Topic: Disasters, terror and stress management

PROTECT: Prospective Research On Terrorist Events and Collective Trauma

The overall aim of the PROTECT study is to provide knowledge to improve the health services’ preparedness and response to terrorist attacks and disasters.

2019 This project is ongoing 2024

Project Manager

Project Members

Unmet health care needs have been found among those exposed to terror attacks. The project further aims to develop a method that can be applied after terrorist attacks and similar events across Europe to allow for coordinated research internationally and to develop knowledge to strengthen the health care delivery to affected individuals and communities.

The unpredictability and chaotic circumstances of terrorist attacks make it extremely challenging to conduct methodologically sound research in the wake of such events. Previous studies have important limitations. They have usually applied a cross-sectional design and lacked detailed data on health service utilization as well as comparable data from the general population. Furthermore, their results can often not be compared or applied across different settings or countries. There is an urgent need for better knowledge on how to enhance the provision of health services and psychosocial support to terror-exposed individuals and populations. PROTECT assesses both national plans for psychosocial care and health services provided in the wake of terror attacks. The project involves international interdisciplinary collaboration where perspectives from political science have been integrated into the health services research to generate knowledge about the strengths and weaknesses of different health care systems in the context of terrorist attacks. An investigation of the psychosocial care responses to terrorist attacks in Norway, France and Belgium revealed that the responses differed substantially between countries, in spite of available international guidelines for post-disaster psychosocial care and that all countries have universal health coverage with largely publicly financed health services. All countries had plans for the acute provision of psychosocial care, but there were variable and partly scarce information about how to ensure long-term follow-up of those in need of care beyond the acute phase. Furthermore, we identified several differences between the health care systems and characteristics of the attacks that may have impacted the psychosocial care responses. For instance, the provision of acute psychosocial care was primary-care based in Norway, while in France the emergency psychosocial units were mainly composed of professionals from the specialized mental health services. This was also reflected in the research results regarding individuals directly exposed to terrorist attacks, which indicated that the use of General Practitioners (GPs) was clearly more common in survivors of the Utøya attack in Norway than in survivors of the 13 November attacks in France. The findings underscore the need for more systematic monitoring, evaluation and research that can be compared across countries. We further collect longitudinal register-based and administrative claims data on health problems and different types of health service utilization from directly exposed individuals and the general population before and after terrorist attacks. So far, our analyses of register-based data from Norway indicate that it is important to anticipate an increased healthcare utilization several years following terrorist attacks. Both primary care physicians/GPs and practitioners within specialized mental health services played important roles in providing healthcare for psychological problems in young survivors of terrorism, although the health care utilization increased most within specialized mental health services. Norway has universal and mostly publicly financed healthcare and a regular GP-based gatekeeping system. It is important to bear in mind that the healthcare utilization after mass trauma may be different in countries with other health systems or psychosocial care responses. Hereafter, register-based data will be linked with self-reported information from terror-exposed individuals, e.g. about their perceived health, satisfaction with care and other factors that may be important in the planning and implementation of post-disaster health services. This approach may enable both a temporal and geographical comparative perspective with data from before as well as the early and late aftermath of terrorist attacks. This could further provide new and important insight into how the health care needs may change over time, and help us develop better models for follow-up after mass trauma.

The objectives will be investigated using a temporal and geographical comparative perspective by assessing health service utilization and medication prescriptions before and after attacks in Norway and France.
PROTECT is funded by the Research Council of Norway. The project is conducted in collaboration with NTNU (Norway), the French National Institute of Health and Medical Research (Inserm) and the French Public Health Agency (Santé publique France)


Askenazy, F., Fernandez, A., Altan, L., Battista, M., Dückers, M., Gindt, M., Nachon, O., Ivankovic, A., Porcar-Becker, I., Prieto, N., Robert, P., Stene, L. E., Thummler, S., & Manera, V. (2022). Remote training as a common tool for the different professionals involved in the acute phase after terror attacks across Europe: Perspectives from an expert panel. Frontiers in Psychiatry, 13. doi:10.3389/fpsyt.2022.915929

Bosmans, M., Plevier, C., Schutz, F., Stene, L. E., Yzermans, C. J., & Dückers, M. (2022). The impact of a terrorist attack: Survivors’ health, functioning and need for support following the 2019 Utrecht tram shooting 6 and 18 months post-attack. Frontiers in Psychology, 13. doi:10.3389/fpsyg.2022.981280

Stene, L. E., Vuillermoz, C., Overmeire, R. V., Bilsen, J., Dückers, M., Nilsen, L. G., & Vandentorren, S. (2022). Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium. BMC Health Services Research, 22. doi:10.1186/s12913-022-07691-2

Vuillermoz, C., Pirard, P., Stene, L. E., & Vandentorren, S. (2022). Short-term psychological support to civilians exposed to the January 2015 terrorist attacks in France. European psychiatry.

Motreff, Y., Pirard, P., Vuillermoz, C., Rabet, G., Petitclerc, M., Stene, L. E., . . . Vandentorren, S. et al. (2021). Mental health care utilization by first responders after Paris attacks. Occupational Medicine, 72(2), 81-90. doi:10.1093/occmed/kqab150

Robert, M., Stene, L. E., Garfin, D. R., Vandentorren, S., Motreff, Y., du Roscoät, E., & Pirard, P. (2021). Media Exposure and Post-traumatic Stress Symptoms in the Wake of the November 2015 Paris Terrorist Attacks: A Population-Based Study in France. Frontiers in Psychiatry. doi:10.3389/fpsyt.2021.509457

Stene, L. E. (2021). Face à la pandémie et au terrorisme: santé mentale, soutien social et confiance en crise [Facing the pandemic and terrorism: mental health, social support and trust in times of crisis]. Revue de neuropsychologie.

Pirard, P., Baubet, T., Motreff, Y., Rabet, G., Marillier, M., Vandentorren, S., Vuillermoz, C., Stene, L. E., & Messiah, A. (2020). Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris. BMC Health Services Research. doi:10.1186/s12913-020-05785-3

Stene, L. E. (2020). Le projet PROTECT (Santé publique France). Oslo: Nasjonalt kunnskapssenter om vold og traumatisk stress.

Stene, L. E. (2019). PROTECT: Prospective Research On Terrorist Events and Collective Trauma – A cross-border study of health service utilization and prescriptions. Oslo: Nasjonalt kunnskapssenter om vold og traumatisk stress.