Senior researcher Disasters and Environmental Hazards
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Zorggebruik na schietincident in Alphen aan den Rijn: gezondheid van getroffenen en niet-getroffen omwonenden 1 jaar na dato.
Dijk, C.E. van, Sman-de Beer, F. van der, Tielen, J.T., Velden, P.G. van der, IJzermans, C.J. Zorggebruik na schietincident in Alphen aan den Rijn: gezondheid van getroffenen en niet-getroffen omwonenden 1 jaar na dato. Nederlands Tijdschrift voor Geneeskunde: 2014, 158(A6986)
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Doel: Inventariseren welke effecten het schietincident in Alphen aan den Rijn op 9 april 2011 had op de gezondheid van getroffenen, vergeleken met een referentiegroep. Opzet: Observationeel longitudinaal onderzoek. Methode: Getroffenen van het schietincident en referentiepersonen werden geïdentificeerd via de zorgregistraties van verschillende zorginstanties (Slachtofferhulp Nederland (SHN), ggz, maatschappelijk werk), waarbij de hulpvraag in kaart gebracht werd. De gezondheid en het zorgtraject van 161 getroffenen en 115 omwonenden in het jaar vóór en het jaar na het schietincident kon worden gevolgd met gegevens uit de elektronische medische dossiers van huisartsenpraktijken. Effecten van het schietincident op de gezondheid en het zorggebruik werden geanalyseerd met logistische regressieanalyses en multilevel Poisson-regressieanalyses voor herhaalde metingen. Resultaten: De prevalentie van psychosociale problemen, gepresenteerd aan de huisarts, nam bij getroffenen toe na het schietincident (oddsratio (OR): 2,99; 95%-BI: 1,75-5,12) vergeleken met het jaar vóór het schietincident, en verschilde van de referentiegroep (OR: 2,68; 95%-BI: 0,93-7,72). Er was met name een sterke toename in de prevalentie van angst en stress (OR: 4,07; 95%-BI: 1,86-8,92), en het voorschrijven van hypnotica en sedativa (OR: 2,32; 95%-BI: 1,08-4,98) en van benzodiazepines (OR: 1,87; 95%-BI: 1,07-3,26). Deze problemen namen na het eerste kwartaal echter sterk af. Een kleine groep mensen was vanwege een posttraumatische stressstoornis onder behandeling bij de ggz, terwijl de helft van alle onderzochte getroffenen werd aangemeld bij SHN. Conclusie: Het schietincident had gedurende een beperkte periode een sterke weerslag op de psychische gezondheid en op het zorggebruik van getroffenen. (aut.ref.)
Healthcare utilisation of those affected by the shooting incident in Alphen aan den Rijn, the Netherlands; health of affected and non-affected neighbouring residents 1 year afterwards. Objective: To examine effects of the mass shooting in the city of Alphen aan den Rijn, the Netherlands, on the 9th of April 2011 on the health and healthcare utilisation of those affected. Design: Observational longitudinal study in general practice in which affected persons were compared with a reference group of neighbouring residents.
Method: Effects of the mass shooting on the health and healthcare utilisation of those affected was analysed using healthcare data from victim services, mental health care organisations, social work and general practitioners in the neighbourhood in which the mass shooting occurred. First, for all those affected by the mass shooting (n=677) we identified whether they used any services from victim services, mental health care or social work after the incident. Those affected by the mass shooting were identified based on their demand for healthcare related to the incident and based on information of the municipal health service about relatives of injured, witnesses and healthcare workers. Second, health and healthcare utilisation in general practice of 161 affected persons and 115 residents in the year before and after the mass shooting were extracted from the electronic medical records of general practices. Diagnoses and symptoms were coded using the International Classification of Primary Care (ICPC); drug prescriptions coded according to the Anatomic Therapeutic Chemical (ATC) Effects of the mass shooting on health and healthcare utilisation based on data of general practices were analysed with logistic and Poisson multilevel regression analyses for repeated measurements. Results: Three hundred twenty-six of those affected by the mass shooting (48%) were registered with victim services, of which 43% only had an intake interview. Six percent of those affected (n=42) were registered with social care and six percent (n=39) were under treatment of a mental care organisation. Most of those affected under treatment of a mental care organisation (88%) were still under treatment one year after the mass shooting. After the shooting, prevalence of psychological and social problems as presented in general practice increased significantly for affected persons (OR:2.99;95%CI:1.75-5.12), especially the prevalence of anxiety and stress reactions (OR:4.07;95%CI: 1.86-8.92). Problems predominantly were presented in the first quarter after the mass shooting. The trend in prevalence of psychological and social problems was higher for those affected compared with the reference group of neighbouring residents (OR:2.68;95%CI:0.93-7.72), but not for any other health problem examined. After the mass shooting incident, drugs active on the central nervous system were more often prescribed to both those affected by the mass shooting and residents (OR: 2,12; 95%CI:1,35-3,33 and OR: 1,95 95%CI:1,10-3,45). Those affected by the mass shooting were more often prescribed hypnotics and sedatives (OR:2.32; 95%CI:1.08-4.98) and benzodiazepines (OR: 1.87; 95%CI:1.07-3.26) in the year after the incident compared with a year before. The trend in drug prescriptions did not differ between those affected and the reference group of residents. The number of contacts with general practice did not change after the incident for both those affected by the mass shooting and the reference group of residents. Conclusion:
