Mental Health Service Use Among Asian Americans Being Exposed to the World Trade Center Attack 5-6 Years Later

Background:

Considerable Asian Americans were exposed to the World Trade Center (WTC) attack.  They had significantly higher PTSD rates compared to Whites, but no study investigated their mental health service use despite their persistent underutilization pattern.  This study fills the knowledge gap.

Methods:

Based on data from the WTC Health Registry funded by CDC, we examined Asians’ service use and its associated factors 5-6 years after 9/11.  Participants were all directly exposed to the disaster, including rescue/recovery workers and workers, residents and passersby in the vicinity.  Included in this study were 2,513 Asians and 32,030 non-Hispanic Whites as a reference group.  Separate multinomial logistic regression models were run for each race based on significant factors of interest in the bivariate analyses.  Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were derived from the estimated model parameters. 

Results:

Asians had a significantly lower proportion in utilizing mental health service (counseling or medication) than Whites in the past year (15.8% vs. 26.6%, p<.0001) despite their higher proportion in probable PTSD and Severe Psychological Distress (p<.0001).  Asians’ subjective mental health measure of having >14 poor mental health days in the past month increased the chance of service use by 3 times, while having Severe Psychological Distress (K6) and probable PTSD (PCL) also enhanced such odds by 97% and 43% respectively.  Post 9/11 mental health diagnosis among Asians increased the chance of service use by 6 times, indicating effects of a history of mental disorder and knowledge of provider access.  These current and prior mental health measures were also significant for Whites though to a lesser extent.  Having routine medical checkup increased the chance of receiving treatment, likely due to health care access and general practitioners’ treatment or referral.

Being female or not married/cohabiting increased mental health service use for both races.  However, age, education, income and immigrant status which were not associated with Asians’ service use were significant in Whites.  In bivariate analyses, higher proportions of Asians with lowest income and oldest age groups used more service than otherwise, which was opposite to hypotheses and the phenomenon of Whites.  This might suggest Asians’ dependence on Medicaid/Medicare and free post-9/11 services, thereby attenuated SES’s impact in the final model.

Implications:

This study highlighted the importance of Asians’ knowledge of their mental health needs and access.  Having a mental health diagnosis could indicate knowledge of their mental health needs and provider access.  This points to the value of practitioners informing service recipients of their mental health diagnoses, educating and alerting them of future needs.  Massive public mental health education after 9/11 probably helped to destigmatize Asians’ adverse reaction to treatment, which needs to continue.  This was validated in Asians’ subjective recognition of psychological distress in greatly enhancing service use.  General health care system being possible “bridge” to mental health care highlighted the value of routine screening of patient’s mental health in checkups.  Asians’ strikingly lower service utilization indicated that much work still needs to be done to educate, outreach and effectively treat this population.