Assessing the risk of subsequent self-harm after hospitalisation for COVID-19 is critical for mental health care planning during and after the pandemic.

This study aims to compare the risk of admission to hospital for self-harm within 12 months following a COVID-19 hospitalisation during the first half of 2020, with the risk following hospitalisations for other reasons.

Using the French administrative healthcare database, logistic regression models were employed to analyse data from patients admitted to hospitals in metropolitan France between January and June 2020. The analysis included adjustments for sociodemographic factors, psychiatric history and the level of care received during the initial hospital stay.

Of the 96 313 patients hospitalised for COVID-19, 336 (0.35%) were subsequently admitted for self-harm within 12 months, compared to 20 135 (0.72%) of 2 797 775 patients admitted for other reasons. This difference remained significant after adjusting for sociodemographic factors (adjusted odds ratio (aOR) = 0.66, 95% CI: 0.59–0.73), psychiatric disorder history (aOR = 0.65, 95% CI: 0.58–0.73) and the level of care received during the initial hospital stay (aOR = 0.70, 95% CI: 0.63–0.78). History of psychiatric disorders and intensive care were strongly correlated with increased risk, while older age was inversely associated with self-harm admissions.

Hospitalisation for COVID-19 during the early pandemic was linked to a lower risk of subsequent self-harm than hospitalisation for other reasons. Clinicians should consider psychiatric history and intensive care factors in evaluating the risk of future suicide.

Following a terrorist attack, responses to a psychosocial disaster range from low-intensity initiatives to high-intensity treatment. Some studies described post-disaster psychosocial services and planning across Europe. However, little is known about the psychosocial support (PS) actually delivered after terrorist attacks.

This study assesses prevalence and the factors associated with not receiving short-term PS among terror-exposed people with probable mental health disorders following the January 2015 terrorist attacks in France.

This study used data from the first wave of a longitudinal survey conducted six months after the attacks. Prevalence and factors associated with not receiving PS were described in the immediate period (48 hours), the early post-immediate period (48 hours-one week), and the medium-term (over one week) using a robust Poisson regression for each of the three periods.

Nearly one-half of the participants (N = 189) did not receive PS in any period (46.6% in the immediate period, 45.5% in the early post-immediate period, and 54.5% in the medium-term). In each period, not receiving PS was associated with not being very close to the attack sites. Not receiving PS in the immediate period was also associated with being a direct witness (DW) rather than being directly threatened (DT) and not having support in daily life; in the early post-immediate period, not receiving PS was associated with not having a peri-traumatic dissociation experience and being followed for a psychological problem before the attacks; and in the medium-term period, it was associated with perceived social isolation.

The characteristics of the terror exposure and social support seemed to influence presence or absence of PS after the terrorist attack and highlight the need for strategies to reach out to people regardless of the type of exposure.

Although COVID-19 has been associated with psychiatric symptoms in patients, no study to date has examined the risk of hospitalization for psychiatric disorders after hospitalization for this disease.

We aimed to compare the proportions of hospitalizations for psychiatric disorders in the 12 months following either hospitalization for COVID-19 or hospitalization for another reason in the adult general population in France during the first wave of the current pandemic.

We conducted a retrospective longitudinal nationwide study based on the national French administrative healthcare database.

Among the 2,894,088 adults hospitalized, 96,313 (3.32%) were admitted for COVID-19. The proportion of patients subsequently hospitalized for a psychiatric disorder was higher for COVID-19 patients (11.09 vs. 9.24%, OR = 1.20 95%CI 1.18–1.23). Multivariable analyses provided similar results for a psychiatric disorder of any type and for psychotic and anxiety disorders (respectively, aOR = 1.06 95%CI 1.04–1.09, aOR = 1.09 95%CI 1.02–1.17, and aOR = 1.11 95%CI 1.08–1.14). Initial hospitalization for COVID-19 in intensive care units and psychiatric history were associated with a greater risk of subsequent hospitalization for any psychiatric disorder than initial hospitalization for another reason.

Compared with hospitalizations for other reasons, hospitalizations for COVID-19 during the first wave of the pandemic in France were associated with a higher risk of hospitalization for a psychiatric disorder during the 12 months following initial discharge. This finding should encourage clinicians to increase the monitoring and assessment of psychiatric symptoms after hospital discharge for COVID-19, and to propose post-hospital care, especially for those treated in intensive care.

Terrorist attacks occurred in Paris in January 2015.

To assess the mental health impact and the access to psychomedical care of people exposed to the attacks.

We implemented an open-cohort design 6 and 18 months after the attacks. Exposed civilians and rescue workers were included according to the exposure criteria A for post-traumatic stress disorder (PTSD) in DSM-5. A face-to-face questionnaire conducted by trained psychologists was used to collect sociodemographic characteristics, exposure level, scores on psychometric scales, an international neuropsychiatric interview and access to care.

Six months after the attacks, 18% of civilians reported symptoms of PTSD, 31% had anxiety disorders and 11% depression. Among rescue workers, 3% reported symptoms of PTSD and 14% anxiety disorders. During the 48 h following the attacks, 53.2% of civilian had access to psychomedical care v. 35% of rescue and police staff.

We found severe psychological consequences, even in people who were less exposed.

None.

The 11th of March 2011, a magnitude 9.0 earthquake struck alongside the north-east coast of Honshu Island, Japan, causing a tsunami and a major nuclear accident. The French Institute for Public Health Surveillance (InVS) set up, within one week after the triple catastrophe, an Internet-based registry for French nationals who were in Japan at the time of the disasters. In this string of disasters, in this context of uncertainties about the nuclear risks, the aim of this registry was to facilitate the: (1) realization of further epidemiologic studies, if needed; and (2) contact of people if a medical follow-up was needed. The purpose of this report was to describe how the health registry was set up, what it was used for, and to discuss further utilization and improvements to health registries after disasters.

