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BJPsych Open (2020) 6, e79, 1–3. doi: 10.1192/bjo.2020.57 Short Report Long-term effects of the terror attack in Berlin in 2016 on paranoid ideation in female emergency personnel Ulrich Wesemann, Manuel Mahnke, Sarah Polk and Gerd Willmund In a pilot study, female emergency personnel showed increased Differentiated preparation and follow-up for emergency paranoid ideation following a terror attack. This newly designed responders is recommended moving towards health-related confirmatory study aims to replicate these previously found equality. gender-specific results and investigate the progression of effects Keywords after 2 years. Participants were exposed and unexposed emer- gency personnel (n = 120). Exposed female versus exposed male Terror attack; paranoid ideation; emergency personnel; gender; personnel showed higher paranoid ideation at both time points. trauma. There was a group × time interaction effect in paranoid ideation: Copyright and usage paranoid ideation increased over time in the exposed versus the unexposed female group. The same effect was observed with © The Author(s) 2020. Published by Cambridge University Press exposed female emergency personnel showing a significant on behalf of The Royal College of Psychiatrists. This is an Open 2-year post-deployment increase compared with the total group Access article, distributed under the terms of the Creative including unexposed female as well as exposed and unexposed Commons Attribution licence (http://creativecommons.org/ male emergency personnel. There is, as yet, no conclusive licenses/by/4.0/), which permits unrestricted re-use, distribu- explanation for this difference. Sexual harassment in a male- tion, and reproduction in any medium, provided the original work dominated profession may be a vulnerability factor. is properly cited. Background differences; notably, female personnel showed higher paranoid idea- tion. Although the results regarding the occupational groups have Responses to a potentially traumatic event span a wide range from been replicated (U. Wesemann, personal communication, 2020), increased stress to mental disorders, such as depression, post-trau- those regarding gender-specific differences in paranoid ideation matic stress disorder, other anxiety disorders or addiction. are still provisional and no conclusive explanation for this difference Numerous publications focus on the psychological effects of disas- is given. A meta-analysis showed a robust association between ters on emergency responders, but the systematic investigation of paranoid ideation and violence in the general population, and this differences between genders or occupational groups is compara- association remained stable when controlling for drug misuse or tively limited. Indeed, the psychological reactions of emergency other psychiatric comorbidities. Regarding gender differences, the personnel exposed to terror attacks in Europe have until now 3–5 theory of tokenism predicts gender stereotypes and harassment in rarely been examined. However, understanding these differences organisations where women are underrepresented. This theory is necessary for the development of specific preparation and follow- seems to be of particular relevance in organisations where length up tools. In particular, gender differences are of interest in addres- of employment is shorter for women, which is often the case in sing health inequalities in pre- and post-mission outcomes. emergency services such as fire brigades. Indeed, sexual assaults on In military contexts, computer-based prevention programs that women are more common in male-dominated occupations, are target group-specific can be used during preparation for foreign which could increase vulnerability to paranoid ideation. Therefore, missions; in the USA, the ‘Stress Resilience in Virtual Environments this confirmation study aims to repeat these gender- Program’ (STRIVE) was developed for this purpose. STRIVE is spe- specific findings, with the hypothesis of more pronounced paranoid cific to target group and deployment, although not adaptive because ideation among exposed female emergency personnel. of its fixed programmed scenarios. In Germany, the ‘Chaos Driven Situation Management Retrieval System’ (CHARLY) was recently launched. CHARLY is a blended learning program that has already been made available for certain military professions, such Method as paramedics or ordnance technicians, and has demonstrated a spe- cific preventive effect on post-traumatic stress disorder. Similarly, All emergency personnel from the fire brigade, police, non-govern- specific programs would be useful for emergency personnel. mental organisations and civil rescue services deployed to respond to the terror attack at Breitscheidplatz in Berlin were given the opportunity to participate in the study (exposed group). A compari- Research findings after the 2016 terrorist attack son group comprised personnel from the same units who had not in Berlin responded to the attack. The recruitment was conducted with the In order to examine whether the efforts to investigate occupation- consent of the organisations. Task force leaders were informed and gender-specific differentiation is warranted, an explorative about the study and invited to participate. If task force leaders pilot study was conducted after the 2016 terrorist attack in agreed, brief information sessions were held for the respective Berlin, when a tractor-trailer was steered into a crowd