OLDER ADULTS BEHAVIORAL HEALTH PROFILES

REGION 9

ARIZONA

CALIFORNIA

HAWAII

NEVADA

AMERICAN SAMOA

COMMONWEALTH OF THE NORTHERN 

MARIANA ISLANDS

FEDERATED STATES OF MICRONESIA

GUAM

MARSHALL ISLANDS

REPUBLIC OF PALAU

A Behavioral Health Resource

SAMHSA’s State Technical Assistance Contract 

September 2016

CA

NV

HI AZ
OLDER ADULTS BEHAVIORAL HEALTH PROFILES

OVERVIEW

The Substance Abuse and Mental Health Services Administration 

recognizes the importance of behavioral health for older adults and 

the key role states, territories, and communities play in addressing the 

needs of this vital and growing population. Administrators need clear 

and concise information to plan, implement, and evaluate effective 

prevention and treatment efforts in their states and territories. 

The Older Adults Behavioral Health Profiles help states, territories, and 

communities identify focus areas for behavioral health plans, select 

population-level goals, and coordinate and target services to address 

priority issues. The profiles compare state and territory trends with 

those in the region and the nation. State, territory, and community 

administrators, planners, and providers can use the information in 

these profiles and their own data, knowledge, and experience to 

establish and implement policies that improve the health and future 

of our valued older citizens.

Disclaimer: Data were current at the time this document was prepared.

Developed under the Substance Abuse and Mental Health Services Administration’s State Technical Assistance 

Task Order. Reference #HHSS283201200002I/Task Order No. HHSS28342002T.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Arizona
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

ARIZONA’S POPULATION

Arizona Population by Age Group

Arizona is home to 6,731,484 people. 

Of these:

• 2,296,712 (34.1 percent) are over age 50.

• 1,449,556 (21.5 percent) are over age 60.

• 719,112 (10.7 percent) are over age 70.

• 255,774 (3.8 percent) are ages 80 and 

older.

The proportion of women rises fairly 

steadily in each age group, and women 

make up 57.7 percent of the 80+ group. 

The racial/ethnic composition of older 

Arizonans is as follows:

Race/Ethnicity of Arizonans 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

89.9% 3.4% 3.1% 2.4% 0.1% 1.0% 16.3%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Arizona Population by Age Group, 2014

455 466 488

437 415 411

344

218

108

437 446 454

423 413 436

386

245

148

0

100

200

300

400

500

600

700

800

900

1,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Arizonans Is Growing

The proportion of Arizona’s population 

that is 65 and older is growing while 

the proportion that is younger than 65 

is shrinking. The U.S. Census Bureau 

estimates that 22.1 percent of Arizona’s 

population will be 65 and older by the 

year 2030, an increase of 100.7 percent 

from 2015.

Projected Population in Arizona

Age Group 2015 2025 2030

Under 18 25.2% 24.8% 24.3%

18 to 44 33.7% 31.9% 31.9%

45 to 64 25.2% 22.9% 21.6%

65+ 15.8% 20.4% 22.1%

Source: U.S. Census Bureau, 2005

Exhibit 2. Arizona Population by Age Group, 2000–2030

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

Arizona
2

Arizona Arizona Profile 2016

SUICIDE AMONG OLDER ARIZONANS

Arizona Suicide Rate Compared With Regional and National Rates

The suicide rate among Arizonans ages 

50 and older is higher than the rate 

among younger age groups. In 2013, 

the total suicide rate among all people 

ages 50+ was 24.5 per 100,000 people 

(10.8 for women and 39.8 for men). 

The rate among those ages 50–64 was 

higher than both the rate in the region 

(including California, Hawaii, and Nevada) 

and the rate in the United States.

States vary in their reporting of suicides. 

The suicide rate is influenced by these 

reporting practices.

Exhibit 3. Suicide Rates in Arizona, Region 9, and the 

United States, 2013

17.6

14.0

26.0

22.6

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

30

All Under 50 50 to 64 65+

Arizona Region 9 U.S.

