1
|
Pirard P, Motreff Y, Stene LE, Rabet G, Vuillermoz C, Vandentorren S, Baubet T, Messiah A. Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks. Arch Public Health 2023; 81:207. [PMID: 38031202 PMCID: PMC10685664 DOI: 10.1186/s13690-023-01206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Terrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors. METHODS Data were collected from a web-based survey of civilians 8-12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation. RESULTS Among the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were "did not feel the need", "it was not the right time to talk about it", and "not offered". For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims. CONCLUSION The organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.
Collapse
Affiliation(s)
- Philippe Pirard
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France.
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Yvon Motreff
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Gabrielle Rabet
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- UMR 1219, Bordeaux Population Health Research Center, PHARes Team, University of Bordeaux, Bordeaux, France
| | - Thierry Baubet
- Université Sorbonne Paris Nord, UTRPP EA 4403, Villetaneuse, France
- AP-HP, Hôpital Avicenne, Bobigny, France
- Resources and Resilience National Centre (CN2R), LilleParis, France
| | - Antoine Messiah
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
| |
Collapse
|
2
|
Han HJ, Suh HS. Predicting Unmet Healthcare Needs in Post-Disaster: A Machine Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6817. [PMID: 37835087 PMCID: PMC10572666 DOI: 10.3390/ijerph20196817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Unmet healthcare needs in the aftermath of disasters can significantly impede recovery efforts and exacerbate health disparities among the affected communities. This study aims to assess and predict such needs, develop an accurate predictive model, and identify the key influencing factors. Data from the 2017 Long-term Survey on the Change of Life of Disaster Victims in South Korea were analyzed using machine learning techniques, including logistic regression, C5.0 tree-based model, and random forest. The features were selected based on Andersen's health behavior model and disaster-related factors. Among 1659 participants, 31.5% experienced unmet healthcare needs after a disaster. The random forest algorithm exhibited the best performance in terms of precision, accuracy, Under the Receiver Operating Characteristic (AUC-ROC), and F-1 scores. Subjective health status, disaster-related diseases or injuries, and residential area have emerged as crucial factors predicting unmet healthcare needs. These findings emphasize the vulnerability of disaster-affected populations and highlight the value of machine learning in post-disaster management policies for decision-making.
Collapse
Affiliation(s)
- Hyun Jin Han
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea;
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hae Sun Suh
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea;
- Institute of Regulatory Innovation through Science (IRIS), Kyung Hee University, Seoul 02447, Republic of Korea
- College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea
| |
Collapse
|
3
|
Van Overmeire R, Muysewinkel E, Van Keer RL, Vesentini L, Bilsen J. Victims of the Terrorist Attacks in Belgium and Professional Mental Health Aid Barriers: A Qualitative Study. Front Psychiatry 2021; 12:638272. [PMID: 34276430 PMCID: PMC8283008 DOI: 10.3389/fpsyt.2021.638272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Terrorist attacks can cause short and long-term stress-reactions, anxiety, and depression among those exposed. Sometimes, professional mental health aid, meaning all types of professional psychotherapy, would be appropriate, but victims often delay or never access mental health aid, even up to a decade after the initial event. Little is known about the barriers terrorist-victims encounter when they try to access professional mental health aid. Method: Using a qualitative design, 27 people exposed to the 22/03/2016 terrorist attack in Belgium were interviewed using half-structured, in-depth interviews, on their experiences with professional mental health aid. A reflexive thematic analysis was employed. Results: Five main barriers for professional mental health aid seeking by victims were found. First, their perception of a lack of expertise of mental health aid professionals. Second, the lack of incentives to overcome their uncertainty to contact a professional. Third, social barriers: people did not feel supported by their social network, feared stigma, or trusted that the support of their social network would be enough to get them through any difficulties. Fourth, a lack of mental health literacy, which seems to be needed to recognize the mental health issues they are facing. Finally, there are financial barriers. The cost of therapy is often too high to begin or continue therapy. Conclusions: This study showed that the barriers for seeking professional mental health aid are diverse and not easily overcome. More mental health promotion is needed, so that there is a societal awareness of possible consequences of being exposed to terrorist attacks, which might result in less stigma, and a quicker realization of possible harmful stress reactions due to a disaster.
Collapse
Affiliation(s)
- Roel Van Overmeire
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emilie Muysewinkel
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rose-Lima Van Keer
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
4
|
Psychological outcomes for young adults after disastrous events: A mixed-methods scoping review. Soc Sci Med 2021; 276:113851. [PMID: 33812159 DOI: 10.1016/j.socscimed.2021.113851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/03/2021] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
RATIONALE Young adulthood (18 to 34) is a time of transitional change where individuals can be highly susceptible to mental health concerns. Despite similar vulnerabilities to their adolescent counterparts, the psychological outcomes for young adults following disasters are not well understood. OBJECTIVE This scoping review aimed to explore the literature on the psychological outcomes for young adults after disaster events. METHODS A systematic search of the literature was conducted in seven electronic databases, including PsycINFO, Medline, CINAHL, PILOTS, EMBASE, Scopus, and ProQuest dissertations and theses global. In total, 91 reports from 15 countries were included. RESULTS Findings suggested that young adults experience a range of psychological consequences after disasters, including posttraumatic stress symptoms, depression, anxiety, and other psychological outcomes, such as general/non-specific psychological distress. Pre-disaster, peri-disaster, and post-disaster factors were also found to influence the degree of psychological outcomes experienced by young adults, including prior psychological functioning and disaster exposure, among a host of other factors. CONCLUSION Future research is recommended to better understand young adults' psychological outcomes, experiences, and service needs following disasters.
Collapse
|
5
|
Binet É, Ouellet MC, Lebel J, Békés V, Morin CM, Bergeron N, Campbell T, Ghosh S, Bouchard S, Guay S, MacMaster FP, Belleville G. A Portrait of Mental Health Services Utilization and Perceived Barriers to Care in Men and Women Evacuated During the 2016 Fort McMurray Wildfires. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:1006-1018. [PMID: 33641027 PMCID: PMC7914389 DOI: 10.1007/s10488-021-01114-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
This study examines the influence of gender on mental health services utilization and on perceived barriers to treatment one year after the 2016 Fort McMurray wildfires. Data was collected through a phone survey from May to July 2017 (N = 1510). Participants were English-speaking evacuees aged 18 and older. Mental health services utilization and barriers to mental health care were assessed with the Perceived Need for Care questionnaire. Probable diagnoses of posttraumatic stress disorder, depression and insomnia were assessed with validated self-report questionnaires. Multiple logistic regressions confirmed that gender was a significant predictor of services utilization, after controlling for associated sociodemographic variables and presence of probable diagnoses. Women were respectively 1.50, 1.55 and 1.86 times more likely than men to receive information, medication and psychological help. Self-reliance was the most frequently reported reason for not receiving help, and motivational barriers, such as pessimism and stigma, were reported in a higher proportion than structural barriers, including nonresponse and finance. No significant gender differences were found in the types of perceived barriers to services. Among the Fort McMurray fire evacuees, mental health services utilization was similar to other studies on natural disaster victims, and higher in women than in men. Efforts to increase services utilization in natural disaster victims should focus on motivational barriers and offering treatments fostering people's autonomy, such as online treatments.
Collapse
Affiliation(s)
- Émilie Binet
- School of Psychology, Université Laval, Québec, QC, Canada
| | | | - Jessica Lebel
- School of Psychology, Université Laval, Québec, QC, Canada
| | - Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, New York City, NY, USA
| | | | - Nicolas Bergeron
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, QC, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | | | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Stéphane Guay
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, QC, Canada
| | | | | |
Collapse
|
6
|
Pirard P, Baubet T, Motreff Y, Rabet G, Marillier M, Vandentorren S, Vuillermoz C, Stene LE, Messiah A. Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris. BMC Health Serv Res 2020; 20:959. [PMID: 33076901 PMCID: PMC7574168 DOI: 10.1186/s12913-020-05785-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD). Methods Santé publique France conducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use. Results Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps. Conclusion Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.
