National Data on Adolescent Mental Health

1
National Data on Adolescent Mental Health
National Adolescent Health Information Center and
The Public Policy Analysis
Education Center for Middle Childhood,
Adolescent Young Adult Health,
Department of Pediatrics Institute for Health
Policy Studies
University of California, San Francisco
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21 Critical Health Objectives for Adolescents
Young Adults

• 26-11 (d) Reduce the proportion of persons
  engaging in binge drinking of alcoholic
  beverages. 12- to 17-year-olds.
• 26-10 (b) Reduce past-month use of illicit
  substances (marijuana). 12- to 17-year-olds.
• 18-01 Reduce the suicide rate. 10?to
  19?year-olds.
• 18-02 Reduce the rate of suicide attempts by
  adolescents that required medical attention. 9th
  12th grade students.
• 06-02 Reduce the proportion of children and
  adolescents with disabilities who are reported to
  be sad, unhappy, or depressed. 4- to
  17-year-olds.
• 18-07 Increase the proportion of children with
  mental health problems who receive treatment.

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Nature of Available Data

• Focus on National Data
• Promising Regional Data
• Great Smoky Mountains Study
  (e.g., Costello et al., 2003)
• MECA study (e.g., Shaffer et al., 1996)
• Local studies limited
• range of sampling, age groups, disorder
  definitions, and analyses

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These data are presented out of context and
without reference to etiology. This tends to
create the image of individuals whose problems
were instigated by internal pathology. Such an
interpretation tends to minimize attention to
environmental conditions that often are the
primary instigating causes of subsequent
emotional, behavioral, learning, and
developmental problems.
Source Youngsters Mental Health and
Psychosocial Problems What are the Data?
December 2003 UCLA School Mental Health Project
website http//smhp.psych.ucla.edu
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How Do We Measure Adolescent Mental Health
Nationally?

• Positive measures of well-being (e.g., pro-social
  activities, connectedness to parents schools)
• Broad measures of well-being or distress
  (e.g., sadness and normal routines)
• Formalized measures of MH status (e.g., scales of
  functional impairment, behavioral checklists)
• Use of Services (ranges from talked to adult to
  specific treatment facilities)

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Overview of National Data Sources
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Positive Measures of Well-Being

• Provides more rounded profile of mental health
• Few national measures monitored on an ongoing
  basis
• Major data sets include National Survey of
  Americas Families (NSAF), National Longitudinal
  Survey of Adolescent Health (AddHealth)

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Broad Measures of Well-Being or Distress

• Questions more feasible in local assessments, and
  can be compared to national data
• National trend data available
• Not linked to formal diagnoses
• Major data sets include Youth Risk Behavior
  Survey (YRBS), National Household Survey on Drug
  Use and Health (NHSDUH), National Health
  Interview Survey (NHIS), NSAF

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Formalized Assessment of MH Status

• Provides more formal, specific assessment of
  mental health status
• Less trend data available
• Less feasible for local use (e.g., can require
  long interviews by well-trained interviewers)
• Major surveys include NHIS, National
  Co-morbidity Study, AddHealth

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Use of Services

• Provides another perspective on how many youths
  need services
• Some trend data available
• Indicates extent of unmet need
• Some survey questions adaptable for local use
• Major surveys include NHSDUH, Pediatric Research
  in Office Settings (PROS), NHIS

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National Data Next Steps

• Some identification of sub-groups at risk, more
  needed
• Inconsistent age groupings, sub-group analyses
• Need to link broad measures to more formalized
  assessments specific diagnoses
• Less data on absent and out-of-school youth
• Limited trend data

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What do we know?

• A look at
• Positive measures
• Comprehensive assessment of mental health
• Specific disorders
• Suicidal behavior and ideation
• Data on services

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Positive Measures of Well-Being
Percent of Adolescents Reporting "Very Close" to
Parent in Household by Age Group, Grades 7-12,
1995
Source Resnick et al., 1997 AddHealth
Self-report
14
Positive Measures of Well-Being
Percentage of Youth with High Engagement in
School by Income Year, Ages 12-17, 1997-2002
Source Vandivere et al., 2004 NSAF Parent
report
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Overall Assessment Behavioral Emotional
Problems
Trends in Percent of Parents Reporting Child Has
High Level of Behavioral and Emotional Problems
by Age Group, Income Year, Ages 6-17, 1997-2002
Source Vandivere et al., 2004 NSAF Parent
report
16
Overall Assessment Specific Diagnoses
Percent of youth with significant problems, Ages
7-16, 1989 and 1999
Source Achenbach et al., 2003 Achenbach Scale
Self-report
17
Depression Broad Measure
Sadness or Hopelessness which Prevented Usual
Activities by Gender and Race/Ethnicity, High
School Students, 2001
Source Grunbaum et al., 2003 YRBS Self-report
18
Major Depression
Lifetime Prevalence of Major Depression
(DSM-III-R) by Age Group, Ages 15-20, 1998
Source Kessler, 1998 National Co-morbidity
Study Self-report
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Major Depression Co-morbidity

