological studies, both descriptive and statistical, this paper's objective is to isolate a hypothesis about a psychopathological ground from which a criminological mechanism could emerge. Despite the lack of blatant psychosis, some traits might be identified in suicide-homicide cases - such as paranoid, psychopathic, narcissistic, melancholic - which can intertwine, potentiate one with another forming a distorted view of the world. The offense dynamic is possibly composed of preparatory behaviours, triggers, the use of death as a narcissistic support, identity choices… METHODS: The data were collected from scientific publications, personal cases, and open source. RESULTS: Despite the variety of behaviours included in this typology, we were able to identify a few mechanisms that could be found in two types of suicide-homicide [Private suicide-homicide (within the family circle) vs. Public space suicide-homicide (suicide by aircraft, school shooting…)]. DISCUSSION: Suicide-homicide phenomenon is the result of the interaction of societal, ideological, psychopathological and criminological elements which burst out in a lethal and paroxystic gesture. Psychiatrists and psychologists may have an important part to play in modelling a pattern to better understand it.

Conduct of Occupational Health During Major Disasters: A Comparison of Literature on Occupational Health Issues in the World Trade Center Terrorist Attack and the Fukushima Nuclear Power Plant Accident.

Workers who respond to large-scale disasters can be exposed to health hazards that do not exist in routine work. It is assumed that learning from past cases is effective for preparing for and responding to such problems, but published information is still insufficient. Accordingly, we conducted a literature review about the health issues and occupational health activities at the World Trade Center (WTC) terrorist attack and at the Fukushima Nuclear Power Plant accident to investigate how occupational health activities during disasters should be conducted. Seven studies about the WTC attack were extracted and categorized into the following topics: "in relation to emergency systems including occupational health management"; "in relation to improvement and prevention of health effects and occupational hygiene"; and "in relation to care systems aimed at mitigating health effects." Studies about the Fukushima Nuclear Power Plant accident have been used in a previous review. We conclude that, to prevent health effects in workers who respond to large-scale disasters, it is necessary to incorporate occupational health regulations into the national response plan, and to develop practical support functions that enable support to continue for an extended period, training systems for workers with opportunities to report accidents, and care systems to mitigate the health effects.

[Emergency plans in crisis situations]. / Les plans de secours en situation de crise.

In November 2015, in Paris, a wave of terrorist attacks brought horror to France. The medical and nursing teams were severely tested but demonstrated efficiency and courage. The organisation of the emergency response requires fast and essential decision making and actions.

[Symptomatic reactions, self-healing and trauma]. / Les approches thérapeutiques du traumatisme post-attentat.

The victims of a terrorist attack are subjected to a trauma which must be treated to avoid any sequalae. Long-term treatments and complementary therapeutic approaches can be envisaged. The caregivers take into account the individual character of the times required for psychological management and lead the victim and those close to them to gradually re-appropriate the common time of renewed life.

[The day after the Nice attack]. / Le jour d'après l'attentat de Nice.

A private practice nurse talks about the day after the terrorist attack which took place in Nice during the night of 14th July 2016. Caring, listening, supporting, sharing and drawing on her resources as a local health professional were her immediate reflexes.

[The hospital care of victims of terrorist attacks]. / La prise en charge hospitalière des victimes des attentats.

The treatment of victims of terrorist attacks in a trauma centre requires the putting in place of plans, training and simulation exercises. Previous experiences have highlighted the areas which require improvement. As exceptional health situations are unpredictable, it is essential to always be vigilant and prepared for an unforeseen event.

[The nurse within emergency medical-psychological units]. / L'infirmier au sein des cellules d'urgence médico-psychologique.

The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams.

Posttraumatic stress disorder and exposure to trauma reminders after a terrorist attack.

The aims of this study were twofold: (a) to systematically describe the type and frequency of trauma reminders reported after a terrorist attack and (b) to examine whether posttraumatic stress disorder (PTSD) is associated with frequency of exposure to trauma reminders. A total of 285 survivors (M age = 22.2, SD = 4.3, 53% males) of the 2011 massacre on Utøya Island, Norway, were interviewed face to face 14-15 months after the terror. Participants were asked how often they had experienced a range of different trauma reminders in the past month and which was most distressing. Current posttraumatic stress reactions were measured using the University of California at Los Angeles PTSD Reaction Index. In all, 33.3% of the survivors reported having experienced 1 or more trauma reminders often/very often in the past month. Auditory reminders were most frequently encountered and were reported to be the most distressing, especially sudden and sharp noises. Meeting the diagnostic criteria for PTSD was significantly associated with frequency of exposure to trauma reminders. The findings suggest that trauma reminders are common among survivors of a terrorist attack almost 1.5 years after the trauma and that PTSD is strongly related to the frequency of exposure to reminders. It is important that clinicians are aware of the significant role trauma reminders may play in maintaining PTSD and help trauma survivors recognize and manage reminders.

