Reluctance to Utilize Mental Health Services after a Disaster

Schwarz, Eitan D.; Kowalski, Janice M.

doi:10.1097/00005053-199212000-00005

Cited by 83 publications

(44 citation statements)

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“…Recently, it was reported that treatment seeking for mental health disorders typically involves a significant amount of time from symptom onset to actual treatment (Wang, Berglund, Olfson, & Kessler, 2004), so it is possible that the racial disparity found will diminish with time. It also has been reported that some persons may be reluctant to seek postdisaster mental health care to avoid the psychological distress associated with discussing traumatic events (Schwarz & Kowalski 1992), which could be a factor in our study.…”

Section: Discussionmentioning

confidence: 80%

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

Boscarino

Adams

Stuber

et al. 2005

Journal of Traumatic Stress

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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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Section: Discussionmentioning

confidence: 80%

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

Boscarino

Adams

Stuber

et al. 2005

Journal of Traumatic Stress

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“…Overall, the proportion of family members who met symptomatic criteria for PTSD was 14.0% (95% CI, 9.7%-19.3%); PCL scores ranged from 17 to 76 with a median (IQR) of 29 (22,37). The proportion of family members who met symptomatic criteria for depression was 18.4% (95% CI, 13.5%-24.1%).…”

Section: Predictors Survey Measuresmentioning

confidence: 99%

Predictors of Symptoms of Posttraumatic Stress and Depression in Family Members After Patient Death in the ICU

Gries

Engelberg

Kross

et al. 2010

Chest

276

250

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Background: Patients' deaths in the ICU have been associated with a high burden of psychologic symptoms in families. This study identifi es characteristics associated with psychologic symptoms in family members. Methods: Families of patients dying in the ICU or within 30 h of ICU discharge in 11 hospitals previously participated in a randomized trial. In the current study, we assessed these families for symptoms of posttraumatic stress disorder (PTSD) and depression with follow-up surveys. Outcomes included validated measures of PTSD (PTSD Checklist) and depressive (Patient Health Questionnaire) symptoms. Predictors included family member mental-health history, involvement in decision making, and demographics. Results: Surveys were completed by 226 families. Response rate was 46% in the original randomized trial and 82% in this study. Prevalence (95% CI) of PTSD and depressive symptoms were 14.0% (9.7%-19.3%) and 18.4% (13.5%-24.1%), respectively. Family characteristics associated with increased symptoms included: female gender (PTSD, P 5 .020; depression, P 5 .005), knowing the patient for a shorter duration (PTSD, P 5 .003; depression, P 5 .040), and discordance between family members' preferences for decision making and their actual decision-making roles (PTSD, P 5 .005; depression, P 5 .049). Depressive symptoms were also associated with lower educational level ( P 5 .002). Families with psychologic symptoms were more likely to report that access to a counselor (PTSD, P , .001; depression, P 5 .003) and information about spiritual services might have been helpful while the patient was in the ICU (PTSD, P 5 .024; depression, P 5 .029). Conclusions

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“…This conceptualization has been supported by empirical evidence (McFarlane, 1992;Steil & Ehlers, 2000) and is also valid for help-seeking after traumatization. The wish to avoid trauma-related stimuli opposes the wish for treatment and impedes it (Schwarz & Kowalski, 1992 ).…”

Section: Variables Influencing the Basic Modelmentioning

confidence: 99%

Seeking Psychosocial Care After Interpersonal Violence: An Integrative Model

Schreiber¹,

Renneberg²,

Maercker

2009

Violence Vict

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Andreas Maercker Prof Dr DrUniversität Zürich, SwitzerlandMany people experience a traumatic event at least once in their lifetime. But only a fraction of those traumatized and in need of mental health care receive psychosocial care or treatment. This may be due to barriers people experience within the help-seeking process.The individual help-seeking process is consequently highly relevant for any mental health care for trauma survivors. Understanding why people refrain from asking for help or delay the help-seeking process is central to understanding help-seeking after traumatization. Based on empirical data and theoretical models, an integrative model of individual mental health help-seeking is developed. This integrative model delineates parameters relevant for seeking psychosocial care or refraining from it.

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Reluctance to Utilize Mental Health Services after a Disaster

Cited by 83 publications

References 0 publications

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

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

Predictors of Symptoms of Posttraumatic Stress and Depression in Family Members After Patient Death in the ICU

Seeking Psychosocial Care After Interpersonal Violence: An Integrative Model

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