title: Use of mental health services among disaster survivors: predisposing factors.
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.
  
  
  CONCLUSIONS
  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.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. dirkdenouden@gmail.com
authors.forename: Dirk-Jan
authors.initials: DJ
authors.lastname: den Ouden
authors.forename: Peter G
authors.initials: PG
authors.lastname: van der Velden
authors.forename: Linda
authors.initials: L
authors.lastname: Grievink
authors.forename: Mattijn
authors.initials: M
authors.lastname: Morren
authors.forename: Anja J E
authors.initials: AJ
authors.lastname: Dirkzwager
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D004190:Disasters; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*