Use of mental health services among disaster survivors: predisposing factors

Mental health and well-being in older women in China: implications from the Andersen model

BACKGROUND

Mental health and well-being among older women is an important topic due to the feminization of later life as women tend to have longer life expectancy resulting in elderly women being more advanced in age and outnumbering men. Older women generally play a key role in their families lifelong and mostly depend on social support from their family and close friends in older age to cope with any limitations they face as a result of age-related changes in their health and functional ability.

METHODS

We examine which factors predict mental health and well-being in older women using the Third Wave of the 2010 Female Social Status Survey conducted by the All-China Women's Federation (n = 3527). Applying the Andersen Model, regression analysis exploring predisposing, enabling and health need variables were tested using SPSS version 22 predicting a mental health scale.

RESULTS

Results showed that living with a spouse was not a significant predictor of mental health for women, while it was for men (b = - 1.2, p < .01), ownership of property is significant only for men (b = -.96, p < .05), whereas women's mental health is more strongly predicted by current exercise (b = -.89, p < .01) and participation in leisure activities (b = -.69, p < .001). Close relationships with neighbors, qualifying for old-age benefit programs and being in better overall health supports positive mental health for both men and women. Reporting delayed medical treatment is associated with a negative impact on mental health for men, but oddly women who report the same actually report better mental health, perhaps suggesting older women take pride in their self-sacrifice.

CONCLUSION

The findings of this study suggest that gender differences in wealth, living alone, and social participation are interpreted differently by women, who have longer lives with generally fewer material resources. Enabling factors tend to be more associated with financial factors for men, while women rely on a social convoy to thrive longer than their male counterparts.

Predictors of treatment utilization and unmet treatment need among individuals with posttraumatic stress disorder from a national sample

OBJECTIVE

Posttraumatic stress disorder (PTSD) is a chronic psychiatric condition associated with significant disability that often remains untreated. Sociodemographic and family-level factors may serve as predictors of unmet treatment need, identifying groups that would most benefit from policies aimed at increasing access to the mental health care system.

METHOD

Data from the nationally representative Collaborative Psychiatric Epidemiologic Surveys were used to identify predictors of mental health treatment utilization, both with a mental health specialist and with a general health practitioner, and self-reported unmet treatment need among individuals who endorsed past-year PTSD. We defined unmet treatment need as self-reporting a mental health problem and not accessing mental health care in the general or specialty mental health care system.

RESULTS

Among 600 participants, predictors of unmet treatment need included being non-Latino black [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.25-3.54], having a high school education versus some college (OR 2.45, 95% CI 1.34-4.48), and being employed or unemployed versus not being in the workforce (OR 1.74, 95% CI 1.00-3.02 and OR 4.95, 95% CI 1.60-15.34, respectively). Recursive partitioning identified younger age and being married as predictors of low treatment utilization.

CONCLUSIONS

Future research should elucidate barriers to accessing treatment among those with PTSD in these underserved groups.

Health service utilization after terrorism: a longitudinal study of survivors of the 2011 Utøya attack in Norway

Background

For effective organization of health services after terror attacks, it is vital to gain insight into survivors’ health service utilization. Following the 2011 Utøya mass shooting in Norway, a proactive outreach programme was launched to prevent unmet help needs. All survivors received health services during the first five months, yet an important minority were not proactively followed-up. This study assessed the prevalence of health service utilization and factors associated with mental health service utilization among the survivors 5–15 months after the attack.

Methods

The study comprised data from interviews using standardised questionnaires performed 4–5 (T1) and 14–15 (T2) months after the attack. Altogether 281 of 490 (57.3%) survivors answered questions on health service utilization at T2 and were included in this study. Users and non-users of mental health services were compared using Pearson Chi Square tests (categorical variables) and independent t-tests (continuous variables). Multivariate logistic regression analyses were conducted to examine the relationship between mental health service utilization at T2 and early (model 1) and concurrent (model 2) posttraumatic stress reactions, mental distress and somatic symptoms. Both models were adjusted for age, gender and predisaster utilization of mental health services.

Results

Altogether 267 (95.0%) of 281 survivors reported contact with health services at T2, including 254 (90.4%) with ≥1 types of primary care services; and 192 (68.3%) with mental health services. In bivariate analyses, mental health service utilization was associated with female gender, injuries, PTSD, mental distress, somatic symptoms, and sleep problems. After multivariate adjustments for early symptom levels (model 1), only mental distress remained significantly associated with mental health service utilization at T2 (OR 2.8, 95% CI 1.2-6.8). In the analysis adjusting for concurrent symptom levels (model 2), only somatic symptoms were associated with mental health service utilization (OR 4.4, 95% CI 1.8-10.8).

Conclusions

The high utilization of both primary and secondary health services among young survivors 5–15 months after the attack underscores the importance of allocating resources to meet the increased demand for services over a longer time period. The results further highlight the need to address somatic symptoms in disaster survivors who receive mental health services.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-0811-6) contains supplementary material, which is available to authorized users.

Stages of drug market change during disaster: Hurricane Katrina and reformulation of the New Orleans drug market

BACKGROUND

In recent years, numerous weather disasters have crippled many cities and towns across the United States of America. Such disasters present a unique opportunity for analyses of the disintegration and reformulation of drug markets. Disasters present new facts which cannot be "explained" by existing theories. Recent and continuing disasters present a radically different picture from that of police crack downs where market disruptions are carried out on a limited basis (both use and sales). Generally, users and sellers move to other locations and business continues as usual.

METHODS

The Katrina Disaster in 2005 offered a larger opportunity to understand the functioning and processes by which drug markets may or may not survive. Utilizing a variety of qualitative data including ethnographic field notes, in-depth interview transcripts, and focus group transcripts, we investigate the operation of the New Orleans drug market before, during, and after Hurricane Katrina.

RESULTS

Our data clearly indicate that drug markets go through a series of stages in the wake of disaster in which they disintegrate and then reconstitute themselves. In the case of New Orleans, the post-Katrina drug market was radically different from the pre-Katrina drug market.

CONCLUSION

Ultimately this manuscript presents a paradigm which uses stages as a testable concept to scientifically examine the disintegration and reformulation of drug markets during disaster or crisis situations. It describes the specific processes - referred to as stages - which drug markets must go through in order to function and survive during and after a natural disaster.