This revised B-Start application proposes to assess barriers to mental health treatment in disaster relief workers deployed to the site of the World Trade Center attacks of September 11, 2001. Although empirically supported treatments for Post-traumatic Stress Disorder (PTSD) exist, epidemiological studies indicate that only 38% of PTSD sufferers in any given year are treated. Since untreated PTSD can be chronic and impinge on health, social relationships, and educational/occupational performance, it is imperative to study factors that influence treatment seeking-especially in disaster workers who face duty-related trauma exposure yet are typically reluctant to seek professional help. The 3 primary aims of the study are: (1) identify what kinds of professional services disaster workers do seek for PTSD (e.g., medical, mental health, spiritual, or other); (2) identify reasons disaster workers do not avail themselves of professional help (e.g., lack of perceived need, financial concerns, inaccessibility of treatment, stigma, or beliefs/attitudes about efficacy of treatment); and, (3) identify reasons disaster workers drop out of treatment. The study will piggy-back on an ongoing program of psychological screening of 3,800 utility workers deployed to the WTC site, thus making use of a unique opportunity to reach those have not connected with mental health services. Preliminary screening findings indicated that 17% of disaster workers in this sample had full or subsyndromal PTSD, yet only 10% of those with PTSD were in mental health treatment at time of interview. This study will employ questions adapted from the National Comorbidity Survey, which though designed to assess psychiatric disorders in the general population also examined health service utilization, and yielded data that have been widely published. For the purposes of this study, data will be collected on disaster workers diagnosed with full or subsyndromal PTSD on the basis of structured clinical interview (n = 350). Findings will be used to develop a brief motivational interview that can be used by any clinician to engage symptomatic disaster workers in treatment. ? ? ?
