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Indeed, sexual assaults on women are more common in male-dominated occupations, Reference Kabat-Farr and Cortina12 which could increase vulnerability to paranoid ideation. Reference Kanter10 This theory seems to be of particular relevance in organisations where length of employment is shorter for women, Reference Wilson11 which is often the case in emergency services such as fire brigades. Reference Coid, Ullrich, Bebbington, Fazel and Keers9 Regarding gender differences, the theory of tokenism predicts gender stereotypes and harassment in organisations where women are underrepresented. A meta-analysis showed a robust association between paranoid ideation and violence in the general population, and this association remained stable when controlling for drug misuse or other psychiatric comorbidities. Wesemann, personal communication, 2020), those regarding gender-specific differences in paranoid ideation are still provisional and no conclusive explanation for this difference is given. Reference Wesemann, Bühler, Mahnke, Butler, Polk and Willmund8 Although the results regarding the occupational groups have been replicated (U. Initial cross-sectional analyses found occupational and gender differences notably, female personnel showed higher paranoid ideation. In total, 12 people were killed and another 55 injured. This was the first Islamist terrorist attack in Germany in which more people died than the perpetrator himself. In order to examine whether the efforts to investigate occupation- and gender-specific differentiation is warranted, an explorative pilot study was conducted after the 2016 terrorist attack in Berlin, when a tractor-trailer was steered into a crowd at the Breitscheidplatz Christmas market. Research findings after the 2016 terrorist attack in Berlin Reference Wesemann, Kowalski, Jacobsen, Beudt, Jacobs and Fehr7 Similarly, specific programs would be useful for emergency personnel. CHARLY is a blended learning program that has already been made available for certain military professions, such as paramedics or ordnance technicians, and has demonstrated a specific preventive effect on post-traumatic stress disorder. In Germany, the ‘Chaos Driven Situation Management Retrieval System’ (CHARLY) was recently launched. Reference Rizzo, Buckwalter, John, Newman, Parsons and Kenny6 STRIVE is specific to target group and deployment, although not adaptive because of its fixed programmed scenarios. In military contexts, computer-based prevention programs that are target group-specific can be used during preparation for foreign missions in the USA, the ‘Stress Resilience in Virtual Environments Program’ (STRIVE) was developed for this purpose. In particular, gender differences are of interest in addressing health inequalities in pre- and post-mission outcomes. Reference Skogstad, Heir, Hauff and Ekeberg3– Reference Motreff, Baubet, Pirard, Rabet, Petitclerc and Stene5 However, understanding these differences is necessary for the development of specific preparation and follow-up tools. Reference Neria, Nandi and Galea2 Indeed, the psychological reactions of emergency personnel exposed to terror attacks in Europe have until now rarely been examined. Reference Zvolensky, Farris, Kotov, Schechter, Bromet and Gonzalez1 Numerous publications focus on the psychological effects of disasters on emergency responders, but the systematic investigation of differences between genders or occupational groups is comparatively limited. Responses to a potentially traumatic event span a wide range from increased stress to mental disorders, such as depression, post-traumatic stress disorder, other anxiety disorders or addiction. Differentiated preparation and follow-up for emergency responders is recommended moving towards health-related equality. Sexual harassment in a male-dominated profession may be a vulnerability factor. There is, as yet, no conclusive explanation for this difference. The same effect was observed with exposed female emergency personnel showing a significant 2-year post-deployment increase compared with the total group including unexposed female as well as exposed and unexposed male emergency personnel. There was a group × time interaction effect in paranoid ideation: paranoid ideation increased over time in the exposed versus the unexposed female group.

Exposed female versus exposed male personnel showed higher paranoid ideation at both time points. Participants were exposed and unexposed emergency personnel ( n = 120). This newly designed confirmatory study aims to replicate these previously found gender-specific results and investigate the progression of effects after 2 years.

In a pilot study, female emergency personnel showed increased paranoid ideation following a terror attack.