Mental Health and NCHS data: an under-explored resource

Laura A. Pratt, PhDNational Center for Health Statistics

Data Users’ ConferenceJuly 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

0

10

20

30

40

50

60

25-44 45-54 55-64 65-74 75-84 85+

PsychiatristsOrthopedicsCardiologists

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

02468

1012141618

45-54 55-64 65-74 75-84 85+

1990199520002003

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 0-

24.Score ≥ 13 indicates serious psychological

distress (SPD)

Prevalence of SPD by age and sex: 2003-2004 NHIS

0

1

2

3

4

5

6

18-24 25-44 45-64 65-74 75+

menwomen

Percent

Age

Source: Data Warehouse on Trends in Health and Aging

Prevalence of major depression by age and sex: NHIS 1999

0123456789

10

18-24 25-44 45-64 65-74 75+

malefemale

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

0

20

40

60

80

100

120

18-44 45-54 55-64

mental illnessdiabetesheartarthritis

Persons per 1,000 population

Age

Source: Health US, 2005

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

0

1

2

3

4

5

6

7

8

18-24 25-44 45-64 65-74 75+

1997-19982003-2004

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 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 symptomsTrouble concentrating long enough to

complete tasksFrequently confused, disoriented or

forgetfulAlzheimers 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

0

10

20

30

40

50

60

25-44 45-54 55-64 65-74 75-84 85+

malefemale

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

0

200

400

600

800

1000

1200

1400

55-64 65-74 75-84 85+

UCDany mention

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.

www.cdc.gov/nchs