Mental Health Impact and Service Use Among Asian Survivors and Rescuers Exposed

描述(申请人提供)：世界贸易中心(WTC)袭击对那些直接暴露于世贸中心的人的影响是长期的，并影响他们的日常生活。由于唐人街距离灾难现场很近，而且有大量南亚人在世贸中心和附近的建筑工作，亚裔美国人(AA)在遭受袭击的人中占了相当大的比例。这种创伤给心理健康专业人员带来了重大挑战。虽然已有数十项研究调查了袭击事件对幸存者心理健康的影响，但很少有人将亚洲人纳入研究样本。目的：本次调查以亚裔社区为调查对象，旨在评估创伤对直接暴露于袭击中的个人的心理健康影响，并了解他们的心理健康服务使用模式，以便更有效地与他们接触。文献表明，由于文化的影响，再生障碍性贫血倾向于强调情绪痛苦的躯体表达，将巨大的耻辱归因于精神疾病本身和精神卫生服务的使用。因此，延误治疗和利用医疗来解决精神痛苦的身体症状是很常见的。由于纽约市71%的戒酒协会是移民，语言障碍、缺乏服务知识以及双语服务的缺乏也造成了服务使用的实际障碍。文化适应压力和袭击后唐人街周围长期的经济挫折也加剧了他们所经历的压力。再生障碍性贫血患者中很少有人研究由近期创伤引起的创伤后应激障碍。WTC袭击事件提供了一个独特的测试案例，以了解创伤后应激障碍在戒酒协会中的影响，看看这场广为人知的灾难是否对寻求帮助有改善作用，以及9/11指定的项目是否成功地接触到戒酒协会。设计与方法：为了解决知识差距，将使用WTC健康注册中心的大型研究进行二次数据分析，重点是袭击的幸存者和救援人员。注册处有3波数据，其中亚洲样本为4,885个。这项跨越9年的纵向研究也扩展了现有研究的视野。我们将研究再生障碍者的心理健康影响和心理健康及医疗保健服务的使用情况，并将其与怀特人作为参照组进行比较。还将对救援和恢复工作人员和华裔美国人进行亚样本分析，以提供职业重点，并检查最大的亚裔群体。这项研究的具体目的是：1)评估WTC袭击事件对再生障碍性贫血的短期、中期和长期心理健康影响，并与白人比较；2)研究再生障碍性贫血患者的心理健康服务使用模式，找出影响服务使用的促成因素和障碍，并将其与白人的这些因素进行比较，以更好地了解种族差异；3)研究再生障碍性贫血和白人之间的心理困扰和医疗保健使用之间的关系，以及心理和身体痛苦共存对他们使用医疗保健服务的影响，揭示潜在的种族差异的过程。

DESCRIPTION (provided by applicant): 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. Due to the proximity of Chinatown to the disaster site and a large number of South Asians working in the WTC and nearby buildings, Asian Americans (AA) constituted a sizeable proportion of those exposed to the attack. The trauma has created major challenges for mental health professionals. While dozens of studies have investigated the mental health impact of the attack on the survivors, few have included Asians in their study samples. Objectives: this investigation targets the Asian community and attempts to assess the mental health impact of the trauma to individuals directly exposed to the attack, and to understand their mental health service use patterns so as to more effective in reaching out to them. The literature has indicated that due to cultural impact AA tend to emphasize the somatic expression of emotional distress, attribute immense stigma to mental illness itself and to mental health service use. As a result, delay in treatment and the use of medical care to address physical symptoms of emotional distress is common. Since 71% of AA in New York City are immigrants, language barriers, lack of knowledge about services, and the paucity of bilingual services also created practical barriers to service use. Acculturation stress and the prolonged economic setbacks around Chinatown following the attack also aggravated the stress they experienced. PTSD resulting from recent trauma has hardly been studied among AA. The WTC attack offers a unique test case to understand the impact of PTSD among AA, to see if the widely recognized disaster had ameliorating effect on help-seeking, and if 9/11-designated programs succeeded in reaching out to AA. Design & Methods: to address the knowledge gap, secondary data analyses will be conducted using the large study of WTC Health Registry focusing on survivors and rescuers of the attack. The Registry has 3 waves of data with a large Asian sample of 4,885. The longitudinal study spanning over 9 years also extends the horizon of existing studies. Mental health impact and mental health and medical care service use among AA will be studied and compared against the Whites as a reference group. Subsample analyses of the rescue and recovery workers and Chinese Americans would also be done to provide an occupational focus and to examine the largest Asian ethnic group. Specific aims of the study are: 1)To assess the short-, medium-, and long-term mental health impact of the WTC attack on AA, its course and related risk factors, and to compare to those of the Whites; 2) To examine patterns of mental health service use and identify the enabling factors vs. barriers affecting service use among AA, and compare them with these factors among Whites, to better understand racial disparities; 3)To examine the relationship between psychological distress and medical care use among AA and Whites, and the impact of comorbidity of psychological and physical distress on their use of medical care service, to illuminate processes underlying racial disparities.