Unmet Mental Health Care Need Among Asians after World Trade Center Attack a Decade Later

Background and Purpose:

Asian Americans (AA) constitute a substantial number of individuals directly exposed to the World Trade Center (WTC) due to its proximity to Chinatown and many South Asians working nearby.  The short- and long-term mental health impact of those exposed has been well documented.  AA’s mental health service underutilization pattern has persisted for decades and was revealed in the WTC study.  Mental health service use is a typical objective measure to detect service disparity, but it does not indicate mental health needs being met.  Individuals’ subjective perception of unmet mental health care need (UMHCN) provides more nuanced information on the actual service demand.  This study investigates AA’s prevalence of UMHCN 10-11 years after 9/11, and its associated factors to improve services and outreach efforts.  It was hypothesized that this group has high UMHCN due to practical and attitudinal barriers.

Methods:

The study uses data from the WTC Health Registry’s longitudinal study funded by FEMA, and examined wave 3 data at 10-11 years post-9/11.  Participants included 2,244 AA workers near WTC, passers-by, residents, and rescue/recovery workers.  UMHCN is defined as participants indicating not having received needed mental health care through medication or counseling within past year.  These unmet needs were attributed to attitudinal, economic and access barriers.  Descriptive statistics, bivariate analyses, and hierarchical logistical regression was employed to examine effects of groups of factors on UMHCN.  These factors included socioeconomic variables, mental health conditions (post-WTC mental health diagnosis, probable current mental health disorders [PTSD, Depression, Generalized Anxiety], functional impairment, and number of poor mental health days in past month), stressful events, social support, health insurance and mental health service use in past year.

Results:

Among the 11.99% of the participants indicating UMHCN, 8.7% attributed it to attitudinal, 4.9% to cost and 3.9% to access barriers (not mutually exclusive).  In the final model, participants with disrupted health insurance had the highest odds of having UMHCN.  Mental health conditions (functional impairment, mental health comorbidity, post/9/11 mental health diagnosis, ≥14 poor mental health days in past month) and lower income were significantly associated with greater odds of UMHCN, while social support was associated with lower odds.

Conclusion and Implications:

The prevalence of UMHCN among Asian Americans directly exposed to the WTC attack remained sizable a decade after the attack, and the cause of unmet need was attributed most frequently to attitudinal barriers, followed by cost and access barriers.   Thus, continued outreach efforts to Asian communities through public mental health education to increase knowledge about mental illness and the value of and options for mental health treatment, and to de-stigmatize the illness is of paramount importance.  Free and convenient access to mental health services to eligible individuals through adequate allocation of public funding is crucial to ensure that issues of cost and access will not prevent individuals from addressing their mental health needs.  Further exploration of subjective perception of UMHCN to provide information on the actual demand for mental health service and ways to improve treatment among Asian Americans is also warranted.