1、PSYCHIATRIC SERVICES ps.psychiatryonline.org September 2006 Vol. 57 No. 91339Objective: This study examinednews coverage of mental healthresources after the attacks of Sep-tember 11, 2001, in order to in-form mental health disaster plan-ning and response. Methods: Key-word searches resulted in a ran
2、-dom sample of stories reported inthe United States between Sep-tember 11 and 25, 2001. A total of10,428 stories combining attackand mental health terms weregathered, and a sample of 438 ar-ticles that mentioned mentalhealth formed the basis of thiscontent analysis. Results: Of the438 reports in the
3、 nationwide sam-ple, 35 (8 percent) identified atleast one risk factor for developingemotional problems after the at-tacks, 204 (47 percent) describedat least one coping mechanism, 25(6 percent) provided contact infor-mation for support, and 97 (22percent) cited expert sources.Conclusions: This expl
4、oratorystudy suggests a need to evaluateand improve the dissemination ofmental health information to helpthe public cope in the aftermath ofdisasters. (Psychiatric Services 57:13391341, 2006)In the aftermath of disasters, newsorganizations connect to the publicin unique and important ways (1).Large
5、audiences follow hurricanes orterrorist attacks via the news, andnews professionals are positionedwhere they sometimes play a criticalrole in the demand for and provisionof mental health services after a disas-ter. For example, through constantportrayals of traumatic events, newscan magnify a popula
6、tions psycholog-ical response to disaster (2). Alterna-tively, contextual information in disas-ter reporting can help the publicidentify their own responses, deter-mine if their responses are normal,and connect with social supports (3).Existing studies of mental healthnews coverage tend to focus on
7、vio-lent behaviors and criminalization ofpersons with mental illness (4). Stud-ies of disaster coverage often focus oninadequacies in reporting and mythperpetuation (5,6). Despite much re-search on the provision of mentalhealth services after disasters (7), noknown studies have examined howjournalis
8、ts portray access to mentalhealth resources in crises.To begin to address this gap, cross-sectional content analysis was used todescribe news reporting of informa-tion related to mental health in thetwo weeks after September 11, 2001.This study specifically examined howU.S. news coverage mentioned a
9、s-pects of mental health and identifiedpopulations at risk of emotional prob-lems or mental disorders, describedcoping mechanisms for emotionaldistress, provided mental health sup-port contact information, and usedexpert mental health sources.MethodsNews stories disseminated from Sep-tember 11 to 25
10、, 2001, by U.S. dailynewspapers and national, broadcast,and cable outlets were obtained fromthe LexisNexis general news data-base. Search terms representing theattacks were September 11, variantsof the terms terror, attack or attacks,Pentagon, World Trade Center, Som-erset County, Flight 11, Flight
11、175,Flight 93, and Flight 77. Search termsfor mental health were mental health,mental illness, depression, anxiety,stress, post traumatic stress, PTSD,counseling, grief, and mourning. Theresulting 10,428 stories combining at-tack and mental health terms camefrom 119 U.S. newspapers and 19broadcast a
12、nd cable outlets.To improve the efficiency of the es-timates, news organizations were di-vided into strata on the basis of threecharacteristics predicted to influencevariation in reporting: market size,geographic proximity to an attack,and medium. Newspapers were allo-cated into four strata: daily n
13、ewspa-pers that were in the top 50 circula-News Coverage Analyses of MentalHealth Services Immediately After September 11, 2001Diane Rose Renzulli, Sc.M.Felicia Mebane, Ph.D.Elaine Sieff, M.S.Ms. Renzulli is affiliated with the Depart-ment of Administration, PhiladelphiaHealth Management Corporation
14、, 260South Broad Street, Philadelphia, PA19102 (e-mail: renzulliphmc.org). Thiswork was done while Ms. Renzulli was agraduate student in the Department ofHealth and Social Behavior at the Har-vard School of Public Health. Dr. Mebaneis with the Department of Health Policyand Administration, Universit
15、y of NorthCarolina at Chapel Hill School of PublicHealth. Ms. Sieff is with Marketing Infor-mation and Research, University of NorthCarolina Health Care, Chapel Hill. Thisbrief report is part of a special issue ofPsychiatric Services commemorating thefive-year anniversary of the September11, 2001, a
16、ttacks.Brief Reportren.qxd 8/21/2006 10:14 AM Page 1339tion and were located close to an at-tack, daily newspapers that were inthe top 50 circulation and were notlocated close to an attack, daily news-papers that were not in the top 50 cir-culation and were located close to anattack, and daily newsp
