# Presentation: 922511

## Healthy People 2010 Focus Area 18Mental Health and Mental Disorders Progress ReviewNovember 15, 2007

## A leading cause of:
Disability
Absenteeism and lost productivity in the workplace
Affects approximately one of every four adults (2002)
$100 billion spent on treatment in 2003
Depression is associated with the development of hypertension, heart disease, diabetes, and stroke.

**A leading cause of:**
**Disability**
**Absenteeism and lost productivity in the workplace**
**Affects approximately one of every four adults (2002)**
**$100 billion spent on treatment in 2003**
**Depression is associated with the development of hypertension, heart disease, diabetes, and stroke.**

**Notes:**
Impact –  A leading cause of disability - Global mental health 1 - No health without mental health Prince, M; Patel, V; Shekhar S; Maj, M; Maselko, J; Phillips, M; Rahman, A;  LANCET 370 (9590): 859-877 SEP 8 2007
	A leading cause of absenteeism and lost productivity - Sing, M., Hill, S., & Puffer, L. (2001). Improving mental health insurance benefits without increasing costs. DHHS Publication. No. SMA 01-3542. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.	
	Affects one in four adults in 2002 – Kessler, R; Chiu W; Demler O; Walters E; Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-627.
	$100 billion spent on treatment in 2003 - Mark TL, Levit KR, Coffey RM, McKusick DR, Harwood HJ, King EC, Bouchery E, Genuardi JS, Vandivort-Warren R, Buck JA, Ryan, K. National Expenditures for Mental Health Services and Substance Abuse Treatment, 1993–2003 SAMHSA Publication No. SMA 07-4227. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2007.
	Depression is associated with incidence of:
	Hypertension - Jonas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Arch Fam Med, 6:43-49; 1997.
	Heart Disease – Wassertheil-Smoller S, Shumaker S, Ockene J, et al. Depression and cardiovascular sequelae in pstmenopausal women: the Women’s Health Initiative (WHI), Arch Intern Med 2004;164:289-298.
	Diabetes – Carnethon, M; Biggs, M; Barzilay J, et al. Longitudianl Association Between depressive symptoms and incident type 2 diabetes mellitus in older adults. Arch Intern Med. 2007;167:802-807.
	Stroke - Jonas BS, Mussolino ME. Symptoms of Depression as a Prospective Risk Factor for Stroke. Psychosomatic Medicine, 62: 463-71, 2000. 

## Prevalence of Mental Disorders in Adults, 2002             

**Percent**

**Prevalence of Mental Disorders in**** Adults, 2002****             **

**Anxiety disorders**

**Mood disorders**

***Impulse-Control disorders**

**Substance**
**disorders**

**30**

**20**

**10**

**0**

**Notes:**
All estimates are based on twelve-month Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) disorders.  Mental disorder was defined as the diagnosis of one or more of anxiety, mood, impulse-control or substance disorder.
DSM-IV diagnoses were based on the World Mental Health (WMH) Composite International Diagnostic Interview (CIDI), a fully structured lay interview that generates diagnoses according to DSM-IV criteria.  Twelve month disorders include:
Anxiety disorders - (panic disorder, generalized anxiety disorder, agoraphobia without panic disorder, specific phobia, social phobia, posttraumatic stress disorder, obsessive-compulsive disorder, separation anxiety disorder)
Mood disorders - (major depressive disorder, dysthymia, bipolar disorder I or II,)
Impulse control disorders – (oppositional defiant disorder, conduct disorder, attention-deficit/hyperactivity disorder, intermittent explosive disorder)

Any anxiety disorder		18.1
Any mood disorder		9.5
Any impulse control disorder	8.9
Any Substance disorder		3.8

At least 1 disorder		26.2
1 disorder				14.4
2 disorders				5.8
3+ disorders			6.0

## Highlighted Objectives

**Highlighted Objectives**

- * Percent of targeted progress achieved is between -10% and 10%, and/or not statistically significant.

