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Use of mental health services among disaster survivors: predisposing factors.
BMC Public Health. 2007 Jul 24; 7:173.BP

Abstract

BACKGROUND

Given the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000).

METHODS

Electronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2-3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0-18 months and 18-36 months post-disaster were examined using multiple logistic regression models.

RESULTS

In multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48-5.53), hostility (OR:2.04; CI:1.28-3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25-2.65), injuries as a result of the disaster (OR:1.80;CI:1.13-2.86), social functioning problems (OR:1.61;CI:1.05-2.44) and younger age (OR:0.98;CI:0.96-0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04-5.07) and hostility (OR:3.77;CI:1.51-9.40) predicted MHS utilization following 18 months post-disaster.

CONCLUSION

This study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases.

Authors+Show Affiliations

Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. dirkdenouden@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17650339

Citation

den Ouden, Dirk-Jan, et al. "Use of Mental Health Services Among Disaster Survivors: Predisposing Factors." BMC Public Health, vol. 7, 2007, p. 173.
den Ouden DJ, van der Velden PG, Grievink L, et al. Use of mental health services among disaster survivors: predisposing factors. BMC Public Health. 2007;7:173.
den Ouden, D. J., van der Velden, P. G., Grievink, L., Morren, M., Dirkzwager, A. J., & Yzermans, C. J. (2007). Use of mental health services among disaster survivors: predisposing factors. BMC Public Health, 7, 173.
den Ouden DJ, et al. Use of Mental Health Services Among Disaster Survivors: Predisposing Factors. BMC Public Health. 2007 Jul 24;7:173. PubMed PMID: 17650339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of mental health services among disaster survivors: predisposing factors. AU - den Ouden,Dirk-Jan, AU - van der Velden,Peter G, AU - Grievink,Linda, AU - Morren,Mattijn, AU - Dirkzwager,Anja J E, AU - Yzermans,C Joris, Y1 - 2007/07/24/ PY - 2006/08/18/received PY - 2007/07/24/accepted PY - 2007/7/26/pubmed PY - 2007/9/20/medline PY - 2007/7/26/entrez SP - 173 EP - 173 JF - BMC public health JO - BMC Public Health VL - 7 N2 - BACKGROUND: Given the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000). METHODS: Electronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2-3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0-18 months and 18-36 months post-disaster were examined using multiple logistic regression models. RESULTS: In multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48-5.53), hostility (OR:2.04; CI:1.28-3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25-2.65), injuries as a result of the disaster (OR:1.80;CI:1.13-2.86), social functioning problems (OR:1.61;CI:1.05-2.44) and younger age (OR:0.98;CI:0.96-0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04-5.07) and hostility (OR:3.77;CI:1.51-9.40) predicted MHS utilization following 18 months post-disaster. CONCLUSION: This study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/17650339/Use_of_mental_health_services_among_disaster_survivors:_predisposing_factors_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-173 DB - PRIME DP - Unbound Medicine ER -