Suicide Rate per 100,000 Population

Source: Centers for Disease Control and Prevention (CDC), National Center 

for Health Statistics (NCHS), Underlying Cause of Death 1999-2013 on CDC 

WONDER Online Database, released 2015

Trends in Suicide Rates in Arizona

The suicide rate among Arizonans 

ages 50+ fluctuated from a low of 

20.6 per 100,000 in 2004 to a high 

of 25.4 per 100,000 in 2009. From 

2004 to 2013, the rate was generally 

highest among those in the 50–64 

age group.

How a state reports suicides can 

vary from year to year. The number 

of suicides is generally low, so even a 

small difference in reported numbers 

may make the rate fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Arizona by Age Group, 

2004–2013

0

5

10

15

20

25

30

35

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 Arizona Arizona Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER ARIZONANS

30-Day Binge Drinking Among Older Arizonans

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience falls 

and other accidents. Older people have a 

lower tolerance for alcohol. Binge drinking 

decreases with age and occurs more 

frequently among men than it does among 

women. As Exhibit 5 shows, 13.5 percent 

of Arizona men ages 50–64 reported 

binge drinking in the past 30 days, while 

8.8 percent of those in the 65+ group 

reported similar behavior.

Exhibit 5. Binge Drinking Rates in Arizona by Age Group 

and Sex, 2013

23.1%

13.5%

8.8%

13.0%

6.2%

3.0%

0%

5%

10%

15%

20%

25%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects the 

entrance into this age group of the 

baby boom cohort, whose rates of 

illicit drug use have been higher than 

those of older cohorts. Although statespecific data are not available, the 

Arizona Behavioral Health Barometer

is available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data/

population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

Arizona Arizona Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Arizonans

In 2012, there were 2,997 admissions 

of Arizonans ages 50 and older 

to substance use disorder (SUD) 

treatment in state-funded treatment 

programs, a rate of 130.5 per 100,000 

people ages 50+. This rate was lower 

than the regional rate and the national 

average. Men made up 61.1 percent 

of these admissions. Of all admissions, 

84.4 percent were White/Caucasian, 

9.3 percent were Black/African 

American, and 18.8 percent were 

Hispanic.

The principal sources of referral to 

treatment among those ages 50 and 

older were: 

Self-Referral Criminal Justice Other

60.6% 14.3% 25.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Arizona, Region 9, and the United States by Sex, 2012

169.2

274.2

383.2

96.0 104.8 120.3

0

50

100

150

200

250

300

350

400

450

Arizona Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: Treatment Episode Data Set (TEDS), 20121

1

 TEDS data are collected by states as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states report all clients 

admitted to publicly financed treatment; however, states are inconsistent in applying the guidelines. States may structure and implement different quality controls 

over the data. For example, states may collect different categories of information to answer TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

States may choose not to report some of 

the fields to TEDS, including information on 

treatment admission insurance types. These 

data were not reported by Arizona in 2012. 

Therefore, the rates for Region 9 are used 

instead.

In Region 9, 53.4 percent of older adults 

admitted to SUD treatment were uninsured, 

25.4 percent had Medicaid, 10.9 percent 

had Medicare, and 10.2 percent had private 

insurance.

SUD Treatment Admissions Among 

Arizonans Ages 50+ by Primary Sources of 

Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of health 

insurance (if any) clients had at admission; the table above 

represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2% 

25.4% 

10.9% 

53.4% 

14.9% 

20.4% 

10.8% 

53.9% 

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Arizona Arizona Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Arizonans Ages 50+

Alcohol was the most frequently cited 

substance used by older Arizonans 

in publicly financed SUD treatment in 

2012. It was mentioned as a substance 

of use in 53.5 percent of admissions 

among those ages 50+. This was 

higher than the regional rate and lower 

than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Arizona, Region 9, and the United States, 2012

53.5%

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Arizona Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

Substances other than alcohol were 

cited as the primary substances of 

use for 46.5 percent of older adult 

admissions to publicly funded 

treatment in Arizona.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Arizona, Region 9, 

and the United States, 2012

46.5%

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Arizona Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

Arizona Arizona Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Arizonans in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

