Abstract
Background
This study examined the use of professionals for mental health problems among New York City residents who were directly affected by the September 11, 2001 terrorist attacks on the World Trade Center (WTC) or had a probable diagnosis of post-traumatic stress disorder (PTSD) or depression in its aftermath. Correlates of help seeking from professionals for mental health problems after the attacks and barriers to care were also assessed.
Method
Data were from a random digit dial telephone survey of 2,752 adults representative of the Greater New York Metropolitan area conducted 6 months after the September 11 terrorist attacks.
Results
Fifteen percent of those directly affected and 36% of those with probable PTSD or depression sought help from a professional for a mental health problem after the attacks. There was little new utilization of professionals for mental health problems after the attacks among persons who were not already receiving care prior to September 11. Barriers that prevented people from seeking help for mental health problems 6 months after the September 11 attacks included traditional barriers to care (e.g., cost) and barriers that are unique to the post-disaster context (e.g., the belief that others need the services more than oneself).
Conclusions
This study suggests that there was potential unmet mental health need in New York City 6 months after the September 11 attacks on the WTC, but these findings should be tempered by research showing an apparent decrease in population-rates of PTSD. In the aftermath of a disaster, interventions should target persons with mental health needs who were not previously seeking help from a professional for a mental health problem.
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References
Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK (1993) The de factor US mental and addictive disorders system service: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 50:85–94
Kessler RC, Zhao S, Katz SJ, Kouzis AC, Frank RG, Edlund M, Leaf P (1999) Past-year use of outpatient services for psychiatric problems in the national comorbidity survey. Am J Psychiatry 156:115–123
Norris FH (1992) Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clinical Psychol 60:409–418
Green BL (1991) Evaluating the effects of disasters. Psychol Assess 3:538–546
Schuster MA, Stein BD, Jaycox LH, Collins RL, Marshall GN, Elliott MN, Zhou AJ, Kanouse DE, Morrison JL, Berry SH (2001) A national survey of stress reactions after the September 11, 2001 terrorist attacks. New Engl J Med 345(20):1507–1512
Galea S, Ahern J, Resnick H, Kilpatrick D, Bucuvalas M, Gold J, Vlahov D (2002) Psychological sequelae of the September 11 terrorist attacks in New York City. New Engl J Med 346:982
Schlenger W, Caddeell JEL, Jordan B et al (2002) Psychological reactions to terrorist attacks: Findings from the National Study of Americans’ reactions to September 11. J Am Med Assoc 288:581
Galea S, Vlahov D, Resnick H, Ahern J, Susser E, Gold J, Bucuvalas M, Kilpatrick D (2003) Progression of posttraumatic stress disorder symptoms among adults in New York City after the September 11 terrorist attacks. Am J Epidemiol 158(6):514–524
Smith DW, Christiansen EH, Vincent R, Hann NE (1999) Population effects of the bombing of Oklahoma City. J Oklahoma State Med Assoc 92:193–198
Carr VJ, Lewin TJ, Carter GL, Webster RA (1989) Patterns of service utilization following 1989 Newcastle earthquake: findings form phase 1 of the quake impact. Aust J Public Health 16:330–369
Smith EM, North CS, McCool RE, Shea JM (1990) Acute postdisaster psychiatric disorders: identification of persons at risk. Am J Psychiatry 147:202–206
Boscarino JA, Galea S, Ahern J, Resnick H, Vlahov D (2002) Utilization of Mental Health Services following the September 11th Terrorist Attacks in Manhattan. Int J Emerg Mental Health 4(3):143–155
Boscarino JA, Galea S, Ahern J, Resnick H, Vlahov D (2003) Psychiatric medication use among New York City residents following a mass urban disaster: Implications for research and medical care. J Traumat Stress 16(3):301–306
Kessler RC, Berglund PA, Bruce ML, Koch JR, Laska EM, Leaf PJ, Manderscheid RW, Rosenheck RA, Walters EE, Wang PS (2001) The prevalence and correlates of untreated serious mental illness. Health Services Res 36(6 part I):987–1007
Majtabai R, Olfson M, Mechanic D (2002) Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry 59(1):77–84
McAlpine DD, Mechanic D (2002) Utilization of Specialty Mental Health Care among Persons with Severe Mental Illness: the roles of Demographics, Need, Insurance and Risk. Health Serv Res 35(1 part II):277–292
Mechanic D, (2002) Removing Barriers to Care among Persons with Psychiatric Symptoms. Health Affairs 21(3):137–147
Lindey JL, Grace MC, Green BL (1981) Survivors: Outreach to a reluctant population. Am J Orthopsychiatry 51(3):468–478
McFarlane AC (1985) Posttraumatic morbidity of a disaster: a study of cases presenting for psychiatric treatment. J Nerv Ment Dis 174(1):4–15
Wilkinson CB (1983) Aftermath of a disaster: the Collapse of the Hyatt Regency Hotel Skywalks. Am J Psychiatry 140:1134–1139
