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

Document created by Steven Stellman on Dec 1, 2016
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  Ghuman, S. J., Brackbill, R. M., Stellman, S. D., Farfel, M. R.,   Cone, J. E. 14 (1) 491-

  Abstract: 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.

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