Emergency Department Visits for Behavioral and Mental Health Care After a Terrorist Attack
Received 3 August 2006; received in revised form 4 October 2006; accepted 19 October 2006. published online 12 December 2006.
Study objective
We assess emergency department (ED) utilization by a population whose health care encounters can be tracked and quantified for behavioral and mental health conditions in the aftermath of the terrorist attacks of September 11, 2001.
Methods
We assessed presentations to EDs by using Medicaid analytic extract files for adult New York State residents for 2000 and 2001. We created 4 mutually exclusive geographic areas that were progressively more distant from the World Trade Center and divided data into 4 periods. All persons in the files were categorized by their zip code of residence. We coded primary ED diagnoses for posttraumatic stress disorder, substance abuse, psychogenic illness, severe psychiatric illness, depression, sleep disorders, eating disorders, stress-related disorders, and adjustment disorders.
Results
There was a 10.1% relative temporal increase in the rate of ED behavioral and mental health diagnoses after the September 11, 2001, terrorist attacks for adult Medicaid enrollees residing within a 3-mile radius of the World Trade Center site. Other geographic areas experienced relative declines. In population-based comparisons, Medicaid recipients who lived within 3 miles of the World Trade Center after the September 11, 2001, terrorist attacks had a 20% increased risk of an ED mental health diagnosis (prevalence density ratio 1.2; 95% confidence interval 1.1 to 1.3) compared to those who were non–New York City residents.
Conclusion
The complex role that EDs may play in responding to terrorism and disasters is becoming increasingly apparent. To the best of our knowledge, this is the first report of a quantifiable increase in ED utilization for mental health services by persons exposed to a terrorist attack in the United States.
aDepartment of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY
bDepartment of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
cDepartment of Emergency Medicine, The Mount Sinai School of Medicine, New York, NY.
Address for reprints: Charles DiMaggio, PhD, MPH, PA-C, Columbia University Mailman School of Public Health, 722 West 168 Street, Rm r806, New York, NY 10032; 212-342-6920, fax 212-305-9413.
Supervising editor: Debra E. Houry, MD, MPH
Author contributions: CD, SG, and LDR all made substantive contributions to the study, and all endorse the data and conclusions. CD conceived and designed the study, received the funding, acquired the data, obtained institutional review board approval, and conducted the statistical analyses. CD, SG, and LDR interpreted the results, drafted the manuscript, and contributed to critical revisions for important intellectual content. CD takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Supported by Centers for Disease Control and Prevention Health Protection Research Initiative grant No. 1 K01 CE000494-02.
ABSTRACT