17、apers thatwere not in the top 50 circulation andwere not located close to an attack.National broadcast and cable tran-scripts were allocated into a fifth stra-tum. A 7 percent random sample wasselected from each stratum, with anoversample of stratum 3 to ensure ad-equate representation. After elimi-
18、nating duplicates, the final samplecontained 772 news stories.Two research assistants each codedhalf of the stories. To measure inter-rater agreement, both coded everytenth one. Four elements of each sto-ry were captured: at-risk populations,coping mechanisms, contact informa-tion for mental health
19、support, andexpert mental health sources. Theagreement rate across all study vari-ables was 72 percent.We attempted to determine theproportion of nationwide reports onthe attacks that addressed mentalhealth issues. Terms related to the at-tacks but not to mental health wereused to search the same Le
20、xisNexisdatabase used in creating our sample.This yielded more than 1,000 storiesper day during the two weeks afterSeptember 11, 2001. Because theLexisNexis software cannot providean exact story count if search termsyield more than 1,000 stories per day,this approach was not feasible.In an alternati
21、ve approach, we usedterms related to the attacks but not tomental health to search 17 print newssources in the LexisNexis databasefor New York State. From thatarchive, 10,510 articles mentionedthe attacks during the study period.Of these reports, a subsequent searchfound that 1,516 (14 percent) men-
22、tioned mental health terms. By usingthe assumption (based on our resultsbelow) that 57 percent of the articlesthat mentioned the attacks and men-tal health services together would berelevant to our search (that is, thecombination of search terms was notrandom), 864 of the 1,516 articleswould be rele
23、vant to our study, or 8percent overall (864 of 10,510). Eightpercent is likely an overestimate ofmental health reporting throughoutthe United States in the aftermath ofSeptember 11, 2001, given that thedemand for mental health serviceswas likely greatest in New York City,the location of Ground Zero,
24、 andtherefore, more news stories fromthis area would mention these issues.ResultsOf the 772 news stories sampled fromreports mentioning the attacks andmental health services together, 438of these stories (57 percent) were rel-evant to our study. The remaininganalysis focuses on these 438 mentalhealt
25、h stories.Thirty-five of the mental health sto-ries (8 percent) included at least onerisk factor for developing emotionalproblems after the attacks. Six of thestories (1 percent) mentioned risk as-sociated with personal health history.Three stories (1 percent) mentionedan indirect experience, such a
26、s watch-ing the attacks on television. Themost frequently mentioned risk fac-tor for developing emotional prob-lems, direct experience of the trauma,appeared in 29 stories (7 percent).As shown in Table 1, one or morecoping strategies for dealing withemotional problems after the attacksappeared in 20
27、4 stories (47 percent).Of those 204 stories, seeking assis-tance from clergy or a religious groupwas the most frequently cited copingmechanism; 116 stories (57 percent)included that information. Seekingassistance from a health professionalor health institution was mentionedless frequently: 25 storie
28、s (12 per-cent) included that information.Contact information for mentalhealth support by telephone orthrough the Internet was mentionedin 20 stories (6 percent).Ninety-seven stories (22 percent)cited an expert source. Health profes-sionals were the most frequently citedexperts and were mentioned in
29、 42stories (10 percent), followed by 31 (7percent) citing religious leaders and30 (7 percent) citing academic re-searchers.DiscussionOur analyses show that a majority ofnews reports about the attacks did notmention mental health issues. Whenmental health was mentioned, infor-mation that could assist
30、 the country incoping with the psychological after-math of the attacks was lacking. Fewarticles alerted news audiences to riskfactors likely to influence their psy-chological reaction to the attacks ofSeptember 11, 2001, missing an op-portunity to prompt audiences to as-sess their reactions. For peo
31、ple whorecognized their risk of developingemotional problems or who soughthelp for themselves or loved ones,PSYCHIATRIC SERVICES ps.psychiatryonline.org September 2006 Vol. 57 No. 91340Table 1News reports mentioning mental health and ways to cope in the immediate aftermath of the terrorist attacks o
32、f September 11, 2001, disseminated betweenSeptember 11 and 25, 2001 (N=204)aCoping mechanism N %Seek assistance from clergy or a religious group 116 57Donate services, money, or blood 85 42Seek assistance from family or friends 42 21Reduce stress 30 15Seek assistance from health professionalsor inst
