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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
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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 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 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 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 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 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 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 symptoms Trouble concentrating long enough to complete tasks Frequently confused, disoriented or forgetful Alzheimers 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 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 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
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