Mental Health and NCHS data: an under-explored resource Laura A. Pratt, PhD National Center for Health Statistics Data Users’ Conference July 11, 2006

Importance of mental illness in health research  Mental illness causes suffering in patients and families.  Mental illness is a major cause of disability and leads to high health care utilization.  Many mental illnesses are associated with higher rates of mortality from natural and external causes.  90% of completed suicides had a diagnosable mental illness at the time of their death.

NCHS data systems  National Health and Nutrition Examination Survey (NHANES)  National Health Care Survey (NHCS)  National Hospital Discharge Survey  National Ambulatory Medical Care Survey  National Nursing Home Survey  National Health Interview Survey (NHIS)

NCHS data systems  Longitudinal Studies of Aging (LSOAs)  State and Local Area Integrated Telephone Survey (SLAITS)  National Survey of Children’s Health (NSCH)  Vital Statistics  Mortality Data

National Health and Nutrition Examination Survey  Adult Mental Health (½ sample of persons aged years)  NHANES III – Diagnostic Interview Schedule (DIS)  NHANES Composite International Diagnostic Interview (CIDI)  Major depressive disorder  Dysthymia  Generalized anxiety disorder  Panic attack and panic disorder

National Health and Nutrition Examination Survey  Diagnostic Interview Schedule for Children (DISC-IV)  Modules asked of children 8-19 years  Generalized anxiety disorder, major depressive disorder, eating disorders, panic disorder, conduct disorder  Parents of children 8-15 years  Major depressive disorder, eating disorders, conduct disorder, attention deficit/hyperactivity disorder, elimination disorders

National Health and Nutrition Examination Survey  Persons 12 years of age and older  Substance use  Alcohol  Cocaine  Injection drug use  Home interview (any age)  Health professional ever said s.p. had  Attention Deficit Disorder  Learning Disability

National Health and Nutrition Examination Survey  Persons 60 years of age and older  Cognitive function ( )  Digit Symbol Substitution Test (DSST)  Starting with NHANES  Patient Health Questionnaire – 9 (PHQ-9)  Sample persons 12 years of age and older  Depression screener – depression module of PRIME- MD  Depressive symptom count and major depressive disorder diagnosis

National Health Care Survey  Encounter-based not person-based  Outpatient visits  National Ambulatory Medical Care Survey (NAMCS)  National Hospital Ambulatory Medical Care Survey (NHAMCS)  Diagnosis codes  Drug mentions  Physician specialty

Visit rates to selected specialists by age: NAMCS Rate per 100 population Age Source: Data Warehouse on Trends in Health and Aging

National Health Care Survey  Inpatient visits  National Hospital Discharge Survey (NHDS)  Diagnosis codes  Length of stay  Long-term care  National Nursing Home Survey (NNHS)

Average length of stay for serious mental illness, in days: National Hospital Discharge Survey, Source: Data Warehouse on Trends in Health and Aging Age Days

National Health Interview Survey  Adult Mental Health  NHIS 1997-present: K6 - serious psychological distress (SPD)  NHIS 1999 mental health supplement: Composite International Diagnostic Interview-short form (CIDI-SF)  Major depressive disorder  Generalized anxiety disorder  Panic attack and panic disorder

The K6 measure of psychological distress During the PAST 30 DAYS, how often did you feel...  …So sad that nothing could cheer you up?  …Nervous? ... Restless or fidgety? ... Hopeless? ... That everything was an effort? ... Worthless?

Scoring the K6 Possible responses, Likert scale:  All of the time (4)  Most of the time (3)  Some of the time (2)  A little of the time (1)  None of the time (0) Responses summed to yield a score with a range of Score ≥ 13 indicates serious psychological distress (SPD)

Prevalence of SPD by age and sex: NHIS Percent Age Source: Data Warehouse on Trends in Health and Aging

Prevalence of major depression by age and sex: NHIS 1999 percent Age Source: 1999 NHIS

National Health Interview Survey  Adult mental health  Persons with activity limitations: What condition or health problem causes you to have difficulty with …?  Adult mental health – treatment  During the past 12 months, have you seen or talked to a mental health professional?

Chronic health conditions causing limitation of activity, Persons per 1,000 population Age Source: Health US, 2005

Visits to mental health professional: NHIS and Age percent Source: Data Warehouse on Trends in Health and Aging

National Health Interview Survey  Child Mental Health  Strengths and difficulties questionnaire (SDQ)  2001, 2003, 2004 – 25 items  2002, 2005 – abbreviated, 5 items  SDQ impact supplement   Overall, do you think that {Sample child name} has difficulties in any of the following areas: emotions, concentration, behavior, or being able to get along with other people?  Child Behavior Checklist   4 questions based on 6 age/sex groups

National Health Interview Survey  Child Mental Health  Strengths and difficulties questionnaire (SDQ)  3 choices: not true, somewhat true, or certainly true  Reference period: 6 months  Examples: He/she is generally well-behaved, usually does what adults request He/she has many worries or often seems worried He/she is often unhappy, depressed or tearful He/she gets along better with adults than with other children/youths He/she has good attention span, see chores or homework through to the end

Longitudinal Studies of Aging  Longitudinal Study of Aging (LSOA)  4 interviews,  Trouble remembering things  Frequently confused  Have Alzheimer’s Disease  Second Longitudinal Study of Aging (LSOA II)  3 interviews,

Second Longitudinal Study of Aging  Baseline interview,  Cognitive symptoms  Trouble concentrating long enough to complete tasks  Frequently confused, disoriented or forgetful  Alzheimers or other senility disorder

Second Longitudinal Study of Aging  Cognitive functioning  Waves 2 and 3  Self-respondents  11 questions, 22 points  Based on Telephone Interview for Cognitive Status (TICS)  Proxy-respondents  9 questions, score from 1-5  From Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

National Survey of Children’s Health (NSCH)  Two ways to access  Through State and Local Area Integrated Telephone Survey (SLAITS) – bottom of home page under “Existing Survey Modules”  Bottom of NCHS home page under “Micro-data Access”

National Survey of Children’s Health (NSCH)  Has a doctor or health professional ever told you that {Child} has any of the following conditions?  Attention Deficit Disorder or Attention Deficit Hyperactive Disorder, that is ADD or ADHD?  Depression or anxiety problems?  Behavioral or conduct problems?  Autism?

National Survey of Children’s Health (NSCH)  Behavior problems scale (7 items)  Sample items:  is stubborn, sullen, or irritable  is unhappy, sad, or depressed  Social competence scale (4 items)  Sample item:  gets along well with other children.  Parental concerns about child (11 items)

Suicide rates by sex and age, 2002 Age Source: Data Warehouse on Trends in Health and Aging Rate per 100,000 population

Mortality from Alzheimer’s Disease as underlying cause of death or any mention, by age, 2002 Source: Data Warehouse on Trends in Health and Aging Age Rate per 100,000 population

Summary: where to go  Aggregate data on many mental health indicators can be found in the Data Warehouse on Trends in Health and Aging.  Questionnaires, documentation, and micro-data can be found on the web pages of each data system.