33、itutions 25 12Limit exposure to media coverage of the event 25 12Seek assistance from an employer 11 5Seek assistance from school counselorsand other sources 10 5Seek assistance from a crisis hotline 4 2Seek assistance from a government agency 2 1Seek assistance from a charity 2 1Other 11 5aOf the 4
34、38 reports examined, 234 (53 percent) did not mention any coping mechanisms and 204(47 percent) listed at least one coping mechanism.ren.qxd 8/21/2006 10:14 AM Page 1340about half of the mental health arti-cles described general coping mecha-nisms. Very few stories provided spe-cific contact informa
35、tion to link audi-ences with specific resources.This news coverage highlighted therange of formal and informal re-sources that people rely on in crisissituations. For example, news organi-zations portrayals of clergy as asource of support mirrors researchshowing that people turn to religiousand spir
36、itual coping mechanisms af-ter exposure to mass disaster (8). In-formal coping mechanismssuch asseeking help from clergy, family, orfriends; making donations; or reduc-ing stresswere cited much morefrequently than formal coping mech-anismssuch as seeking help fromhealth professionals, employers,scho
37、ol counselors, crisis hotlines, gov-ernment agencies, or charities. Al-though health professionals were notthe most frequently cited copingmechanism, they were cited most fre-quently as an expert source.One limitation of this study is thelack of precision in mental healthkeywords used to conduct a s
38、earch ofthe LexisNexis database. Additionalterms may have captured a higherpercentage of relevant articles. Inaddition, we based the assessment ofgaps in coverage on an assumptionthat if at least 50 percent of the rele-vant articles mentioned key informa-tion about risk factors for emotionaldistress
39、 or factors for coping withsuch distress, the information wouldbe adequately disseminated. Betterguidelines for reporting on mentalhealth issues and assessing the re-sults are needed and could be mod-eled on work by the Dart Center onJournalism and Trauma at the Uni-versity of Washington and the Ass
40、o-ciation of Health Care Journalists.Finally, although these news sourcesare representative of the news out-lets in LexisNexis, it is not clear howadequately all news coverage is rep-resented.ConclusionsThe results suggest that further con-sideration of mental health reportingafter disasters is warr
41、anted. For ex-ample, health professionals were atop source for information in thesereports and were tied for fifth placeas a mentioned source for help. Thiscombination may reflect journalistsreliance on medical experts to ex-plain health issues but a reluctanceto recommend mental health servic-es. T
42、o the extent that information inthe news helps to triage potential pa-tients, the result may be a subopti-mal demand for psychiatric care. Pa-tients needing psychiatric care mayinstead be treated inadequately inother settings. Additional research isrequired to explain whether thistrend results from
43、journalists train-ing or preferences for objectivity orwhether it reflects a cultural stigmatoward mental illnesses, in whichjournalists are reluctant to mention aresource that they assume readerswould rather avoid. Further efforts to understand thedissemination of mental health infor-mation in a cr
44、isis could assist mentalhealth experts and journalists to ex-pand their abilities in helping thepublic cope with disasters.AcknowledgmentsThe authors thank Kristina Hanson,Shoou-Yih Daniel Lee, Andrew Perrin,Chanequa Walker-Barnes, and WendyWolford for commenting on the manu-script. The authors also
45、 thank AshleyManos, Carrie Johnson, Katrina Rank-ins, and especially Suja Rajan for theirassistance.References1. Perez-Lugo M: Media uses in disaster situ-ations: a new focus on the impact phase.Sociological Inquiry 74:210225, 20042. Ahern J, Galea S, Resnick H, et al: Televi-sion images and psychol
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47、. Sieff EM: Media frames of mental illness:the potential impact of negative frames.Journal of Mental Health 12:259269, 20035. Fischer HW: Response to Disaster: Fact vsFiction and Its Perpetuation, 2nd ed. Uni-versity Press of America, 19986. Quarantelli EL: Local mass media opera-tions in disasters
48、in the USA. Disaster Pre-vention and Management 5:510, 19967. Norris F, Friedman JF, Watson PJ, et al:60,000 disaster victims speak: part II. sum-mary and implications of the disaster men-tal health research. Psychiatry 65:240 260,20028. Schuster MA, Stein BD, Jaycox L, et al: Anational survey of stress reactions after theSeptember 11, 2001, terrorist attacks. NewEngland Journal of Medicine 345:15071512, 2001PSYCHIATRIC SERVICES ps.psychiatryonline.org September 2006 Vol. 57 No. 91341ren.qxd 8/21/2006 10:14 AM Page 1341