Collapse
Affiliation(s)
- Philippe Pirard
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France. .,Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Thierry Baubet
- CESP, Inserm, Université Sorbonne Paris Nord, Villetaneuse, France.,APHP, Hôpital Avicenne, Bobigny, France.,Centre National de Ressources et de Résilience (CN2R), Lille/Paris, France
| | - Yvon Motreff
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France.,Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Gabrielle Rabet
- Support, Data Treatment and Analysis Division, Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Maude Marillier
- Non Communicable Diseases and Trauma Division, Santé Publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Stéphanie Vandentorren
- Scientific and International Division, Santé Publique France (The French Public Health Agency), Saint-Maurice, France.,INSERM, Bordeaux Population Health Research Center, UMR 1219, Univ Bordeaux, F-33000, Bordeaux, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75012, Paris, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Antoine Messiah
- Team MOODS, CESP, Inserm, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
| |
Collapse
|
7
|
van Herpen MM, Boeschoten MA, Te Brake H, van der Aa N, Olff M. Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test. J Med Internet Res 2020; 22:e19716. [PMID: 32975521 PMCID: PMC7547397 DOI: 10.2196/19716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. OBJECTIVE The goal of this study was to assess MIRROR's use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. METHODS MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR's outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale-21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). RESULTS In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range -.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. CONCLUSIONS MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic.
Collapse
Affiliation(s)
- Merel Marjolein van Herpen
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Hans Te Brake
- ARQ Centre of Expertise for the Impact of Disasters and Crises, Diemen, Netherlands
| | | | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam University Medical Center, Amsterdam, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
| |
Collapse
|
8
|
Jacobson MH, Norman C, Sadler P, Petrsoric LJ, Brackbill RM. Characterizing Mental Health Treatment Utilization among Individuals Exposed to the 2001 World Trade Center Terrorist Attacks 14⁻15 Years Post-Disaster. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040626. [PMID: 30791669 PMCID: PMC6406725 DOI: 10.3390/ijerph16040626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 12/04/2022]
Abstract
Following the World Trade Center (WTC) attacks in New York City (NYC) on 11 September 2001 (9/11), thousands in NYC experienced significant stress reactions and disorders, presenting an immediate need for counseling and treatment. While other studies documented post-9/11 mental health treatment utilization, none have data more than two years post-disaster. We used data from 35,629 enrollees of the WTC Health Registry, a longitudinal cohort study of those exposed to the WTC attacks, to examine predictors of counseling after 9/11, the types of practitioners seen, and the perceived helpfulness of therapy up to 15 years post-disaster. Among enrollees, 37.7% reported receiving counseling at some time after 9/11. Predictors of seeking counseling included race/ethnicity, age at 9/11, education level, exposure to the WTC attacks, other traumatic experiences, mental health symptomology, and pre-9/11 counseling. Whites and Hispanics, those who were children on 9/11, and those with high levels of exposure to the WTC attacks sought counseling soonest after 9/11. Among those who sought counseling, Blacks, Asians, and those with lower education and income were less likely to see mental health specialists and more likely to see general practitioners or religious advisors. Finally, among those who sought recent counseling, women, Blacks, those aged ≥65 years, and those with very high WTC exposures were more likely to rate their recent counseling as very helpful. This study used data up to 15 years post-disaster to document mental health treatment utilization patterns, trends, and disparities that have implications for future preparedness plans and needs assessments.
Collapse
Affiliation(s)
- Melanie H Jacobson
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Christina Norman
- Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA.
| | - Pablo Sadler
- Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA.
| | - Lysa J Petrsoric
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | - Robert M Brackbill
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
| |
Collapse
|
9
|
Gouweloos-Trines J, Te Brake H, Sijbrandij M, Boelen PA, Brewin CR, Kleber RJ. A longitudinal evaluation of active outreach after an aeroplane crash: screening for post-traumatic stress disorder and depression and assessment of self-reported treatment needs. Eur J Psychotraumatol 2019; 10:1554406. [PMID: 30693072 PMCID: PMC6338285 DOI: 10.1080/20008198.2018.1554406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/06/2018] [Accepted: 11/14/2018] [Indexed: 01/20/2023] Open
Abstract
Background: In 2009, an aeroplane crashed near Amsterdam. To remedy unmet mental health needs, active outreach was used to identify victims at risk for post-traumatic stress disorder (PTSD) and depression. Objective: The active outreach strategy was evaluated by examining the accuracy of screening methods in predicting PTSD and depression, self-reported treatment needs, and the extent to which perceived treatment needs predict trajectories of PTSD. Method: In 112 adult survivors, semi-structured telephone interviews were held at 2 (T1, n = 76), 9 (T2, n = 77) and 44 months (T3, n = 55) after the crash. The Trauma Screening Questionnaire (TSQ) and the Patient Health Questionnaire-2 (PHQ-2) measured symptoms of PTSD and depression, respectively. At T3, a clinical interview assessed PTSD and depression diagnoses. Based on the TSQ scores at the three time-points, participants were grouped into five 'trajectories': resilient (n = 38), chronic (n = 30), recovery (n = 9), delayed onset (n = 9) and relapse (n = 3). Results: The TSQ accurately predicted PTSD at T3 (sensitivity: .75-1.00; specificity: .79-.90). The PHQ-2 showed modest accuracy (sensitivity: .38-.89; specificity: .67-.90). Both measures provided low positive predictive values (TSQ: 0.57; PHQ-2: .50 at T3). A number of participants reported unmet treatment needs (T1: 32.9%; T2: 19.5%; T3: 10.9%). Reporting unmet needs at T2 was more often assigned to a chronic PTSD trajectory compared to reporting no needs (p < .01). Conclusions: The prevalence of unmet needs at 44 months after the crash within a chronic PTSD trajectory indicated that active outreach may be warranted. Nevertheless, although the TSQ was accurate, many participants screening positive did not develop PTSD. This implies that, although active outreach may benefit those with unmet needs, it also has its costs in terms of possible unnecessary clinical assessments.
Collapse
Affiliation(s)
- Juul Gouweloos-Trines
- Knowledge Center Impact, Arq Psychotrauma Expert Group, Diemen, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Hans Te Brake
- Knowledge Center Impact, Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Free University of Amsterdam, Amsterdam, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| |
Collapse
|
10
|
Gobin M, Rubin GJ, Albert I, Beck A, Danese A, Greenberg N, Grey N, Smith P, Oliver I. Outcomes of Mental Health Screening for United Kingdom Nationals Affected by the 2015-2016 Terrorist Attacks in Tunisia, Paris, and Brussels. J Trauma Stress 2018; 31:471-479. [PMID: 30084509 DOI: 10.1002/jts.22317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 11/11/2022]
Abstract
Following several terrorist attacks in 2015 and 2016, a national program was set up to identify and support residents of England whose mental health had been affected. We report the outcomes of the program's screening and assessment components. Questionnaires and information about the program were mailed to 483 people and 49 families known to the police. Individuals who screened positive on an assessment for posttraumatic stress disorder, anxiety, depression, increased smoking, or problematic alcohol consumption were offered clinical assessment and referred to an appropriate National Health Service (NHS) service, if required. Of the 195 eligible people who returned our questionnaires, 179 (91.8%) screened positive on one or more measure. Following clinical assessment, 78 adults and three children were referred for treatment. The program was broadly successful in facilitating access to services. However, most people who had been directly exposed to the attacks did not participate and data protection issues limited communication with those who were affected. Further discussion of data protection concerns may help future programs operate more efficiently.
