Unmet Mental Health Care Needs among Asian Americans 10⁻11 Years After Exposure to the World Trade Center Attack

Int J Environ Res Public Health. 2019 Apr 11;16(7):1302. doi: 10.3390/ijerph16071302.


This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10-11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61-3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.

Keywords: Asian Americans; World Trade Center attack; disaster; health insurance; mental health conditions; mental health service use; social support; stressful life events; unmet mental health care needs.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Asian Americans / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mental Disorders / epidemiology*
  • Mental Disorders / therapy*
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • Needs Assessment / statistics & numerical data*
  • New York City / epidemiology
  • Prevalence
  • September 11 Terrorist Attacks / statistics & numerical data*
  • Survivors / statistics & numerical data*
  • Young Adult