at the units, and attendees were informed about the purpose of the Breitscheidplatz Christmas market. This was the first Islamist terror- study. Participation in the information sessions and the study was ist attack in Germany in which more people died than the perpetra- voluntary, and written informed consent was given by all partici- tor himself. In total, 12 people were killed and another 55 injured. pants. The study was approved by the Ethics Committee of the Initial cross-sectional analyses found occupational and gender Charité. The first survey was distributed 3–4 months after the 1 Wesemann et al revealed a significant influence of gender on paranoid ideation Table 1 Distribution of emergency service personnel according to within the exposed group, F(1,57) = 11.6, P = 0.001, R = 0.17, gender, occupation and deployment to the terror attack β = 0.41, with female personnel scoring higher. This influence was Deployment at Fire Armed not seen within the comparison group, F(1,58) = 3.1 (not signifi- Breitscheidplatz Brigade Forces NGO Police PSNV Total cant). Similar results were found 2 years after the attack: female per- Yes sonnel in the exposed group continued to report higher paranoid Male 22 2 9 5 4 42 ideation, F(1,57) = 8.9, P = 0.004, R = 0.14, β = 0.37. This influence Female 2 0 4 5 6 17 Other 1 was absent in the comparison group, F(1,57) = 1.6 (not significant). Total 24 2 13 10 10 60 rmANOVA revealed an interaction effect in paranoid ideation, No F(1, 115) = 5.0, P = 0.027, ƞ² = 0.04; compared with all other parti- Male 21 0 0 17 0 38 cipants, paranoid ideation increased significantly among exposed Female 0 0 0 20 2 22 female personnel. This interaction effect remained when directly Total 21 0 0 37 2 60 comparing only female personnel of each group, F(1, 37) = 4.2, Total Male 43 2 9 22 4 80 P = 0.047, ƞ² = 0.103, with a significant increase in paranoid ideation Female 2 0 4 25 8 39 in exposed female personnel. Finally, a Kruskal–Wallis H-test Other 1 carried out within deployed female personnel showed that Total 45 2 13 47 12 120 there was no statistically significant difference in paranoid ideation NGO, non-governmental organisation; PSNV, Psychosocial Emergency and Crisis score between the different occupation groups, χ²(3) = 1.92, Network (Psychosoziale Notfallversorgung); a. Excluded from occupational affiliation because of data protection reasons. P = 0.589. attack, and a second measurement was conducted 18 to 21 months after the first survey. Participants received the questionnaires in the Discussion mail. A total of n = 120 volunteers participated at the first time point, The current study replicated the results of the pilot study. The 60 in the exposed group and 60 in the comparison group. At the finding that gender influences paranoid ideation following terror second time point, 39 individuals from the exposed group and 33 attacks or catastrophes has, to our knowledge, not been replicated from the comparison group responded. All deployed personnel in other studies since, but studies relating high-risk occupations had been on site with the exception of a dispatcher. Gender and to paranoid ideation are so far inconsistent. For example, medical occupational group distributions are shown in Table 1. prison staff reported higher paranoid ideation than the general Data collection consisted of questionnaires including demo- population, but veterans deployed to the Gulf War did not graphics and the Brief Symptom Inventory (BSI) to evaluate para- differ from a matched comparison group of soldiers. However, noid ideation. The BSI consists of five items that assess aspects of these studies did not control for gender, and although in the mistrust up to strong paranoid ideation on a five-point Likert scale. sample of medical prison staff, the proportion of female employees Statistical analyses were conducted with SPSS (Version 21). (53.6%) may have driven this difference, among the sample of Gulf Missing values at the second time point were imputed using the War veterans, only 3.1% were women. Thus, future research may baseline-observation-carried-forward method. To test for drop- consider gender-specific evaluations, or controlling for gender out bias, two-sample t-tests were conducted for metric parameters when comparing different studies. and Pearson χ was calculated for categorial parameters. Using As a result of limitations of this study, the results should be linear regression, the exposed group and comparison group were interpreted carefully. The sample size for the subgroup analysis tested separately to test whether gender had an influence on para- was small, and because of a drop-out rate of 40%, some data had noid ideation. Participants who indicated their gender as ‘other’ to be imputed at the second time point, which notably restricts were excluded, as the small number (n = 1) would not have interpretation of the effects seen after 2 years. Further, because of allowed for meaningful evaluation. In order to check whether the the small sample size, direct comparison between female personnel occupational group had an influence on paranoid ideation, a in the exposed group and comparison group was only carried out Kruskal–Wallis H-test was carried out within deployed female per- over time. Also, approximately 90% of the female control group sonnel. Additionally, differences in change in paranoid ideation are police, limiting representativeness. Nevertheless, occupational between the exposed group and comparison group were examined group differences