Collapse
Affiliation(s)
- Maya Gobin
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Idit Albert
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Alison Beck
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andrea Danese
- Social, Genetic, and Developmental Psychiatry Centre, King's College, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National and Specialist CAMHS Trauma and Anxiety Clinic, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Hove, United Kingdom.,Department of Psychology, University of Sussex, Brighton, United Kingdom
| | - Patrick Smith
- Department of Psychology, King's College London, London, United Kingdom
| | - Isabel Oliver
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| |
Collapse
|
11
|
Rubin GJ, Webster R, Rubin AN, Amlot R, Grey N, Greenberg N. Public attitudes in England towards the sharing of personal data following a mass casualty incident: a cross-sectional study. BMJ Open 2018; 8:e022852. [PMID: 29780033 PMCID: PMC5961558 DOI: 10.1136/bmjopen-2018-022852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess public attitudes towards data sharing to facilitate a mental health screening programme for people caught up in a mass casualty incident. DESIGN Two, identical, cross-sectional, online surveys, using quotas to ensure demographic representativeness of people aged 18-65 years in England. Participants were randomly allocated to consider a scenario in which they witness a terrorism-related radiation incident or mass shooting, after which a police officer records their contact details. SETTING Participants were drawn from an online panel maintained by a market research company. Surveys were conducted before and immediately after a series of terrorist attacks and a large tower block fire occurred in England. PARTICIPANTS One thousand people aged 18-65 years participated in each survey. MAIN OUTCOME MEASURES Three questions asking participants if it would be acceptable for police to share their contact details, without asking first, with 'a health-related government organisation, so they can send you a questionnaire to find out if you might benefit from extra care or support', 'a specialist NHS team, to provide you with information about ways to get support for any physical or mental health issues' and 'your GP, so they can check how you are doing'. RESULTS A minority of participants reported that it would be definitely not acceptable for their details to be shared with the government organisation (n=259, 13.0%), the National Health Service (NHS) (n=141, 7.1%) and their general practitioner (GP) (n=166, 8.3%). There was a small, but significant increase in acceptability for the radiation incident compared with the mass shooting. No major differences were observed between the preincident and postincident surveys. CONCLUSIONS Although most people believe it is acceptable for their details to be shared in order to facilitate a mental health response to a major incident, care must be taken to communicate with those affected about how their information will be used.
Collapse
Affiliation(s)
- G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Rebecca Webster
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Richard Amlot
- Behavioural Science Emergency Response Department Science and Technology (ERD S&T), Health Protection Directorate, Public Health England, Porton Down, UK
| | - Nick Grey
- Mood and Anxiety Clinical Academic Group, Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, London, UK
| |
Collapse
|
12
|
Kantor V, Knefel M, Lueger-Schuster B. Perceived barriers and facilitators of mental health service utilization in adult trauma survivors: A systematic review. Clin Psychol Rev 2016; 52:52-68. [PMID: 28013081 DOI: 10.1016/j.cpr.2016.12.001] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 11/29/2022]
Abstract
Many trauma survivors seem to be reluctant to seek professional help. The aim of the current review was to synthesize relevant literature, and to systematically classify trauma survivors' perceived barriers and facilitators regarding mental health service utilization. The systematic search identified 19 studies addressing military personnel and 17 studies with trauma survivors of the general population. The data analysis revealed that the most prominent barriers included concerns related to stigma, shame and rejection, low mental health literacy, lack of knowledge and treatment-related doubts, fear of negative social consequences, limited resources, time, and expenses. Perceived facilitators lack attention in research, but can be influential in understanding mental health service use. Another prominent finding was that trauma survivors face specific trauma-related barriers to mental health service use, especially concerns about re-experiencing the traumatic events. Many trauma survivors avoid traumatic reminders and are therefore concerned about dealing with certain memories in treatment. These perceived barriers and facilitators were discussed regarding future research and practical implications in order to facilitate mental health service use among trauma survivors.
Collapse
Affiliation(s)
- Viktoria Kantor
- Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria.
| | - Matthias Knefel
- Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | | |
Collapse
|
13
|
Xu W, Wang J, Wang Z, Li Y, Yu W, Xie Q, He L, Maercker A. Web-based intervention improves social acknowledgement and disclosure of trauma, leading to a reduction in posttraumatic stress disorder symptoms. J Health Psychol 2016; 21:2695-2708. [PMID: 25934590 DOI: 10.1177/1359105315583371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to investigate the effectiveness of web-based intervention on social acknowledgement and disclosure of trauma and to examine the mediating effect of the improvement in social acknowledgement and disclosure of trauma on the reduction of posttraumatic stress disorder symptoms. A randomized controlled trial was used, with 21 participants in a web-based intervention group and 29 participants in a wait-list control group completing a pre-test and post-test. Results showed that social acknowledgement and disclosure of trauma improved significantly after 1-month intervention, and this improvement mediated the reduction in the posttraumatic stress disorder symptoms. Implications and limitations of this study are discussed.
Collapse
Affiliation(s)
- Wei Xu
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Jianping Wang
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China.,2 Capital Medical University, P.R. China
| | | | - Yifei Li
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Wei Yu
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Qiuyuan Xie
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | - Li He
- 1 Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, P.R. China
| | | |
Collapse
|
14
|
Haga JM, Stene LE, Wentzel-Larsen T, Thoresen S, Dyb G. Early postdisaster health outreach to modern families: a cross-sectional study. BMJ Open 2015; 5:e009402. [PMID: 26681694 PMCID: PMC4691779 DOI: 10.1136/bmjopen-2015-009402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/07/2015] [Accepted: 10/21/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This study investigated whether the early outreach programme following the Utøya massacre reached out to the parents of the young survivors. Additionally, we explored whether specialised mental healthcare services were provided to parents presenting elevated levels of PTSD and depression reactions. DESIGN Cross-sectional survey, face-to-face interviews and questionnaires. SETTING Norway, aftermath of the Utøya massacre, 4-7 months postdisaster. BACKGROUND Following the Utøya massacre, proactive early outreach programmes were launched in all municipalities that were affected, facilitating access to appropriate healthcare services. PARTICIPANTS A total of 453 parents of the Utøya survivors aged 13-33 years took part. Overall, 59.8% of the survivors were represented by one or more parent in our study. MAIN OUTCOME MEASURES Engagement with the proactive early outreach programme (psychosocial crisis teams and contact persons in the municipalities), utilisation of healthcare services (general practitioner and specialised mental healthcare services) and mental distress (UCLA PTSD-RI and HSCL-8). RESULTS A majority of the participants reported contact with the proactive early outreach programme (crisis team, 73.9%; and contact person, 73.0%). Failure of outreach to parents was significantly associated with non-intact family structure (crisis team: OR 1.69, 95% CI 1.05 to 2.72, p=0.032) and non-Norwegian origin (crisis team: OR 2.39, 95% CI 1.14 to 4.98, p=0.021). Gender of the parent was not significantly associated with failure of the outreach programme (p ≥ 0.075). Provision of specialised mental healthcare services was significantly associated with higher levels of PTSD (OR 2.08, 95% CI 1.55 to 2.79, p<0.001) and depression (OR 2.42, 95% CI 1.71 to 3.43, p<0.001) and not with the sociodemography (p ≥ 0.122). CONCLUSIONS Proactive early outreach strategies may be helpful in identifying healthcare needs and facilitating access to the required services in a population struck by disaster. Our findings prompt increased attention to the complexity of family structures in reaching out universally to modern families following a disaster.
Collapse
Affiliation(s)
- Jon Magnus Haga
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Department of Social Pediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre of Violence and Traumatic Stress Studies, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| |
Collapse
|
15
|
Psychiatric disorders and suicide attempts in Swedish survivors of the 2004 southeast Asia tsunami: a 5 year matched cohort study. Lancet Psychiatry 2015; 2:817-24. [PMID: 26236006 DOI: 10.1016/s2215-0366(15)00124-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Survivors of natural disasters are thought to be at an increased risk of psychiatric disorders, however the extent of this risk, and whether it is linked to pre-existing psychopathology, is not known. We aimed to establish whether Swedish survivors of tsunamis from the 2004 Sumatra-Andaman earthquake had increased risks of psychiatric disorders and suicide attempts 5 years after repatriation. METHODS We identified Swedish survivors repatriated from southeast Asia (8762 adults and 3742 children) and 864 088 unexposed adults and 320 828 unexposed children matched for sex, age, and socioeconomic status. We retrieved psychiatric diagnoses and suicide attempts from the Swedish patient register for the 5 years after the tsunami (from Dec 26, 2004, to Jan 31, 2010) and estimated hazard ratios (HRs), then adjusted for pre-tsunami psychiatric disorders, and, for children, for parental pre-tsunami disorders. FINDINGS Exposed adults were more likely than unexposed adults to receive any psychiatric diagnosis (547 [6·2%] vs 47 734 [5·5%]; adjusted HR 1·21, 95% CI 1·11-1·32), particularly stress-related disorders (187 [2·1%] vs 8831 [1·0%]; 2·27, 1·96-2·62) and suicide attempts (38 [0·43%] vs 2752 [0·32%]; 1·54, 1·11-2·13), but not mood or anxiety disorders. Risk of psychiatric diagnoses did not differ between exposed and unexposed children and adolescents (248 [6·6] vs 22 081 [6·9%]; 0·98, 0·86-1·11), although exposed children and adolescents had a higher risk for suicide attempts with uncertain intent (1·43; 1·01-2·02) and stress-related disorders (1·79; 1·30-2·46), mainly during the first 3 months after the tsunami. INTERPRETATION The 2004 tsunami was, independently of previous psychiatric morbidity, associated with an increased risk of severe psychopathology, mainly stress-related disorders and suicide attempts, in children and adults. Survivors of natural disasters should be targeted with early interventions and active long-term follow-up to prevent, detect, and alleviate psychiatric disorders that might follow. FUNDING The Swedish Council for Working Life and Social Research, Swedish Board of Health and Welfare, Polish Ministry of Science and Higher Education, Swedish Society for Medical Research.
