Abstract
BackgroundGiven the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000).MethodsElectronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2–3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0–18 months and 18–36 months post-disaster were examined using multiple logistic regression models.ResultsIn multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48–5.53), hostility (OR:2.04; CI:1.28–3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25–2.65), injuries as a result of the disaster (OR:1.80;CI:1.13–2.86), social functioning problems (OR:1.61;CI:1.05–2.44) and younger age (OR:0.98;CI:0.96–0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04–5.07) and hostility (OR:3.77;CI:1.51–9.40) predicted MHS utilization following 18 months post-disaster.ConclusionThis study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases.
Highlights
Given the high prevalence of mental health problems after disasters it is important to study health services utilization
Predictors for post-disaster mental health services (MHS) use To investigate factors associated with post-disaster MHS use socio-demographic and disaster variables were entered into the first regression model
We found that disaster intrusions and avoidance reactions and symptoms of hostility were important factors to predict post-disaster MHS utilization
Summary
Given the high prevalence of mental health problems after disasters it is important to study health services utilization. Most disaster survivors experience a number of responses in the aftermath of a disaster, such as feelings of sadness, anger, guilt, numbness and sleep disturbances. These responses can be seen as normal stress reactions to an abnormal situation. Intrusions are manifested in a preoccupation with the disaster, repeated thoughts about the event, vivid memories accompanied by painful emotions or nightmares. Avoidance reactions such as emotional numbness, refusal to talk about it and avoidance of locations reminding of the traumatic event are considered as attempts to block out the intrusions. Hyperarousal is characterised by a state of nervousness, accelerated heart beat, difficulty sleeping
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