Barriers to treatment in WTC attack disaster workers

描述(由申请人提供)：这份修订后的B-START申请建议评估被部署到2001年9月11日世贸中心袭击现场的救灾人员的心理健康治疗障碍。尽管有经验支持的创伤后应激障碍(PTSD)治疗方法，但流行病学研究表明，在任何一年，只有38%的PTSD患者得到了治疗。由于未经治疗的创伤后应激障碍可能是慢性的，并影响健康、社会关系和教育/职业表现，因此必须研究影响寻求治疗的因素--特别是在灾难工作者中，他们面临与工作有关的创伤暴露，但通常不愿寻求专业帮助。这项研究的三个主要目的是：(1)确定灾难工作人员确实向创伤后应激障碍寻求何种专业服务(例如，医疗、心理健康、精神或其他)；(2)确定灾难工作人员无法获得专业帮助的原因(例如，缺乏感知的需要、经济方面的担忧、无法获得治疗、耻辱或对治疗效果的信念/态度)；以及(3)确定灾难工作人员退出治疗的原因。这项研究将利用一项正在进行的项目，对部署在WTC现场的3800名公用事业工人进行心理筛查，从而利用一个独特的机会接触到那些没有心理健康服务的人。初步筛查结果显示，在这一样本中，17%的灾难工作人员患有完全或亚综合征创伤后应激障碍，而在访谈时，只有10%的创伤后应激障碍患者正在接受精神健康治疗。这项研究将采用改编自国家共病调查的问题，该调查虽然旨在评估普通人群中的精神障碍，但也检查了卫生服务的利用情况，并产生了已被广泛公布的数据。为了本研究的目的，将根据结构化的临床访谈(n=350)收集被诊断为完全或亚症状创伤后应激障碍的灾难工作人员的数据。调查结果将被用来开发一个简短的激励性访谈，任何临床医生都可以使用它来邀请有症状的灾难工作者参与治疗。

DESCRIPTION (provided by applicant): This revised B-Start application proposes to assess barriers to mental health treatment in disaster relief workers deployed to the site of the World Trade Center attacks of September 11, 2001. Although empirically supported treatments for Post-traumatic Stress Disorder (PTSD) exist, epidemiological studies indicate that only 38% of PTSD sufferers in any given year are treated. Since untreated PTSD can be chronic and impinge on health, social relationships, and educational/occupational performance, it is imperative to study factors that influence treatment seeking-especially in disaster workers who face duty-related trauma exposure yet are typically reluctant to seek professional help. The 3 primary aims of the study are: (1) identify what kinds of professional services disaster workers do seek for PTSD (e.g., medical, mental health, spiritual, or other); (2) identify reasons disaster workers do not avail themselves of professional help (e.g., lack of perceived need, financial concerns, inaccessibility of treatment, stigma, or beliefs/attitudes about efficacy of treatment); and, (3) identify reasons disaster workers drop out of treatment. The study will piggy-back on an ongoing program of psychological screening of 3,800 utility workers deployed to the WTC site, thus making use of a unique opportunity to reach those have not connected with mental health services. Preliminary screening findings indicated that 17% of disaster workers in this sample had full or subsyndromal PTSD, yet only 10% of those with PTSD were in mental health treatment at time of interview. This study will employ questions adapted from the National Comorbidity Survey, which though designed to assess psychiatric disorders in the general population also examined health service utilization, and yielded data that have been widely published. For the purposes of this study, data will be collected on disaster workers diagnosed with full or subsyndromal PTSD on the basis of structured clinical interview (n = 350). Findings will be used to develop a brief motivational interview that can be used by any clinician to engage symptomatic disaster workers in treatment.