Use of Counseling, Meds Rose Slightly After Sept. 11 But Not Among Men, Young Adults, Uninsured

NEW YORK CITY, Sept. 20 -- Counseling and psychiatric medication use in New York increased only slightly after the Sept. 11 terrorist attacks, and three groups were least likely to receive either type of assistance: males, the uninsured, and New Yorkers 18-24 years old, according to new research by The New York Academy of Medicine. Details of the study will be presented for the first time on Sept. 23 at the annual meeting of the American College of Epidemiology in Albuquerque, N.M.

Cultural factors and perceived stigma may have been among the barriers keeping these populations from accessing mental health services, said lead author Joseph Boscarino, Ph.D., M.P.H., a senior scientist in the Division of Health and Science Policy at The New York Academy of Medicine. Boscarino said other studies have shown that younger people and men tend to use mental health services less frequently. But the level of use by New Yorkers overall after Sept. 11, was surprising.

"Actually, we expected post-disaster mental service use to be higher in New York than what we found, given the wide availability of these services in the city," said Boscarino, who specializes in post-traumatic stress disorder and health outcomes research in the U.S.

A related Academy study being published in October in the quarterly International Journal of Emergency Mental Health found that 19.4 percent of Manhattan residents sought professional mental help 30 days after the attack, compared to 16.9 percent in the 30 days before. The increase is statistically significant but much smaller than expected.

"Originally we thought that 30 days post-disaster may not have been sufficient time to assess large-scale changes in Manhattan, considering the city's high level of disruption at the time," said Boscarino, lead author of the journal article, entitled Utilization of Mental Health Services Following the Sept. 11th Terrorist Attacks in Manhattan. "However, preliminary results from more recent surveys are very similar. There still has not been a large increase in mental health service use."

Certain factors were associated with increased psychiatric care after the terrorist attacks, according to the journal study. These include being female, being younger than 65, suffering a panic attack during the disaster, and having experienced higher life stress before the disaster. The explanations for these associations are varied, Boscarino said. Those who suffer a panic attack may be compelled to seek help more often than others because many actually suffer from an acute physiologic reaction. Women are typically higher users of medical and mental health services. The study also found that those with moderate involvement in post-disaster recovery (such as those who made donations) were more likely to seek help than those with direct involvement (such as rescue workers) because the latter group may have experienced a delayed stress response or perhaps had access to informal support groups at the disaster site.

Both research papers are based on a random-dial telephone survey in English and Spanish of 988 adults living south of 110th Street in Manhattan. Both are also co-authored by Boscarino, Sandro Galea, M.D., M.P.H., Jennifer Ahern, M.P.H., and David Vlahov, Ph.D., all staff scientists at The New York Academy of Medicine, and Heidi Resnick, Ph.D., of the Medical University of South Carolina in Charleston. The survey was conducted between five and eight weeks after two airplanes intentionally slammed into the towers, killing 2,801 people. Of those surveyed after the tragedy, 8.8 percent met the criteria for a diagnosis of current post-traumatic stress disorder (PTSD), 9.7 percent met the criteria for major depression, and 12.6 percent reported having suffered a panic attack during the disaster.

In results to be presented at the Monday conference, researchers found that nearly half of all those with PTSD or major depression made at least one mental health visit within 30 days of the disaster. However, certain subgroups fared far worse than others, according to the study, entitled Access to Psychiatric Services in New York City Following the Sept. 11 Terrorist Attacks:

• Males: Only 27.5 percent of males with either PTSD or major depression received mental health treatment, compared to 50.7 percent of females.

• 18- to 24-Year-Olds: Only 7.3 percent of this age group with either PTSD or major depression had treatment after Sept. 11, compared to 58 percent of 45- to 64-year-olds.

• Uninsured: Only 1.1 percent of the uninsured suffering from PTSD or depression received psychiatric medications after the disaster. In contrast, 24.6 percent of the insured received post-disaster medications for these conditions.

The study showed that 11.6 percent of Manhattan residents took psychiatric medications within 30 days of the attack, and 19.4 percent had a mental health visit. Another 10 percent increased their usual frequency of mental health visits. "We are currently conducting more definitive studies in New York City, related to both access to mental care, and the effectiveness of the care received," said Boscarino, who has been conducting PTSD research for more than 20 years. "Many important questions have yet to be answered."

The New York Academy of Medicine is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on the problems affecting disadvantaged urban populations.

Posted on September 23, 2002

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