Exhibit 11 shows the proportion 

of SUD treatment admissions of 

Arizonans ages 50+ with a cooccurring mental disorder. This rate 

is higher than the regional rate and 

the national average. However, state 

reporting practices are a factor in 

these results.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Arizona, Region 9, 

and the United States, 2012

35.5%

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Arizona Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Arizona Arizona Profile 2016

7

MENTAL HEALTH

Older Arizonans Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). Exhibit 12 shows that older 

Arizonans experience FMD at a rate that 

is lower than the regional and national 

rates.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Arizona, Region 9, and the United States, 2013

13.7%

12.6%

6.7%

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Arizona Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Arizonans Reporting Frequent Mental Distress by Age Group and Sex

As Exhibit 13 shows, in Arizona, 

9.9 percent of men in the 50–64 age 

group reported FMD (14 days or more 

per 30-day period) compared with 

15.2 percent of women in this age 

group. Men in the 65+ age group 

reported a higher rate of FMD than 

women in the same age group 

(7.2 percent compared with 6.3 percent). 

Hawaii is the only other state in the 

region where men in the 65+ age group 

did not report a lower rate of FMD than 

women in this age group.

Exhibit 13. Arizonans Reporting Frequent Mental 

Distress by Age Group and Sex, 2013

10.2%

17.2%

9.9%

15.2%

7.2%

6.3%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

Arizona Arizona Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older Arizonans.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 10.3% 8.5% 13.3%

Dissatisfied or very 

dissatisfied 6.5% 8.1% 4.0%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 Arizona Arizona Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Arizonans Admitted to State Mental Health Services

Approximately 3.4 percent of the people served by the Arizona mental health system were ages 65 and 

older. This represents more than 5,380 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 Arizona Arizona Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States that receive CMHS Block Grants are required to report aggregate data to URS. URS 

reports include information about utilization of mental health services and client demographic and 

outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). States 

that receive Substance Abuse Prevention and Treatment Block Grant funds submit individual client data 

to TEDS. TEDS includes both admission and discharge data sets, and some 1.5 million admissions are 

reported annually. TEDS includes information about utilization of SUD treatment services and client 

demographic and outcome information. TEDS is an admission-based system, and TEDS admissions do 

not represent individuals. Thus, an individual admitted to treatment twice within a calendar year would 

be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

California
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

CALIFORNIA’S POPULATION

California Population by Age Group

California is home to 38,802,500 people. 

Of these:

• 12,172,699 (31.4 percent) are over age 50.

• 7,058,201 (18.2 percent) are over age 60.

• 3,328,840 (8.6 percent) are over age 70.

• 1,311,686 (3.4 percent) are ages 80 and 

older.

The proportion of women rises fairly 

steadily in each age group, and women 

make up 61.1 percent of the 80+ group. 

The racial/ethnic composition of older 

Californians is as follows:

Race/Ethnicity of Californians 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

75.5% 1.2% 6.1% 15.0% 0.4% 1.8% 23.8%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. California Population by Age Group, 2014

2,589 2,632

3,020

2,721 2,597 2,516

1,771

911

511

2,481 2,517

2,826

2,650 2,596 2,599

1,958

1,106

801

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Californians Is Growing

The proportion of California’s 

population that is 65 and older is 

growing while the proportion that 

is younger than 65 is shrinking. The 

U.S. Census Bureau estimates that 

17.8 percent of California’s population 

will be 65 and older by the year 2030, 

an increase of 58.5 percent from 2015.

Projected Population in California

Age Group 2015 2025 2030

Under 18 24.5% 24.4% 23.8%

18 to 44 38.0% 37.1% 37.0%

45 to 64 24.5% 22.0% 21.4%

65+ 13.0% 16.4% 17.8%

Source: U.S. Census Bureau, 2005

Exhibit 2. California Population by Age Group, 2000–

2030

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

California
2

California California Profile 2016

SUICIDE AMONG OLDER CALIFORNIANS

California Suicide Rate Compared With Regional and National Rates

The suicide rate among Californians 

ages 50 and older is higher than the rate 

among younger age groups. In 2013, the 

total suicide rate among all people ages 

50+ was 17.1 per 100,000 people (7.6 

for women and 27.9 for men). The rate 

among those ages 50–64 was lower than 

both the rate in the region (including 

Arizona, Hawaii, and Nevada) and the 

rate in the United States.

