Skip to main content

Advertisement

SpringerLink
Log in

Frequencies and predictors of barriers to mental health service use: a longitudinal study of Hurricane Ike survivors

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

The majority of disaster survivors suffering from psychological symptoms do not receive mental health services. Research on barriers to service use among disaster survivors is limited by a lack of longitudinal studies of representative samples and investigations of predictors of barriers. The purpose of this study was to address these limitations through analysis of a three-wave population-based study of Hurricane Ike survivors (N = 658).

Methods

Frequencies of preference, outcome expectancy, resource, and stigma barriers among participants with unmet mental health needs were documented and logistic regression using a generalized estimating equations approach explored predisposing (e.g., age), illness-related (e.g., posttraumatic stress) and enabling (e.g., insurance coverage) factors as predictors of each type of barrier.

Results

Preference barriers were most frequently cited at each wave, whereas stigma barriers were least frequently cited. Older age and higher emotional support predicted preference barriers; being a parent of a child under 18-years old at the time of the hurricane, higher generalized anxiety, and lack of insurance predicted resource barriers; and higher posttraumatic stress predicted stigma barriers.

Conclusions

These findings suggest that postdisaster practices targeting subpopulations most likely to have barriers to service use may be indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiat 52(12):1048. doi:10.1001/archpsyc.1995.03950240066012

    Article  CAS  PubMed  Google Scholar 

  2. Roberts AL, Gilman SE, Breslau J, Breslau N, Koenen KC (2011) Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med 41(1):71–83. doi:10.1017/S0033291710000401

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Norris FH, Friedman WJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K (2002) 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65(3):207–239. doi:10.1521/psyc.65.3.207.20173

    PubMed  Google Scholar 

  4. Kessler RC, Galea S, Jones RT, Parker HA (2006) Mental illness and suicidality after Hurricane Katrina. B World Health Organ 84(12):930–939. doi:10.2471/BLT.06.033011

    Article  Google Scholar 

  5. Administration for Children and Families (2013) HHS delivers more than $474 million in grants for hurricane sandy recovery. http://www.acf.hhs.gov/press/hhs-delivers-more-than-474-million-in-grants-for-hurricane-sandy-recovery. Accessed 26 June 2013

  6. Rodriguez JJ, Kohn R (2008) Use of mental health services among disaster survivors. Curr Opin Psychiatr 21(4):370–378. doi:10.1097/YCO.0b013e328304d984

    Article  Google Scholar 

  7. Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB, Kessler RC (2007) Mental health service use among Hurricane Katrina survivors in the eight months after the disaster. Psychiatr Serv 58(11):1403–1411. doi:10.1176/appi.ps.58.11.1403

    Article  PubMed Central  PubMed  Google Scholar 

  8. Stecker T, Shiner B, Watts BV, Jones M, Conner KR (2013) Treatment-seeking barriers for Veterans of the Iraq and Afghanistan conflicts who screen positive for PTSD. Psychiatr Serv 64(3):280–283. doi:10.1176/appi.ps.001372012

    Article  PubMed  Google Scholar 

  9. Sareen J, Jagdeo A, Cox B, Clara I, ten Have M, Shay-Lee B, de Graaf R, Stein M (2007) Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands. Psychiatr Serv 58(3):357–364. doi:10.1176/appi.ps.58.3.357

    Article  PubMed  Google Scholar 

  10. Mojtabai R, Olfson M, Mechanic D (2002) Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiat 59(1):77–84. doi:10.1001/archpsyc.59.1.77

    Article  PubMed  Google Scholar 

  11. Mokrue K, O’Neill P, Weiden P, Friedman S, Cavaleri M (2011) Trauma survivors’ emotional distress and barriers to early psychological intervention in an inner-city acute surgical trauma service. J Agg Maltreat Traum 20(1):58–69. doi:10.1080/10926771.2011.537600

    Article  Google Scholar 

  12. Craske MG, Edlund MJ, Sullivan G, Roy-Byrne P, Sherbourne C, Bystritsky A, Stein MB (2005) Perceived unmet need for mental health treatment and barriers to care among patients with panic disorder. Psychiatr Serv 56(8):988–994. doi:10.1176/appi.ps.56.8.988