[Stories and drawings by children after the 2015 terrorist attacks in Paris]. / Récits et dessins d'enfants après les attentats de 2015 à Paris.

Through the stories and drawings of children in a medical-psychological centre, it is possible to explore their psychological representations of the terrorist attacks which took place in Paris in January 2015. This work highlights the need to rethink the methods of care provided to these children in order to adapt them to their specific needs.

PTSD, depression, and anxiety after the October 7, 2023 attack in Israel: a nationwide prospective study.

Background: The magnitude of the Oct 7, 2023 attack in southern Israel was without precedent. More than 1300 civilians were murdered, and 240 civilians were kidnapped and taken hostage. In this national cohort study, for which baseline outcome data were established before the attacks, a prospective assessment of posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) was conducted one month after the attack. Methods: A representative sample of 710 Israeli adults (362 female, 51.1%), Jews (557, 79.9%) and Arabs (153, 20.1%), aged 18-85 years (mean = 41.01, SD = 13.72) completed the study at two timepoints: T1, on Aug 20-30, 2023 (6-7 weeks before the attack) and T2, on Nov 9-19, 2023 (5-6 weeks after the attack). 30 (4.2%) of the 710 participants had direct exposure to the attack, and 131 (18.5%) had loved ones who were murdered, kidnapped, or injured during the attack. Findings: Probable PTSD prevalence almost doubled from 16.2% at T1 to 29.8% at T2 (p < 0.0001), with the prevalence of probable GAD and depression also increasing from 24.9% at T1 to 42.7% at T2, and from 31.3% at T1 to 44.8% at T2, respectively. Direct exposure to the attack was found to contribute to probable PTSD (OR = 3.15, 95% CI = 1.48-6.65) and probable depression (OR = 2.18, 95% CI = 1.02-4.87) at T2. Interpretation: Our study suggests a broad and significant impact of the Oct 7, 2023 attack on the mental health of the Israeli population. The findings underscore the need to provide rapid, nationwide assessments and triage for interventions to address the mental health needs of Jewish and Arab citizens. Funding: Not applicable.

Differences in predictive factors for post-traumatic stress disorder encompassing partial PTSD and full PTSD: a cross-sectional study among individuals exposed to the November 13, 2015 Paris attacks.

Background: When faced with a surge of physically injured individuals, especially following a traumatic event like an attack, frontline practitioners prioritize early triage. Detecting potential psychological injuries soon after such events remains challenging. Some individuals might develop post-traumatic stress disorder (PTSD) according to DSM-V criteria. Others may exhibit PTSD symptoms without meeting full diagnostic criteria, termed partial or sub-syndromal PTSD, a less-explored area in literature. This study aims to identify predictive factors for both full and partial PTSD. Method: In a cohort of victims of the 2015 Paris attacks, multinomial logistic regressions explored predictive factors for partial or full PTSD status 8 to 18 months post-attacks. Analyses considered pre, peri, and posttraumatic factors chosen from literature review and univariate analysis within each group. Results: Within the cohort, 50 individuals showed no signs of PTSD, 35 experienced partial PTSD, and 30 presented with full PTSD. After logistic regression, risk factors associated with full PTSD included a history of trauma (OR = 1.30, CI [1.02-1.66], p < 0.05), the intensity of peri-traumatic physical reactions (OR = 1.22, CI [1.09-1.36], p < 0.001), the difficulties in suppressing intrusive thoughts (OR = 1.11, CI [1.02-1.21], p < 0.013). Only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD (OR = 1.13, [CI 1.02-1.24], p < 0.001). Discussion: This study revealed that a history of trauma, the intensity of peri-traumatic physical reactions (e.g., tachycardia, trembling, flushes, numbness.), and the difficulties in suppressing intrusive thoughts constitute risk factors for the development of full PTSD. Moreover, the study identified that only the intensity of peri-traumatic physical reactions emerged as a risk factor for partial PTSD. These findings seem to underscore the significance of peri-traumatic experiences in influencing the development of post-traumatic stress symptoms. Conclusion: This study emphasizes the significance of examining peri-traumatic reactions in PTSD development, suggesting its potential as a straightforward screening tool for post-traumatic stress disorder. It also underscores the influence of prior traumatic experiences, before de novo traumatization, in shaping vulnerability to PTSD and illuminates the crucial role of compromised control of intrusive thoughts that could perpetuate PTSD.