States vary in their reporting of suicides. 

The suicide rate is influenced by these 

reporting practices.

Exhibit 3. Suicide Rates in California, Region 9, and the 

United States, 2013

10.5

7.5

17.2 17.0

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

California Region 9 U.S.

Suicide Rate per 100,000 Population Suicide Rate per 100,000 Population

Source: Centers for Disease Control and Prevention (CDC), National Center 

for Health Statistics (NCHS), Underlying Cause of Death 1999-2013 on CDC 

WONDER Online Database, released 2015

Trends in Suicide Rates in California

The suicide rate among Californians 

ages 50+ fluctuated from a low of 

14.8 per 100,000 in 2005 to a high 

of 17.7 per 100,000 in 2010. From 

2004 to 2013, the rate was generally 

highest among those in the 50–64 

age group.

How a state reports suicides can 

vary from year to year. The number 

of suicides is generally low, so even a 

small difference in reported numbers 

may make the rate fluctuate widely.

Exhibit 4. Trends in Suicide Rates in California by Age Group, 

2004–2013

0

2

4

6

8

10

12

14

16

18

20

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 California California Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER CALIFORNIANS

30-Day Binge Drinking Among Older Californians

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience falls 

and other accidents. Older people have a 

lower tolerance for alcohol. Binge drinking 

decreases with age and occurs more 

frequently among men than it does among 

women. As Exhibit 5 shows, 15.9 percent 

of California men ages 50–64 reported 

binge drinking in the past 30 days, while 

9.1 percent of those in the 65+ group 

reported similar behavior.

Exhibit 5. Binge Drinking Rates in California by Age 

Group and Sex, 2013

30.2%

15.9%

9.1%

15.6%

10.4%

3.7%

0%

5%

10%

15%

20%

25%

30%

35%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects the 

entrance into this age group of the 

baby boom cohort, whose rates of 

illicit drug use have been higher than 

those of older cohorts. Although statespecific data are not available, the 

California Behavioral Health Barometer

is available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data 

/population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

California California Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Californians

In 2012, there were 24,552 admissions 

of Californians ages 50 and older 

to substance use disorder (SUD) 

treatment in state-funded treatment 

programs, a rate of 201.7 per 100,000 

people ages 50+. This rate was higher 

than the regional rate and lower than 

the national average. Men made up 

70.6 percent of these admissions. Of all 

admissions, 54.3 percent were White/

Caucasian, 25.6 percent were Black/

African American, and 20.0 percent 

were Hispanic.

The principal sources of referral to 

treatment among those ages 50 and 

older were: 

Self-Referral Criminal Justice Other

56.1% 21.5% 22.4%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in California, Region 9, and the United States by Sex, 2012

303.5

274.2

383.2

111.6 104.8 120.3

0

50

100

150

200

250

300

350

400

450

California Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: Treatment Episode Data Set (TEDS), 20121

1

 TEDS data are collected by states as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states report all clients 

admitted to publicly financed treatment; however, states are inconsistent in applying the guidelines. States may structure and implement different quality controls 

over the data. For example, states may collect different categories of information to answer TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

States may choose not to report some of 

the fields to TEDS, including information for 

treatment admission insurance types. These 

data were not reported by California in 2012. 

Therefore, the rates for Region 9 are used 

instead.

In Region 9, 53.4 percent of older adults 

admitted to SUD treatment were uninsured, 

25.4 percent had Medicaid, 10.9 percent 

had Medicare, and 10.2 percent had private 

insurance.

