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Pirard P, Motreff Y, Stene LE, Rabet G, Vuillermoz C, Vandentorren S, Baubet T, Messiah A. Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks. Arch Public Health 2023; 81:207. [PMID: 38031202 PMCID: PMC10685664 DOI: 10.1186/s13690-023-01206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Terrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors. METHODS Data were collected from a web-based survey of civilians 8-12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation. RESULTS Among the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were "did not feel the need", "it was not the right time to talk about it", and "not offered". For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims. CONCLUSION The organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.
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Affiliation(s)
- Philippe Pirard
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France.
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Yvon Motreff
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Gabrielle Rabet
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- UMR 1219, Bordeaux Population Health Research Center, PHARes Team, University of Bordeaux, Bordeaux, France
| | - Thierry Baubet
- Université Sorbonne Paris Nord, UTRPP EA 4403, Villetaneuse, France
- AP-HP, Hôpital Avicenne, Bobigny, France
- Resources and Resilience National Centre (CN2R), LilleParis, France
| | - Antoine Messiah
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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Prioux C, Marillier M, Vuillermoz C, Vandentorren S, Rabet G, Petitclerc M, Baubet T, Stene LE, Pirard P, Motreff Y. PTSD and Partial PTSD among First Responders One and Five Years after the Paris Terror Attacks in November 2015. Int J Environ Res Public Health 2023; 20:4160. [PMID: 36901168 PMCID: PMC10001642 DOI: 10.3390/ijerph20054160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Following the Paris terror attacks in November 2015, a large number of first responders (FR) were mobilized and consequently were at risk of developing posttraumatic stress disorder (PTSD). Based on the ESPA 13 November survey, the objectives of this study were to 1) describe the prevalence of PTSD and partial PTSD in FR five years after the attacks, 2) describe the changes in PTSD and partial PTSD from one to five years after the attacks, and 3) examine factors associated with PTSD and partial PTSD five years after the attacks. Data were collected using an online questionnaire. PTSD and partial PTSD were measured using the Post-Traumatic Stress Disorder Checklist based on the DSM-5 (PCL-5). Gender, age, responder category, education level, exposure, mental health history, history of traumatic events, training, social support, concern about the COVID-19 epidemic, and somatic problems present after the attacks were all analyzed as potential factors associated with PTSD and partial PTSD using multinomial logistic regression. A total of 428 FR were included 5 years after the attacks, of which 258 had participated also 1 year after the attacks. Five years after the attacks, the prevalence of PTSD and partial PTSD were 8.6% and 22%, respectively. Presence of somatic problems after the attacks were associated with PTSD. Involvement in dangerous crime scenes was associated with a higher risk of partial PTSD. No awareness of psychological risks in the context of professional activity through specific training was associated with partial PTSD, in particular among participants aged 45 years or more. To mitigate PTSD for FR, monitoring mental health symptoms, providing mental health education, and providing treatment may be needed for several years after the attacks.
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Affiliation(s)
- Clémentine Prioux
- Santé Publique France, Direction des Maladies non Transmissibles et Traumatismes, F-94415 Saint-Maurice, France
| | - Maude Marillier
- Santé Publique France, Direction des Maladies non Transmissibles et Traumatismes, F-94415 Saint-Maurice, France
| | - Cécile Vuillermoz
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Sorbonne Université, F-75012 Paris, France
| | - Stéphanie Vandentorren
- INSERM, Bordeaux Population Health Research Center, University of Bordeaux, U1219, F-33000 Bordeaux, France
- Santé Publique France, Direction Scientifique et Internationale, F-94415 Saint-Maurice, France
| | - Gabrielle Rabet
- Santé Publique France, Direction Appui, Traitements et Analyses des Données, F-94415 Saint-Maurice, France
| | - Matthieu Petitclerc
- Service Médical D’urgence—Bureau de Santé et de Prévention, Brigade de Sapeurs-Pompiers de Paris, 1, Place Jules-Renard, F-75017 Paris, France
- Laboratoire UTRPP, Université Sorbonne Paris Nord, F-93430 Villetaneuse, France
| | - Thierry Baubet
- Laboratoire UTRPP, Université Sorbonne Paris Nord, F-93430 Villetaneuse, France
- APHP Hôpital Avicenne, Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, F-93009 Bobigny, France
- Centre National de Ressources et de Résilience Lille-Paris (CN2R), F-59000 Lille, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), NO-0409 Oslo, Norway
| | - Philippe Pirard
- Santé Publique France, Direction des Maladies non Transmissibles et Traumatismes, F-94415 Saint-Maurice, France
- CESP, INSERM, MOODS team, Faculté de Médecine Paris–Saclay, Université Paris–Saclay, F-94275 Le Kremlin Bicêtre, France
| | - Yvon Motreff
- Santé Publique France, Direction des Maladies non Transmissibles et Traumatismes, F-94415 Saint-Maurice, France
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Sorbonne Université, F-75012 Paris, France
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Motreff Y, Pirard P, Vuillermoz C, Rabet G, Petitclerc M, Stene L, Baubet T, Vandentorren S. Mental health impact and mental health care among first responders following the Paris terror attacks in November 2015. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
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 web-based 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.