**Target Met**
**18–3****	**** PATH clients receiving social ****	****	**** services who also receive  ****	****	****	**** mental health services**
**18–6****	**** HRSA funded primary care ****	****	****	**** facilities that provide mental ****	****	**** health treatment**
**18–11****	**** County with jail diversion****	****	****	**** programs for adults with    ****	****	****	**** serious mental illness **
**Little or No Progress***
**18–1****	**** Suicide**
**18–2****	**** Serious suicide attempts among ****	****	**** adolescents**
**18–5****	**** Adolescents engaging in        ****	****	**** disordered eating**
**18–7****	**** Use of services by children with ****	****	**** serious mental health problems**

**Baseline Only**
**18–4****	**** Employment of persons with ****	****	**** serious mental illness**
**18–9a  Treatment for serious mental ****	****	****  illness **
**18–9b****	**** Treatment for major depressive ****	****	**** disorder**
**18–9d****	**** Treatment for generalized  ****	****	****	**** anxiety disorder**

## Suicide

**Age Adjusted Rate per 100,000 Population**

**Obj. 18–1**

**0**

**1999**

**2004**

**20**

**Decrease desired**

**2010 Target: 4.8**

- NOTES:      = 95% confidence interval. Based on ICD-10 codes U03, X60–X84, Y870. Data are age adjusted to the 2000 standard population. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.
- SOURCE: National Vital Statistics System - Mortality (NVSS-M), CDC, NCHS.

**5**

**Suicide**

**Hispanic**

**Black **

**Female **

**Male**

**Total**

**15**

**10**

**White**

**American Indian/ Alaskan Native**

**Asian or**
**Pacific Islander**

**Notes:**
ICD–9 (1979–1998) – E950–E959
ICD–10 (1999–2004) – U03, X60–X84,Y870

## Suicide, 2000–2004

- NOTES: Based on ICD-10 codes U03, X60–X84, Y870.  Data are age adjusted to the 2000 standard population. Rates were calculated by health service area.  Rates are per 100,000 population.  Legend represents quintiles of the rates.
- SOURCE: National Vital Statistics System—Mortality (NVSS-M), CDC, NCHS.

**Suicide, 2000–2004**

**Obj. 18–1**

**15.7–34.5**

**13.1–15.7**

**11.5–13.1**

**9.9–11.5**

**4–9.9**

**Age Adjusted Rate**
**per 100,000**
**population**

**2010 Target: 4.8**

**Notes:**
Suicide Map
							 	2002			2002
			AADR			 	Population (#)	Population (%)

	Highest	15.8-34.5			17,526,170			5.9
			13.2-15.7			41,675,134			14.1
			11.6-13.1			38,206,174			12.9
			10.0-11.5			82,709,528			27.9
	Lowest	4.0-9.9			115,941,548		39.2

	Total						296,058,554 

## Serious Suicide Attempts Requiring Medical Attention Among Adolescents

**Percent of Students**

**Obj. 18–2**

**0**

**1999**

**2005**

**5**

**2010**
**Target:**
**1.0**

- NOTES: I= 95% confidence interval. Data are for students in grades 9 through 12. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select one or more races. The categories black and white include persons who reported only one racial group. Serious suicide attempts are those requiring medical attention
- SOURCE: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

**1**

**Serious Suicide Attempts Requiring Medical Attention Among Adolescents**

**Male **

**Female**

**Total**

**Gender**

**3**

**2**

**4**

## Adolescents Engaging in

**Percent of Students**

**Obj. 18–5**

**0**

**2001**

**2005**

**30**

**2010**
**Target:**
**16**

- NOTES: I = 95% confidence interval. Data are for students in grades 9 through 12. Disordered eating includes any of the following behaviors to lose weight or to keep from gaining weight: (a) going without eating for 24 hours or more, (b) taking diet medication without a doctor’s advice, (c) or vomiting or taking laxatives. Persons were asked to select one or more races. The categories black and white include persons who reported only one racial group and exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.
- SOURCE: Youth Risk Behavior Surveillance System (YRBSS), CDC, NCCDPHP.