SUD Treatment Admissions Among 

Californians Ages 50+ by Primary Sources 

of Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of health 

insurance (if any) clients had at admission; the table above 

represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2% 

25.4% 

10.9% 

53.4% 

14.9% 

20.4% 

10.8% 

53.9% 

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 California California Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Californians Ages 50+

Alcohol was the most frequently cited 

substance used by older Californians 

in publicly financed SUD treatment in 

2012. It was mentioned as a substance 

of use in 37.3 percent of admissions 

among those ages 50+. This was lower 

than the regional and national rates.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in California, Region 9, and the United States, 

2012

37.3%

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

California Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

Substances other than alcohol were 

cited as the primary substances of 

use for 62.7 percent of older adult 

admissions to publicly funded 

treatment in California.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in California, Region 9, 

and the United States, 2012

62.7%

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

California Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

California California Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Californians in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

Exhibit 11 shows the proportion 

of SUD treatment admissions of 

Californians ages 50+ with a cooccurring mental disorder. This rate 

is lower than the regional rate and 

the national average. However, state 

reporting practices are a factor in these 

results.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in California, Region 9, 

and the United States, 2012

21.0%

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

California Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 California California Profile 2016

7

MENTAL HEALTH

Older Californians Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). Exhibit 12 shows that older 

Californians experience FMD at a rate 

that is higher than the regional and 

national rates.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in California, Region 9, and the United States, 2013

11.0%

15.1%

9.2%

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

California Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Californians Reporting Frequent Mental Distress by Age Group and Sex

Older men in California were more likely 

to indulge in binge drinking, but older 

women were more likely to report that 

they had FMD (14 days or more per 

30-day period). As Exhibit 13 shows, 

15.5 percent of women in the 50–64 age 

group and 10.4 percent in the 65+ age 

group reported FMD, while 14.8 percent 

of men in the 50–64 age group and 

7.8 percent in the 65+ age group 

reported FMD.

Exhibit 13. Californians Reporting Frequent Mental 

Distress by Age Group and Sex, 2013

10.1%

11.9%

14.8%

15.5%

7.8%

10.4%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

California California Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older Californians.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 12.9% 11.5% 15.0%

Dissatisfied or very 

dissatisfied 5.6% 6.8% 3.7%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 California California Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Californians Admitted to State Mental Health Services

Approximately 3.1 percent of the people served by the California mental health system were ages 65 and 

older. This represents more than 21,720 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 California California Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States that receive CMHS Block Grants are required to report aggregate data to URS. URS 

reports include information about utilization of mental health services and client demographic and 

outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). States 

that receive Substance Abuse Prevention and Treatment Block Grant funds submit individual client data 

to TEDS. TEDS includes both admission and discharge data sets, and some 1.5 million admissions are 

reported annually. TEDS includes information about utilization of SUD treatment services and client 

demographic and outcome information. TEDS is an admission-based system, and TEDS admissions do 

not represent individuals. Thus, an individual admitted to treatment twice within a calendar year would 

be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Hawaii
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

HAWAII’S POPULATION

Hawaii Population by Age Group

Hawaii is home to 1,419,561 people. Of 

these:

• 500,115 (35.2 percent) are over age 50.

• 315,230 (22.2 percent) are over age 60.

• 153,548 (10.8 percent) are over age 70.

• 65,873 (4.6 percent) are ages 80 and 

older.

The proportion of women rises fairly 

steadily in each age group, and women 

make up 62.1 percent of the 80+ group. 

The racial/ethnic composition of older 

Hawaiians is as follows:

Race/Ethnicity of Hawaiians 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

28.7% 0.3% 1.0% 50.1% 7.3% 12.6% 4.4%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Hawaii Population by Age Group, 2014

91 84

120

100

87 92

79

41

25

87

79

96

91

86

93

83

47

41

0

50

100

150

200

250

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Hawaiians Is Growing

The proportion of Hawaii’s population 

that is 65 and older is growing while 

the proportion that is younger than 65 

is shrinking. The U.S. Census Bureau 

estimates that 22.3 percent of Hawaii’s 

population will be 65 and older by the 

year 2030, an increase of 44.6 percent 

from 2015.

