Disparities in mental health treatment following the World Trade Center Disaster: Implications for mental health care and health services research

Abstract

To assess disparities in mental health treatment in New York City (NYC) after the World Trade Center Disaster (WTCD) reported previously related to care access, we conducted analyses among a cross-sectional survey of adults who had posttraumatic stress disorder (PTSD) or major depression (N = 473) one year after the event. The dependent variables examined were use of mental health services, in general, and use of mental health services related to the WTCD. Similar dependent variables were developed for medication usage. Although a number of bivariate results were statistically significant for postdisaster mental health visits, in a multivariate logistic regression model, only WTCD exposure remained significant. For service utilization related to the WTCD, the multivariate results indicated that African Americans were less likely to have had these visits compared to Whites, while those with a regular doctor, who had greater exposure to WTCD events, and those who had a perievent panic attack were more likely to have had such visits. In terms of medication use, multivariate results suggested that African Americans were less likely to use postdisaster medications, whereas persons 45 + years old and those with a regular doctor, were more likely to use them. For WTCD-related medication use, multivariate models indicated that African Americans were less likely to use medications, relative to Whites, while those between 45 and 64 years old, those with a regular doctor, those exposed to more WTCD events, and those who had a perievent panic attack, were more likely to have taken medications related to the disaster. The primary reason respondents gave for not seeking treatment (55% of subsample) was that they did not believe that they had a problem (73%). Other reasons were that they wanted to solve the problem on their own (5%), had problems accessing services (6%), had financial problems (4%), or had a fear of treatment (4%). Despite the availability of free mental health services offered in a supportive and potentially less stigmatizing environment post disaster, there still appeared to be barriers to receiving postdisaster services among those presumably in need of care.The terrorist attacks in New York City (NYC) on September 11, 2001, resulted in one of the largest death tolls of any disaster in the United States (Centers for Disease Control, 2002). An initial study of the psychological impact in Manhattan after the attacks indicated that 7.5% of adults had symptoms consistent with PTSD related to these attacks and 9.7% had symptoms Galea et al., 2002). While major disasters are rare, previous studies have suggested that psychiatric disorders are common among disaster survivors (Green, 1991;Norris, 1992;Norris et al., 2002;Smith, North, McCool, & Shea, 1990). Furthermore, although some research suggests the contrary (McFarlane, 1989), these effects may be more severe for disasters involving significant loss of life (Rubonis & Bickman, 1991).Although use of mental health services has been documented following...

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