**5**

**Adolescents Engaging in**
**Disordered Eating**

**Black**

**Race/ethnicity**

**White **

**Male **

**Female**

**Total**

**Gender**

**Hispanic**

**20**

**10**

**25**

**15**

**Notes:**
Persons are considered to have disordered eating if they respond “yes” to any of the questions- During the past 30 days, did you: go without eating for 24 hours or more (also called fasting) to lose weight or to keep from gaining weight?  take any diet pills, powders, or liquids without a doctor’s advice to lose weight or to keep from gaining weight? vomit or take laxatives to lose weight or to keep from gaining weight?

## Use of Services by Children with Serious Mental Health Problems

**Percent**

**Obj. 18–7**

**0**

**2001**

**2006**

**80**

**2010**
**Target:**
**67**

- NOTES: I= 95% confidence interval. The age group is 4-17 years. The black and white categories exclude persons of Hispanic origin.  Persons of Hispanic origin may be any race.  Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. Use of services include: seen or talked to a mental health professional, general doctor or receiving special educational or early intervention services.
- SOURCE: National Health Interview Survey (NHIS), CDC, NCHS.

**20**

**Use of Services by Children with Serious Mental Health Problems**

**Black**

**Race/ethnicity**

**White **

**Male **

**Female**

**Total**

**Gender**

**Hispanic**

**60**

**40**

**Notes:**
Child mental health problems are defined as definite or severe difficulties in the areas: emotions, concentration, behavior, or being able to get along with people.  Use of services include: seen or talked to a mental health professional, general doctor or receiving special educational or early intervention services.

Nearly 5% of children with serious mental health problems in 2005 (NHIS)

## Prevalence of Serious Mental Illness, Major Depressive Disorder, and Generalized Anxiety Disorder in Adults, 2002             

**Percent**

**Prevalence of Serious Mental Illness, Major Depressive Disorder, and Generalized Anxiety Disorder in Adults, 2002             **

**30**

**20**

**10**

**0**

**Serious Mental Illness**
**(Role Impairment)**

**Major Depressive**
**Disorder**

**Generalized Anxiety Disorder**

**Notes:**
All estimates are based on twelve-month Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) disorders.  Mental disorder was defined as the diagnosis of one or more of anxiety, mood, impulse-control or substance disorder.

Generalized anxiety disorder		3.1
Major depressive disorder		6.7
Serious Mental Illness 			5.6

## Employment of Persons with Serious Mental Illness, 2002

**Obj. 18–4**

**Percent Employed**

**2010 Target: 54**

**Total**

**Female**

**Male**

**Hispanic**

**Black**

**White**

**Less than high school                               **

**High school**

**At least some college**

**0**

**10**

**20**

**30**

**40**

**60**

**50**

**70**

**80**

**90**

**Employment of Persons with Serious Mental Illness, 2002**

**52%**

**Notes:**
The SMI definition required at least one Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM-IIIR) disorder other than substance use disorders in the past 12 months. The SMI definition included those with a 12-month mental disorder that interfered with their vocational capacity, their main productive role, or was associated with serious interpersonal impairment. 

The National Comorbidity Survey - Replication (NCS-R) used the WHO World Mental Health initiative version of the Composite International Diagnostic Interview (WMH-CIDI) to collect data for this objective.  Severe mental illness (SMI) is operationalized in the NCS-R as: 1) diagnosable mental, behavioral, or emotional disorders  (that meets DSM-IV criteria) ; 2) 12-month prevalence of nonaffective psychosis or mania; 3) lifetime occurrence of nonaffective psychosis or mania; or 4) a 12-month suicide attempt with serious lethality intent.  The SMI definition included those with a 12-month mental disorder that interfered with their vocational capacity, their main productive role, or was associated with serious interpersonal impairment. 