Collapse
|
16
|
Cone JE, Li J, Kornblith E, Gocheva V, Stellman SD, Shaikh A, Schwarzer R, Bowler RM. Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11. Am J Ind Med 2015; 58:483-93. [PMID: 25851164 DOI: 10.1002/ajim.22446] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Police enrolled in the World Trade Center Health Registry (WTCHR) demonstrated increased probable posttraumatic stress disorder (PTSD) after the terrorist attack of 9/11/2001. METHODS Police enrollees without pre-9/11 PTSD were studied. Probable PTSD was assessed by Posttraumatic Stress Check List (PCL). Risk factors for chronic, new onset or resolved PTSD were assessed using multinomial logistic regression. RESULTS Half of police with probable PTSD in 2003-2007 continued to have probable PTSD in 2011-2012. Women had higher prevalence of PTSD than men (15.5% vs. 10.3%, P = 0.008). Risk factors for chronic PTSD included decreased social support, unemployment, 2+ life stressors in last 12 months, 2+ life-threatening events since 9/11, 2+ injuries during the 9/11 attacks, and unmet mental health needs. CONCLUSION Police responders to the WTC attacks continue to bear a high mental health burden. Improved early access to mental health treatment for police exposed to disasters may be needed.
Collapse
Affiliation(s)
- James E. Cone
- New York City Department of Health and Mental Hygiene; New York New York
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene; New York New York
| | | | - Vihra Gocheva
- Department of Psychology; San Francisco State University; San Francisco California
| | - Steven D. Stellman
- New York City Department of Health and Mental Hygiene; New York New York
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York New York
| | - Annum Shaikh
- Emory University; Rollins School of Public Health; Atlanta Georgia
| | - Ralf Schwarzer
- Institute for Positive Psychology and Education; Faculty of Health Sciences; Australian Catholic University; Strathfield New South Wales Australia
| | - Rosemarie M. Bowler
- Department of Psychology; San Francisco State University; San Francisco California
| |
Collapse
|
17
|
Thorpe LE, Assari S, Deppen S, Glied S, Lurie N, Mauer MP, Mays VM, Trapido E. The role of epidemiology in disaster response policy development. Ann Epidemiol 2015; 25:377-86. [PMID: 25150446 PMCID: PMC4667544 DOI: 10.1016/j.annepidem.2014.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/08/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Disasters expose the general population and responders to a range of potential contaminants and stressors which may harm physical and mental health. This article addresses the role of epidemiology in informing policies after a disaster to mitigate ongoing exposures, provide care and compensation, and improve preparedness for future disasters. METHODS The World Trade Center disaster response is used as a case study. We examine how epidemiologic evidence was used to shape postdisaster policy and identify important gaps in early research. RESULTS In the wake of World Trade Center attacks, epidemiologic research played a key role in identifying and characterizing affected populations, assessing environmental exposures, quantifying physical and mental health impacts, and producing evidence to ascribe causation. However, most studies suffered from methodological challenges, including delays, selection biases, poor exposure measurement, and nonstandardized outcomes. Gaps included measuring unmet health needs and financing coverage, as well as coordination across longitudinal cohorts of studies for rare conditions with long latency, such as cancer. CONCLUSIONS Epidemiologists can increase their impact on evidence-based policymaking by ensuring core mechanisms are in place before a disaster to mount monitoring of responders and other affected populations, improve early exposure assessment efforts, identify critical gaps in scientific knowledge, and coordinate communication of scientific findings to policymakers and the public.
Collapse
Affiliation(s)
- Lorna E Thorpe
- Epidemiology and Biostatistics Program, City University of New York School of Public Health, NY.
| | - Shervin Assari
- Health Behavior and Health Education Program, University of Michigan School of Public Health, Ann Arbor
| | - Stephen Deppen
- Department of Epidemiology, Vanderbilt University Medical Center, Nashville, TN
| | - Sherry Glied
- School of Public Service, Wagner School of Public Service, New York University, NY
| | - Nicole Lurie
- Department of Health and Human Services, Washington, DC
| | - Matthew P Mauer
- Department of Epidemiology and Biostatistics, Albany School of Public Health, State University of New York, Albany
| | - Vickie M Mays
- Department of Psychology, School of Public Health, University of California, Los Angeles, Los Angeles
| | - Edward Trapido
- Department of Epidemiology, School of Public Health, Louisiana State University, New Orleans
| |
Collapse
|
18
|
Lowe SR, Fink DS, Norris FH, Galea S. Frequencies and predictors of barriers to mental health service use: a longitudinal study of Hurricane Ike survivors. Soc Psychiatry Psychiatr Epidemiol 2015; 50:99-108. [PMID: 24929355 PMCID: PMC4285706 DOI: 10.1007/s00127-014-0908-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The majority of disaster survivors suffering from psychological symptoms do not receive mental health services. Research on barriers to service use among disaster survivors is limited by a lack of longitudinal studies of representative samples and investigations of predictors of barriers. The purpose of this study was to address these limitations through analysis of a three-wave population-based study of Hurricane Ike survivors (N = 658). METHODS Frequencies of preference, outcome expectancy, resource, and stigma barriers among participants with unmet mental health needs were documented and logistic regression using a generalized estimating equations approach explored predisposing (e.g., age), illness-related (e.g., posttraumatic stress) and enabling (e.g., insurance coverage) factors as predictors of each type of barrier. RESULTS Preference barriers were most frequently cited at each wave, whereas stigma barriers were least frequently cited. Older age and higher emotional support predicted preference barriers; being a parent of a child under 18-years old at the time of the hurricane, higher generalized anxiety, and lack of insurance predicted resource barriers; and higher posttraumatic stress predicted stigma barriers. CONCLUSIONS These findings suggest that postdisaster practices targeting subpopulations most likely to have barriers to service use may be indicated.
