Mental Health and NCHS data: an under-explored resource
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Mental Health and NCHS data: an under-explored resource
Laura A. Pratt, PhDNational Center for Health Statistics
Data Users’ ConferenceJuly 11, 2006
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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.
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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)
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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
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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
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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
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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
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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
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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
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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
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National Health Care Survey Inpatient visits
National Hospital Discharge Survey (NHDS) Diagnosis codes Length of stay
Long-term care National Nursing Home Survey (NNHS)
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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
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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
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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?
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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)
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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
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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
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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?
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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
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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
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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
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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
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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
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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
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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)
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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”
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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?
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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)
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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
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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
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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