Frequencies and predictors of barriers to mental health service use: a longitudinal study of Hurricane Ike survivors

Sarah R. Lowe, David S. Fink, Fran H. Norris, Sandro Galea

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish
Pages (from-to)99-108
Number of pages10
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number1
StatePublished - 1 Jan 2015


  • Barriers to service use
  • Mental health services
  • Natural disasters
  • Posttraumatic stress
  • Stigma


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