Projected Population in Hawaii

Age Group 2015 2025 2030

Under 18 23.8% 23.1% 22.2%

18 to 44 34.6% 34.7% 35.4%

45 to 64 25.3% 21.3% 20.1%

65+ 16.3% 20.9% 22.3%

Source: U.S. Census Bureau, 2005

Exhibit 2. Hawaii Population by Age Group, 2000–2030

0

100

200

300

400

500

600

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

Hawaii
2

Hawaii Hawaii Profile 2016

SUICIDE AMONG OLDER HAWAIIANS

Region 9 Suicide Rates Compared With National Rates

Suicide data for Hawaiians of various 

ages were unavailable for 2013. 

Therefore, the rates for Region 9 

(including Arizona, California, and 

Nevada) are used instead.

The suicide rate among individuals ages 

50+ in Region 9 was higher than the rate 

among younger age groups. In 2013, 

the total suicide rate among all people 

ages 50+ was 18.8 per 100,000 people 

(8.3 for women and 30.6 for men). The 

rate among those ages 50–64 was higher 

than the rate in the United States.

States vary in their reporting of suicides. 

The suicide rate is influenced by these 

reporting practices.

Exhibit 3. Suicide Rates in Region 9 and the United 

States, 2013

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population 

Region 9 U.S.

Source: Centers for Disease Control and Prevention (CDC), National Center 

for Health Statistics (NCHS), Underlying Cause of Death 1999-2013 on CDC 

WONDER Online Database, released 2015

Trends in Suicide Rates in Region 9

Suicide data for Hawaiians of various 

ages were unavailable. Therefore, the 

rates for Region 9 are used instead. 

The suicide rate among individuals in 

Region 9 ages 50+ fluctuated from 

a low of 16.4 per 100,000 in 2005 to 

a high of 19.5 per 100,000 in 2009. 

From 2004 to 2013, the rate was 

generally highest among those in the 

50–64 age group.

How a state reports suicides can 

vary from year to year. The number 

of suicides is generally low, so even a 

small difference in reported numbers 

may make the rate fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Region 9 by Age Group, 

2004–2013

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 Hawaii Hawaii Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER HAWAIIANS

30-Day Binge Drinking Among Older Hawaiians

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience falls 

and other accidents. Older people have a 

lower tolerance for alcohol. Binge drinking 

decreases with age and occurs more 

frequently among men than it does among 

women. As Exhibit 5 shows, 20.6 percent 

of Hawaii men ages 50–64 reported 

binge drinking in the past 30 days, while 

8.1 percent of those in the 65+ group 

reported similar behavior.

Exhibit 5. Binge Drinking Rates in Hawaii by Age Group 

and Sex, 2013

33.5%

20.6%

8.1%

16.2%

9.5%

2.1% 0%

5%

10%

15%

20%

25%

30%

35%

40%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects the 

entrance into this age group of the 

baby boom cohort, whose rates of 

illicit drug use have been higher than 

those of older cohorts. Although statespecific data are not available, the 

Hawaii Behavioral Health Barometer

is available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data/

population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

Hawaii Hawaii Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Hawaiians

In 2012, there were 684 admissions 

of Hawaiians ages 50 and older 

to substance use disorder (SUD) 

treatment in state-funded treatment 

programs, a rate of 136.8 per 100,000 

people ages 50+. This rate was lower 

than the regional rate and the national 

average. Men made up 79.7 percent 

of these admissions. Of all admissions, 

51.4 percent were White/Caucasian, 

3.2 percent were Black/African 

American, and 7.0 percent were 

Hispanic.

The principal sources of referral to 

treatment among those ages 50 and 

older were: 

Self-Referral Criminal Justice Other

49.4% 28.5% 22.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Hawaii, Region 9, and the United States by Sex, 2012

230.7

274.2

383.2

52.7

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Hawaii Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: Treatment Episode Data Set (TEDS), 20121

1

 TEDS data are collected by states as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states report all clients 

admitted to publicly financed treatment; however, states are inconsistent in applying the guidelines. States may structure and implement different quality controls 

over the data. For example, states may collect different categories of information to answer TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Hawaiians Ages 50+ by Insurance Type 

In Hawaii, 24.8 percent of older adult 

admissions to SUD treatment were 

uninsured, 58.1 percent had Medicaid, 

8.2 percent had Medicare, and 

8.9 percent had private insurance.