Collapse
Affiliation(s)
- Sarah R. Lowe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St, Room 720F, New York, NY 10032
| | - David S. Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St, Room 1513, New York, NY 10032
| | - Fran H. Norris
- Department of Psychiatry, Dartmouth Medical School, 215 North Main Street, White River Junction, VT 05009
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St, Room 1508, New York, NY 10032
| |
Collapse
|
19
|
A. Crane M, Levy-Carrick NC, Crowley L, Barnhart S, Dudas M, Onuoha U, Globina Y, Haile W, Shukla G, Ozbay F. The Response to September 11: A Disaster Case Study. Ann Glob Health 2014; 80:320-31. [DOI: 10.1016/j.aogh.2014.08.215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
20
|
Welch AE, Debchoudhury I, Jordan HT, Petrsoric LJ, Farfel MR, Cone JE. Translating research into action: An evaluation of the World Trade Center Health Registry's Treatment Referral Program. DISASTER HEALTH 2014; 2:97-105. [PMID: 28229004 DOI: 10.4161/dish.28219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/09/2014] [Accepted: 02/13/2014] [Indexed: 11/19/2022]
Abstract
This manuscript describes the design, implementation and evaluation of the World Trade Center (WTC) Health Registry's Treatment Referral Program (TRP), created to respond to enrollees' self-reported 9/11-related physical and mental health needs and promote the use of WTC-specific health care. In 2009-2011, the TRP conducted personalized outreach, including an individualized educational mailing and telephone follow-up to 7,518 selected enrollees who resided in New York City, did not participate in rescue/recovery work, and reported symptoms of 9/11-related physical conditions or posttraumatic stress disorder (PTSD) on their most recently completed Registry survey. TRP staff spoke with enrollees to address barriers to care and schedule appointments at the WTC Environmental Health Center for those eligible. We assessed three nested outcomes: TRP participation (e.g., contact with TRP staff), scheduling appointments, and keeping scheduled appointments. A total of 1,232 (16.4%) eligible enrollees participated in the TRP; 32% of them scheduled a first-time appointment. We reached 84% of participants who scheduled appointments; 79.4% reported having kept the appointment. Scheduling an appointment, but not keeping it, was associated with self-reported unmet health care need, PTSD, and poor functioning (≥14 days of poor physical or mental health in the past 30 days) (P < 0.05). Neither scheduling nor keeping an appointment was associated with demographic characteristics. Successful outreach to disaster-exposed populations may require a sustained effort that employs a variety of methods in order to encourage and facilitate use of post-disaster services. Findings from this evaluation can inform outreach to the population exposed to 9/11 being conducted by other organizations.
Collapse
Affiliation(s)
- Alice E Welch
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | | | - Hannah T Jordan
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | - Lysa J Petrsoric
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene ; Queens, NY USA
| |
Collapse
|
21
|
Abstract
In the presented case, “Daryl” experienced 12 hr of uncertainty regarding the safety of a friend before learning the friend was killed during the April 16th shootings at Virginia Tech. Treatment began 4 years following the shootings. Daryl has two previous premature terminations, was treatment resistant, and at high risk for dropping out. Prolonged exposure (PE) was postponed for nine sessions while comprehensive assessment and psychoeducation occurred. PE took place over 15 sessions, with follow-ups occurring at 3, 6, and 12 months following treatment. During PE, a second shooting and accompanying deteriorating sleep led to brief pauses and modification of treatment. Daryl showed marked reduction of posttraumatic stress disorder (PTSD) symptoms throughout the course of treatment, resulting in complete remission of PTSD at the end of formal treatment as he maintained gains during follow-ups. The case study demonstrates the usefulness of symptom monitoring, specific modifications used within treatment, and the importance of assessing for preparedness for treatment.
Collapse
|
22
|
Ghuman SJ, Brackbill RM, Stellman SD, Farfel MR, Cone JE. Unmet mental health care need 10-11 years after the 9/11 terrorist attacks: 2011-2012 results from the World Trade Center Health Registry. BMC Public Health 2014; 14:491. [PMID: 24885506 PMCID: PMC4053282 DOI: 10.1186/1471-2458-14-491] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/29/2014] [Indexed: 01/05/2023] Open
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.
Collapse
Affiliation(s)
- Sharon J Ghuman
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
| | | | | | | | | |
Collapse
|
23
|
CRANE MA, CHO HG, LANDRIGAN PJ. Implications of the World Trade Center Health Program (WTCHP) for the public health response to the Great East Japan Earthquake. INDUSTRIAL HEALTH 2013; 52:5-12. [PMID: 24317449 PMCID: PMC4202764 DOI: 10.2486/indhealth.2013-0205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/03/2013] [Indexed: 06/02/2023]
Abstract
The attacks on the World Trade Center (WTC) on September 11, 2001 resulted in a serious burden of physical and mental illness for the 50,000 rescue workers that responded to 9/11 as well as the 400,000 residents and workers in the surrounding areas of New York City. The Zadroga Act of 2010 established the WTC Health Program (WTCHP) to provide monitoring and treatment of WTC exposure-related conditions and health surveillance for the responder and survivor populations. Several reports have highlighted the applicability of insights gained from the WTCHP to the public health response to the Great East Japan Earthquake. Optimal exposure monitoring processes and attention to the welfare of vulnerable exposed sub-groups are critical aspects of the response to both incidents. The ongoing mental health care concerns of 9/11 patients accentuate the need for accessible and appropriately skilled mental health care in Fukushima. Active efforts to demonstrate transparency and to promote community involvement in the public health response will be highly important in establishing successful long-term monitoring and treatment programs for the exposed populations in Fukushima.
Collapse
|
24
|
Weissman O, Israeli H, Rosengard H, Shenhar G, Farber N, Winkler E, Stahl S, Haik J. Examining disaster planning models for large scale burn incidents--a theoretical plane crash into a high rise building. Burns 2013; 39:1571-6. [PMID: 23768718 DOI: 10.1016/j.burns.2013.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/15/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The escalation of global terrorist attacks has resulted in a rise of traumatic injuries. Planning for mass casualty incidents (MCIs) is critical to decrease the morbidity and mortality that ensues after large-scale terrorist attacks. This study provides criteria for the management of burn victims following large-scale disasters. METHODS Mass casualty outcomes from three disasters involving commercial aircraft crashes were analyzed. The three events included the El-Al cargo Aircraft crash near the Amsterdam Schiphol Airport in 1992, the World Trade Center attacks in New York and the attack against the Pentagon in Washington, DC on 9/11/01. RESULTS Using the data obtained from these events, the severity of injuries in patients were determined. The result is a general template that may be customized with locally or regionally specific data, in order to evaluate the preparedness of a specific burn alignment for such a scenario. CONCLUSION Recommendations based on the analysis of previous MCI's were put forth. Based on the needs recognized during these past events, suggestions were made to enhance the preparedness of burn units, hospitals and national agencies as well as municipal authorities.
Collapse
Affiliation(s)
- Oren Weissman
- Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Brackbill RM, Stellman SD, Perlman SE, Walker DJ, Farfel MR. Mental health of those directly exposed to the World Trade Center disaster: unmet mental health care need, mental health treatment service use, and quality of life. Soc Sci Med 2013; 81:110-4. [PMID: 23337833 DOI: 10.1016/j.socscimed.2012.12.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 11/20/2012] [Accepted: 12/12/2012] [Indexed: 11/17/2022]
Abstract
Mental health service utilization several years following a man-made or natural disaster can be lower than expected, despite a high prevalence of mental health disorders among those exposed. This study focused on factors associated with subjective unmet mental health care need (UMHCN) and its relationship to a combination of diagnostic history and current mental health symptoms, 5-6 years after the 9-11-01 World Trade Center (WTC) disaster in New York City, USA. Two survey waves of the WTC Health Registry, after exclusions, provided a sample of 36,625 enrollees for this analysis. Important differences were found among enrollees who were categorized according to the presence or absence of a self-reported mental health diagnosis and symptoms indicative of post-traumatic stress disorder or serious psychological distress. Persons with diagnoses and symptoms had the highest levels of UMHCN, poor mental health days, and mental health service use. Those with symptoms only were a vulnerable group much less likely to use mental health services yet reporting UMHCN and poor mental health days. Implications for delivering mental health services include recognizing that many persons with undiagnosed but symptomatic mental health symptoms are not using mental health services, despite having perceived need for mental health care.
Collapse
Affiliation(s)
- Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 2 Gotham Center, 42-09 28th Street, 7th Floor, Queens, NY 11101, USA.
| | | | | | | | | |
Collapse
|
26
|
Axinn WG, Ghimire DJ, Williams NE, Scott KM. Gender, traumatic events, and mental health disorders in a rural Asian setting. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2013; 54:444-461. [PMID: 24311755 PMCID: PMC3891584 DOI: 10.1177/0022146513501518] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Research shows a strong association between traumatic life experience and mental health and important gender differences in that relationship in the western European Diaspora; but much less is known about these relationships in other settings. We investigate these relationships in a poor rural Asian setting that recently experienced a decade-long armed conflict. We use data from 400 adult interviews in rural Nepal. The measures come from World Mental Health survey instruments clinically validated for this study population to measure depression, posttraumatic stress disorder, and intermittent explosive disorder. Our results demonstrate that traumatic life experience significantly increases the likelihood of mental health disorders in this setting, and that these traumatic experiences have a larger effect on the mental health of women than men. These findings offer important clues regarding the potential mechanisms producing gender differences in mental health in many settings.
