Background
Method
Design and study population
Exposure groups
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Staff who were on site during the attack in a private capacity (‘bystander exposure’) with two further subgroups:
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Staff who did not participate in the care for victims then or later ‘bystander exposure only’;
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Staff who did participate in the care of attack victims ‘mixed exposure’;
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Staff who were not on site during the attack but cared for victims either as first responders or later (‘professional exposure only’);
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Unexposed staff members (exposed neither as bystanders on the attack site nor through their professional activity in relation to the attack) (‘Unexposed’).
Non-inclusion criteria
Data collection
Web-based questionnaire
Information collected
Analysis
Statistical analysis
Qualitative analysis
Results
Participation and respondents socio-demographic profiles
Professional exposure only (n = 285) | Bystander exposure (n = 203) | p-value | |||
---|---|---|---|---|---|
Na | (%) | Na | (%) | ||
Hospital specialty | 0.194 | ||||
Adult departments | 223 | (78.6) | 169 | (82.2) | |
Pediatric departments | 61 | (21.4) | 34 | (16.8) | |
Performed tasks involving physical care | <.001 | ||||
Yes | 222 | (77.9) | 88 | (43.4) | |
No | 63 | (22.1) | 115 | (56.7) | |
Performed tasks involving deceased bodies | 0.383 | ||||
Yes | 68 | (24.3) | 42 | (20.9) | |
No | 212 | (75.7) | 159 | (79.1) | |
Performed tasks involving injured or deceased children | 0.002 | ||||
Yes | 114 | (40.9) | 55 | (27.4) | |
No | 165 | (59.1) | 146 | (72.6) | |
Provided psychological support to victims or families / Had to communicate with families | <.001 | ||||
Yes | 233 | (81.8) | 88 | (43.4) | |
No | 52 | (18.3) | 115 | (56.6) | |
Performed administrative tasks | <.001 | ||||
Yes | 176 | (61.8) | 63 | (31.0) | |
No | 109 | (38.3) | 140 | (69.0) | |
Were confronted with such tasks for the first time | <.001 | ||||
Yes | 214 | (77.0) | 87 | (43.1) | |
No | 64 | (23.0) | 115 | (56.9) | |
Performed tasks unrelated to their training | 0.001 | ||||
Yes | 83 | (29.6) | 32 | (15.8) | |
No | 197 | (70.4) | 170 | (84.2) | |
Mean | [SD] | Mean | [SD] | p-value | |
Mean duration of professional exposure (hours) on July 14 and 15 | 10.5 | [±6.5] | 3.0 | [±5.4] | 0.034 |
Mean duration of professional exposure (days) from July 16 | 22.1 | [±26.3] | 10.5 | [±6.5] | <.001 |
Exposure
Quotes pertaining to professional exposure
Effects on mental health
Professional exposure only (n = 285) | Bystanders (n = 203) | Unexposed (n = 316) | p-value | ||||
---|---|---|---|---|---|---|---|
Na | (%) | Na | (%) | Na | (%) | ||
PTSD (PCL 5)b | 0.068 | ||||||
Probable Full PTSD | 19 | (9.4) | 17 | (12.2) | – | – | |
Probable Partial PTSD | 36 | (17.7) | 37 | (26.6) | – | – | |