    Article  PubMed  Google Scholar 

  13. Wang PS, Gruber MJ, Powers RE, Schoenbaum M, Speier AH, Wells KB, Kessler RC (2008) Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. Am J Psychiat 165(1):34–41. doi:10.1176/appi.ajp.2007.07030502

    Article  PubMed Central  PubMed  Google Scholar 

  14. Andersen R (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 36(1):1–10. doi:10.2307/2137284

    Article  CAS  PubMed  Google Scholar 

  15. Elhai JD, North TC, Frueh BC (2005) Health service use predictors among trauma survivors: a critical review. Psychol Serv 2(1):3–19. doi:10.1037/1541-1559.2.1.3

    Article  Google Scholar 

  16. Ojeda VD, Bergstresser SM (2008) Gender, race-ethnicity, and psychosocial barriers to mental health care: an examination of perceptions and attitudes among adults reporting unmet need. J Health Soc Behav 49(3):317–334. doi:10.1177/002214650804900306

    Article  PubMed  Google Scholar 

  17. Ouimette P, Vogt D, Wade M, Tirone V, Greenbaum MA, Kimerling R, Laffaye C, Fitt JE, Rosen CS (2011) Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder. Psychol Serv 8(3):212–223. doi:10.1037/a0024360

    Article  Google Scholar 

  18. Pietrzak R, Johnson D, Goldstein M, Malley J, Southwick S (2009) Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatr Serv 60(8):1118–1122. doi:10.1176/appi.ps.60.8.1118

    Article  PubMed  Google Scholar 

  19. Norris FH, Tracy M, Galea S (2009) Looking for resilience: understanding the longitudinal trajectories of responses to stress. Soc Sci Med 68(12):2190–2198. doi:10.1016/j.socscimed.2009.03.043

    Article  PubMed  Google Scholar 

  20. Raghunathan TE, Solenberger PW, Van Hoewyk J (2002) IVEware: imputation and variance estimation software. Survey Methodology Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI

  21. Meadows G, Harvey C, Fossey E, Burgess P (2000) Assessing perceived need for mental health care in a community survey: development of the Perceived Need for Care Questionnaire (PNCQ). Soc Psych Psych Epid 35(9):427–435. doi:10.1007/s001270050260

    Article  CAS  Google Scholar 

  22. Stuber J, Galea S, Boscarino JA, Schlesinger M (2006) Was there unmet mental health need after the September 11, 2001 terrorist attacks? Soc Psych Psych Epid 41(3):230–240. doi:10.1007/s00127-005-0022-2

    Article  Google Scholar 

  23. Smith DW, Kilpatrick DG, Falsetti SA, Best CL (2002) Postterrorism services for victims and surviving family members: Lessons from Pan Am 103. Cogn Behav Pract 9(4):280–286. doi:10.1016/S1077-7229(02)80021-9

    Article  Google Scholar 

  24. Ortega AN, Alegría M (2002) Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans. Ment Health Serv Res 4(3):131–140. doi:10.1023/A:1019707012403

    Article  PubMed  Google Scholar 

  25. Nelson CH, Park J (2006) The nature and correlates of unmet health care needs in Ontario, Canada. Soc Sci Med 62(9):2291–2300. doi:10.1016/j.socscimed.2005.10.014

    Article  PubMed  Google Scholar 

  26. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P (1998) Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Arch Gen Psychiat 55(7):626–632. doi:10.1001/archpsyc.55.7.626

    Article  CAS  PubMed  Google Scholar 

  27. Kroenke K, Spitzer RL (2002) The PHQ-9: a new depression diagnostic and severity measure. Psychiat Ann 32(9):1–9

    Google Scholar 

  28. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Internal Med 16(9):606–613. doi:10.1046/j.1525-1497.2001.016009606.x

    Article  CAS  Google Scholar 

  29. Spitzer RL, Kroenke K, Williams JBW, Lowe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Internal Med 166(10):1092–1097. doi:10.1001/archinte.166.10.1092

    Article  Google Scholar 

  30. Galea S, Tracy M, Norris FH, Coffey SF (2008) Financial and social circumstances and the incidence and course of PTSD in Mississippi during the first two years after Hurricane Katrina. J Trauma Stress 21(4):357–368. doi:10.1002/jts.20355

