Changes in healthcare utilization after mass trauma: A register-based study of young survivors’ utilization of primary care and mental health services before and after the Utøya attack in Norway

Abstract Introduction Using register-based data, this study had a unique possibility to investigate how young survivors’ use of primary care and mental health services (MHS) changed after a terrorist attack. Methods We analyzed data on consultations with primary care physicians (PCP) and MHS among 255 survivors (48% female) of the 2011 Utøya youth camp attack in Norway three 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 majority of survivors consulted PCP both before and after the attack, with a marked increase in psychological reasons for encounter after the attack. Few consulted MHS before the attack, while most survivors did after the attack. In total, 93% of female survivors and 88% of male survivors consulted PCP in the three years before the attack, compared to respectively 98% and 96% in the three years after the attack. Moreover, 17% of female survivors and 11% of male survivors consulted MHS in the 3 years before the attack, compared to respectively 80% and 65% in the 3 years after the attack. From the year before to the year after the attack, the mean yearly consultation rates (CR) increased two-fold for PCP and nearly 8-fold for MHS in female survivors, and more than two-fold for PCP and nearly 12-fold for MHS in male survivors. Both before and after the attack, the consultations rates for PCP and MHS were higher for female than male survivors. The levels of posttraumatic stress, depression and anxiety symptoms and somatic symptoms were also higher in female survivors both early and at long-term after the attack. Conclusions Our study demonstrated that both PCP and MHS played important roles in providing healthcare for psychological problems in young survivors of terrorism in Norway. Potential implications for public health preparedness to mass trauma will be discussed in the presentation.


Introduction:
While many studies have shown how terrorist attacks can have a mental health impact, there currently is little insight into how governments try to aid victims of terrorist attacks. In this study we viewed the long-term governmental psychosocial care response after the attacks of 22/03/2016 in Belgium, from both the level of the policy, as well as from the perspective of victims.

Methods:
This study employed a qualitative design. First, we studied guidelines, reports, policy documents and other relevant grey literature concerning the governmental psychosocial care response to the terrorist attacks. Second, we interviewed 27 victims of the terrorist attacks on their experiences with terrorist attacks for the micro level. We analyzed these interviews using a reflexive thematic analysis.

Results:
On the policy level, a problem occurred in the transfer from responsibilities from the federal level to the community's level. Furthermore, there was no proper psychotraumatology network of therapists, which did not allow for the proper therapy to be easily sought by victims. This was noticed also by the victims, who had issues finding a therapist that fitted their needs and could help with their trauma-related disorders. Furthermore, on both policy level and victim level, a reoccurring problem is the lack of recognition and knowledge of the mental health issues occurring after disasters such as terrorist attacks.

Conclusions:
The Belgian long-term psychosocial care response to the terrorist attacks of 22/03/2016 was not well organized and left some victims without proper aid. To improve the psychosocial response after terrorist attacks in the long-term, a combination of both more knowledge and recognition is needed.
Abstract citation ID: ckac129.336 Changes in healthcare utilization after mass trauma: A register-based study of young survivors' utilization of primary care and mental health services before and after the Utøya attack in Norway Lise Eilin Stene L Stene 1 , S Thoresen 1 , T Wentzel-Larsen 1 , G Dyb 1 1 NKVTS, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway Contact: l.e.stene@nkvts.no

Introduction:
Using register-based data, this study had a unique possibility to investigate how young survivors' use of primary care and mental health services (MHS) changed after a terrorist attack.

Methods:
We analyzed data on consultations with primary care physicians (PCP) and MHS among 255 survivors (48% female) of the 2011 Utøya youth camp attack in Norway three 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 majority of survivors consulted PCP both before and after the attack, with a marked increase in psychological reasons for encounter after the attack. Few consulted MHS before the attack, while most survivors did after the attack. In total, 93% of female survivors and 88% of male survivors consulted PCP in the three years before the attack, compared to respectively 98% and 96% in the three years after the attack. Moreover, 17% of female survivors and 11% of male survivors consulted MHS in the 3 years before the attack, compared to respectively 80% and 65% in the 3 years after the attack. From the year before to the year after the attack, the mean yearly consultation rates (CR) increased two-fold for PCP and nearly 8-fold for MHS in female survivors, and more than two-fold for PCP and nearly 12-fold for MHS in male survivors. Both before and after the attack, the consultations rates for PCP and MHS were higher for female than male survivors. The levels of posttraumatic stress, depression and anxiety symptoms and somatic symptoms were also higher in female survivors both early and at long-term after the attack.

Conclusions:
Our study demonstrated that both PCP and MHS played important roles in providing healthcare for psychological problems in young survivors of terrorism in Norway. Potential implications for public health preparedness to mass trauma will be discussed in the presentation.

Introduction:
During the evening of 13 November 2015, a terror attack occurred in France in the Paris area. Overall, 130 people were killed, 643 were injured and several thousands were psychologically impacted. Thousands of first responders (FRs), including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on FRs, and its associated factors 12 months after the 13 November 2015 terrorist attacks, as well as their engagement in mental health care and its associated factors.

Methods:
FRs who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a webbased study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of Post Traumatic Stress Disorder (PTSD). PTSD and partial PTSD were measured using the PTSD checklist for DSM-5 (PCL-5) and depression with the hospital anxiety and depression (HAD) scale.

Results:
Overall, 663 FRs were included in the analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers. Low educational level, social isolation, intervention on unsecured crime scenes and lack of training were associated with PTSD. Among FRs with PTSD, partial PTSD or depression, 38% sought mental health care. Mental health care engagement was associated with a history of mental health care, post-immediate support and the presence of PTSD, partial PTSD or depression.

Conclusions:
Our results highlight that improving access to mental health care for FRs after terror attacks is needed. Efforts should be made before and after potentially traumatic events to ensure mental health education for FRs. Special attention should be given to FRs living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes.