Mental health service use 1-year after the World Trade Center disaster: implications for mental health care

Abstract

The objective of this study was to assess prevalence and predictors of mental health service use in New York City (NYC) after the World Trade Center disaster (WTCD). One year after the attacks, we conducted a community survey by telephone of 2368 adults living in NYC on September 11, 2001. In the past year, 19.99% (95% confidence interval [CI]=18.2–21.77) of New Yorkers had mental health visits and 8.1% (95% CI=7.04–9.16) used psychotropic medications. In addition, 12.88% (95% CI=11.51–14.25) reported one or more visits were related to the WTCD. Compared to the year before, 8.57% (95% CI=7.36–9.79) had increased post-disaster visits and 5.28% (95% CI=4.32–6.25) had new post-disaster treatment episodes. Psychotropic medication use related to the WTCD was 4.51% (95% CI=3.75–5.26). Increased post-disaster medication use, compared to the year before, was 4.11% (95% CI=3.35–4.86) and new medication episodes occurred among 3.01% (95% CI=2.34–3.69). In multivariate logistic analyses, mental health visits were associated with younger age, peri-event panic attack, posttraumatic stress disorder (PTSD) and depression. In addition, WTCD-related visits had a positive “dose-response” association with WTCD event exposures ( P<0.0001). WTCD-related visits also were positively associated with peri-event panic, anxiety, lower self-esteem, PTSD, and depression. All three medication measures were positively related to PTSD and depression, and negatively associated with African American status. WTCD-related medication use also was positively related to younger age, female gender, WTCD event exposures, negative life events, anxiety and lower self-esteem. Finally, while the percentage of New Yorkers seeking post-disaster treatment did not increase substantially, the volume of visits among patients apparently increased. We conclude that exposure to WTCD events was related to post-disaster PTSD and depression, as well as WTCD-related mental health service use. African Americans were consistently less likely to use post-disaster medications. Although the WTCD did have an impact on treatment-seeking among current patients, it did not substantially increase mental health treatment among the general population.