The mass shooting had a negative impact on the psychological well-being of those affected, but on group level of relatively limited duration and extent in the first year after the mass shooting. For a small group, this was not the case: 6% of those affected were under treatment of a mental health organisation. Comparing the results of this study with the international literature on effects of mass shooting incidents, effects on health of those affected are much smaller in our study compared with US studies. Such differences are, in addition to the differences in study design (questionnaires vs. electronic medical records), common in research on the effects of traumatic events and found in other epidemiologic studies also. Another important explanation may be that we have a large variation in the degree of exposure to the mass shooting incident: people less exposed to the mass shooting incident report less health problems. Furthermore, not all of those affected will visit a general practice for their health problems. (aut.ref.)
Method: Effects of the mass shooting on the health and healthcare utilisation of those affected was analysed using healthcare data from victim services, mental health care organisations, social work and general practitioners in the neighbourhood in which the mass shooting occurred. First, for all those affected by the mass shooting (n=677) we identified whether they used any services from victim services, mental health care or social work after the incident. Those affected by the mass shooting were identified based on their demand for healthcare related to the incident and based on information of the municipal health service about relatives of injured, witnesses and healthcare workers. Second, health and healthcare utilisation in general practice of 161 affected persons and 115 residents in the year before and after the mass shooting were extracted from the electronic medical records of general practices. Diagnoses and symptoms were coded using the International Classification of Primary Care (ICPC); drug prescriptions coded according to the Anatomic Therapeutic Chemical (ATC) Effects of the mass shooting on health and healthcare utilisation based on data of general practices were analysed with logistic and Poisson multilevel regression analyses for repeated measurements. Results: Three hundred twenty-six of those affected by the mass shooting (48%) were registered with victim services, of which 43% only had an intake interview. Six percent of those affected (n=42) were registered with social care and six percent (n=39) were under treatment of a mental care organisation. Most of those affected under treatment of a mental care organisation (88%) were still under treatment one year after the mass shooting. After the shooting, prevalence of psychological and social problems as presented in general practice increased significantly for affected persons (OR:2.99;95%CI:1.75-5.12), especially the prevalence of anxiety and stress reactions (OR:4.07;95%CI: 1.86-8.92). Problems predominantly were presented in the first quarter after the mass shooting. The trend in prevalence of psychological and social problems was higher for those affected compared with the reference group of neighbouring residents (OR:2.68;95%CI:0.93-7.72), but not for any other health problem examined. After the mass shooting incident, drugs active on the central nervous system were more often prescribed to both those affected by the mass shooting and residents (OR: 2,12; 95%CI:1,35-3,33 and OR: 1,95 95%CI:1,10-3,45). Those affected by the mass shooting were more often prescribed hypnotics and sedatives (OR:2.32; 95%CI:1.08-4.98) and benzodiazepines (OR: 1.87; 95%CI:1.07-3.26) in the year after the incident compared with a year before. The trend in drug prescriptions did not differ between those affected and the reference group of residents. The number of contacts with general practice did not change after the incident for both those affected by the mass shooting and the reference group of residents. Conclusion:
The mass shooting had a negative impact on the psychological well-being of those affected, but on group level of relatively limited duration and extent in the first year after the mass shooting. For a small group, this was not the case: 6% of those affected were under treatment of a mental health organisation. Comparing the results of this study with the international literature on effects of mass shooting incidents, effects on health of those affected are much smaller in our study compared with US studies. Such differences are, in addition to the differences in study design (questionnaires vs. electronic medical records), common in research on the effects of traumatic events and found in other epidemiologic studies also. Another important explanation may be that we have a large variation in the degree of exposure to the mass shooting incident: people less exposed to the mass shooting incident report less health problems. Furthermore, not all of those affected will visit a general practice for their health problems. (aut.ref.)
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