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Muysewinkel E, Vesentini L, Van Deynse H, Gisle L, Smith P, Bruggeman H, Bilsen J, Van Overmeire R. Trauma Exposure, Social Support and Mental Health in the General Population in Belgium. Eur J Investig Health Psychol Educ 2024; 14:2047-2056. [PMID: 39056651 PMCID: PMC11276464 DOI: 10.3390/ejihpe14070136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION International research has shown that trauma exposure can lead to mental health disorders and affect social support. However, there is little insight into trauma exposure and its related issues in the general population of Belgium. METHODS Secondary cross-sectional data on the general adult population were retrieved from the Belgian Health Interview Survey. Using a representative sample, data were collected on trauma exposure in the past 12 months, and the disclosure of trauma, social support, depressive/anxiety symptoms and background factors were investigated. RESULTS In total, 7728 participants were included in this study, and 4.8% (N = 369) reported trauma exposure within the past 12 months. People with trauma exposure (4.8%, N = 369) consistently had more anxiety and depressive symptoms than those without trauma (p < 0.001), and people with multiple trauma exposures had more symptoms than those with a single trauma (p < 0.001). Social support was observed to be lower among those with trauma exposure (p < 0.001), and 17.1% had never disclosed their trauma to anyone. Sexual violence was higher among women (64.5%) and was also the least disclosed form of trauma. CONCLUSIONS Trauma exposure is associated with poorer mental health in Belgium. Around a fifth of those who experience trauma do not disclose their trauma, which is the most common after sexual violence.
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Affiliation(s)
- Emilie Muysewinkel
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (E.M.); (L.V.); (J.B.)
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (E.M.); (L.V.); (J.B.)
| | - Helena Van Deynse
- Department of Public Health, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
| | - Lydia Gisle
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (L.G.); (P.S.); (H.B.)
| | - Pierre Smith
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (L.G.); (P.S.); (H.B.)
| | - Helena Bruggeman
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; (L.G.); (P.S.); (H.B.)
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (E.M.); (L.V.); (J.B.)
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (E.M.); (L.V.); (J.B.)
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Muysewinkel E, Vesentini L, Van Deynse H, Stene LE, Bilsen J, Van Overmeire R. The psychosocial aid response after the 22/03/2016 attacks in Belgium: a community case study. Front Public Health 2024; 12:1362021. [PMID: 38525333 PMCID: PMC10957622 DOI: 10.3389/fpubh.2024.1362021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
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.
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Affiliation(s)
- Emilie Muysewinkel
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Public Health Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Helena Van Deynse
- Public Health Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
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Muysewinkel E, Vesentini L, Van Deynse H, Vanclooster S, Bilsen J, Van Overmeire R. A day in the life: psychological impact on emergency responders during the 22 March 2016 terrorist attacks. Front Psychiatry 2024; 15:1353130. [PMID: 38410678 PMCID: PMC10894950 DOI: 10.3389/fpsyt.2024.1353130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Terrorist attacks can cause severe long-term mental health issues that need treatment. However, in the case of emergency responders, research is often vague on the type of stressors that emergency responders encounter. For example, in addition to the threat that they work under, studies have shown that ill-preparation adds to the stress experienced by emergency responders. However, few studies have looked into the experience of emergency responders. In this study, we looked at the experience of emergency responders during the 22 March 2016 terrorist attacks in Belgium. Methods We used a qualitative design, in which we interviewed different types of emergency responders. Police officers, nurses, soldiers, firefighters, and Red Cross volunteers were included. Interviews were coded by two researchers and analyzed using a thematic approach. Results Four large themes were developed: constant threat and chaos, frustrations with lack of preparedness and training, ethical decisions, and debriefings. In addition, although emergency responders encountered constant threat, they often felt that they were ill-prepared for such attacks. One specific example was their lack of training in tourniquet usage. Furthermore, in a disaster setting, the emergency responders had to make life-and-death decisions for which they were not always prepared. Finally, debriefings were conducted in the aftermath of the attacks. Whereas most were perceived as positive, the debriefings among police officers were viewed as insufficient. Conclusions Emergency responding to terrorist attacks has many different dimensions of events that can cause stress. Our study revealed that preparation is key, not only in terms of material but also in terms of ethics and debriefings.
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Affiliation(s)
- Emilie Muysewinkel
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Helena Van Deynse
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stephanie Vanclooster
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
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De Cauwer H, Mortelmans LJ, Somville F, Cras P. 50 Years of terrorism in Belgium: a review of 121 incidents in the global terrorism database. Acta Chir Belg 2024:1-7. [PMID: 38265761 DOI: 10.1080/00015458.2024.2308400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Belgium is not only prone to inland terrorism but also attracts terrorist factions aiming at various political, diplomatic, military, and/or religious targets. This study aimed to identify and characterize all documented terrorist attacks in Belgium reported to the Global Terrorism Database (GTD) over a period of 50 years. METHODS The GTD was searched for all terrorist attacks in Belgium between 1970 and 2019. Analyses were performed on temporal factors, location, target type, attack and weapon type, attacker type, and number of casualties or hostages. RESULTS In 50 years, 121 incidents accounted for 80 confirmed fatalities and 498 injured people. Bombings and explosions were the most frequently identified attack type (46.3%), followed by assassination (16.5%), infrastructure damage (15.7%) and armed or unarmed assaults (14.0%). Governmental and diplomatic institutions were the most frequent target (24.0%). For those perpetrators the GTD did have enough information we saw a timely change from far left and separatist dominating the early decades to Jihadi groups in the last decade, while anti-semitic factions were active in every decade. CONCLUSION In contrast to other studies, this study did not show an increase over time. Left-wing perpetrators dominated the eighties. In 50 years of terrorist activity in Belgium, the health care system was spared. Devastating mass casualty attacks challenging the health care system are rare in Belgium.