No PTSD | 148 | (72.9) | 85 | (61.2) | – | – | |
HAD Anxiety scale | 0.611 | ||||||
> 10 (probable anxiety) | 29 | (13.2) | 21 | (14.7) | 24 | (10.3) | |
8–10 (possible anxiety) | 46 | (21.0) | 34 | (23.8) | 48 | (20.7) | |
≤ 7 (no anxiety symptoms) | 144 | (65.8) | 88 | (61.5) | 160 | (69.0) | |
HAD Depression scale | 0.848 | ||||||
> 10 (probable depression) | 10 | (4.6) | 6 | (4.1) | 8 | (3.5) | |
8–10 (possible depression) | 12 | (5.5) | 12 | (8.2) | 15 | (6.5) | |
≤ 7 (no depression symptoms) | 196 | (89.9) | 129 | (87.8) | 209 | (90.1) | |
Suicidal thoughts | 0.020 | ||||||
Present | 12 | (5.5) | 9 | (6.1) | 3 | (1.2) | |
Absent | 208 | (94.5) | 139 | (93.9) | 239 | (98.8) | |
Tobacco | <.001 | ||||||
Initiated or relapsed / Increased | 33 | (13.8) | 26 | (15.5) | 13 | (4.9) | |
Otherc | 207 | (86.2) | 142 | (84.5) | 250 | (95.1) | |
Alcohol intake | 0.085 | ||||||
Initiated or relapsed / Increased | 11 | (4.6) | 13 | (7.7) | 8 | (3.1) | |
Otherc | 228 | (95.4) | 155 | (92.3) | 253 | (96.9) | |
Self-medication | 0.116 | ||||||
Initiated or relapsed / Increased | 17 | (7.1) | 14 | (8.4) | 10 | (3.8) | |
Otherc | 222 | (92.9) | 152 | (91.6) | 251 | (96.2) | |
Since the attack, started taking medication for sleep disturbance | 0.003 | ||||||
Yes | 8 | (3.3) | 12 | (7.2) | 1 | (0.4) | |
No | 232 | (96.7) | 155 | (92.8) | 269 | (99.6) | |
Since the attack, started taking medication for difficulties related to anxiety and/or stress | 0.001 | ||||||
Yes | 9 | (3.8) | 11 | (6.6) | 1 | (0.4) | |
No | 231 | (96.2) | 155 | (93.4) | 267 | (99.6) | |
Since the attack, started taking medication for difficulties related to depression | 0.781 | ||||||
Yes | 5 | (2.1) | 4 | (2.4) | 4 | (1.5) | |
No | 234 | (97.9) | 164 | (97.6) | 265 | (98.5) |
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
OR | [CI 95%] | p-value | Adj OR | [CI 95%] | p-value | |
Gender | ||||||
Male | 1 | 1 | ||||
Female | 2.91 | [1.28; 6.63] | 0.011 | 2.79 | [1.19; 6.56] | 0.019 |
Age | ||||||
< 30 | 1 | |||||
[30; 40[ | 0.93 | [0.39; 2.22] | 0.876 | |||
[40; 50[ | 1.24 | [0.53; 2.88] | 0.618 | |||
> =50 | 0.46 | [0.18; 1.16] | 0.101 | |||
Marital status | ||||||
Lives with a partner | 1 | |||||
Lives alone | 1.53 | [0.80; 2.90] | 0.198 | |||
Social isolation | ||||||
Yes (feels rather lonely / very lonely) | 3.09 | [1.16; 8.27] | 0.025 | 3.80 | [1.30; 11.16] | 0.015 |
No (feels rather supported / well supported) | 1 | 1 | ||||
Educational level | ||||||
Advanced education | 1 | |||||
Secondary level education | 1.43 | [0.64; 3.19] | 0.380 | |||
Hospital | ||||||
Adult | 1 | |||||
Paediatric | 0.81 | [0.37; 1.77] | 0.591 | |||
Profession | ||||||
Medical staff/care providers/students | 1 | |||||
Other staff | 1.54 | [0.80; 2.93] | 0.195 | |||
Awareness of psychological consequences | ||||||
Yes | 1 | |||||
No | 2.54 | [1.00; 6.44] | 0.050 | |||
Performed tasks involving physical care | ||||||
Yes | 1.30 | [0.57; 2.95] | 0.531 | |||
No | 1 | |||||
Performed tasks involving deceased bodies | ||||||
