Emergency department visits for Behavioral and mental health care after a terrorist attack
Emergency department visits for Behavioral and mental health care after a terrorist attack
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DOI：
10.1016/j.annemergmed.2006.10.021
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发表时间：
2007-09-01
影响因子：
6.2
通讯作者：
Richardson, Lynne D.
中科院分区：
文献类型：
--
作者：
DiMagglo, Charles;Galea, Sandro;Richardson, Lynne D.
研究目的：我们评估急诊科（艾德）的利用率的人口，其卫生保健遇到可以跟踪和量化的行为和心理健康状况的恐怖袭击后的2001.9月11日。方法：我们评估了演示文稿，ED使用医疗补助分析提取文件的成年纽约州居民2000年和2001年。我们创建了4个相互排斥的地理区域，这些区域逐渐远离世界贸易中心，并将数据分为4个时期。档案中的所有人都按居住地的邮政编码分类。我们将创伤后应激障碍、物质滥用、心因性疾病、严重精神疾病、抑郁症、睡眠障碍、进食障碍、应激相关障碍和适应障碍的主要艾德诊断编码。在2001年9月11日之后，艾德行为和精神健康诊断的比率相对时间增加了10.1%，恐怖分子袭击居住在世界贸易中心遗址3英里半径范围内的成年医疗补助注册者。其他地理区域则相对减少。在基于人群的比较中，2001年9月11日恐怖袭击后居住在世界贸易中心3英里范围内的医疗补助接受者患艾德精神健康诊断的风险增加了20（患病率密度比1.2; 95%置信区间1.1 ~ 1.3）。结论：在应对恐怖主义和灾害方面，紧急情况可能发挥的复杂作用正变得越来越明显。据我们所知，这是第一份关于美国遭受恐怖袭击的人利用艾德进行心理健康服务的数量增加的报告。
Study objective: We assess emergency department (ED) utilization by a population whose health care encounters can be tracked and quantified for behavioral and mental health conditions in the aftermath of the terrorist attacks of September 11, 2001.Methods: We assessed presentations to EDs by using Medicaid analytic extract files for adult New York State residents for 2000 and 2001. We created 4 mutually exclusive geographic areas that were progressively more distant from the World Trade Center and divided data into 4 periods. All persons in the files were categorized by their zip code of residence. We coded primary ED diagnoses for posttraurnatic stress disorder, substance abuse, psychogenic illness, severe psychiatric illness, depression, sleep disorders, eating disorders, stress-related disorders, and adjustment disorders.Results: There was a 10.1% relative temporal increase in the rate of ED behavioral and mental health diagnoses after the September 11, 2001, terrorist attacks for adult Medicaid enrollees residing within a 3-mile radius of the World Trade Center site. Other geographic areas experienced relative declines. In population-based comparisons, Medicaid recipients who lived within 3 miles of the World Trade Center after the September 11, 2001, terrorist attacks had a 20% increased risk of an ED mental health diagnosis (prevalence density ratio 1.2; 95% confidence interval 1.1 to 1.3) compared to those who were non-New York City residents.Conclusion: The complex role that EDs may play in responding to terrorism and disasters is becoming increasingly apparent. To the best of our knowledge, this is the first report of a quantifiable increase in ED utilization for mental health services by persons exposed to a terrorist attack in the United States.