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Affiliation(s)
- Harald De Cauwer
- Department of Neurology, Sint-Dimpna Regional Hospital, Geel, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Luc J Mortelmans
- Center for Research and Education in Emergency Care, University of Leuven, Leuven, Belgium
- Department of Emergency Medicine, ZNA Camp Stuivenberg, Antwerp, Belgium
- REGEDIM, Free University Brussels, Brussels, Belgium
| | - Francis Somville
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Emergency Medicine, Ziekenhuis Geel, Geel, Belgium
- Faculty of Medicine, University of Leuven, Leuven, Belgium
- Center for Research and Education in Emergency Care (CREEC), University of Leuven, Leuven, Belgium
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences, Born-Bunge Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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Muysewinkel E, Van Deynse H, Van Overmeire R. Comment on 'Posttraumatic stress disorder and depression after the 2018 Strasbourg Christmas Market terrorist attack: a comparison of exposed and non-exposed police personnel': moving towards shared methodology in terrorism-research. Eur J Psychotraumatol 2023; 14:2272476. [PMID: 37902992 PMCID: PMC10763859 DOI: 10.1080/20008066.2023.2272476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 11/01/2023] Open
Abstract
In the recent article 'Post-traumatic stress disorder and depression following the 2018 Strasbourg Christmas Market terrorist attack: a comparison of exposed and non-exposed police personnel,' important insights are provided about the association between terrorism exposure and Post-Traumatic Stress Disorder (PTSD). However, in our opinion, there are several methodological issues that limit the results of this study. In this letter, we discuss the problematic use of partial PTSD, the adjustment of the PCL-5 to refer only to a specific terrorist attack, and the significance of criterion A.
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Affiliation(s)
- Emilie Muysewinkel
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Helena Van Deynse
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Roel Van Overmeire
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Stene LE, Thoresen S, Wentzel-Larsen T, Dyb G. Healthcare utilization after mass trauma: a register-based study of consultations with primary care and mental health services in survivors of terrorism. BMC Psychiatry 2022; 22:720. [PMID: 36401197 PMCID: PMC9675057 DOI: 10.1186/s12888-022-04358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1-3, NO-0484, Oslo, Norway.
| | - Siri Thoresen
- grid.504188.00000 0004 0460 5461Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1-3, NO-0484 Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Forskningsveien 3A, NO-0373 Oslo, Norway
| | - Tore Wentzel-Larsen
- grid.504188.00000 0004 0460 5461Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1-3, NO-0484 Oslo, Norway ,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1, NO-0484 Oslo, Norway
| | - Grete Dyb
- grid.504188.00000 0004 0460 5461Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1-3, NO-0484 Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1171, Blindern, NO-0318 Oslo, Norway
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Bosmans MWG, Plevier C, Schutz F, Stene LE, Yzermans CJ, Dückers MLA. The impact of a terrorist attack: Survivors’ health, functioning and need for support following the 2019 Utrecht tram shooting 6 and 18 months post-attack. Front Psychol 2022; 13:981280. [DOI: 10.3389/fpsyg.2022.981280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundExtremely violent events such as terrorist attacks and mass shootings form a severe risk for the health and wellbeing of affected individuals. In this study based on a public health monitor, we focus on the health impact (including PTSD symptoms, physical problems and day-to-day functioning) of the Utrecht tram shooting, which took place in the morning of March 18th 2019. A lone gunman opened fire on passengers within a moving tram. Four people died, and six people were injured in this attack. The attack resulted in nationwide commotion and drew much media attention. Aim of this study was to increase insight into the health effects for the survivors (those directly impacted by a terrorist attack and the bereaved), and whether they received the needed care and support.MethodsSemi-structured interviews with accompanying questionnaires were conducted at six and 18 months post-attack. Overall, 21 survivors (victims/witnesses and loved ones of deceased victims) participated in the first series of interviews, 15 in the second series. Qualitative data were analyzed using reflexive thematic analysis, quantitative data was only described because of the low sample size.ResultsAt both six and 18 months after the attack many survivors had been able to resume daily life, and most rated their overall health as (very) good or excellent. At the same time, a substantial portion suffered from health problems such as posttraumatic stress symptoms and other complaints, and needed professional care. Furthermore, those in need did not always find their own way to appropriate care through the existing health system: half of the survivors still needed support in finding the right care 18 months later.ConclusionAlthough the design and implementation of this public health monitor were accompanied by multiple challenges, it was possible to track a portion of the survivors and gain insight in the considerable health burden of the attack. Also, it is clear in this study that the health impact of terrorism affects survivors in the long run and requires attention from health authorities and professionals, as survivors were not able to find the right care by themselves.
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