Unmet mental health care need 10–11 years after the 9/11 terrorist attacks: 2011–2012 results from the World Trade Center Health Registry

BMC Public Health

James E Cone²  Mark R Farfel²  Steven D Stellman¹  Robert M Brackbill²  Sharon J Ghuman² 

[1] Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA;New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA

关键词: Functional impairment;    Comorbid PTSD and depression;    Depression;    Posttraumatic stress disorder (PTSD);    Barriers to mental health care;    9/11;    September 11, 2001;    World Trade Center disaster;    Unmet mental health care need;   

Others  :  1130366
DOI  :  10.1186/1471-2458-14-491

 received in 2013-12-30, accepted in 2014-04-29,  发布年份 2014

【 摘 要 】

Background

There is little current information about the unmet mental health care need (UMHCN) and reasons for it among those exposed to the World Trade Center (WTC) terrorist attacks. The purpose of this study was to assess the level of UMHCN among symptomatic individuals enrolled in the WTC Health Registry (WTCHR) in 2011–2012, and to analyze the relationship between UMHCN due to attitudinal, cost, and access factors and mental health symptom severity, mental health care utilization, health insurance availability, and social support.

Methods

The WTCHR is a prospective cohort study of individuals with reported exposure to the 2001 WTC attacks. This study used data from 9,803 adults who completed the 2003–2004 (Wave 1) and 2011–2012 (Wave 3) surveys and had posttraumatic stress disorder (PTSD) or depression in 2011–2012. We estimated logistic regression models relating perceived attitudinal, cost and access barriers to symptom severity, health care utilization, a lack of health insurance, and social support after adjusting for sociodemographic characteristics.

Results

Slightly more than one-third (34.2%) of study participants reported an UMHCN. Symptom severity was a strong predictor of UMHCN due to attitudinal and perceived cost and access reasons. Attitudinal UMHCN was common among those not using mental health services, particularly those with relatively severe mental health symptoms. Cost-related UMHCN was significantly associated with a lack of health insurance but not service usage. Access-related barriers were significantly more common among those who did not use any mental health services. A higher level of social support served as an important buffer against cost and access UMHCN.

Conclusions

A significant proportion of individuals exposed to the WTC attacks with depression or PTSD 10 years later reported an UMHCN, and individuals with more severe and disabling conditions, those who lacked health insurance, and those with low levels of social support were particularly vulnerable.