The conception of the questionnaire to register French nationals was based on a form developed as part of the Steering Committee for the management of the post-accident phase in the event of nuclear accident or a radiological emergency situation (CODIRPA) work. The questionnaire was available online.

The main objective was achieved since it was theoretically possible to contact again the 1,089 persons who completed the form. According to the data collected on their space-time budget, to the result of internal contamination measured by the French Institute for Radiological Protection and Nuclear Safety (IRSN) and dosimetric expertise published by the World Health Organization (WHO), it was not suitable to conduct an epidemiologic follow-up of adverse effects of exposure to ionizing radiations among them. However, this registry was used to launch a qualitative study on exposure to stress and psychosocial impact of the Great East Japan Earthquake on French nationals who were in Japan in March 2011.

Setting a registry after a disaster is a very important step in managing the various consequences of a disaster. This experience showed that it is quickly feasible and does not raise adverse side effects in involved people.

MotreffY , PirardP , LagréeC , RoudierC , Empereur-BissonnetP . Voluntary Health Registry of French Nationals after the Great East Japan Earthquake, Tsunami, and Fukushima Daiichi Nuclear Power Plant Accident: Methods, Results, Implications, and Feedback. Prehosp Disaster Med.2016;31(3):326–329.

During the night of February 27 and the early morning of February 28, 2010, 15 coastal municipalities situated in two French departments, Vendée and Charente-Maritime, were violently stricken by a severe windstorm named “Xynthia.” This storm caused the death of 12 individuals in Charente-Maritime and 29 people in Vendée. Houses, agricultural fields, and shellfish companies were severely flooded with seawater. Several thousand people temporarily had to leave their homes. The objective of this study was to estimate the short-term mental health impact of Xynthia, in terms of psychotropic drug delivery, on the resident population of the 15 coastal municipalities severely hit by the flooding.

The French national health insurance database was used to calculate a daily number of new psychotropic treatments from September 1, 2008 through December 24, 2010. New treatments were calculated for each of the following European Pharmaceutical Marketing Research Association (EphMRA) classes: tranquilizers (N05C), hypnotics (N05B), and antidepressants (N06A). A period of three weeks following the storm was defined as the exposure period. A generalized additive model with a Poisson distribution that allows for over-dispersion was used to analyze the correlation between the Xynthia variable and the number of new psychotropic treatments.

With a relative risk (RR) of 1.54 (95% CI, 1.39-1.62) corresponding to an estimate of 409 new deliveries of psychotropic drugs during the three weeks following the storm, this study confirms the importance of the psychological impact of Xynthia. This impact is seen on all three classes of psychotropic drugs studied. The impact is greater for tranquilizers (RR of 1.78; 95% CI, 1.59-1.89) than for hypnotics (RR of 1.53; 95% CI, 1.31-1.67) and antidepressants (RR of 1.26; 95% CI, 1.06-1.40). The RR was higher for females than for males.

This study shows the importance of the psychological impact of the storm as observed clinically by health workers who intervened in the field during the aftermath of Xynthia. It confirms that administrative databases can be used to show a health impact of a disaster even at a local level. This is one more step in the direction of a comprehensive strategy of collecting information to allow the assessment of the health impact of an extreme event, the detection of vulnerable populations, and the orientation of the short-, mid- and long-term public health response.

MotreffY, PirardP, GoriaS, LabradorB, Gourier-FréryC, NicolauJ, Le TertreA, Chan-CheeC. Increase in Psychotropic Drug Deliveries after the Xynthia Storm, France, 2010. Prehosp Disaster Med. 2013;28(5):1-6.

Following the Xynthia storm of February 2010 in France, an outreach program was initiated by the regional health authorities during the post-emergency phase to improve access to mental health care for the population exposed to the floods. The program was designed to complement routine health and social care services. It relied on a special telephone service and outreach consultations located in the town halls of the five most affected cities. The objective of this outreach service was to provide initial psychological counseling free of charge and without appointment. Another objective was to refer persons for appropriate treatment and follow-up by routine health care services. A surveillance program was developed to monitor the use of mental health services by first-time users, describe outreach service users with psychological manifestations, and provide timely information to decision makers.

Health providers working in affected towns were asked to complete an individual record sheet for each person who displayed psychological manifestations directly or indirectly linked with the storm on their first visit, and to send it to the regional health office. Participation was voluntary. Data analysis was performed monthly during the six-month surveillance period.

Only mental health providers participated in the surveillance. A total of 227 individual files were sent from April 7 through September 19, 2010. New cases were mainly female adults, and one fifth had a past history of psychiatric illness. Depressive signs and anxiety were the most commonly reported symptoms, followed by signs of post-traumatic stress disorder. A total of five feedback reports were produced for surveillance participants (informants) and authorities.

With initiation in the post-emergency phase of a disaster and timely regular feedback, the surveillance program enabled the authors to describe the occurrence of psychological distress, monitor mental health service use by first-time users, and provide guidance to health authorities. This research showed the advantages of integrating epidemiology in the development of strategy for mental health and psychosocial support in the aftermath of natural catastrophes.

RaguenaudM-E , GermonneauP , LeseigneurJ , ChavagnatJJ , MotreffY , Vivier-DarrigolM , PirardP . Epidemiological Surveillance Linked to an Outreach Psychological Support Program after the Xynthia Storm in Charente-Maritime, France, 2010. Prehosp Disaster Med.2012;27(5):1-6.