title: Mental health service use by cleanup workers in the aftermath of the Deepwater Horizon oil spill.
abstract: High rates of mental health (MH) problems have been documented among disaster relief workers. However, few workers utilize MH services, and predictors of service use among this group remain unexplored. The purpose of this study was to explore associations between predisposing, illness-related, and enabling factors from Andersen's behavioral model of treatment-seeking and patterns of service use among participants who completed at least one full day of cleanup work after the Deepwater Horizon oil spill and participated in home visits for the NIEHS GuLF STUDY (N = 8931). Workers reported on MH symptoms and whether they had used counseling or medication for MH problems since the oil spill. Hierarchical logistic regression models explored associations between predictors and counseling and medication use in the full sample, and type of use (counseling only, medication only, both) among participants who used either service. Analyses were replicated for subsamples of participants with and without symptom inventory scores suggestive of probable post-disaster mental illness. Having a pre-spill MH diagnosis, pre-spill service use, more severe post-spill MH symptoms, and healthcare coverage were positively associated with counseling and medication use in the full sample. Among participants who used either service, non-Hispanic Black race, pre-spill counseling, lower depression, and not identifying a personal doctor or healthcare provider were predictive of counseling only, whereas older age, female gender and pre-spill medication were predictive of medication only. The results were generally consistent among participants with and without probable post-disaster mental illness. The results suggest variability in which factors within Andersen's behavioral model are predictive of different patterns of service use among disaster relief workers.
authors.affiliation: Department of Epidemiology, Columbia University, Mailman School of Public Health, USA. Electronic address: srl2143@columbia.edu.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Lowe
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Kwok
authors.affiliation: Epidemiology and Public Health Studies, Social & Scientific Systems, Inc., USA.
authors.forename: Julianne
authors.initials: J
authors.lastname: Payne
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, USA; Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health, USA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Engel
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, USA.
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, USA.
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
mesh_terms: D000328:Adult; D000367:Age Factors; D001008:Anxiety Disorders / Q000628:therapy; D003376:Counseling; D003865:Major Depressive Disorder / Q000628:therapy; D004190:Disasters; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D059392:Petroleum Pollution; D055553:Prescription Drugs; D012066:Relief Work; D012737:Sex Factors; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy
chemical_list: D055553:Prescription Drugs
keywords: Deepwater Horizon oil spill; Disaster relief workers; Disasters; Mental health service use