Schwart ED, Klowalski JM (1992) Malignant Memories: Reluctance to Utilize Mental Health Services After a Disaster. J Nervous Mental Dis 180(2):767–772
Wunsch-Hitzig R, Plapinger J, Draper J, del Campo E (2002) Calls for Help after September 11: a Community Mental Health Hot Line. J Urban Health 79(3):417–428
Rudenstine S, Galea S, Ahern J, Felton C, Vlahov D, (2003) Awareness and perceptions of a community-wide mental health program 4–5 months after the September 11 terrorist attacks in New York City. Psychiatric Serv 54(10):1404–1406
Mechanic D, McAlpine D, Rosenfield S, Davis D (1994) Effects of illness attribution and depression on the quality of life among persons with serious mental illness. Soc Sci Med 39(2):155–164
The American Association for Public Opinion Research (2000) Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. Ann Arbor, Michigan: AAPOR. http://www.aapor.org/default.asp?page=survey_methods/standards_and_best_practices/standard_definitions
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC
Kilpatrick DG, Resnick HS, Freedy JR, Pelcovitz D, Resnick PA, Roth S, van der Kolk B (1998) The posttraumatic stress disorder field trial: evaluation of the PTSD construct- criteria A through E. In: Widiger T, Frances A, Pincus H et al (eds) DSM-IV sourcebook, vol 4. American Psychiatric Association Press Washington, DC 803–844
Resnick HS, Kilpatrick DG, Dansky BS et al (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61:984–991
Spitzer RL, Williams JB, Gibbon M (1987) Structured Clinical Interview for DSM-III-R-Non-patient Version. Biometrics Research Department, New York State Psychiatric Institute. New York, NY
Acierno R, Kilpatrick DG, Resnick H et al (2000) Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: findings from the National Survey of Adolescents. J Traumat Stress 13:381–396
Kilpatrick DG, Ruggiero KJ, Acierno R, et al (2003) Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the national survey of adolescents. J Consult Clin Psychol 71(4):692–700
Galea S, Vlahov D, Tracy M, Hoover D, Resnick H, Kilpatrick DG (2004) Hispanic ethnicity and post-traumatic stress disorder after a disaster: evidence from a general populations survey after September 11. Ann Epidemiol 14(8):520–531
DeLisi L, Maurizio A, Yost M, Papparozzi C, Fulchino C, Katz C, Altesman J, Biel M, Lee J, Stevens P (2003) A survey of New Yorkers after the September 11, 2001 terrorist attacks. Am J Psychiatry 160:780–783
Beroff J, Kulka RA, Douvan E (1981)Mental health in America: patterns of help-seeking from 1957 to 1976. Basic Books, New York, NY
Rabinowtiz J, Gross R, Feldman D (1999) Correlates of a perceived need for mental health assistance and differences between those who do and do not seek help. Soc Psychiatry Psychiatr Epidemiol 34:141–146
Blendon RJ (1988) The public’s views of the future of health care. J Am Med Assoc 259:3587
Jajich-Toth C, Roper BW (1990) Americans’ Views on Health Care: a Study in Contradictions. Health Affairs 9(4):149–157
Callahan D (1992) Symbols, rationality, and justice: rationing health care. Am J Law Med XVII(1,2):1–13
Independent Sector (2001) A survey of charitable giving after September 11th 2001. http://www.independentsector.org/PDF/Sept11_giving.pdf
Goldman LS, Nielsen NH, Champion HC (1999) Awareness, diagnosis, and treatment of depression. J Gen Intern Med 14(9):569–580
Sherbourne CD, Dwight-Johnson M, Klap R (2001) Psychological distress, unmet need, and barriers to mental health care for women. Women’s Health Issues 11(3):231–243
Roper Starch Worldwide Inc. (2001) America’s Mental Health Survey. Prepared for the National Mental Health Association. http://www.nmha.org/pdfdoc/mentalhealthreport2001.pdf
Stein MB, Walker JR, Hazen AL, Forde DR (1997) Full and partial post-traumatic stress disorder: findings from a community survey. Am J Psychiatry 154:1114–1119
Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, Struening EL (2001) Comorbidity, impairment, and suicidality in subsyndromal PTSD. Am J Psychiatry 158:1467–1473
Bebbington PE (1990). Population surveys of psychiatric disorder and the need for treatment. Soc Psychiatry Psychiat Epidemiol 15:33–40
Johnson S, Thornicroft G, Phelan M, Slade M (1996). Assessing needs for mental health services. In: Thornicroft G, Tansella M (eds). Mental health outcome measures. Springer-Verlag, Berlin pp. 217–226
Felton C (2002) Project Liberty: a public health response to the mental health needs of New Yorkers arising from the World Trade Center terrorist attacks. J Urban Health 79(3): 429–433
Acknowledgements
Supported by grants from the National Institute of Mental Health (RO1 MH 66081-01), The United Way of New York City and the New York Community Trust.
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Stuber, J., Galea, S., Boscarino, J.A. et al. Was there unmet mental health need after the September 11, 2001 terrorist attacks?. Soc Psychiat Epidemiol 41, 230–240 (2006). https://doi.org/10.1007/s00127-005-0022-2
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DOI: https://doi.org/10.1007/s00127-005-0022-2