The Russian invasion of Ukraine led to a major humanitarian crisis resulting in many Ukrainians seeking refugee status in European countries. Unlike the positive attitudes towards Ukrainian refugees, Afghan refugees who were also required to leave their country following the Taliban\'s takeover of Afghanistan, received a negative reaction from the same European countries. Examining similar crises, a year apart, where people fled perilous situations in their countries, reveals contrasting reactions that emphasize the need to understand factors driving diverse public attitudes. Integrated Threat Theory (ITT), which posits that perceived threats can lead to prejudice and negative attitudes, may elucidate mechanisms behind opposing reactions towards Ukrainian and Afghan refugees. This study explores whether symbolic threats, intergroup anxiety, fear of terrorism, and political orientation are differentially related to attitudes towards Afghan and Ukrainian refugees in 250 European participants. Results demonstrate that participants hold more positive attitudes towards Ukrainian refugees compared to Afghan refugees. All the aforementioned factors predicted attitudes towards Afghan refugees, but only symbolic threats predicted attitudes towards Ukrainian refugees. Ethnicity and religiosity explain the relationship between symbolic threats and attitudes towards Afghan refugees. Western European participants show a stronger link between terrorism fear and negative views on Afghan refugees than Eastern Europeans, possibly due to higher terrorism rates in the West. Thus, attitudes towards refugees are intricate, but the study emphasizes the role of ITT, terrorism fear, politics, ethnicity, religiosity, and region. The findings could refine policies, stressing the need to address these factors for fostering inclusive, empathetic European societies.

BACKGROUND: The bio-psycho-social model is mostly used to understand the etiology and pathogenesis of psychiatric disorders. Even though in our era, the biological factors became more dominant in the field, the stress-diathesis model is quite acceptable to explain and understand the evolution of psychotic as well as affective disorders.
BACKGROUND: In this case report we present a patient, in her late 40\'s, admitted to our department with a manic-psychotic episode for the first time in her life, after the massive terror attack of October 7, and in which we suggest that the signs and symptoms might be explained using the psycho-dynamic theory.
CONCLUSIONS: We conclude suggesting that the equilibrium of the bio-psycho-social model, should be adjusted in the context of time and space, especially during a situation of catastrophic scale in the patient environment.
CONCLUSIONS: Although stress is a risk factor for the development of affective disorders and especially manic-psychotic episodes, there is scarce literature to support it. On the other hand, psycho-dynamic theories sometimes consider stressful life events as a causative factor for the development of depressive as well as manic episodes.

BACKGROUND: On October 7, 2023, terrorist organizations led by Hamas, launched an extensive attack on Israel. Within days following the initial attack, there was a clear need to provide psychological support to individuals who were exposed to the horrors of the October 7 attacks. Hence, the Tel Aviv Sourasky Medical Center opened the \"Ichilov Otef Nefesh\" clinic to provide psychological first aid to the first-line victims of the war. As the fighting spread, the services were extended to the entire population. The guiding principle of the intervention was that it is crucial in the acute phase after exposure to significant trauma, and its main purpose is to support the natural course of one\'s recovery processes. This case series describes three representative cases from among the hundreds of people who applied to the clinic. The intervention provided was guided by an integrated approach that promotes introspection and connectedness to one\'s environment and community, enhancing cognitive functions, emotional regulation and utilizing available resources to reduce distress. The main themes that emerged shifted between feelings of helplessness and a sense of agency; a breach in basic trust and renewed trust, guilt and self-compassion; anger, abandonment and alienation versus solidarity and connecting to the present and the future, despair versus hope and loss versus acceptance and connectedness. In face of these, the therapists endorsed techniques of validation, restoring self-agency, promoting a sense of self-agency and self-compassion, creating a link between the past and present, and finding connection and hope.

