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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.

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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 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


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 (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


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 2003-2004

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, 1990-2003

Days

Age

Source: Data Warehouse on Trends in Health and Aging


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 0-24.

    Score ≥ 13 indicates serious psychological distress (SPD)


Prevalence of SPD by age and sex: 2003-2004 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, 2002-03

Persons per 1,000 population

Age

Source: Health US, 2005


Visits to mental health professional: NHIS 1997-98 and 2003-04

percent

Age

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

      • 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


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, 1984-1990

      • Trouble remembering things

      • Frequently confused

      • Have Alzheimer’s Disease

  • Second Longitudinal Study of Aging (LSOA II)

    • 3 interviews, 1994-2000


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


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

Rate per 100,000 population

Age

Source: Data Warehouse on Trends in Health and Aging


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


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


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