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PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1367-1374

Unmet Need for Counseling Services by Children in New York City After the September 11th Attacks on the World Trade Center: Implications for Pediatricians

Gerry Fairbrother, PhD^*,, Jennifer Stuber, PhD^*, Sandro Galea, MD, MPH, Betty Pfefferbaum, MD, JD^|| and Alan R. Fleischman, MD^¶

^* Division of Health and Science Policy, New York Academy of Medicine, New York, New York
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, New York, New York
Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York
^|| Department of Psychiatry, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
^¶ Center for Urban Bioethics, The New York Academy of Medicine, New York, New York

Objective. The objectives of this study were to describe the prevalence of counseling services, contrasted with the need after the terrorist attacks of September 11, 2001, the types of counseling received, and the predictors of receipt of counseling services.

Methods. A cross-sectional, random-digit-dial survey was conducted in New York City (NYC) of parents (N = 434) of children who were 4 to 17 years of age 4 months after the September 11th terrorist attacks on the World Trade Center.

Results. Overall, 10% of NYC children received some type of counseling after the September 11th attacks, according to parental report. Among these, 44% received counseling in schools, 36% received counseling from medical or professional providers, and 20% received counseling from other sources. However, only 27% of the children who had severe/very severe posttraumatic stress reactions (PTSR) after the attacks received counseling services. In a multivariate model, receipt of counseling before the September 11th attacks (odds ratio: 4.44) and having severe/very severe PTSR (odds ratio: 3.59) were the most important predictors of use of counseling services after the September 11th attacks. Minority status and having a parent who experienced the loss of a friend or a relative were also associated with receipt of services.

Conclusions. There was substantial disparity between apparent need (as indicated by severe/very severe PTSR) for and receipt of mental health services for children after the September 11th attacks. There is need for intensified efforts to identify, refer, and treat children in need, especially for children who are not already in a therapeutic relationship. An enhanced role for pediatricians is indicated.

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Key Words: posttraumatic stress reactions • children • disaster • trauma

Abbreviations: NYC, New York City • PTSD, posttraumatic stress disorder • PTSR, posttraumatic stress reactions • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • OR, odds ratio

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Received for publication Jun 24, 2003; Accepted Oct 3, 2003.

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