BACKGROUND: On October 7, 2023, operation \"Iron Swords\" erupted following a barbaric terror attack, resulting in over 1,200 casualties, with more than 250 individuals, abducted. The aftermath of this slaughter led to the evacuation of hundreds of thousands from their homes in both the south and north of Israel. This situation triggered an unprecedented surge in the request for mental health support as reported by health funds and helplines. Global observations of large-scale traumatic events indicate increased usage of mental health services. The question then arises regarding the scope of services required in response to the mega-atrocity of October 7.
OBJECTIVE: To chart the utilization of psychiatric clinical treatment services in Israel in the aftermath of the October 7 attack.
METHODS: This is a retrospective cohort analysis using the electronic database from the research division of Clalit Health Services. We performed a comparative charting of mental health clinic treatments among individuals aged 15 and above, focusing on October-December 2023. These data were then compared to corresponding months over the previous five years (2018-2022).
RESULTS: From October to December 2023, there was a 23.2% increase in the requests for mental health clinic treatments, compared to the same period in 2022. This surge extends a continuing upward trend in the utilization of mental health services observed since 2018.
CONCLUSIONS: The study results emphasize the necessity for a responsive and flexible mental health system, to address immediate and long-term psychiatric care needs. The insights derived from these data are crucial for policymakers and clinicians to restructure mental health services, aiming to enhance the quality and accessibility of care for the Israeli population.
CONCLUSIONS: The consistent rise in utilization of clinical mental health services significantly intensified following October 7, 2023. This echoes trends observed in global studies, underscoring the profound and enduring effects of traumatic experiences on mental health. These insights highlight the necessity for ongoing, high-quality therapeutic services and underscores the critical need for strategic policy development and increased investment in mental health services.

With about 1200 individuals murdered, the massacre of October 7th was one of the deadliest terrorist attacks in modern history. The mental health consequences of terrorist attacks have been documented. However, little is known of the impact of the potentially morally injurious experience (PMIE) of betrayal--in which individuals feel betrayed by leaders they once trusted--on levels of psychological burden in the aftermath of such an attack. In this national prospective cohort study, we examined to what extent the PMIE of betrayal exacerbates the risk for posttraumatic stress disorder (PTSD) and depression in the wake of the October 7th terrorist attack. A representative sample of 710 Israeli adults (362 female, 51.1%), Jews (557, 79.9%) and Arabs (153, 20.1%), aged 18-85 (M = 41.01, SD = 13.72) completed validated self-report questionnaires assessing PTSD, depression, and PMIE-betrayal at two timepoints: T1, in August 2023 (6-7 weeks before the attack) and T2, in November 2023 (5-6 weeks after the attack). In two hierarchical logistic regressions, we found that experience of PMIE-betrayal predicted diagnoses of both PTSD (OR 1.92, 95% CI 1.26-2.92) and depression (OR 2.03, 95% CI 1.37-3.01) at T2, beyond probable PTSD/depression at T1 and demographic and trauma-related variables. Moreover, in two repeated-measure analyses predicting PTSD/depression symptoms, we found significant interactions between PTSD/depression trajectories and PMIE-betrayal, meaning that the increase of PTSD/depression symptoms was significantly higher among participants experiencing betrayal in the context of the attack. Our study highlights the impact of PMIE of betrayal on the dramatic increase in psychopathology following the October 7th terror attack on Israel\'s population. Clinicians treating individuals coping with PTSD and depression should attend to their patients\' possible exposure to betrayal following the attack. Moreover, national leaders and policymakers should take significant steps to repair the public\'s betrayal experience.

Major incidents and mass casualty events can affect people of all ages. However, when planning the response to a major incident the focus is often on adult casualties rather than children. It is essential that the needs of paediatric patients are taken into account throughout major incident planning. Whether considering equipment, staffing or surgical and critical care capacity, hospitals should meet the needs of children as well as adults following a major incident and where possible, keep families together. The new Major Incident Triage Tool introduced in the National Health Service (NHS) in 2024 has a tendency to over triage paediatric casualties and so hospitals who may be receiving children following a UK major incident must be aware of this and plan for the potential implications. This article reviews the evidence and learning from previous mass casualty events and makes recommendations for hospitals to ensure that the needs of children will be met if a major incident occurs.