SUD Treatment Admissions Among 

Hawaiians Ages 50+ by Primary 

Sources of Payment

Self-Pay Medicaid Other

9.1% 30.5% 60.4%

Self-pay data include private insurance.

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Hawaii, Region 9, and the United States by Insurance 

Type, 2012

8.9%

58.1%

8.2%

24.8%

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

70%

Private Medicaid Medicare None

Hawaii Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Hawaii Hawaii Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Hawaiians Ages 50+

Alcohol was the most frequently cited 

substance used by older Hawaiians 

in publicly financed SUD treatment in 

2012. It was mentioned as a substance 

of use in 55.4 percent of admissions 

among those ages 50+. This was 

higher than the regional rate and 

lower than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Hawaii, Region 9, and the United States, 2012

55.4%

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Hawaii Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

Substances other than alcohol were 

cited as the primary substances of 

use for 44.6 percent of older adult 

admissions to publicly funded 

treatment in Hawaii.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Hawaii, Region 9, and 

the United States, 2012

44.6%

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Hawaii Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

Hawaii Hawaii Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Hawaiians in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

Exhibit 11 shows the proportion 

of SUD treatment admissions of 

Hawaiians ages 50+ with a cooccurring mental disorder. This rate is 

higher than the regional rate and lower 

than the national average. However, 

state reporting practices are a factor in 

these results.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Hawaii, Region 9, 

and the United States, 2012

31.5%

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Hawaii Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Hawaii Hawaii Profile 2016

7

MENTAL HEALTH

Older Hawaiians Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). Exhibit 12 shows that older 

Hawaiians experience FMD at a rate that 

is lower than the regional and national 

rates.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Hawaii, Region 9, and the United States, 2013

8.5%

9.5%

6.0%

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Hawaii Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Hawaiians Reporting Frequent Mental Distress by Age Group and Sex

As Exhibit 13 shows, in Hawaii, 

9.3 percent of men in the 50–64 age 

group reported FMD (14 days or more 

per 30-day period) compared with

9.7 percent of women in this age group. 

Men in the 65+ age group reported the 

same rate of FMD as women in the same 

age group (6.0 percent for both). Arizona 

is the only other state in the region 

where men in the 65+ age group did 

not report a lower rate of FMD than 

women in this age group.

Exhibit 13. Hawaiians Reporting Frequent Mental 

Distress by Age Group and Sex, 2013

7.8%

9.3% 9.2%

9.7%

6.0% 6.0%

0%

2%

4%

6%

8%

10%

12%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

Hawaii Hawaii Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older Hawaiians.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 16.7% 10.9% 2.4%

Dissatisfied or very 

dissatisfied 3.3% 3.7% 2.7%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 Hawaii Hawaii Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Hawaiians Admitted to State Mental Health Services

Approximately 8.1 percent of the people served by the Hawaii mental health system were ages 65 and 

older. This represents more than 1,030 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 Hawaii Hawaii Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States that receive CMHS Block Grants are required to report aggregate data to URS. URS 

reports include information about utilization of mental health services and client demographic and 

outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). States 

that receive Substance Abuse Prevention and Treatment Block Grant funds submit individual client data 

to TEDS. TEDS includes both admission and discharge data sets, and some 1.5 million admissions are 

reported annually. TEDS includes information about utilization of SUD treatment services and client 

demographic and outcome information. TEDS is an admission-based system, and TEDS admissions do 

not represent individuals. Thus, an individual admitted to treatment twice within a calendar year would 

be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Nevada
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

NEVADA’S POPULATION

Nevada Population by Age Group

Nevada is home to 2,839,099 people. Of 

these:

• 941,249 (33.2 percent) are over age 50.

• 565,626 (19.9 percent) are over age 60.

• 256,379 (9.0 percent) are over age 70.

• 81,448 (2.9 percent) are ages 80 and 

older.

The proportion of women rises fairly 

steadily in each age group, and women 

make up 57.5 percent of the 80+ group. 