    Article  PubMed  Google Scholar 

  31. Boardman J, Finch BK, Ellison CG, Williams DR, Jackson JS (2001) Neighborhood disadvantage, stress, and drug use among adults. J Health Soc Behav 42(2):151–165. doi:10.2307/3090175

    Article  CAS  PubMed  Google Scholar 

  32. Blanchard E, Jones-Alexander J, Buckley T, Forneris C (1996) Psychometric properties of the PTSD checklist (PCL). Behav Res Ther 34(8):669–673. doi:10.1016/0005-7967(96)00033-2

    Article  CAS  PubMed  Google Scholar 

  33. Weathers, FW, Litz B, Herman, DS, Huska, JA, Keane, TM. (October, 1993). The PTSD checklist (PCL): reliability, validity, and diagnostic utility. Presented to the meeting of the International Society of Traumatic Stress Studies

  34. Endicott J, Nee J, Harrison W, Blumenthal R (1993) Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharma Bull 29(2):321–326

    CAS  Google Scholar 

  35. Rappaport MH, Clary C, Fayyad R, Endicott J (2005) Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatr 162(6):1171–1178. doi:10.1176/appi.ajp.162.6.1171

    Article  Google Scholar 

  36. Kaniasty K, Norris FH (2000) Help-seeking comfort and receiving social support: the role of ethnicity and context of need. Am J Commun Psychol 28(4):545–581. doi:10.1023/A:1005192616058

    Article  CAS  Google Scholar 

  37. Ballinger GA (2004) Using generalized estimating equations for longitudinal data analysis. Organ Res Meth 7(2):127–150. doi:10.1177/1094428104263672

    Article  Google Scholar 

  38. Rubin DB (1987) Multiple imputation for nonresponse in surveys. Wiley, New York

    Book  Google Scholar 

  39. Pepin R, Segal DL, Coolidge FL (2009) Intrinsic and extrinsic barriers to mental health care among community-dwelling younger and older adults. Aging Ment Health 13(5):769–777. doi:10.1080/13607860902918231

    Article  PubMed  Google Scholar 

  40. Kilmer RP, Gil-Rivas V (2010) Responding to the needs of children and families after a disaster: linkages between unmet needs and caregiver functioning. Am J Orthopsychiat 80(1):135–142. doi:10.1111/j.1939-0025.2010.01016.x

    Article  PubMed Central  PubMed  Google Scholar 

  41. Lowe SR, Chan CS, Rhodes JE (2011) The impact of child-related stressors on the psychological functioning of lower-income mothers after Hurricane Katrina. J Fam Issues 32(10):1303–1324. doi:10.1177/0192513X11412492

    Article  PubMed Central  PubMed  Google Scholar 

  42. Thoits PA (1986) Social support as coping assistance. J Consult Clin Psych 54(4):416–423. doi:10.1037/0022-006X.54.4.416

    Article  CAS  Google Scholar 

  43. McAlpine DD, Mechanic D (2000) Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk. Health Serv Res 35(1):277–292

    CAS  PubMed Central  PubMed  Google Scholar 

  44. Miller CT, Kaiser CR (2001) A theoretical perspective on coping with stigma. J Soc Issues 57(1):73–92. doi:10.1111/0022-4537.00202

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by the National Center for Disaster Mental Health Research (NIMH Grant 5 P60 MH082598) and the National Institute for Mental Health (T32-MH-13043 to SRL). The National Institute of Mental Health had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St, Room 720F, New York, NY, 10032, USA

    Sarah R. Lowe, David S. Fink & Sandro Galea

  2. Department of Psychiatry, Dartmouth Medical School, 215 North Main Street, White River Junction, VT, 05009, USA

    Fran H. Norris

Authors
  1. Sarah R. Lowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David S. Fink
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fran H. Norris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandro Galea
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah R. Lowe.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 26 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lowe, S.R., Fink, D.S., Norris, F.H. et al. Frequencies and predictors of barriers to mental health service use: a longitudinal study of Hurricane Ike survivors. Soc Psychiatry Psychiatr Epidemiol 50, 99–108 (2015). https://doi.org/10.1007/s00127-014-0908-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-014-0908-y

Keywords

Search

Navigation