BACKGROUND: The risk of terrorist attacks in the Federal Republic of Germany is present and is currently increasing. Publicly funded acute care hospitals and their owners are involved in disaster control as part of their remit and are responsible for taking comprehensive precautions to ensure their operational capability in the event of disasters. This mandate must also be ensured in the event of terrorist attacks and amok incidents. For this purpose, an optimal cooperation between preclinical and clinical care is indispensable.
OBJECTIVE: Recommended actions for collaboration between nonclinical and clinical planning to manage a mass casualty incident in terrorist life-threatening response situations are presented.
METHODS: The Inter-Hospital Security Conference Baden-Württemberg (IHSC BW) is an association of representatives of acute hospitals in Baden-Württemberg, the Ministry of the Interior, Digitalization and Migration Baden-Württemberg, the Ministry of Social Affairs and Integration Baden-Württemberg, the State Police Headquarters Baden-Württemberg and the Baden-Württemberg Hospital Association. From 2018 to 2020, the IHSC BW developed recommendations for action on cooperation between police, hospitals and non-police emergency response. The recommendations for action were agreed by the group members in 6 working sessions and initialled in two subsequent video conferences. A recommendation was considered adopted when the IHSC BW plenary assembly finally gave its approval with an absolute majority.
CONCLUSIONS: Competence-based interface solutions for a smooth cooperation between prehospital and hospital management in the care of patients who have become victims of a terrorist attack are to be demanded. For preliminary planning, the establishment of a local safety conference at the county disaster control authority level with the following participants is recommended: disaster control authority, fire department, regional police headquarters, chief emergency physician, rescue services and disaster control officers of affected clinics. It is recommended to set up a joint command and situation center (CSC), where management personnel from the police, rescue service, fire department and disaster control can meet to organize the handling of the incident jointly, competently and without loss of time. From this CSC, a liaison officer should then provide the clinics with information at regular intervals. Exercises should take place regularly. Cross-organizational exercises are particularly important, and this is one of the tasks of the local safety conference.
UNASSIGNED: HINTERGRUND: Die Gefahr terroristischer Anschläge in der Bundesrepublik Deutschland ist gegeben und nimmt aktuell weiter zu. Öffentlich geförderte Akutkrankenhäuser haben eigenverantwortlich umfassende Vorsorge für ihre Einsatzfähigkeit bei Katastrophen zu treffen. Dieser Auftrag ist auch bei Terror- und Amoklagen sicherzustellen. Eine optimale Abstimmung zwischen präklinischer und klinischer Versorgung ist unabdingbar.
UNASSIGNED: Es werden Handlungsempfehlungen zur Zusammenarbeit von außerklinischer und klinischer Planung zur Bewältigung eines Massenanfalls von Verletzten bei lebensbedrohlichen Einsatzlagen (LebEL) vorgestellt.
METHODS: Die Klinikübergreifende Sicherheitskonferenz Baden-Württemberg (KLÜSIKO BW) ist eine Arbeitsgemeinschaft aus Vertretern der Akutkliniken in Baden-Württemberg, des Ministeriums für Inneres, Digitalisierung und Migration Baden-Württemberg, des Ministeriums Soziales und Integration Baden-Württemberg, des Landespolizeipräsidiums Baden-Württemberg und der Baden-Württembergischen Krankenhausgesellschaft e. V. Von 2018 bis 2020 wurden in der KLÜSIKO BW Handlungsempfehlungen zur „Zusammenarbeit zwischen Polizei, Kliniken und nichtpolizeilicher Gefahrenabwehr“ erarbeitet. Die Handlungsempfehlungen wurden in 6 Arbeitssitzungen konzertiert und in 2 anschließenden Videokonferenzen parafiert. Eine Empfehlung galt als verabschiedet, wenn abschließend die Vollversammlung der KLÜSIKO BW ihre Zustimmung mit absoluter Mehrheit gab.
UNASSIGNED: Zu fordern sind kompetenzbasierte Schnittstellenlösungen für ein reibungsloses Zusammenwirken von Präklinik und Klinik bei der Versorgung von Patienten, die Opfer einer LebEL wurden. Für die Vorplanung wird die Einrichtung einer lokalen Sicherheitskonferenz auf der Ebene Landkreis/Untere Katastrophenschutzbehörde mit folgenden Teilnehmern empfohlen: Untere Katastrophenschutzbehörde, Feuerwehr, regionales Polizeipräsidium, Leitender Notarzt, Rettungsdienste, Katastrophenschutzbeauftragte betroffener Kliniken. Empfohlen wird ein gemeinsames Führungs- und Lagezentrum (FLZ), wo sich Führungspersonal von Polizei, Rettungsdienst, Feuerwehr und Katastrophenschutz einfinden, um die Abwicklung des Schadensereignisses gemeinsam, kompetent und ohne Zeitverlust zu organisieren. Aus diesem FLZ sollten dann die Kliniken in regelmäßigen zeitlichen Abständen mit Informationen versorgt werden. Übungen sollten regelmäßig stattfinden. Eine besondere Bedeutung kommt organisationsübergreifenden Übungen zu.