## Treatment for Adults with Serious

**Obj. 18–9a**

**Percent**

**2010 Target: 68**

**Total**

**Female**

**Male**

**Hispanic**

**Black**

**White**

**Less than high school                               **

**High school**

**At least some college**

**0**

**10**

**20**

**30**

**40**

**60**

**50**

**70**

**80**

**90**

**Treatment for Adults with Serious**
**Mental Illness, 2002**

**62%**

**Notes:**
The SMI definition required at least one Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM-IIIR) disorder other than substance use disorders in the past 12 months. The SMI definition included those with a 12-month mental disorder that interfered with their vocational capacity, their main productive role, or was associated with serious interpersonal impairment.

The National Comorbidity Survey - Replication (NCS-R) used the WHO World Mental Health initiative version of the Composite International Diagnostic Interview (WMH-CIDI) to collect data for this objective.  Severe mental illness (SMI) is operationalized in the NCS-R as: 1) diagnosable mental, behavioral, or emotional disorders  (that meets DSM-IV criteria) ; 2) 12-month prevalence of nonaffective psychosis or mania; 3) lifetime occurrence of nonaffective psychosis or mania; or 4) a 12-month suicide attempt with serious lethality intent.  The SMI definition included those with a 12-month mental disorder that interfered with their vocational capacity, their main productive role, or was associated with serious interpersonal impairment. 

## Treatment for Adults with

**Obj. 18–9b**

**2010 Target: 64**

**0**

**10**

**20**

**30**

**40**

**60**

**50**

**70**

**80                       **

**90**

**Treatment for Adults with**
**Major Depressive Disorder, 2002**

**58%**

**Percent**

**Total**

**Female**

**Male**

**Hispanic**

**Black**

**White**

**Less than high school                               **

**High school**

**At least some college**

**Notes:**
The Composite International Diagnostic Interview (CIDI) uses the Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM-IIIR) criteria to establish a diagnosis of major depressive episode.

## Treatment for Adults with

**Obj. 18–9d**

**Total**

**Female**

**Male**

**Hispanic**

**Black**

**White**

**Less than high school                               **

**High school**

**At least some college**

**0**

**10**

**20**

**30**

**40**

**60**

**50**

**70**

**90                       **

**Increase**
**desired**

**Treatment for Adults with**
**Generalized Anxiety Disorder, 2002**

**60%**

**2010 Target: 79**

*****

**Percent**

**80                       **

**Notes:**
The Composite International Diagnostic Interview (CIDI) uses the Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM-IIIR) criteria to establish a diagnosis of generalized anxiety disorder. 

## PATH Clients Receiving Social Services

**PATH Clients Receiving Social Services**
**Who Also Receive Mental Health Services**

- NOTE: Homeless adults 18 years and older in social services who may or may not be diagnosed with mental health problems.
- SOURCE: Projects for Assistance in Transition from Homelessness (PATH), SAMHSA, CMHS.

**Obj. 18-3**

**2010 Target: 30**

**Percent**

- Projects for Assistance in Transition from Homelessness (PATH)

**0**

**10**

**20**

**30**

**40**

**50**

**2000**

**2001**

**2002**

**2003**

**2004**

**2005**

**Notes:**
PATH tracks the number of homeless adults 18 years and older in social services who may or may not be diagnosed with mental health problems.  The numerator is the number of homeless PATH clients that receive mental health services.  The denominator is the number of homeless persons contacted by PATH mental health outreach workers.

## HRSA-Funded Primary Care Facilities that

**HRSA-Funded Primary Care Facilities that**
**Provide Mental Health Treatment**

- NOTE: Includes primary care facilities that provide mental health treatment on site or paid by referral.
- SOURCE: Uniform Data System (UDS), HRSA.

**Obj. 18–6**

**2010 Target: 68**

**Percent**

**0**

**20**

**40**

**60**

**80**

**2000**

**2001**

**2002**

**2003**

**2004**

**2005**

**2006**

**Notes:**
Percents are based on the number of primary care facilities that provide mental health treatment on site or paid by referral out of the total number of facilities.

