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Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015-16 terrorist attacks.

ABSTRACT: BACKGROUND:The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context. METHODS:This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one's traumatic event under the influence of the ß-blocker propranolol, once a week, for 10-25?min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center (N?=?400) pragmatic trial with a one-year follow-up. DISCUSSION:Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities. TRIAL REGISTRATION:Clinical Trials (ClinicalTrials.gov). June 3, 2016. NCT02789982.

SUBMITTER: Brunet A

PROVIDER: S-EPMC6842179 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015-16 terrorist attacks.

Brunet A A Ayrolles A A Gambotti L L Maatoug R R Estellat C C Descamps M M Girault N N Kalalou K K Abgrall G G Ducrocq F F Vaiva G G Jaafari N N Krebs M O MO Castaigne E E Hanafy I I Benoit M M Mouchabac S S Cabié M C MC Guillin O O Hodeib F F Durand-Zaleski I I Millet B B

BMC psychiatry 20191108 1

<h4>Background</h4>The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to ...[more]

PMID: 31703570

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Project description:BackgroundThe use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD).MethodsSanté publique France conducted a web-based survey of civilians 8-11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims' or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use.ResultsTwo-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps.ConclusionOur results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.

Project description:BackgroundThe international terrorism threat urges societies to invest in the planning and organization of psychosocial care. With the aim to contribute to cross-national learning, this study describes the content, target populations and providers of psychosocial care to civilians after terrorist attacks in Norway, France and Belgium.MethodsWe identified and reviewed pre- and post-attack policy documents, guidelines, reports and other relevant grey literature addressing the psychosocial care response to terrorist attacks in Oslo/Utøya, Norway on 22 July 2011; in Paris, France on 13 November 2015; and in Brussels, Belgium on 22 March 2016.ResultsIn Norway, there was a primary care based approach with multidisciplinary crisis teams in the local municipalities. In response to the terrorist attacks, there were proactive follow-up programs within primary care and occupational health services with screenings of target groups throughout a year. In France, there was a national network of specialized emergency psychosocial units primarily consisting of psychiatrists, psychologists and psychiatric nurses organized by the regional health agencies. They provided psychological support the first month including guidance for long-term healthcare, but there were no systematic screening programs after the acute phase. In Belgium, there were psychosocial intervention networks in the local municipalities, yet the acute psychosocial care was coordinated at a federal level. A reception centre was organized to provide acute psychosocial care, but there were no reported public long-term psychosocial care initiatives in response to the attacks.ConclusionsPsychosocial care responses, especially long-term follow-up activities, differed substantially between countries. Models for registration of affected individuals, monitoring of their health and continuous evaluation of countries' psychosocial care provision incorporated in international guidelines may strengthen public health responses to mass-casualty incidents.

Project description:BackgroundThe management of the psychological consequences of the COVID-19 pandemic is all the more difficult when subjects suffer from a prior psychiatric illness. BV13 is a 54-month prospective longitudinal cohort study of 111 subjects who were present in the Bataclan concert hall during the November 2015 terrorist attack in Paris.ObjectivesOur first objective was to investigate the association between stress related to the COVID-19 pandemic and PTSD symptoms, notably with respect to two positive risk factors: trait mindfulness and social support. The second was to explore how PTSD severity mediated the relationship between trait mindfulness and COVID-19-induced stress.MethodThe primary endpoint was evaluated using the COVID-19 Peritraumatic Distress Index (CPDI). PTSD symptoms were evaluated using the PTSD Check List Scale (PCL-5) during the sanitary crisis and two years before. Social support was assessed with a Likert scale that measured perceived support from family, friends and the workplace. Trait mindfulness was measured with the 14-item Freiburg Mindfulness Inventory (FMI).Results54 months after the attack, a univariate analysis identified a significant positive correlation between COVID-19 stress (CPDI) and PCL-5 (r=0.77, p<0.01) scores, on the one hand, and significant negative correlations with FMI (r=-0.59, p<0.01), and social support (r=-0.28, p<0.01) scores, on the other hand. In the multivariate model, CPDI scores were closely associated with PCL-5 scores (p<0.01) after adjustment for FMI and social support scores. CPDI and FMI scores were significantly associated (p=0.05), but not CPDI and social support scores (p=0.89). The PTSD score was a strong mediator of the relationship between trait mindfulness (FMI) and COVID-19 stress (CPDI) scores.ConclusionPTSD symptoms diminished the beneficial impact of trait mindfulness on stress related to COVID-19. Our finding highlights that subjects with previous experience of trauma need specific treatment for PTSD symptoms during the COVID-19 crisis.

Dataset Information

Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015-16 terrorist attacks.

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Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015-16 terrorist attacks.

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