Mental Health and NCHS data: an under-explored resource

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

2. 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.

4. 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)

5. 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

6. National Health and Nutrition Examination Survey • Adult Mental Health (½ sample of persons aged 20-39 years) • NHANES III – Diagnostic Interview Schedule (DIS) • NHANES 1999-2004 Composite International Diagnostic Interview (CIDI) • Major depressive disorder • Dysthymia • Generalized anxiety disorder • Panic attack and panic disorder

7. 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

8. 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

9. National Health and Nutrition Examination Survey • Persons 60 years of age and older • Cognitive function (1999-2004) • Digit Symbol Substitution Test (DSST) • Starting with 2005-2006 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

11. 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

12. Visit rates to selected specialists by age: NAMCS 2003-2004 Rate per 100 population Age Source: Data Warehouse on Trends in Health and Aging

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

14. Average length of stay for serious mental illness, in days: National Hospital Discharge Survey, 1990-2003 Days Age Source: Data Warehouse on Trends in Health and Aging

15. 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

16. 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?

17. 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 0-24. Score ≥ 13 indicates serious psychological distress (SPD)

18. Prevalence of SPD by age and sex: 2003-2004 NHIS Percent Age Source: Data Warehouse on Trends in Health and Aging

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

20. 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?

21. Chronic health conditions causing limitation of activity, 2002-03 Persons per 1,000 population Age Source: Health US, 2005

22. Visits to mental health professional: NHIS 1997-98 and 2003-04 percent Age Source: Data Warehouse on Trends in Health and Aging

23. 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 • 2001-2005 • 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 • 1997-2000 • 4 questions based on 6 age/sex groups

24. 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

25. Longitudinal Studies of Aging • Longitudinal Study of Aging (LSOA) • 4 interviews, 1984-1990 • Trouble remembering things • Frequently confused • Have Alzheimer’s Disease • Second Longitudinal Study of Aging (LSOA II) • 3 interviews, 1994-2000

26. Second Longitudinal Study of Aging • Baseline interview, 1994-1996 • Cognitive symptoms • Trouble concentrating long enough to complete tasks • Frequently confused, disoriented or forgetful • Alzheimers or other senility disorder

27. 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)

29. 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”

30. 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?

31. 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)

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

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

35. 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. www.cdc.gov/nchs