Mental Health Impact and Service Use Among Asian Survivors and Rescuers Exposed to the WTC Attack

Details

• Personal Author:
  Kung W ; Liu X ; Yang L
• Description:
  The impact of the World Trade Center (WTC) attack on those directly exposed to it is long-lasting, and affects their day-to-day living. Asian Americans constituted a sizeable proportion of those exposed due to the proximity of Chinatown to the disaster site and a large number of South Asians working around WTC. However, the number of studies that examined the impact on Asian Americans' mental health and mental health service use remains small. Based on the WTC Health Registry (the Registry) data we compared between Asians and Whites. We found that Asians showed persistently high prevalence of short-, medium- and long-term diagnosable PTSD throughout the 3 waves of data collected (2-3, 5-6 and 10-11 years post 9/11), ranging from 15.6% to 17.6%, which were 5 times higher than in a non-clinical community population (3.5%). For short-term PTSD, Asians showed a significantly higher prevalence than Whites (14.6% vs 11.7%). Comparing short- to medium-term PTSD change, Asians showed a higher proportion of "chronic" PTSD (which persisted over time; 8.6% vs. 7.4%), but a lower proportion of being resilient (no PTSD at both times, 76.5% vs 79.8%). However, long-term PTSD prevalence did not show significant racial difference (15.1% vs 14.4%). The risk and protective factors for PTSD indicated racial difference in relation to socioeconomic status. Asians had significantly lower socioeconomic background, with less coping resources. Risk factors which increased the odds of PTSD included low income, having job loss due to 9/11, and being immigrants. However, some factors which decreased the odds of PTSD for Whites were not protective of Asians - higher education and being employed were protective of Whites but increased odds for or had no effect on Asians. Higher disaster exposure and the presence of lower respiratory symptoms, e.g. shortness of breath or persistent coughing, were universal risk factors of PTSD for both races. Regarding mental health service use, Asians showed a much lower prevalence within the past 12 months (15.8% vs. 26.6%). Service use was greatly driven by individuals' mental health conditions: having 14 or more poor mental health days in the past month, having serious psychological distress, and having a mental health diagnosis after 9/11 increased their odds for service use. Previous mental health access and having routine medical checkup also increased Asians' mental health service use. Our study clearly points to the need for outreach efforts to Asian Americans who had persistently high PTSD prevalence, low coping resources, and low mental health service use. Our findings signals specific Asian subgroups to target such efforts: those who had low household income, job loss due to the attack, immigrant status, high WTC exposure, and pre 9/11 mental health diagnosis (including depression and anxiety disorder). Given the low mental health service use among Asians due to strong stigma, inadequate bilingual mental health services, and their tendency to seek help for physical manifestations of psychological distress, a "bridge" between medical and psychiatric services whereby both services are available on one site could promote mental health service use. [Description provided by NIOSH]
• Subjects:
  Delivery Of Health Care Healthcare Disparities Mental Health Nervous System Occupational Health Race Factors Safety September 11 Terrorist Attacks
• Keywords:
  Coping Behavior Health Disparities Medical Care Mental Health Post-traumatic Stress Disorder Psychosocial Factors PTSD Racial Factors Sociological Factors World Trade Center WTC

  More +
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-36
• NIOSHTIC Number:
  nn:20052950
• NTIS Accession Number:
  PB2019-100182
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-010516, 2017 Sep; :1-36
• Contact Point Address:
  Winnie Kung, Ph.D., Associate Professor, Graduate School of Social Service, Fordham University, 113 West 60th Street, New York, NY 10023-7484
• Email:
  kung@fordham.edu
• Federal Fiscal Year:
  2017
• Performing Organization:
  Fordham University, New York
• Peer Reviewed:
  False
• Start Date:
  20140701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d850c3cdc2aab926a35f72d0cf3ad062c5585c1c6bbf9c9ee7ec1f512696133f63a662875abaeba532037f420fe92b375438b10f98a0f5969b896633fe7397bc
• Download URL:
  https://stacks.cdc.gov/view/cdc/218736/cdc_218736_DS1.pdf
• File Type:
  [PDF - 339.62 KB ]