Collapse
|
27
|
Runkle JD, Brock-Martin A, Karmaus W, Svendsen ER. Secondary surge capacity: a framework for understanding long-term access to primary care for medically vulnerable populations in disaster recovery. Am J Public Health 2012; 102:e24-32. [PMID: 23078479 PMCID: PMC3519329 DOI: 10.2105/ajph.2012.301027] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 11/04/2022]
Abstract
Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans.
Collapse
|
28
|
Welch AE, Caramanica K, Debchoudhury I, Pulizzi A, Farfel MR, Stellman SD, Cone JE. A qualitative examination of health and health care utilization after the September 11th terror attacks among World Trade Center Health Registry enrollees. BMC Public Health 2012; 12:721. [PMID: 22935548 PMCID: PMC3490950 DOI: 10.1186/1471-2458-12-721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/25/2012] [Indexed: 11/23/2022] Open
Abstract
Background Many individuals who have 9/11-related physical and mental health symptoms do not use or are unaware of 9/11-related health care services despite extensive education and outreach efforts by the World Trade Center (WTC) Health Registry (the Registry) and various other organizations. This study sought to evaluate Registry enrollees’ perceptions of the relationship between physical and mental health outcomes and 9/11, as well as utilization of and barriers to 9/11-related health care services. Methods Six focus groups were conducted in January 2010 with diverse subgroups of enrollees, who were likely eligible for 9/11-related treatment services. The 48 participants were of differing race/ethnicities, ages, and boroughs of residence. Qualitative analysis of focus group transcripts was conducted using open coding and the identification of recurring themes. Results Participants described a variety of physical and mental symptoms and conditions, yet their knowledge and utilization of 9/11 health care services were low. Participants highlighted numerous barriers to accessing 9/11 services, including programmatic barriers (lack of program visibility and accessibility), personal barriers such as stigmatization and unfamiliarity with 9/11-related health problems and services, and a lack of referrals from their primary care providers. Moreover, many participants were reluctant to connect their symptoms to the events of 9/11 due to lack of knowledge, the amount of time that had elapsed since 9/11, and the attribution of current health symptoms to the aging process. Conclusions Knowledge of the barriers to 9/11-related health care has led to improvements in the Registry’s ability to refer eligible enrollees to appropriate treatment programs. These findings highlight areas for consideration in the implementation of the new federal WTC Health Program, now funded under the James Zadroga 9/11 Health and Compensation Act (PL 111-347), which includes provisions for outreach and education.
Collapse
Affiliation(s)
- Alice E Welch
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Claassen C, Kashner TM, Kashner TK, Xuan L, Larkin GL. Psychiatric emergency "surge capacity" following acts of terrorism and mass violence with high media impact: what is required? Gen Hosp Psychiatry 2011; 33:287-93. [PMID: 21601726 DOI: 10.1016/j.genhosppsych.2011.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Adequate preparedness for acts of terrorism and mass violence requires a thorough understanding of the postdisaster mental health needs of all exposed groups, including those watching such events from a distance. This study examined emergency psychiatric treatment-seeking patterns following media exposure to four national terrorist or mass casualty events. METHOD An event was selected for study if (a) it precipitated local front-page headlines for >5 consecutive days and (b) emergency service psychiatrists identified it as specifically precipitating help-seeking in the study hospital. Four events qualified: the Oklahoma City bombing (1995), the Columbine High School (1999) and Wedgewood Baptist Church (1999) shootings and the terrorist attacks of September 11, 2001. Time-series analyses were used to correct for autocorrelation in visit patterns during the postdisaster week, and equivalent time periods from years before and after each event were used as control years. RESULTS Overall, disaster week census did not differ significantly from predisaster weeks, although 3-day nonsignificant decreases in visit rate were observed following each disaster. Treatment-seeking for anxiety-related issues showed a nonsignificant increase following each disaster, which became significant in the "all disaster" model (t=5.17; P=.006). Intensity of media coverage did not impact rate of help-seeking in any analysis. CONCLUSIONS Although these sentinel US disasters varied in scope, method, geographic proximity to the study site, perpetrator characteristics, public response, sequelae and degree of media coverage, the extent to which they impacted emergency department treatment-seeking was minimal. Geographically distant mass violence and disaster events of the type and scope studied here may require only minimal mental health "surge capacity" in the days following the event.
Collapse
Affiliation(s)
- Cindy Claassen
- Department of Psychiatry, University of North Texas Health Sciences Center, Fort Worth, TX 76107, USA.
| | | | | | | | | |
Collapse
|
30
|
Brewin CR, Fuchkan N, Huntley Z, Robertson M, Thompson M, Scragg P, d'Ardenne P, Ehlers A. Outreach and screening following the 2005 London bombings: usage and outcomes. Psychol Med 2010; 40:2049-2057. [PMID: 20178677 PMCID: PMC2964043 DOI: 10.1017/s0033291710000206] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/15/2010] [Accepted: 01/18/2010] [Indexed: 12/02/2022]
Abstract
BACKGROUND Little is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.MethodFollowing a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring ≥6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year. RESULTS Case finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later. CONCLUSIONS Outreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation.
Collapse
Affiliation(s)
- C R Brewin
- Clinical, Educational and Health Psychology, University College London, UK.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Preparedness of Health Systems for Mass-Casualty Situations: A NATO Advanced Research Workshop on Mass-Casualty Situation Recommendations. Prehosp Disaster Med 2010. [DOI: 10.1017/s1049023x00023621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
32
|
Hall BJ, Hobfoll SE, Canetti D, Johnson RJ, Galea S. THE DEFENSIVE NATURE OF BENEFIT FINDING DURING ONGOING TERRORISM: AN EXAMINATION OF A NATIONAL SAMPLE OF ISRAELI JEWS. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2009; 28:993-1021. [PMID: 22058603 DOI: 10.1521/jscp.2009.28.8.993] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A study examining the effects of terrorism on a national sample of 1,136 Jewish adults was conducted in Israel via telephone surveys, during the Second Intifada. The relationship between reports of positive changes occurring subsequent to terrorism exposure (i.e., Benefit finding), posttraumatic stress disorder (PTSD) symptom severity, and negative outgroup attitudes toward Palestinian citizens of Israel (PCI) was examined. Benefit finding was related to greater PTSD symptom severity. Further, Benefit finding was related to greater threat perception of PCI and ethnic exclusionism of PCI. Findings were consistent with hypotheses derived from theories of outgroup bias and support the anxiety buffering role of social affiliation posited by terror management theory. This study suggests that benefit finding may be a defensive coping strategy when expressed under the conditions of ongoing terrorism and external threat.
Collapse
Affiliation(s)
- Brian J Hall
- Kent State University and Rush University Medical Center
| | | | | | | | | |
Collapse
|
33
|
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder. Symptoms present shortly after an exposure to a traumatic event, abate with time in the majority of those who initially express them, and leave a significant minority with chronic PTSD. PTSD may be treated with pharmacotherapy or psychotherapy. Treatment of the early expressions of the disorder constitutes a separate domain of theory and research. Treatment of chronic PTSD often stabilizes the condition but rarely produces stable remission. This article reviews the empirical evidence on the treatment of acute and chronic PTSD, outlines similarities and differences between PTSD and other Axis I disorders, evaluates new therapeutic approaches, and discusses the implications of current knowledge for the forthcoming DSM-V.
