title: Unmet mental health care need 10-11 years after the 9/11 terrorist attacks: 2011-2012 results from the World Trade Center Health Registry.
abstract: BACKGROUND
  There is little current information about the unmet mental health care need (UMHCN) and reasons for it among those exposed to the World Trade Center (WTC) terrorist attacks. The purpose of this study was to assess the level of UMHCN among symptomatic individuals enrolled in the WTC Health Registry (WTCHR) in 2011-2012, and to analyze the relationship between UMHCN due to attitudinal, cost, and access factors and mental health symptom severity, mental health care utilization, health insurance availability, and social support.
  
  
  METHODS
  The WTCHR is a prospective cohort study of individuals with reported exposure to the 2001 WTC attacks. This study used data from 9,803 adults who completed the 2003-2004 (Wave 1) and 2011-2012 (Wave 3) surveys and had posttraumatic stress disorder (PTSD) or depression in 2011-2012. We estimated logistic regression models relating perceived attitudinal, cost and access barriers to symptom severity, health care utilization, a lack of health insurance, and social support after adjusting for sociodemographic characteristics.
  
  
  RESULTS
  Slightly more than one-third (34.2%) of study participants reported an UMHCN. Symptom severity was a strong predictor of UMHCN due to attitudinal and perceived cost and access reasons. Attitudinal UMHCN was common among those not using mental health services, particularly those with relatively severe mental health symptoms. Cost-related UMHCN was significantly associated with a lack of health insurance but not service usage. Access-related barriers were significantly more common among those who did not use any mental health services. A higher level of social support served as an important buffer against cost and access UMHCN.
  
  
  CONCLUSIONS
  A significant proportion of individuals exposed to the WTC attacks with depression or PTSD 10 years later reported an UMHCN, and individuals with more severe and disabling conditions, those who lacked health insurance, and those with low levels of social support were particularly vulnerable.
authors.affiliation: New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA. sghuman@health.nyc.gov.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Ghuman
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brackbill
authors.forename: Steven D
authors.initials: SD
authors.lastname: Stellman
authors.forename: Mark R
authors.initials: MR
authors.lastname: Farfel
authors.forename: James E
authors.initials: JE
authors.lastname: Cone
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D055815:Young Adult