Terrorism continues to be an enigmatic and contested concept, lacking a universally accepted definition despite extensive scholarly debate. Lay intuitions, however, demonstrate a notable convergence in identifying acts as \"terrorism\" when specific situational features are present, such as indiscriminate violence and out-group perpetration. These features elicit predictable and robust precautionary responses, raising the question: Is there a unified and parsimonious explanation for these phenomena? It is hypothesized that a situational template exists in the human mind, the coalitional predation template (CPT), which evolved not to detect modern-day terrorism, per se, but to identify and respond to situations of predatory coalitional conflict. The paper examines the potential cues and mechanisms that constitute the psychological systems activated by such threats, suggesting that matching the input cues of the CPT triggers well-documented precautionary responses to terrorism. However, this cue-based system may not align neatly with contemporary threats, leading to disproportionate responses to some threats while underestimating others. The model also posits that interpretations of violence can vary due to incomplete cues and the social position of the evaluator, leading to public disagreements and inconsistencies in defining terrorism. Consequently, arriving at an unambiguous and widely accepted definition of terrorism may not be possible. The model presented may account for a range of phenomena, including the inclination towards attributing mental illness to particular violent incidents and the uncanny surface similarities between terrorism and war crimes. The findings have significant implications for both the theoretical understanding of terrorism and practical policy responses.

UNASSIGNED: Research has shown evidence of increased substance use (ISU) in populations affected by mass terrorism; however, less is known regarding how psychosocial factors interact to estimate ISU following such events.
UNASSIGNED: To examine which factors are associated with reporting ISU, test whether psychological distress (PD) mediated the association between exposure to trauma and reporting ISU, and whether the mediation effect differed among those with prior mental health (MH) difficulties and those without.
UNASSIGNED: A partially representative cross-sectional survey of the adult Jewish population in Israel (aged 18-70 years) was conducted 4 weeks after October 7, 2023 (October 31 to November 5, 2023). A national Web panel using quotas based on national distributions was used. Randomly chosen adult Jewish members were invited to participate until a predetermined sample size was reached.
UNASSIGNED: The study measures included reporting ISU (outcome), PD (mediator), exposure to terror events and sociodemographic characteristics (variables), and prior MH difficulties (moderator). Hypotheses regarding outcome and variables were formulated before data collection.
UNASSIGNED: A total of 7000 invitations were distributed, 2679 individuals consented, 1432 were excluded owing to quota limits, 74 failed attention tests, and 205 opted out, resulting in 968 participants (490 women [50.6%]; mean [SD] age, 41.5 [14.6] years). Hierarchical regression analysis revealed that participants were significantly more likely to report ISU if they had experienced direct exposure (odds ratio [OR], 5.75; 95% CI, 2.53 to 13.05), indirect exposure (OR, 1.84; 95% CI, 1.27 to 2.67), media exposure (OR, 1.22; 95% CI, 1.09 to 1.36), PD (OR, 1.80; 95% CI, 1.44 to 2.25), or previous MH difficulties (OR, 2.76; 95% CI, 1.86 to 4.09). PD partially mediated the association between indirect exposure (b = 0.20; 95% CI, 0.11 to 0.31) and media exposure (b = 0.14; 95% CI, 0.10 to 0.19) and reporting ISU. No evidence was found to support previous MH difficulties as a moderator of these indirect effects (indirect exposure, b = -0.003; 95% CI, -0.28 to 0.28; media exposure, b = 0.01; 95% CI, -0.06 to 0.08).
UNASSIGNED: This study contributes to the research on the association of mass terrorism with ISU while shedding important light on the role it may play in the self-medication of PD following exposure, even in those who might have no previous MH difficulties. These insights are crucial for planning essential health services and preventive measures.

BACKGROUND: Most research examining first responders of terrorist incidents has been conducted in early post-disaster periods, utilized quantitative research methods, and focused on psychopathology such as post-traumatic stress.
METHODS: Longitudinal follow-up assessments of 124 workers from 181 baseline volunteer rescue and recovery workers originally studied were completed nearly a quarter century after the terrorist bombing of the Murrah Federal Building in Oklahoma City. Open-ended qualitative interviews were used in the follow-up study.
RESULTS: The rescue and recovery work, vividly described decades later, was gruesome. These workers\' descriptions captured their mental toughness and their professional missions, as well as the emotional and mental health (MH) toll on their lives.
CONCLUSIONS: The extreme nature of rescue and recovery work in the aftermath of terrorism suggests potential utility for MH interventions to address the psychological toll that can be expected of human beings under the most extraordinary circumstances.