Yes | 0.98 | [0.49; 1.98] | 0.965 | |||
No | 1 | |||||
Performed tasks involving injured or deceased children | ||||||
Yes | 1.24 | [0.66; 2.32] | 0.509 | |||
No | 1 | |||||
Provided psychological support to, or communicated with families | ||||||
Yes | 1.20 | [0.48; 2.98] | 0.699 | |||
No | 1 | |||||
Perfomed administrative tasks | ||||||
Yes | 1.07 | [0.56; 2.02] | 0.847 | |||
No | 1 | |||||
Were confronted with this type of task for the first time | ||||||
Yes | 3.17 | [1.26; 7.98] | 0.014 | 3.04 | [1.18; 7.85] | 0.022 |
No | 1 | 1 | ||||
Performed tasks unrelated to their training | ||||||
Yes | 1.37 | [0.71; 2.63] | 0.347 | |||
No | 1 |
Quotes related to symptoms pertaining to full or partial PTSD
Physical effects
Symptoms and conditions arisen since the attack | Professional exposure only (n = 285) | Bystanders (n = 203) | Unexposed (n = 316) | p-value | |||
---|---|---|---|---|---|---|---|
Na | (%) | Na | (%) | Na | (%) | ||
Headaches, migraine | 0.174 | ||||||
Yes | 122 | (52.6) | 75 | (47.5) | 113 | (44.1) | |
No | 110 | (47.4) | 83 | (52.5) | 143 | (55.9) | |
Back pain – joint pain | 0.003 | ||||||
Yes | 123 | (53.0) | 85 | (54.1) | 102 | (39.8) | |
No | 109 | (47.0) | 72 | (45.9) | 154 | (60.2) | |
Abdominal pain, colic | 0.435 | ||||||
Yes | 69 | (29.9) | 48 | (30.4) | 64 | (25.4) | |
No | 162 | (70.1) | 110 | (69.6) | 188 | (74.6) | |
Asthma – other respiratory issues | 0.678 | ||||||
Yes | 13 | (5.9) | 7 | (4.7) | 17 | (6.9) | |
No | 208 | (94.1) | 142 | (95.3) | 231 | (93.2) | |
Stomach pain – Gastric ulcer | 0.048 | ||||||
Yes | 56 | (24.4) | 32 | (20.5) | 39 | (15.4) | |
No | 174 | (75.6) | 124 | (79.5) | 214 | (84.6) | |
Arterial hypertension | 0.089 | ||||||
Yes | 20 | (8.7) | 9 | (5.7) | 10 | (4.0) | |
No | 209 | (91.3) | 148 | (94.3) | 243 | (96.0) | |
Skin conditions | 0.112 | ||||||
Yes | 44 | (18.9) | 36 | (23.5) | 38 | (15.2) | |
No | 189 | (81.1) | 117 | (76.5) | 212 | (84.8) | |
Uncontrolled diabetes | 0.641 | ||||||
Yes | 1 | (0.4) | 2 | (1.3) | 2 | (0.8) | |
No | 229 | (99.6) | 151 | (98.7) | 246 | (99.2) | |
Heart trouble | 0.5 | ||||||
Yes | 7 | (3.0) | 4 | (2.6) | 4 | (1.6) | |
No | 223 | (97.0) | 151 | (97.4) | 247 | (98.4) | |
Fatigue / Weariness | 0.018 | ||||||
Yes | 129 | (56.1) | 97 | (61.4) | 120 | (47.6) | |
No | 101 | (43.9) | 61 | (38.6) | 132 | (52.4) | |
Difficulty to concentrate | <.001 | ||||||
Yes | 55 | (23.6) | 61 | (39.4) | 45 | (17.8) | |
No | 178 | (76.4) | 94 | (60.6) | 208 | (82.2) | |
Sleep disorder | <.001 | ||||||
Yes | 105 | (44.9) | 88 | (57.1) | 91 | (36.2) | |
No | 129 | (55.1) | 66 | (42.9) | 160 | (63.8) | |
Tinnitus | 0.602 | ||||||
Yes | 17 | (7.4) | 16 | (10.3) | 22 | (8.8) | |
No | 213 | (92.6) | 139 | (89.7) | 229 | (91.2) | |
Unintentional weight change since the attack | 0.125 | ||||||
Yes (+/− 10%) | 29 | (12.0) | 27 | (16.1) | 27 | (10.2) | |
No | 189 | (78.5) | 120 | (71.4) | 219 | (82.3) | |
Don’t know | 23 | (9.5) | 21 | (12.5) | 20 | (7.5) |