Collapse
Affiliation(s)
- Arieh Y Shalev
- Department of Psychiatry, Hadassah University Hospital, Ein Kerem Campus, P.O. Box 12000, 91120 Jerusalem, Israel.
| |
Collapse
|
34
|
Canetti-Nisim D, Halperin E, Sharvit K, Hobfoll SE. A New Stress-Based Model of Political Extremism: Personal Exposure to Terrorism, Psychological Distress, and Exclusionist Political Attitudes. THE JOURNAL OF CONFLICT RESOLUTION 2009; 53:363-389. [PMID: 22140275 PMCID: PMC3229259 DOI: 10.1177/0022002709333296] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Does exposure to terrorism lead to hostility toward minorities? Drawing on theories from clinical and social psychology, we propose a stress-based model of political extremism in which psychological distress-which is largely overlooked in political scholarship-and threat perceptions mediate the relationship between exposure to terrorism and attitudes toward minorities. To test the model, a representative sample of 469 Israeli Jewish respondents was interviewed on three occasions at six-month intervals. Structural Equation Modeling indicated that exposure to terrorism predicted psychological distress (t1), which predicted perceived threat from Palestinian citizens of Israel (t2), which, in turn, predicted exclusionist attitudes toward Palestinian citizens of Israel (t3). These findings provide solid evidence and a mechanism for the hypothesis that terrorism introduces nondemocratic attitudes threatening minority rights. It suggests that psychological distress plays an important role in political decision making and should be incorporated in models drawing upon political psychology.
Collapse
|
35
|
Benight CC, Ruzek JI, Waldrep E. Internet interventions for traumatic stress: a review and theoretically based example. J Trauma Stress 2008; 21:513-20. [PMID: 19107724 DOI: 10.1002/jts.20371] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Trauma recovery Web sites are proliferating with limited supportive evidence for effectiveness. In this article, the authors review the current very early studies on trauma recovery Web sites highlighting the different approaches, the empirical support provided, and the critical development issues facing this exciting frontier. An example site based on social cognitive theory is also reviewed.
Collapse
Affiliation(s)
- Charles C Benight
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO 80933, USA.
| | | | | |
Collapse
|
36
|
Rubin GJ, Amlôt R, Page L, Wessely S. Methodological challenges in assessing general population reactions in the immediate aftermath of a terrorist attack. Int J Methods Psychiatr Res 2008; 17 Suppl 2:S29-35. [PMID: 19035438 PMCID: PMC6879084 DOI: 10.1002/mpr.270] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Assessing mental health needs following a disaster is important, particularly within high-risk groups such as first responders or individuals who found themselves directly caught up in the incident. Particularly following events involving widespread destruction, ingenuity and hard work are required to successfully study these issues. When considering responses among the general population following less devastating events such as a conventional terrorist attack, or following an event involving a chemical, biological, radiological or nuclear agent, other variables may become more relevant for determining the population's overall psychosocial well-being. Trust, perceived risk, sense of safety, willingness to take prophylaxis and unnecessary attendance at medical facilities will all be important in determining the overall psychological, medical, economic and political impact of such attacks. Assessing these variables can help government agencies and non-governmental organizations to adjust their communication and outreach efforts. As there is often a need to provide these data quickly, telephone surveys using short time-windows for data collection or which use quota samples are often required. It is unclear whether slower, more conventional and more expensive survey methods with better response rates would produce results different enough to these quicker and cheaper methods to have a major impact on any resulting policy decisions. This empirical question would benefit from further study.
Collapse
Affiliation(s)
- G James Rubin
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK.
| | | | | | | |
Collapse
|
37
|
Population psychiatric medication prescription rates following a terrorist attack. Prehosp Disaster Med 2008; 22:479-84. [PMID: 18709935 DOI: 10.1017/s1049023x0000529x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION While several population-based studies have documented behavioral health disturbances following terrorist attacks, a number of mental health service utilization analyses present conflicting conclusions. PURPOSE The purpose of this study was to determine if mental health service utilization increased following a terrorist attack by assessing changes in psychoactive drug prescription rates. METHODS The rate of selective serotonin reuptake inhibitor (SSRI) prescriptions was measured among New York State Medicaid enrollees before and after the terrorist attacks of 11 September 2001. The association between geographic proximity to the events and changes in the rate of SSRI prescriptions around 11 September 2001 was assessed. RESULTS From September to December 2001, among individuals residing within three miles of the World Trade Center site, there was an 18.2% increase in the SSRI prescription rate compared to the previous eight-month period (p = 0.0011). While there was a 9.3% increase for non-New York City residents, this change was not statistically significant (p = 0.74). CONCLUSIONS There was a quantifiable increase in the dispensing of psychoactive drugs following the terrorist attacks of 11 September 2001, and this effect varied by geographic proximity to the events. These findings build on the growing body of knowledge on the pervasive effects of disasters and terrorist events for population health, and demonstrate the need to include mental and behavioral health as key components of surge capacity and public health response to mass traumas.
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW A sizable proportion of individuals following a disaster develop mental health problems. The consequences of these disorders can be long lasting. Only recently has research focused on mental health service delivery following disasters. This review examines the rates, predictors, and barriers to mental health service utilization following a disaster. RECENT FINDINGS Most of the data on mental health service delivery come from three sources: a fireworks disaster in The Netherlands, the September 11, 2001, attack on New York City, and hurricane Katrina. Most survivors of disasters are reluctant to utilize mental health services and face barriers to accessing care. Even among disaster victims who are severely mentally ill, only a minority receive treatment. Among those who do receive assistance, more than half drop out shortly thereafter. Mental health service utilization following a disaster is influenced by a set of predisposing characteristics, enabling resources, and perceived need. The model for mental healthcare delivery following a disaster that has gained acceptance is Psychological First Aid. SUMMARY Research is evolving on mental health service utilization. It is limited however to developed countries, although most disasters occur in developing countries. More research is needed, particularly among populations with scarce resources.
Collapse
|
39
|
DiGrande L, Perrin MA, Thorpe LE, Thalji L, Murphy J, Wu D, Farfel M, Brackbill RM. Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks. J Trauma Stress 2008; 21:264-73. [PMID: 18553414 DOI: 10.1002/jts.20345] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Manhattan residents living near the World Trade Center may have been particularly vulnerable to posttraumatic stress disorder (PTSD) after the September 11, 2001 (9/11) terrorist attacks. In 2003-2004, the authors administered the PTSD Checklist to 11,037 adults who lived south of Canal Street in New York City on 9/11. The prevalence of probable PTSD was 12.6% and associated with older age, female gender, Hispanic ethnicity, low education and income, and divorce. Injury, witnessing horror, and dust cloud exposure on 9/11 increased risk for chronic PTSD. Postdisaster risk factors included evacuation and rescue and recovery work. The results indicate that PTSD is a continued health problem in the local community. The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD.
Collapse
Affiliation(s)
- Laura DiGrande
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB, Kessler RC. Mental health service use among hurricane Katrina survivors in the eight months after the disaster. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2008. [PMID: 17978249 DOI: 10.1176/appi.ps.58.11.1403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined use of mental health services among adult survivors of Hurricane Katrina in order to improve understanding of the impact of disasters on persons with mental disorders. METHODS A geographically representative telephone survey was conducted between January 19 and March 31, 2006, with 1,043 displaced and nondisplaced English-speaking Katrina survivors aged 18 and older. Survivors who reported serious and mild-moderate mood and anxiety disorders in the past 30 days and those with no such disorders were identified by using the K6 scale of nonspecific psychological distress. Use of services, system sectors, and treatments and reasons for not seeking treatment or dropping out were recorded. Correlates of using services and dropping out were examined. RESULTS An estimated 31% of respondents (N=319) had evidence of a mood or anxiety disorder at the time of the interview. Among these only 32% had used any mental health services since the disaster, including 46% of those with serious disorders. Of those who used services, 60% had stopped using them. The general medical sector and pharmacotherapy were most commonly used, although the mental health specialty sector and psychotherapy played important roles, especially for respondents with serious disorders. Many treatments were of low intensity and frequency. Undertreatment was greatest among respondents who were younger, older, never married, members of racial or ethnic minority groups, uninsured, and of moderate means. Structural, financial, and attitudinal barriers were frequent reasons for not obtaining care. CONCLUSIONS Few Katrina survivors with mental disorders received adequate care; future disaster responses will require timely provision of services to address the barriers faced by survivors.
