title: Frequencies and predictors of barriers to mental health service use: a longitudinal study of Hurricane Ike survivors.
abstract: BACKGROUND
  The majority of disaster survivors suffering from psychological symptoms do not receive mental health services. Research on barriers to service use among disaster survivors is limited by a lack of longitudinal studies of representative samples and investigations of predictors of barriers. The purpose of this study was to address these limitations through analysis of a three-wave population-based study of Hurricane Ike survivors (N = 658).
  
  
  METHODS
  Frequencies of preference, outcome expectancy, resource, and stigma barriers among participants with unmet mental health needs were documented and logistic regression using a generalized estimating equations approach explored predisposing (e.g., age), illness-related (e.g., posttraumatic stress) and enabling (e.g., insurance coverage) factors as predictors of each type of barrier.
  
  
  RESULTS
  Preference barriers were most frequently cited at each wave, whereas stigma barriers were least frequently cited. Older age and higher emotional support predicted preference barriers; being a parent of a child under 18-years old at the time of the hurricane, higher generalized anxiety, and lack of insurance predicted resource barriers; and higher posttraumatic stress predicted stigma barriers.
  
  
  CONCLUSIONS
  These findings suggest that postdisaster practices targeting subpopulations most likely to have barriers to service use may be indicated.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St, Room 720F, New York, NY, 10032, USA, srl2143@columbia.edu.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Lowe
authors.forename: David S
authors.initials: DS
authors.lastname: Fink
authors.forename: Fran H
authors.initials: FH
authors.lastname: Norris
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D001294:Attitude to Health; D003144:Communication Barriers; D055867:Cyclonic Storms; D004190:Disasters; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D057545:Social Stigma; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013781:Texas; D055815:Young Adult