## Counties with Jail Diversion Programs for

**Counties with Jail Diversion Programs for**
**Adults with Serious Mental Illness**

- NOTE: Includes programs such as specialized police responses to situations involving individuals with mental health problems, pre-booking programs, mental health courts and post-booking programs.
- SOURCE:  Mental Health Courts Survey (MHCS), SAMHSA, CMHS, DSSI.

**Obj. 18–11**

**2010 Target: 7.6**

**Percent**

**10**

**15**

**0****   **

**5**

**2004**

**2005**

**2006**

**Notes:**
Counties with diversion programs include a variety of programs such as specialized police responses to situations involving individuals with mental health problems, pre-booking programs, mental health courts and post-booking programs. The SMI definition required at least one Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM-IIIR) disorder other than substance use disorders in the past 12 months. The SMI definition included those with a 12-month mental disorder that interfered with their vocational capacity, their main productive role, or was associated with serious interpersonal impairment.

## Little or no progress for:
Suicide
Adolescent suicide attempts
Adolescent disordered eating 
Use of services by children
Target met: HRSA, SAMHSA treatment programs
Treatment rates for serious mental illness, major depressive disorder, and generalized anxiety disorder:
Lower for Hispanics and blacks compared to whites
Lower for males compared to females
Adolescents–girls have significantly higher disordered eating compared to boys

- Suicide
- Adolescent suicide attempts
- Adolescent disordered eating
- Use of services by children
- Target met: HRSA, SAMHSA treatment programs
- Treatment rates for serious mental illness, major depressive disorder, and generalized anxiety disorder:
- Lower for Hispanics and blacks compared to whites
- Lower for males compared to females
- Adolescents–girls have significantly higher disordered eating compared to boys

**Summary**

## Status of Mental Health and Mental

**Disorders ****Objectives**
**              **

- * Percent of targeted progress achieved is between -10% and 10%.

**Target met**
**18–3****	****PATH clients receiving social ****	****	****	****services who also receive mental ****	****	****health services**
**18–6****	****HRSA funded primary care ****	****	****	****facilities that provide mental ****	****	****	****health treatment**
**18–11****	****County with jail diversion****	****	****	****programs for adults with serious ****	****	****mental illness **
**Improving**
**18–8****	****Juvenile residential facilities that ****	****	****screen admissions for mental ****	****	****	****health problems**
**18–12****	****Consumer satisfaction with ****	****	****	****mental health services**
**Getting Worse**
**18–13****	****State mental health plans ****	****	****	****addressing cultural competence**

**Little or No Progress***
**18–1****	****Suicide**
**18–2****	****Serious suicide attempts among ****	****	****adolescents**
**18–5****	****Adolescents engaging in        ****	****	****	****disordered eating**
**18–7****	****Use of services by children with ****	****	****serious mental health problems**
**18–14****	****State mental health plans ****	****	****	****addressing care of elderly**
**Baseline Only**
**18–4****	****Employment of persons with ****	****	****	****serious mental illness**
**18–9a–d ****	****Treatment for serious mental ****	****	****	****illness, major depressive disorder, ****	****	****	****schizophrenia****, generalized anxiety ****	****	****	****disorder**
**18–10****	****Treatment for co-occurring substance ****	****	****abuse and mental disorders**

**Notes:**
 Blue = measurable
 Red = developmental; baseline data secured; target not set (pending SC approval)
 Gray = developmental; no baseline data 

## Richard J. Klein

**Chief - Health Promotion Statistics Branch**
**CDC/National Center for Health Statistics**
**rklein@cdc.gov**
**Bruce S. Jonas**
**Health Statistician **
**CDC/National Center for Health Statistics**
**bjonas@cdc.gov**
**Acknowledgments:**
**Nancy Brady ****	**** ****	****Patricia Pastor **
**Leda Gurley       ****	****	****Carter Roeber **
**Elizabeth Jackson ****	**** ****	****Shelagh Smith **
**Robert Heinssen****	****	**

## http://www.cdc.gov/nchs/hphome.htm

**Progress review data and slides**
**are available on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**