title: [Healthcare utilisation of those affected by the shooting incident in Alphen aan den Rijn, the Netherlands; health of affected and non-affected neighbouring residents 1 year afterwards].
abstract: OBJECTIVE
  To examine the effects of the mass shooting in the city of Alphen aan den Rijn, the Netherlands, on 9 April 2011 on the health and healthcare utilisation of those affected, compared with a reference group of neighbouring residents.
  
  
  METHODS
  Observational longitudinal study.
  
  
  METHODS
  Those affected by the shooting incident and a reference group of neighbouring residents were identified using patient and health care data from various care providers (Dutch Victim Support (SHN), Dutch Association of Mental Health and Addiction Care, social work), in which the request for assistance was documented. The health and healthcare process of 161 affected persons and 115 local residents in the year before and the year after the mass shooting could be followed with data extracted from the electronic medical records of general practices. The effects of the mass shooting on health and healthcare utilisation were analysed with logistic and Poisson multilevel regression analyses for repeated measurements.
  
  
  RESULTS
  After the mass shooting, the prevalence of psychological and social problems presented to the GP increased for affected persons (OR: 2.99; 95% CI: 1.75-5.12) compared with the year before the shooting incident, and differed from the reference group (OR: 2.68; 95% CI: 0.93-7.72). In particular, there was a sharp increase in the prevalence of anxiety and stress reactions (OR: 4.07; 95% CI: 1.86-8.92) and the prescription of hypnotics and sedatives (OR: 2.32; 95% CI: 1.08-4.98) and benzodiazepines (OR: 187; 95% CI: 1.07-3.26). However, these problems declined significantly after the first quarter. A small group of people was treated by mental health care for a post-traumatic stress disorder while half of those affected had registered with SHN.
  
  
  CONCLUSIONS
  For a limited period of time, the mass shooting had a negative impact on the psychological well-being and healthcare utilisation of those affected.
authors.affiliation: NIVEL, Utrecht.
authors.forename: Christel  E
authors.initials: C
authors.lastname: van Dijk
authors.forename: Femke
authors.initials: F
authors.lastname: van der Sman-de Beer
authors.forename: J T Hanneke
authors.initials: JT
authors.lastname: Tielen
authors.forename: Peter G
authors.initials: PG
authors.lastname: van der Velden
authors.forename: C Joris
authors.initials: CJ
authors.lastname: IJzermans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D055815:Young Adult