Collapse
Affiliation(s)
- Philip S Wang
- Interventional Research, National Institute of Mental Health, Bethesda, MD, USA
| | | | | | | | | | | | | |
Collapse
|
41
|
Brewin CR, Scragg P, Robertson M, Thompson M, d'Ardenne P, Ehlers A. Promoting mental health following the London bombings: a screen and treat approach. J Trauma Stress 2008; 21:3-8. [PMID: 18302178 PMCID: PMC2958457 DOI: 10.1002/jts.20310] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Following the 2005 London bombings, a novel public health program was instituted to address the mental health needs of survivors. In this article, the authors describe the rationale for the program, characteristics of individuals assessed within the program, and preliminary outcome data. In addition to validated screening instruments and routine service usage data, standardized questionnaire outcome measures were collected. Seventy-one percent of individuals screened positive for a mental disorder. Of those receiving a more detailed clinical assessment, PTSD was the predominant diagnosis. Preliminary outcome data on 82 patients revealed large effect sizes for treatment comparable to those previously obtained in randomized controlled trials. The program succeeded in its aim of generating many more referrals of affected individuals than came through normal referral channels.
Collapse
Affiliation(s)
| | | | | | | | | | - Anke Ehlers
- Centre for Anxiety Disorders and TraumaLondon, UK
| | | |
Collapse
|
42
|
Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB, Kessler RC. Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. Am J Psychiatry 2008; 165:34-41. [PMID: 18086749 PMCID: PMC2248271 DOI: 10.1176/appi.ajp.2007.07030502] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the disruption of ongoing treatments among individuals with preexisting mental disorders and the failure to initiate treatment among individuals with new-onset mental disorders in the aftermath of Hurricane Katrina. METHODS English-speaking adult Katrina survivors (N=1,043) responded to a telephone survey administered between January and March of 2006. The survey assessed posthurricane treatment of emotional problems and barriers to treatment among respondents with preexisting mental disorders as well as those with new-onset disorders posthurricane. RESULTS Among respondents with preexisting mental disorders who reported using mental health services in the year before the hurricane, 22.9% experienced reduction in or termination of treatment after Katrina. Among those respondents without preexisting mental disorders who developed new-onset disorders after the hurricane, 18.5% received some form of treatment for emotional problems. Reasons for failing to continue treatment among preexisting cases primarily involved structural barriers to treatment, while reasons for failing to seek treatment among new-onset cases primarily involved low perceived need for treatment. The majority (64.5%) of respondents receiving treatment post-Katrina were treated by general medical providers and received medication but no psychotherapy. Treatment of new-onset cases was positively related to age and income, while continued treatment of preexisting cases was positively related to race/ethnicity (non-Hispanic whites) and having health insurance. CONCLUSIONS Many Hurricane Katrina survivors with mental disorders experienced unmet treatment needs, including frequent disruptions of existing care and widespread failure to initiate treatment for new-onset disorders. Future disaster management plans should anticipate both types of treatment needs.
Collapse
|
43
|
van der Velden PG, Yzermans CJ, Kleber RJ, Gersons BPR. Correlates of mental health services utilization 18 months and almost 4 years postdisaster among adults with mental health problems. J Trauma Stress 2007; 20:1029-39. [PMID: 18157885 DOI: 10.1002/jts.20273] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors assess the correlates of mental health services utilization (MHS) after a disaster among adults with mental health problems. Data of a three-wave longitudinal study among adult survivors of a fireworks disaster (T1: 2-3 weeks, T2: 18 months, T3: almost 4 years postdisaster) were linked with their electronic medical records (N = 649). Multivariate logistic regression analyses showed that triple comorbidity of PTSD and high levels of anxiety and depression symptoms were positively associated with self-reported MHS utilization at T2 (n = 270) and T3 (n = 216). Private insurance, predisaster psychological problems, and relocation were associated with MHS utilization at T2 while female gender, being single, and migrant status was associated with MHS utilization at T3. Receiving treatment at T2 was positively associated with receiving treatment at T3, as opposed to medium optimism at T2.
Collapse
|
44
|
Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB, Kessler RC. Mental health service use among hurricane Katrina survivors in the eight months after the disaster. Psychiatr Serv 2007; 58:1403-11. [PMID: 17978249 PMCID: PMC2078533 DOI: 10.1176/ps.2007.58.11.1403] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined use of mental health services among adult survivors of Hurricane Katrina in order to improve understanding of the impact of disasters on persons with mental disorders. METHODS A geographically representative telephone survey was conducted between January 19 and March 31, 2006, with 1,043 displaced and nondisplaced English-speaking Katrina survivors aged 18 and older. Survivors who reported serious and mild-moderate mood and anxiety disorders in the past 30 days and those with no such disorders were identified by using the K6 scale of nonspecific psychological distress. Use of services, system sectors, and treatments and reasons for not seeking treatment or dropping out were recorded. Correlates of using services and dropping out were examined. RESULTS An estimated 31% of respondents (N=319) had evidence of a mood or anxiety disorder at the time of the interview. Among these only 32% had used any mental health services since the disaster, including 46% of those with serious disorders. Of those who used services, 60% had stopped using them. The general medical sector and pharmacotherapy were most commonly used, although the mental health specialty sector and psychotherapy played important roles, especially for respondents with serious disorders. Many treatments were of low intensity and frequency. Undertreatment was greatest among respondents who were younger, older, never married, members of racial or ethnic minority groups, uninsured, and of moderate means. Structural, financial, and attitudinal barriers were frequent reasons for not obtaining care. CONCLUSIONS Few Katrina survivors with mental disorders received adequate care; future disaster responses will require timely provision of services to address the barriers faced by survivors.
Collapse
Affiliation(s)
- Philip S Wang
- Interventional Research, National Institute of Mental Health, Bethesda, MD, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
We review the current literature relating to mental health following terrorist attacks. Studies assessing symptoms of stress in the general population and those assessing the mental health of direct victims are considered. Use of mental health services following an attack is reviewed and recommendations are offered.
Collapse
|
46
|
Abstract
In addition to physical injuries, survivors of disasters also suffer psychological trauma. Resulting mental anguish and illness can be profoundly debilitating and complicate the recovery and rehabilitation process. Front-line trauma teams caring for survivors of disasters must know the risks, assessment, and appropriate response to psychological injury. This article reviews the development of understanding mental disturbance after disasters and current approaches to evaluation and treatment.
Collapse
|
47
|
DiMaggio C, Galea S, Richardson LD. Emergency department visits for behavioral and mental health care after a terrorist attack. Ann Emerg Med 2006; 50:327-34. [PMID: 17145111 DOI: 10.1016/j.annemergmed.2006.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 10/04/2006] [Accepted: 10/19/2006] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE We assess emergency department (ED) utilization by a population whose health care encounters can be tracked and quantified for behavioral and mental health conditions in the aftermath of the terrorist attacks of September 11, 2001. METHODS We assessed presentations to EDs by using Medicaid analytic extract files for adult New York State residents for 2000 and 2001. We created 4 mutually exclusive geographic areas that were progressively more distant from the World Trade Center and divided data into 4 periods. All persons in the files were categorized by their zip code of residence. We coded primary ED diagnoses for posttraumatic stress disorder, substance abuse, psychogenic illness, severe psychiatric illness, depression, sleep disorders, eating disorders, stress-related disorders, and adjustment disorders. RESULTS There was a 10.1% relative temporal increase in the rate of ED behavioral and mental health diagnoses after the September 11, 2001, terrorist attacks for adult Medicaid enrollees residing within a 3-mile radius of the World Trade Center site. Other geographic areas experienced relative declines. In population-based comparisons, Medicaid recipients who lived within 3 miles of the World Trade Center after the September 11, 2001, terrorist attacks had a 20% increased risk of an ED mental health diagnosis (prevalence density ratio 1.2; 95% confidence interval 1.1 to 1.3) compared to those who were non-New York City residents. CONCLUSION The complex role that EDs may play in responding to terrorism and disasters is becoming increasingly apparent. To the best of our knowledge, this is the first report of a quantifiable increase in ED utilization for mental health services by persons exposed to a terrorist attack in the United States.
Collapse
Affiliation(s)
- Charles DiMaggio
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY 10032, USA.
| | | | | |
Collapse
|