The association between exposure to terrorist attacks and mental health in Belgium

Terrorist attacks can be associated with mental health problems among those directly exposed (e.g. being present at the attacks), as well as indirectly (e.g. seeing the attacks on television). A large part of studies on this relationship have looked at post-traumatic stress disorder (PTSD). However, many studies have either used faulty methodology, or are victim to the ever-changing diagnostic criteria of PTSD. This disorder-focussed approach has therefore limited our understanding of the association between terrorism and mental health. Thus, other approaches are needed. In this dissertation we used qualitative methods when studying directly exposed people, while concentrating not on disorders, but on social problems: the impact on social relationships, workenvironment and seeking out professional mental health aid. Among indirect exposed people, we
studied suicide after terrorist attacks, which has been seldom investigated. We also studied behavioural changes in the general population, and reactions of youth on terrorist attacks.
The dissertation is divided into four parts: introduction, methods, results and discussion. The part for the results is divided into two sections. The first section concerns the direct exposure to terrorism, which consists of chapters 1 to 3. The second section looks at the indirect exposure to terrorism, and consists of chapters 4 to 6.
In the first three chapters are concerned exclusively with the people directly exposed to the attacks of 22/03/2016 in Belgium. In chapter 1 we focussed on the impact of these attacks on the social relationships, showing that terrorist attacks can affect the social support of those directly exposed. Social support is an important buffer against the development of mental health problems. Yet, in this chapter we show that the very buffer against these mental health problems is also affected by the trauma of terrorism.
Chapter 2 looks at how these directly exposed people seek out professional mental health aid if they experience mental health issues. The barriers they encountered are numerous, starting with some not wishing to acknowledge their problems, nor not knowing about the possible consequences of terrorism-exposure. Other barriers are the costs of seeking out aid, stigma, not knowing where to find the right help, et cetera.
Chapter 3 is an investigation of employees returning to work at Brussels Airport after having been exposed to the terrorist attacks. These employees returned to an organisation that, in their view, needed to recover from the economic losses of the attacks, and thus neglected the needs of the survivors of the attacks. The employees felt a lack of recognition of the management, which resulted in dissatisfaction. However, at the same time there is stigma with regards to mental health, as the employees are suspicious of colleagues who also experienced the attacks, but are now on long-term sick leave.
Chapters 4 to 6 look deeper at the indirect exposure to terrorist attacks. Chapter 4 looks at the suicide numbers in Flanders, Belgium after two terrorist attacks, namely the 13/11/2015 attacks in France, and the 22/03/2016 attacks in Belgium. The numbers rose clearly after the attacks in Paris, but after the 22/03/2016 attacks this is not noticeable. It remains unclear if terrorist attacks
can affect suicidal ideation in such a way that it turns someone to suicide.
Chapter 5 is a description of the reactions and questions of minors after terrorist attacks. Minors tend to express fear in the immediate aftermath of terrorist attacks, but interestingly, they often conflate their concerns with other events of that day. For example, the fear for terrorist attacks can be mentioned together with a break-up.
Chapter 6 is a survey among the Brussels population, two and a half years after the attacks in Belgium. We looked at how threatened by terrorism the respondents felt, if they had changed their
behaviour due to the attacks, and how it could be associated with depressive and anxiety symptoms. There is an association between behaviour and the perception of threat on the one hand, and mental health on the other hand.
In the last part of the dissertation, we discuss these results and the limitations and strengths of the different studies. We give recommendations for policy and researchers, give suggestions for future research and end with some reflections on terrorism-studies and disaster studies in general.