for paranoid ideation were ruled out for deployed using a single-factor repeated measures ANOVA (rmANOVA) female emergency responders. with a Bonferroni post hoc test. Despite these limitations, the replication of the results of the pilot study provides an indication of gender-specific effects. The Results current study suggests that there is an elevated need for improve- ment in health-related gender equality. Our results could be used There were no significant differences between the completers and for the development of a gender-specific module before and after those who dropped out (Table 2). Linear regression analysis the deployment. Table 2 t-test showing no significant differences between the participants who responded at both time points and those who responded at baseline only Both time points Baseline only n Mean s.d. n Mean s.d. t d.f. P Paranoid ideation 72 1.38 1.38 48 1.15 1.34 0.90 118 0.368 Rank 39 1.64 0.71 28 1.39 0.50 1.69 65 0.116 Years of service 69 14.74 12.04 46 14.30 10.47 0.20 113 0.842 Age, years 69 40.12 11.19 46 39.57 11.09 0.26 113 0.796 Cisgender: χ² <1; not significant. (1, n = 119) 2 Paranoid ideation in female emergency personnel 2 Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a Ulrich Wesemann , Psychotrauma Center, German Armed Forces Hospital Berlin, systematic review. Psychol Med 2008; 38: 467–80. Germany; Manuel Mahnke, Psychotrauma Center, German Armed Forces Hospital 3 Skogstad L, Heir T, Hauff E, Ekeberg Ø. Post-traumatic stress among rescue Berlin, Germany; and Fire and Rescue Station Wedding, Voluntary Fire Brigade, Germany; workers after terror attacks in Norway. Occup Med 2016; 66: 528–535. Sarah Polk, Max Planck Institute for Human Development, Germany; Gerd Willmund, Psychotrauma Center, German Armed Forces Hospital Berlin, Germany 4 Vandentorren S, Pirard P, Sanna A, Aubert L, Motreff Y, Dantchev N, et al. Healthcare provision and the psychological, somatic and social impact on peo- Correspondence: Ulrich Wesemann. Email: email@example.com ple involved in the terror attacks in January 2015 in Paris: cohort study. Br J Psychiatry 2018; 212: 207–214. First received 19 Feb 2020, final revision 18 May 2020, accepted 14 Jun 2020 5 Motreff Y, Baubet T, Pirard P, Rabet G, Petitclerc M, Stene LE, et al. Factors asso- ciated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015. J Psychiatr Res 2019; 121: 143–50. 6 Rizzo A, Buckwalter JG, John B, Newman B, Parsons T, Kenny P, et al. STRIVE: Data availability Stress Resilience In Virtual Environments: a pre-deployment VR system for The data that support the findings of this study are available from the corresponding author training emotional coping skills and assessing chronic and acute stress upon reasonable request. responses. Stud Health Technol Inform 2012; 173: 379–85. 7 Wesemann U, Kowalski JT, Jacobsen T, Beudt S, Jacobs H, Fehr J, et al. Evaluation of a technology-based adaptive learning and prevention program Acknowledgements for stress response - a randomized controlled trial. MilMed 2016; 181: 863–871. We would like to thank Charlyn Löpke from the Bundeswehr Hospital Berlin for supporting our 8 Wesemann U, Bühler A, Mahnke M, Butler O, Polk S, Willmund G. Burdens on work. emergency responders after a terrorist attack in Berlin. Occup Med (Lond) 2018; 68:60–3. Author contribution 9 Coid JW, Ullrich S, Bebbington P, Fazel S, Keers R. Paranoid ideation and vio- lence: meta-analysis of individual subject data of 7 population surveys. U.W.: conception of the work, analysis and interpretation of data for the work, drafting the work, Schizophr Bull 2016; 42: 907–915. approval of the final version and agreement to be accountable for all aspects of the work. M.M.: acquisition of data for the work, revising the work, approval of the final version and agreement 10 Kanter RM. Some effects of proportions on group life: skewed sex ratios and to be accountable for all aspects of the work. S.P.: interpretation of data for the work, revising responses to token women. AJS 1977; 82: 965–990. the work, approval of the final version and agreement to be accountable for all aspects of the 11 Wilson LC. The prevalence of military sexual trauma: a meta-analysis. Trauma work. G.W: conception of the work, analysis and interpretation of data for the work, drafting the work, approval of the final version and agreement to be accountable for all aspects of the work. Violence Abuse 2018; 19: 584–597. 12 Kabat-Farr D, Cortina LM. Sex-based harassment in employment: new insights into gender and context. Law Hum Behav 2014; 38:58–72. Declaration of interest 13 Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory None. report. Psychol Med 1983; 13: 595–605. ICMJE forms are in the supplementary material, available online at https://doi.org/10.1192/ bjo.2020.57. 14 Liu X, Jiang D, Hou Z, He M, Lu Y, Mao Z. Mental health of the prison medical workers (PMWs) and influencing factors in Jiangxi, China. Int J Environ Res Public Health 2017; 14: 1459. 15 Ishoy T, Knop J, Suadicani P, Guldager B, Appleyard M, Gyntelberg F. Increased References psychological distress among Danish gulf war veterans - without evidence for a neurotoxic background. Danish Med Bul 2004; 51: 108–13. 1 Zvolensky MJ, Farris SG, Kotov R, Schechter CB, Bromet E, Gonzalez A, et al. World Trade Center disaster and sensitization to subsequent life stress: a lon- gitudinal study of disaster responders. Prev Med 2015; 75:70–4.
BJPsych Open – Pubmed Central
Published: Aug 3, 2020
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