【 授权许可】

   
2014 Ghuman et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Brackbill R, Stellman SD, Perlman SE, Walker DJ, Farfel M: Mental health of those directly exposed to the World Trade Center disaster: unmet mental health care need, mental health treatment service use, and quality of life. Soc Sci Med 2013, 81:110-114.
• [2]Johnson RJ, Hobfoll SE: Mental Health and Terrorism. In A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems. 1998/02/03 edition. Edited by Scheid TL, Brown TN. Cambridge: Cambridge University Press; 2010:384-405.
• [3]Perlman SE, Friedman S, Galea S, Nair HP, Eros-Sarnyai M, Stellman SD, Hon J, Greene CM: Short-term and medium-term health effects of 9/11. Lancet 2011, 378(9794):925-934.
• [4]Stuber J, Galea S, Boscarino JA, Schlesinger M: Was there unmet mental health need after the September 11, 2001 terrorist attacks? Soc Psychiatry Psychiatr Epidemiol 2006, 41(3):230-240.
• [5]Boscarino JA, Adams RE, Stuber J, Galea S: Disparities in mental health treatment following the World Trade Center disaster: implications for mental health care and health services research. J Trauma Stress 2005, 18(4):287-297.
• [6]76 FR 54112 - James Zadroga 9/11 Health and Compensation Act of 2010 In Federal Register Volume 76, Issue 169. College Park, MD, USA: Office of the Federal Register, National Archives and Records Administration; 2011:54112-54126.
• [7]Bonanno GA, Brewin CR, Kaniasty K, La Greca AM: Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities. Psychol Sci Public Interest 2010, 11(1):1-49.
• [8]Neria Y, Nandi A, Galea S: Post-traumatic stress disorder following disasters: a systematic review. Psychol Med 2008, 38:467-480.
• [9]Chiu S, Niles JK, Webber MP, Zeig-Owens R, Gustave J, Lee R, Rizzotto L, Kelly KJ, Cohen HW, Prezant DJ: Evaluating risk factors and possible mediation effects in posttraumatic depression and posttraumatic stress disorder comorbidity. Public Health Rep 2011, 126(2):201-209.
• [10]Soo J, Webber MP, Gustave J, Lee R, Hall CB, Cohen HW, Kelly KJ, Prezant DJ: Trends in probable PTSD in firefighters exposed to the World Trade Center disaster, 2001–2010. Disaster Med Public Health Prep 2011, 5(Suppl 2):S197-S203.
• [11]Webber MP, Glaser MS, Weakley J, Soo J, Ye F, Zeig-Owens R, Weiden MD, Nolan A, Aldrich TK, Kelly K, Prezant D: Physician-diagnosed respiratory conditions and mental health symptoms 7–9 years following the World Trade Center disaster. Am J Ind Med 2011, 54(9):661-671.
• [12]Pietrzak RH, Feder A, Singh R, Schechter CB, Bromet EJ, Katz CL, Reissman DB, Ozbay F, Sharma V, Crane M, Harrison D, Herbert R, Levin SM, Luft BJ, Moline JM, Stellman JM, Udasin IG, Landrigan PJ, Southwick SM: Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study. Psychol Med 2014, 44(1):205-219.
• [13]Brackbill RM, Hadler JL, DiGrande L, Ekenga CC, Farfel MR, Friedman S, Perlman SE, Stellman SD, Walker DJ, Wu D, Yu S, Thorpe LE: Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack. JAMA 2009, 302(5):502-516.
• [14]Murphy J, Brackbill RM, Thalji L, Dolan M, Pulliam P, Walker DJ: Measuring and maximizing coverage in the World Trade Center Health Registry. Stat Med 2007, 26(8):1688-1701.
• [15]Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC: Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005, 62(6):603-613.
• [16]Mechanic D: The Financing and Delivery of Mental Health Services. In Mental Health and Social Policy: Beyond Managed Care. Fifth edition. Boston, MA: Pearson Education, Inc; 2008:140-166.
• [17]Mojtabai R: Unmet need for treatment of major depression in the United States. Psychiatr Serv 2009, 60(3):297-305.
• [18]Mojtabai R: Trends in contacts with mental health professionals and cost barriers to mental health care among adults with significant psychological distress in the United States: 1997–2002. Am J Public Health 2005, 95(11):2009-2014.
• [19]Allin S, Grignon M, Le Grand J: Subjective unmet need and utilization of health care services in Canada: What are the equity implications? Soc Sci Med 2010, 70:465-472.
• [20]Mojtabai R: Americans’ attitudes toward mental health treatment seeking: 1990–2003. Psychiatr Serv 2007, 58:642-651.
• [21]Mojtabai R, Olfson M, Sampson NA, Jin R, Druss B, Wang PS, Wells KB, Pincus HA, Kessler RC: Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychol Med 2011, 41(8):1751-1761.
• [22]Nelson CH, Park J: The nature and correlates of unmet health care needs in Ontario. Canada Soc Sci Med 2006, 62(9):2291-2300.
• [23]World Trade Center Health Registry: Wave 2 Survey Data File Users’ Manual. New York City Department of Health and Mental Hygiene: Queens, NY; 2012.
• [24]Yu S, Walker DJ, Brackbill R, Maslow CB, Wu D, Osahan S, Turner L, Stellman SD, Farfel M: World Trade Center Health Registry Wave 3 Survey (2011–2012): Adults. Data File User’s Manual. Queens, NY: RTI International, New York City Department of Health and Mental Hygiene; 2013.
• [25]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington DC: American Psychiatric Association; 2000.
• [26]DiGrande L, Perrin MA, Thorpe LE, Thalji L, Murphy J, Wu D, Farfel M, Brackbill RM: Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2–3 years after the September 11, 2001 terrorist attacks. J Trauma Stress 2008, 21(3):264-273.
• [27]Perrin MA, DiGrande L, Wheeler K, Thorpe L, Farfel M, Brackbill R: Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. Am J Psychiatry 2007, 164(9):1385-1394.
• [28]Kroenke K, Spitzer RL, Williams JB, Lowe B: The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010, 32(4):345-359.
• [29]Turner RJ, Brown RL: Social Support and Mental Health. In A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems. 2nd edition. Edited by Scheid TL, Brown TN. Cambridge: Cambridge University Press; 2010:200-212.
• [30]Carmines EG, Zeller RA: Reliability and Validity Assessment. In Quantitative Applications in the Social Sciences. vol. 17. Thousand Oaks, CA: Sage Publications, Inc; 1979.
• [31]Mojtabai R, Olfson M, Mechanic D: Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry 2002, 59(1):77-84.
• [32]Sareen J, Cox BJ, Afifi TO, Clara I, Yu BN: Perceived need for mental health treatment in a nationally representative Canadian sample. Can J Psychiatr 2005, 50:643-651.
• [33]Mechanic D: Is the prevalence of mental disorders a good measure of the need for services? Health Aff (Millwood) 2003, 22(5):8-20.
• [34]Welch AE, Caramanica K, Debchoudhury I, Pulizzi A, Farfel M, Stellman SD, Cone J: A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees. BMC Public Health 2012, 12:721. BioMed Central Full Text
• [35]Marshall EG, Wong ST, Haggerty JL, Levesque JF: Perceptions of unmet healthcare needs: what do Punjabi and Chinese-speaking immigrants think? A qualitative study. BMC Health Serv Res 2010, 10:46. BioMed Central Full Text