Barriers to Mental Health Treatment After Disasters

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40251/2/Stuber_Barriers to Mental Health treatment After_2005.pd

Smoking and the emergence of a stigmatized social status

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60953/1/stuber_smoking and stigma_2008.pd

Gender Disparities in Posttraumatic Stress Disorder After Mass Trauma

Background: Although several studies have shown that rates of posttraumatic stress disorder (PTSD) are higher in women than in men, less is known about whether women are more vulnerable to PTSD after a major community-wide traumatic event. Objective: The aim of this study was to examine gender disparities in the prevalence of probable lifetime PTSD and probable PTSD after a mass traumatic event. Methods: A representative sample of men and women living in the New York City metropolitan area was selected using random-digit dialing, and subjects were interviewed by telephone 6 to 9 months after the September 11, 2001 (9/11) terrorist attacks. We assessed probable lifetime PTSD and probable PTSD related to the 9/11 attacks using a brief screening instrument and potential correlates. Results: A total of 2752 individuals (1479 women, 1273 men) were interviewed. The lifetime prevalence of probable PTSD was significantly higher for women than for men (17.2% vs 12.1%; P = 0.005). Experiences of sexual assault (P < 0.001), preexisting mental health problems (P = 0.04), race/ethnicity (P = 0.01), marital status (P < 0.001), and having had probable peri-event panic in the first few hours after the 9/11 attacks (P < 0.001) were all significantly related to women’s greater susceptibility to probable lifetime PTSD. However, the prevalence of probable PTSD related to 9/11 was not significantly different between women and men (6.5% vs 5.4%), although women were significantly more likely to report re-experiencing (P < 0.001) and hyperarousal (P < 0.001) symptoms than were men. Women were more likely than men to experience probable peri-event panic during the 9/11 attacks (P < 0.001); this explained, in part, the greater subsequent likelihood of re-experiencing and hyperarousal symptoms among women compared with men. Conclusions: More factors explain the risk of PTSD among women and men after interpersonal trauma than after a disaster. Using peri-event panic symptomatology after a traumatic event to determine the risk of posttraumatic symptoms may suggest avenues for intervention that can decrease the burden of PTSD in women. (Gend Med. 2006;3:54–67) Copyright © 2006 Excerpta Medica, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40296/2/Stuber_Gender Disparities in Posttraumatic Stress Disorder_2006.pd

The Association Between Multiple Domains of Discriminations and Self-Assessed Health: A Multilevel Analysis of Latinos and Blacks in Four Low-Income New York City Neighborhoods

Objective. This study examines the association between discrimination due to race and other attributes (e.g., sex, age) and self-assessed mental and physical health among Latinos and blacks. Data Source. Latino and black adult participants (n5873) identified by randomdigit dialing were interviewed by telephone in four low-income neighborhoods in New York City: the South Bronx, East Harlem, Central Harlem, and Bedford-Stuyvesant. Study Design. In this cross-sectional study, generalized estimating equations were used to fit multilevelmultivariablemodels to test the association between discrimination and poor mental and physical health while controlling for socioeconomic status, access to health care, social support, smoking, and the racial and ethnic composition of each neighborhood. Principal Findings. Discrimination due to race and discrimination due to other attributes were associated with poor self-assessed mental but not physical health in separate multivariable models. Persons who experienced multiple domains of discrimination had a greater probability of reporting poor mental health than persons who experienced no discrimination. Conclusions. Discrimination due to race and other attributes was a significant correlate of mental health among Latinos and blacks independent of other accepted determinants of health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40298/2/Stuber_The Association Between Multiple Domains_2003.pd

Unmet Need for Counseling Services by Children in New York City After the September 11th Attacks on the World Trade Center: Implications for Pediatricians

Objective. The objectives of this study were to describe the prevalence of counseling services, contrasted with the need after the terrorist attacks of September 11, 2001, the types of counseling received, and the predictors of receipt of counseling services. Methods. A cross-sectional, random-digit-dial survey was conducted in New York City (NYC) of parents (N 434) of children who were 4 to 17 years of age 4 months after the September 11th terrorist attacks on the World Trade Center. Results. Overall, 10% of NYC children received some type of counseling after the September 11th attacks, according to parental report. Among these, 44% received counseling in schools, 36% received counseling from medical or professional providers, and 20% received counseling from other sources. However, only 27% of the children who had severe/very severe posttraumatic stress reactions (PTSR) after the attacks received counseling services. In a multivariate model, receipt of counseling before the September 11th attacks (odds ratio: 4.44) and having severe/very severe PTSR (odds ratio: 3.59) were the most important predictors of use of counseling services after the September 11th attacks. Minority status and having a parent who experienced the loss of a friend or a relative were also associated with receipt of services. Conclusions. There was substantial disparity between apparent need (as indicated by severe/very severe PTSR) for and receipt of mental health services for children after the September 11th attacks. There is need for intensified efforts to identify, refer, and treat children in need, especially for children who are not already in a therapeutic relationship. An enhanced role for pediatricians is indicatedPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40387/1/Fairbrother_Unmet Need for Counseling Services_2004.pd

Disparities in Mental Health Treatment Following the World Trade Center Disaster: Implications for Mental Health Care and Health Services Research

To assess disparities in mental health treatment in New York City (NYC) after theWorld Trade Center Disaster (WTCD) reported previously related to care access, we conducted analyses among a crosssectional survey of adults who had posttraumatic stress disorder (PTSD) or major depression (N = 473) one year after the event. The dependent variables examined were use of mental health services, in general, and use of mental health services related to the WTCD. Similar dependent variables were developed for medication usage. Although a number of bivariate results were statistically significant for postdisastermental health visits, in a multivariate logistic regression model, onlyWTCD exposure remained significant. For service utilization related to the WTCD, the multivariate results indicated that African Americans were less likely to have had these visits compared toWhites, while thosewith a regular doctor, who had greater exposure toWTCD events, and those who had a perievent panic attack were more likely to have had such visits. In terms of medication use, multivariate results suggested that African Americans were less likely to use postdisaster medications, whereas persons 45 + years old and those with a regular doctor, were more likely to use them. For WTCD-related medication use, multivariate models indicated that African Americans were less likely to use medications, relative to Whites, while those between 45 and 64 years old, those with a regular doctor, those exposed to more WTCD events, and those who had a perievent panic attack, were more likely to have taken medications related to the disaster. The primary reason respondents gave for not seeking treatment (55% of subsample) was that they did not believe that they had a problem (73%). Other reasons were that they wanted to solve the problem on their own (5%), had problems accessing services (6%), had financial problems (4%), or had a fear of treatment (4%). Despite the availability of free mental health services offered in a supportive and potentially less stigmatizing environment post disaster, there still appeared to be barriers to receiving postdisaster services among those presumably in need of care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40262/2/Boscarino_Disparities in Mental Health Treatment Following_2005.pd

Social Factors Associated with AIDS and SARS

We conducted a survey of 928 New York City area residents to assess knowledge and worry about AIDS and SARS. Specific sociodemographic groups of persons were more likely to be less informed and more worried about contracting the diseases.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40253/2/Des Jarlais_Social Factors Associated with AIDS_2005.pd