Background

Following the attacks of November 13, 2015, Santé publique France launched the first phase of a major epidemiological survey in 2016: the Post-Attack Public Health Survey of November 2015 (ESPA November 13). Nearly 1,400 people participated. The results show a significant impact on the mental health of those involved and offer valuable insights for improving support for victims, as well as for the professionals and volunteers who responded in the aftermath of these events*.

Five years later, it is important to understand how this impact has evolved. Indeed, until now, post-attack research has primarily consisted of cross-sectional studies, which unfortunately do not allow us to understand changes over time or potential causal links. It was therefore essential to conduct a longitudinal study.

That is why Santé publique France launched the ^second phase of the survey between November 16, 2020, and April 6, 2021, in collaboration with the University of Paris 13. This project is part of the 13-November Program, a large-scale, 12-year transdisciplinary program (2016–2028) funded primarily by the Investments for the Future initiative via the ANR and scientifically led by the CNRS and Inserm.

Survey Objectives

• To assess the psychological impact five years after the November 13, 2015, attacks, as well as how this impact has evolved between Phase 1 and Phase 2

• To describe and compare the use of care services since the attacks

• For individuals who agree to provide their Social Security number, track their health data from the health insurance system 5 years prior to the attacks and 10 years afterward

Study Population

The ESPA November 13 study was aimed at individuals directly affected by the November 2015 attacks and falling into the categories listed below:

• You were at or near the sites of the attacks carried out in Saint-Denis and Paris on November 13, 2015, and you were injured, directly threatened, or a direct witness to the events

• You witnessed the assault on the building where the terrorists were hiding in Saint-Denis on November 18, 2015

• You have lost a loved one who died in the attacks

• A loved one of yours was physically injured or was directly threatened by the terrorists

• Due to your profession or role, as a member of emergency services, law enforcement, associations, municipal services, or healthcare services, you responded on the night of November 13, or in the days or three weeks that followed, to secure the scene, provide aid and assistance to victims, investigate, restore the site, etc.

• Because of your profession or your involvement, as a member of emergency services, organizations, the City of Saint-Denis, or healthcare services, you responded on November 18, 2015, or in the days or three weeks that followed to provide aid and assistance to victims, investigate, restore the sites, etc.

Survey Process

The survey was conducted via an online questionnaire in two stages:

1. Inclusion questionnaire

Upon your first login, a questionnaire was used to verify that you met the criteria for our study population and to obtain your consent to participate.

You were then asked to:

• enter your Social Security number so we could obtain your healthcare history and utilization data from the National Health Data System (SNDS) through your health insurance provider. However, this information is not required to complete the questionnaire;

• provide your cell phone number to receive a secure access code for the epidemiological questionnaire via text message.

2. Epidemiological Questionnaire

The data collected in the epidemiological questionnaire focused on sociodemographic characteristics (age, gender), experiences of the attacks and their consequences, the psychological and traumatic impact, and the care arrangements adopted. The estimated time to complete the questionnaire was between 25 and 60 minutes. A dedicated hotline allowed participants to reach a psychologist from 10 a.m. to 10 p.m., 6 days a week, for assistance with completing the questionnaire or if psychological support was needed.

Information Regarding Data Processing

Your email address is subject to the processing of personal data under the responsibility of Santé publique France, based on a public interest. It will be processed only by Santé publique France staff involved in the ESPA study to notify you of the study’s start and will be deleted no later than two months after the study begins. You may exercise your rights to object, access, rectify, erase, and restrict the processing of your data by contacting: espa13novembre@santepubliquefrance.fr and indicating “reminder of launch.”
To learn more about the processing of your data: dpo@santepubliquefrance.fr. If you believe your data rights are not being respected, you may file a complaint with the French Data Protection Authority (CNIL): https://www.cnil.fr/fr/plaintes.

Why participate in the ESPA Phase 2 survey?

Partners and funders of the survey speak out to explain why it is important to participate.
Four professionals working alongside victims share their insights in a short one-minute audio clip on the importance of responding to the survey:

• Bastien Brul, Lead Psychologist at the France Victimes Federation

• Carole Damiani, Doctor of Clinical Psychology and Director of the “Paris aide aux victimes” association

• Denis Peschanski, Research Director at the CNRS and Co-Scientific Director of the November 13 Program

• Professor Thierry Baubet, Head of the Psychopathology Department at Avicenne Hospital (Bobigny) and Scientific Co-Director of the CN2R

Results of Participation in Phase 2 of the Survey

445 civilians and 494 first responders who were heavily exposed to the attacks provided valuable information on the psychosocial impact of the attacks and on the use of healthcare services 5 years after the events. Among them, 268 civilians and 324 first responders had already participated in the first phase of the survey.

What will the results be used for?

The results of the ESPA survey will make it possible to:

• better understand the factors associated with the persistence of psychological symptoms, as well as those associated with improvement or, conversely, deterioration;

• analyze data on healthcare utilization covered by social security for the subgroup of participants who agreed to provide their social security number.

These analyses, which are strictly aggregate and do not allow for the identification of any individual, will enable us to observe changes in healthcare utilization before and after the attack. In particular, we will analyze indicators of mental health as well as indicators of various conditions that may arise or worsen following exposure to such an event.

The hundreds of responses provided by participants to the open-ended questions on the questionnaire are currently being analyzed. The analysis of the question regarding the effects of the attacks on relationships with children was the subject of a medical thesis defended on October 20, 2021.

Acknowledgments

We would like to thank 13onze15: Fraternité et Vérité, Life for Paris, the AFVT, Fenvac, France Victimes, Paris Aide aux Victimes, the CUMPs, the Osé Association, the APHP, the 13-Novembre Program, the Guarantee and Compensation Fund for Acts of Terrorism and Other Offenses, the Paris Fire Brigade, the Armed Forces Health Service, the National Police, the Paris Police Prefecture, the Red Cross, Paris Civil Protection, and the city halls of Paris and Saint-Denis, which helped us disseminate information about the survey’s launch to those affected.

We would also like to thank the many participants whose responses will advance our understanding of the impact of the attacks as well as the care provided to those affected by them.

Data Confidentiality

Specific measures have been taken to ensure the IT security of the data collected. The data collected will remain strictly confidential and will be shared only with authorized Santé publique France staff responsible for this survey. Bound by professional confidentiality, they will analyze the information provided in your responses collectively, without using your direct identifying information (last name, first name, contact details), which will be stored in a separate, secure database. Under no circumstances will results be released that could identify you directly or indirectly. Santé publique France has received authorization from the CNIL (CNIL Decision DR-2020-031 of January 28, 2020, regarding Authorization Request No. 919215) and a favorable opinion from the Committee for the Protection of Persons (CPP SUD-EST I, Decision 2019-41) for the implementation of its data processing.

You will find all additional information regarding the protection of your personal data and the preservation of your individual freedoms in the newsletter available here.

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