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Affiliation(s)
- Y Motreff
- Santé Publique France, French National Public Health Agency , Saint-Maurice, France
| | - P Pirard
- Santé Publique France, French National Public Health Agency , Saint-Maurice, France
| | - C Vuillermoz
- Inserm, Department of Social Epidemiology , Paris, France
| | - G Rabet
- Santé Publique France, French National Public Health Agency , Saint-Maurice, France
| | - M Petitclerc
- Departement of Psychology, Université Paris , Paris, France
| | - L Stene
- NKVTS, Norwegian Centre for Violence and Traumatic Stress Studies , Oslo, Norway
| | - T Baubet
- Inserm, Department of Social Epidemiology , Paris, France
| | - S Vandentorren
- Santé Publique France, French National Public Health Agency , Saint-Maurice, France
- Inserm, Department of Social Epidemiology , Paris, France
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Motreff Y, Pirard P, Vuillermoz C, Rabet G, Petitclerc M, Stene LE, Baubet T, Chauvin P, Vandentorren S. Mental health care utilization by first responders after Paris attacks. Occup Med (Lond) 2021; 72:81-90. [PMID: 34729607 PMCID: PMC8863088 DOI: 10.1093/occmed/kqab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC). Aims This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris. Methods A web-based study was conducted 8–12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC. Results Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression. Conclusions Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.
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Affiliation(s)
- Y Motreff
- Santé publique France, Direction des maladies non transmissibles et traumatismes, Saint-Maurice, France.,INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - P Pirard
- Santé publique France, Direction des maladies non transmissibles et traumatismes, Saint-Maurice, France.,MOODS, INSERM U 1018, CESP, Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - C Vuillermoz
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - G Rabet
- Santé publique France, Direction appui, traitements et analyses des données, Saint-Maurice, France
| | - M Petitclerc
- Service médical d'urgence-bureau de santé et de prévention, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, Paris, France.,Université Sorbonne Paris Nord, Ecole doctorale Erasme, Laboratoire UTRPP, Villetaneuse, France
| | - L Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - T Baubet
- Université Sorbonne Paris Nord, Ecole doctorale Erasme, Laboratoire UTRPP, Villetaneuse, France.,APHP Hôpital Avicenne, Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, Bobigny, France.,Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
| | - P Chauvin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - S Vandentorren
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France.,Santé publique France, Direction des régions, Saint-Maurice, France
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Pirard P, Baubet T, Motreff Y, Rabet G, Marillier M, Vandentorren S, Vuillermoz C, Stene LE, Messiah A. Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris. BMC Health Serv Res 2020; 20:959. [PMID: 33076901 PMCID: PMC7574168 DOI: 10.1186/s12913-020-05785-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The 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). Methods Santé 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. Results Two-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. Conclusion Our 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.
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Affiliation(s)
- Philippe Pirard
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France. .,Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Thierry Baubet
- CESP, Inserm, Université Sorbonne Paris Nord, Villetaneuse, France.,APHP, Hôpital Avicenne, Bobigny, France.,Centre National de Ressources et de Résilience (CN2R), Lille/Paris, France
| | - Yvon Motreff
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France.,Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Gabrielle Rabet
- Support, Data Treatment and Analysis Division, Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Maude Marillier
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Stéphanie Vandentorren
- Scientific and International Division, Santé Publique France (The French Public Health Agency), Saint-Maurice, France.,INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ Bordeaux, F-33000, Bordeaux, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Antoine Messiah
- Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
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Motreff Y, Baubet T, Pirard P, Rabet G, Petitclerc M, Stene LE, Vuillermoz C, Chauvin P, Vandentorren S. Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015. J Psychiatr Res 2020; 121:143-150. [PMID: 31821960 DOI: 10.1016/j.jpsychires.2019.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/10/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, 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 first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.
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Affiliation(s)
- Yvon Motreff
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F-94415 Saint-Maurice, France; Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France.
| | - Thierry Baubet
- CESP Inserm 1178, Université Paris 13, Paris, France; Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, APHP Hôpital Avicenne, F93009, Bobigny, France; Centre National de Ressources et de Résilience (CNRR), Paris, France
| | - Philippe Pirard
- Santé publique France, Direction des maladies non transmissibles et traumatismes, F-94415 Saint-Maurice, France; CESP Inserm 1178, Université Paris 13, Paris, France
| | - Gabrielle Rabet
- Santé publique France, Direction appui traitements et analyses des données, F-94415 Saint-Maurice, France
| | - Matthieu Petitclerc
- Service Médical D'urgence - Bureau de Santé et de Prévention, Brigade de Sapeurs-pompiers de Paris, 1, Place Jules-Renard, 75017, Paris, France; Université Paris 13, Ecole Doctorale Erasme, Laboratoire UTRPP, F93430, Villetaneuse, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Cécile Vuillermoz
- Centre National de La Recherche Scientifique (CNRS), Équipe de Recherche sur Les Inégalités Sociales - Centre Maurice Halbwachs (CNRS-UMR8097, EHESS, ENS), Paris, France
| | - Pierre Chauvin
- Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France
| | - Stéphanie Vandentorren
- Sorbonne Université, Inserm, Institut Pierre Louis D'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012, Paris, France; Santé publique France, Direction des régions, F-94415 Saint-Maurice, France
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