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

描述（由申请人提供）：世界贸易中心（WTC）袭击对直接暴露于其下的人的影响是持久的，并影响他们的日常生活。由于唐人街靠近灾难现场，大量南亚人在世贸中心和附近的建筑物工作，亚裔美国人（AA）在遭受袭击的人群中占了相当大的比例。创伤给心理健康专业人员带来了重大挑战。虽然数十项研究调查了袭击对幸存者的心理健康影响，但很少有研究将亚洲人纳入研究样本。目的：这项调查以亚裔社区为对象，试图评估创伤对直接遭受袭击的个人的心理健康影响，并了解他们使用心理健康服务的模式，以便更有效地向他们提供服务。文献表明，由于文化的影响，AA倾向于强调情绪困扰的躯体表达，将巨大的耻辱感归因于精神疾病本身和精神卫生服务的使用。因此，拖延治疗和利用医疗来解决情绪困扰的身体症状是常见的。由于纽约市71%的AA是移民，语言障碍，缺乏对服务的了解，以及双语服务的缺乏也造成了使用服务的实际障碍。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。创伤后应激障碍造成的最近的创伤几乎没有研究中AA。世贸中心的袭击提供了一个独特的测试案例，以了解创伤后应激障碍在AA中的影响，看看这场被广泛认可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与AA接触。设计与方法：为了弥补知识差距，将利用世贸中心卫生登记处的大型研究进行二级数据分析，重点是袭击的幸存者和救援人员。登记处有3波数据，亚洲样本量为4，885人。历时9年的纵向研究也扩展了现有研究的视野。心理健康的影响和心理健康和医疗保健服务之间的AA将进行研究，并与白人作为参考组进行比较。还将对救援和恢复工作者以及华裔美国人进行子样本分析，以提供职业重点，并研究最大的亚裔群体。本研究的具体目的是：1）评估世贸中心袭击对AA的短期、中期和长期心理健康影响，其过程和相关危险因素，并与白人进行比较; 2）探讨匿名戒酒者使用精神卫生服务的模式，找出影响他们使用服务的有利因素和障碍，并将其与白人的这些因素进行比较，3）探讨AA和白人心理困扰与医疗服务利用的关系，以及心理困扰和身体困扰的共患对医疗服务利用的影响，揭示种族差异的内在机制。

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.