Use of Mental Health Services and Psychiatric Medications Among New Yorkers Hardly Rose After the September 11 Terrorist Attacks

Despite living through a terrorist attack, most New Yorkers did not seek more counseling or use more psychiatric medication.

NEW YORK CITY, March 25 ??? New Yorkers in the five boroughs did not substantially increase their use of mental health services or psychiatric medications in the five months after the Sept. 11 terrorist attacks, contrary to expectations and despite widespread availability of free counseling services, according to a new study by The New York Academy of Medicine published in the current issue of Psychiatric Services. In fact, mental health service use appeared to decrease after five months elapsed, following an initial spike in counseling in the first month.

???Basically, we did not see the huge increase in mental health services use in New York City after Sept. 11 that some had predicted,??? said lead author Joseph Boscarino, Ph.D., M.P.H., a Senior Scientist in the Academy???s Division of Health and Science Policy. Boscarino collaborated with Academy scientists Sandro Galea, M.D., Dr. P.H., Richard Adams, Ph.D., Jennifer Ahern, M.P.H., and David Vlahov, Ph.D., as well as with Heidi Resnick, Ph.D., of the Medical University of South Carolina in Charleston. ???Despite the wide availability of the mental health services in New York after Sept. 11, for the most part, the folks that saw mental health professionals after the attack had being seeing those professionals before the event.???

The findings were based on a random-digit-dial telephone survey of approximately 2,000 New York City adults in January and February 2002. Results were compared to those of a similar survey of nearly 1,000 Manhattan residents that the Academy conducted one to two months after Sept. 11. The surveys were conducted in English and Spanish.

More than 95 percent of adults reported no change in their frequency of mental health visits or medication use one month before the attack and five months after. Only 2.7 percent of those surveyed reported making more mental health visits at the time of the survey than in the month before the attacks; 2.8 percent reported using more prescription psychiatric medications, such as antidepressants or sleeping pills for emotional problems, than in the month before the attacks. Only 1.3 percent of those who had not been using mental health services before Sept. 11, were newly doing so. Another 3.9 percent were actually making fewer visits to a psychiatrist or counselor than before the attacks.

Racial and ethnic disparities in post-disaster mental health service use were found, which Boscarino calls ???surprising??? considering the availability of free counseling citywide. African-Americans and Hispanics were significantly less likely than whites to receive post-disaster mental health care, researchers found, as were 18- to 24-year-olds, and those without health insurance or a primary care doctor. Although those who had posttraumatic stress disorder (PTSD) or an episode of depression were more likely to use mental health services after the disaster, researchers found, even they tended not to get treatment if they lacked a doctor or insurance coverage. African-Americans and Hispanics were also less likely than whites to use medication after the attacks.

Certain groups who had been using mental health services before Sept. 11, were more likely to increase that use in the months after Sept. 11: those with a graduate school education, those who had increased alcohol use after the attacks, those who had some involvement in rescue or recovery efforts (not necessarily direct involvement), and those suffering from depression. People suffering from depression were most likely to have increased their medication use after the attacks.

???While there appeared to be an increase in mental health treatment-seeking among existing patients, this increase did not cross over to New Yorkers who did not usually see a mental health professional,??? Boscarino said. ???Our current research suggests that the average New Yorker likely had more psychological self-reliance than we originally thought.???

This Academy study is one of the few studies to examine long-term, population-level mental health service use in the community after a catastrophic event. Psychiatric Services is available online at http://psychservices.psychiatryonline.org/. The New York Academy of Medicine (www.nyam.org) 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 urban populations, especially the disadvantaged.

Posted on March 25, 2004

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