Posttraumatic stress disorder and depression after the 2018 Strasbourg Christmas Market terrorist attack: a comparison of exposed and non-exposed police personnel

ABSTRACT

Background: Police personnel are among the first responders exposed to terrorist attacks, raising in number in the late decades. Due to their profession, they are also exposed to repetitive violence, increasing their vulnerability to PTSD and depression.

Objective: Our study aims at comparing the prevalence of PTSD and depression, and the risk factors associated with these conditions among directly and indirectly exposed versus non-exposed police personnel during the Strasbourg Christmas Market terrorist attack.

Method: Three months after the attack, participants completed a survey assessing their sociodemographic characteristics, occupational data, degree of exposure, sleep debt around the event, event centrality (CES), and three mental health conditions: PTSD (PCL-5), depression (PHQ-9), and suicide risk (yes/no questions).

Results: A total of 475 police personnel responded to the questionnaire: 263 were exposed to the attack (182 of them directly) and 212 were non-exposed. Among directly exposed participants, the prevalences of partial and complete PTSD were 12.6 and 6.6%, and the prevalence of moderate-to-severe depression was 11.5%. Multivariate analysis revealed that direct exposure was associated with a higher risk of PTSD (OR = 2.98 [1.10–8.12], p = .03). Direct exposure was not associated with a higher risk of depression (OR = 0.40 [0.10–1.10], p = .08). A significant sleep debt after the event was not associated with a higher risk of later PTSD (OR = 2.18 [0.81–5.91], p = .13) but was associated with depression (OR = 7.92 [2.40–26.5], p < .001). A higher event centrality was associated with both PTSD and depression (p < .001).

Conclusions: Police personnel directly exposed to the Strasbourg Christmas Market terrorist attack were at higher risk of PTSD but not depression. Efforts to prevent and treat PTSD should focus on directly exposed police personnel. However, general mental health should be monitored for every personnel member.

HIGHLIGHTS

• Direct exposure to the terrorist attack and gender (female) were significantly associated with a higher risk of PTSD among police personnel.

• Sleep debt after the attack was significantly associated with depression but not with PTSD.

• No occupational factor was associated with either PTSD or depression.

• Both PTSD and depression were significantly associated with a higher suicide risk.

• A higher event centrality was significantly associated with direct exposure and a higher risk of both PTSD and depression.

Antecedentes: El personal policial se encuentra entre los primeros en responder y estar expuestos a ataques terroristas, aumentando en número en las últimas décadas. Debido a su profesión, también están expuestos a violencia repetitiva, lo que aumenta su vulnerabilidad al TEPT y la depresión.

Objetivo: Nuestro estudio tiene como objetivo comparar la prevalencia del TEPT y la depresión, y los factores de riesgo asociados con estas condiciones entre el personal policial expuesto directa e indirectamente frente al personal no expuesto durante el ataque terrorista del Mercado de Navidad de Estrasburgo.

Método: Tres meses después del ataque, los participantes completaron una encuesta que evaluó sus características sociodemográficas, datos ocupacionales, grado de exposición, deuda de sueño en torno al evento, centralidad del evento (CES) y tres condiciones de salud mental: TEPT (PCL-5), depresión (PHQ-9) y riesgo de suicidio (preguntas de sí/no).

Resultados: Un total de 475 policías respondieron al cuestionario: 263 estuvieron expuestos al ataque (182 de ellos de manera directa) y 212 no estuvieron expuestos. Entre los participantes expuestos directamente, las prevalencias de TEPT parcial y completo fueron del 12.6 % y 6.6 %, y la prevalencia de depresión moderada a grave fue del 11.5 %. El análisis multivariado reveló que la exposición directa se asoció con un mayor riesgo de TEPT (OR = 2.98 [1.10–8.12], p = .03). La exposición directa no se asoció con un mayor riesgo de depresión (OR = 0.40 [0.10–1.10], p = .08). Una deuda de sueño significativa después del evento no se asoció con un mayor riesgo de TEPT posterior (OR = 2.18 [0.81–5.91], p = .13) pero sí con depresión (OR = 7.92 [2.40–26.5], p < .001). Una mayor centralidad del evento se asoció tanto con el TEPT como con la depresión (p < .001).

Conclusiones: El personal policial directamente expuesto al ataque terrorista del Mercado de Navidad de Estrasburgo tenía un mayor riesgo de TEPT pero no de depresión. Los esfuerzos para prevenir y tratar el TEPT deben centrarse en el personal policial directamente expuesto. Sin embargo, se debe monitorear la salud mental general de cada miembro del personal.

背景：警务人员是暴露在恐怖袭击中的第一响应者，其人数在最近几十年有所增加。 由于其职业，他们也经常遭受暴力，增加了他们患创伤后应激障碍和抑郁的可能性。

目的：我们的研究旨在比较斯特拉斯堡圣诞市场恐怖袭击期间直接和间接暴露与未暴露的警务人员的 PTSD 和抑郁的流行率，及其相关风险因素。

方法：袭击发生三个月后，参与者完成了一项评估其社会人口学特征、职业数据、暴露程度、事件相关睡眠债务、事件中心性 (CES) 以及三种心理健康状况：PTSD (PCL-5)、抑郁症 (PHQ-9) 和自杀风险（是/否问题）的调查。

结果：共有475名警务人员回答了问卷：263人受到攻击（其中182人直接受到攻击），212人没有受到攻击。在直接暴露的参与者中，部分和完全 PTSD 的流行率分别为 12.6% 和 6.6%，中至重度抑郁的流行率为 11.5%。多变量分析显示，直接暴露与更高的 PTSD 风险相关（OR = 2.98 [1.10–8.12]，p = .03）。直接暴露与更高的抑郁风险无关（OR = 0.40 [0.10–1.10]，p = .08）。 事件后严重的睡眠不足与后期 PTSD 的高风险无关（OR = 2.18 [0.81–5.91]，p = .13），但与抑郁相关（OR = 7.92 [2.40–26.5]，p < .001）。较高的事件中心性与 PTSD 和抑郁相关 (p < .001)。

结论：直接接触斯特拉斯堡圣诞市场恐怖袭击的警务人员患创伤后应激障碍的风险较高，但抑郁风险并不更高。预防和治疗 PTSD 的工作应集中在直接暴露的警务人员身上。但是，应监测每位人员的一般心理健康状况。

KEYWORDS:

• Posttraumatic stress disorder
• depression
• suicide
• police
• terrorist attack
• trauma
• occupational factors
• prevention

PALABRAS CLAVE:

• Trastorno de estrés postraumático
• depresión
• suicidio
• policía
• ataque terrorista
• trauma
• factores ocupacionales
• prevención

关键词:

• 创伤后应激障碍；抑郁；自杀；警察；恐怖袭击；创伤；职业因素；预防

Acknowledgments

The authors are most grateful to the participants for their involvement.

The authors would like to thank the Central Direction of the National Police and its departmental directions (Police Judiciaire, Police aux Frontières, Direction Départementale de la Sécurité Publique) who allowed us to collect the data, Florence Foullon, and the clinical psychologists from the psychological support department of the police.

Authors’ contributions

Conceptualization: NN, SAO, PV, ACM

Methodology, investigation: NN, SAO, ACM

Data analysis: NN, SAO, FL, MN

Writing – draft: NN, ACM

Writing – review & editing: JR, SB, MG, PV, BC

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The Yellow Vest Protests are a series of populist grassroots weekly protests that began in France on 17 November 2018. Many police officers were involved in these mass demonstrations.