• 76 with major depression also had other
  diagnoses, two thirds of which preceded the
  depression diagnosis
• Previous diagnoses among the 76 include
• Anxiety disorders (40)
• Conduct disorders (25)
• Addictive disorders (12)
• Source Kessler, 1998

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Moderate-Severe Depression
Moderate and Severe Depression Using CES-D, High
School Students, 1995
Source Rushton et al., 2002 AddHealth
Self-report
21
Moderate-Severe Depression
Depressive Symptom, Wave 1, CES-D Scale, Grades
7-12, 1995
Source Rushton et al., 2002 AddHealth
Self-report
22
Moderate-Severe Depression
Depressive Symptoms Wave 2 by Wave 1 Category,
Grades 7-12, 1995
Source Rushton et al., 2002 AddHealth
Self-report
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Other Disorders

• Substance Abuse Dependence Disorder 8.2 of
  males and 6.2 of females, ages 12-17 (Kilpatrick
  et al., 2003)
• Conduct disorder 3.4 of adolescents in grades
  7-12, (consistent with community studies using
  all 15 criteria) (Van Dulman et al., 2002)
• Eating Disorders/bulimia symptoms 5.4 of high
  school students report using laxitives or
  vomiting to lose weight (7.8 females, 2.9 of
  males) (Grunbaum et al., 2001)

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Learning Disabilities
Learning Disabilities ADHD by Gender, Ages
12-17, 2001
Source Bloom et al., 2003 NHIS Parent report
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Suicide Attempts
Suicide Attempts by Race/Ethnicity Gender, High
School Students, 2001
Source Grunbaum et al., 2003 YRBS Self-report
26
Trends in Suicide Attempts and Ideation
Trends in Suicidal Thoughts and Behavior of High
School Students, 1991-2001
Source Grunbaum et al., 2003 YRBS Self-report
27
Receipt of Treatment/Counseling Services
Past-Year Mental Health Treatment by Gender Age
Group, Ages 12-17, 2002
Source SAMHSA., 2003 NSHDUH Self-report
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Source of Treatment/Counseling Services
Source of Mental Health Treatment/Counseling,
Ages 12-17, 2002
Source SAMHSA., 2003 NSHDUH Self-report
29
Reasons for Seeking Services
Reasons for Mental Health Treatment/Counseling in
Past Year, Ages 12-17, 2002
Source SAMHSA., 2003 NSHDUH Self-report
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What Providers See
Problems Treated by Primary Care Providers, Ages
4-15, 1996
Source Kelleher et al., 2000 Provider Report
31
Receipt of Specialty Services
Percent of Adolescents with Psychosocial Need
Receiving Specialty Mental Health Services by
Number of Indicators, Ages 6-17,1998
Source Katoaka et al., 2002NSAF Parent report
32
Unmet Need
Unmet Need for Mental Health Services by
Race/Ethnicity, Ages 6-17, 1998
Source Ringel Sturm, 1998 NSAF Parental
Report
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Local Monitoring Tools

• Bright Futures (www.brightfutures.com)
  Pediatric Symptom checklist (parents youth),
  CES-DC Depression Scale (self administer)
• UCLA Center for Mental Health in Schools
  (http//smhp.psych.ucla.edu/), University of MD
  Center for School Mental Health Assistance
  (http//csmha.umaryland.edu/)
• Youth Risk Behavior Survey (http//www.cdc.gov/ncc
  dphp/dash/yrbs/index.htm)
• Youth development surveys The Youth Survey,
  Healthy Kids Resilience Assessment, and Profiles
  of Student Life Attitudes Behaviors

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Youth Development Surveys
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National Adolescent Health Information Center
and Public Policy Analysis Education Center
for Middle Childhood, Adolescent Young Adult
Health
ON THE WEB http//nahic.ucsf.edu/ http//
policy.ucsf.edu/ BY EMAIL
nahic_at_ucsf.edu policycenter_at_ucsf.edu BY PHONE
[phone]