Was there unmet mental health need after the September 11, 2001 terrorist attacks?

BackgroundThis 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.MethodData 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.ResultsFifteen 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).ConclusionsThis 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.

[1]  N. Hann,et al.  Population effects of the bombing of Oklahoma City. , 1999, The Journal of the Oklahoma State Medical Association.

[2]  M. Stein,et al.  Full and partial posttraumatic stress disorder: findings from a community survey. , 1997, The American journal of psychiatry.

[3]  J. R. Koch,et al.  The prevalence and correlates of untreated serious mental illness. , 2001, Health services research.

[4]  C. B. Wilkinson.  Ethnicity and Medical Care , 1983 .

[5]  M. Elliott,et al.  A national survey of stress reactions after the September 11, 2001, terrorist attacks. , 2001, The New England journal of medicine.

[6]  E L Struening,et al.  Comorbidity, impairment, and suicidality in subthreshold PTSD. , 2001, The American journal of psychiatry.

[7]  D. Mechanic,et al.  Effects of illness attribution and depression on the quality of life among persons with serious mental illness. , 1994, Social science & medicine.

[8]  Andrea Maurizio,et al.  A survey of New Yorkers after the Sept. 11, 2001, terrorist attacks. , 2003, The American journal of psychiatry.

[9]  H. Resnick,et al.  Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. , 1993, Journal of consulting and clinical psychology.

[10]  S. Galea,et al.  Psychological sequelae of the September 11 terrorist attacks in New York City. , 2002, The New England journal of medicine.

[11]  A. McFarlane.  Posttraumatic Morbidity of a Disaster: A Study of Cases Presenting for Psychiatric Treatment , 1986, The Journal of nervous and mental disease.

[12]  S. Galea,et al.  Hispanic ethnicity and post-traumatic stress disorder after a disaster: evidence from a general population survey after September 11, 2001. , 2004, Annals of epidemiology.

[13]  B. W. Roper,et al.  Americans' views on health care: a study in contradictions. , 1990, Health affairs.

[14]  R. Blendon.  The public's view of the future of health care. , 1988, JAMA.

[15]  Larry S. Goldman,et al.  Awareness, diagnosis, and treatment of depression , 1999, Journal of General Internal Medicine.

[16]  M. Olfson,et al.  Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. , 2002, Archives of general psychiatry.

[17]  E. D. Schwarz,et al.  Malignant memories. Reluctance to utilize mental health services after a disaster. , 1992, The Journal of nervous and mental disease.

[18]  Sandro Galea,et al.  Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. , 2003, American journal of epidemiology.

[19]  R. Acierno,et al.  Assault, PTSD, Family Substance Use, and Depression as Risk Factors for Cigarette Use in Youth: Findings from the National Survey of Adolescents , 2000, Journal of traumatic stress.

[20]  J. Draper,et al.  Calls for help after september 11: a community mental health hot line , 2002, Journal of Urban Health.

[21]  F H Norris,et al.  Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. , 1992, Journal of consulting and clinical psychology.

[22]  D. Mechanic.  Removing barriers to care among persons with psychiatric symptoms. , 2002, Health affairs.

[23]  Elizabeth M. Smith,et al.  Acute postdisaster psychiatric disorders: identification of persons at risk. , 1990, The American journal of psychiatry.

[24]  H. Resnick,et al.  Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. , 2003, Journal of consulting and clinical psychology.

[25]  J. Veroff,et al.  Mental health in America : patterns of help-seeking from 1957 to 1976 , 1981 .

[26]  R. Kessler,et al.  Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. , 1999, The American journal of psychiatry.

[27]  S. Galea,et al.  Psychiatric Medication Use Among Manhattan Residents Following the World Trade Center Disaster , 2003, Journal of traumatic stress.

[28]  V. Carr,et al.  Patterns of service utilisation following the 1989 Newcastle earthquake: findings from phase 1 of the Quake Impact Study. , 2010, Australian journal of public health.

[29]  B. Green.  Evaluating the effects of disasters , 1991 .

[30]  D. Callahan.  Symbols, rationality, and justice: rationing health care. , 1992, American journal of law & medicine.

[31]  Lisa Thalji,et al.  Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. , 2002, JAMA.

[32]  S. Galea,et al.  Awareness and perceptions of a communitywide mental health program in New York city after September 11. , 2003, Psychiatric services.

[33]  Sandro Galea,et al.  Utilization of mental health services following the September 11th terrorist attacks in Manhattan, New York City. , 2002, International journal of emergency mental health.

[34]  C. Wilkinson.  Aftermath of a disaster: the collapse of the Hyatt Regency Hotel skywalks. , 1983, The American journal of psychiatry.

[35]  M. Tansella,et al.  Mental Health Outcome Measures , 2010, Springer Berlin Heidelberg.

[36]  J. Rabinowitz,et al.  Correlates of a perceived need for mental health assistance and differences between those who do and do not seek help , 1999, Social Psychiatry and Psychiatric Epidemiology.

[37]  C. Sherbourne,et al.  Psychological distress, unmet need, and barriers to mental health care for women. , 2001, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[38]  P. Bebbington.  Population surveys of psychiatric disorder and the need for treatment , 1990, Social Psychiatry and Psychiatric Epidemiology.

[39]  F. Goodwin,et al.  The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. , 1993, Archives of general psychiatry.

[40]  Shirley A. Star,et al.  AMERICAN ASSOCIATION FOR PUBLIC OPINION RESEARCH , 1980 .

[41]  D. Mechanic,et al.  Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk. , 2000, Health services research.

[42]  J. Lindy,et al.  Survivors: outreach to a reluctant population. , 1981, The American journal of orthopsychiatry.

[43]  Chip J. Felton,et al.  Project liberty: a public health response to New Yorkers' mental health needs arising fromthe World Trade Center terrorist attacks , 2002, Journal of urban health : bulletin of the New York Academy of Medicine.