The racial/ethnic composition of older 

Nevadans is as follows:

Race/Ethnicity of Nevadans 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

80.9% 1.2% 7.2% 8.7% 0.5% 1.5% 14.1%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Nevada Population by Age Group, 2014

187 186 201 198 197 188

150

85

35

179 177

193 192 188 188

159

90

47

0

50

100

150

200

250

300

350

400

450

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Nevadans Is Growing

The proportion of Nevada’s population 

that is 65 and older is growing while 

the proportion that is younger than 65 

is shrinking. The U.S. Census Bureau 

estimates that 18.6 percent of Nevada’s 

population will be 65 and older by the 

year 2030, an increase of 89.0 percent 

from 2015.

Projected Population in Nevada

Age Group 2015 2025 2030

Under 18 24.6% 25.1% 25.1%

18 to 44 33.8% 31.6% 31.4%

45 to 64 27.8% 26.3% 24.8%

65+ 13.8% 17.1% 18.6%

Source: U.S. Census Bureau, 2005

Exhibit 2. Nevada Population by Age Group, 2000–2030

0

200

400

600

800

1,000

1,200

1,400

1,600

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

Nevada
2

Nevada Nevada Profile 2016

SUICIDE AMONG OLDER NEVADANS

Nevada Suicide Rate Compared With Regional and National Rates

The suicide rate among Nevadans ages 

50 and older is higher than the rate 

among younger age groups. In 2013, 

the total suicide rate among all people 

ages 50+ was 29.0 per 100,000 people 

(12.2 for women and 46.7 for men). 

The rate among those ages 50–64 was 

higher than both the rate in the region 

(including Arizona, California, and Hawaii) 

and the rate in the United States.

Exhibit 3. Suicide Rates in Nevada, Region 9, and the 

United States, 2013

19.4

14.8

28.3

29.9

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

30

35

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population

Nevada Region 9 U.S.

States vary in their reporting of suicides. 

The suicide rate is influenced by these 

reporting practices.

Trends in Suicide Rates in Nevada

The suicide rate among Nevadans 

ages 50+ fluctuated from a low of 

29.0 per 100,000 in 2013 to a high of 

32.3 per 100,000 in 2008. From 2004 

to 2013, the rate was highest among 

those in the 50–64 and the 65+ age 

groups.

How a state reports suicides can 

vary from year to year. The number 

of suicides is generally low, so even a 

small difference in reported numbers 

may make the rate fluctuate widely.

Source: Centers for Disease Control and Prevention (CDC), National Center 

for Health Statistics (NCHS), Underlying Cause of Death 1999-2013 on CDC 

WONDER Online Database, released 2015

Exhibit 4. Trends in Suicide Rates in Nevada by Age Group, 

2004–2013

0

5

10

15

20

25

30

35

40

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 Nevada Nevada Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER NEVADANS

30-Day Binge Drinking Among Older Nevadans

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience falls 

and other accidents. Older people have a 

lower tolerance for alcohol. Binge drinking 

decreases with age and occurs more 

frequently among men than it does among 

women. As Exhibit 5 shows, 12.2 percent 

of Nevada men ages 50–64 reported 

binge drinking in the past 30 days, while 

9.1 percent of those in the 65+ group 

reported similar behavior.

Exhibit 5. Binge Drinking Rates in Nevada by Age Group 

and Sex, 2013

29.1%

12.2%

9.1%

10.5%

9.2%

5.7%

0%

5%

10%

15%

20%

25%

30%

35%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects the 

entrance into this age group of the 

baby boom cohort, whose rates of 

illicit drug use have been higher than 

those of older cohorts. Although statespecific data are not available, the 

Nevada Behavioral Health Barometer

is available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data/

population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

Nevada Nevada Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Nevadans

In 2012, there were 1,131 admissions 

of Nevadans ages 50 and older 

to substance use disorder (SUD) 

treatment in state-funded treatment 

programs, a rate of 120.2 per 100,000 

people ages 50+. This rate was lower 

than the regional rate and the national 

average. Men made up 72.8 percent 

of these admissions. Of all admissions, 

71.3 percent were White/Caucasian, 

16.2 percent were Black/African 

American, and 12.6 percent were 

Hispanic.

The principal sources of referral to 

treatment among those ages 50 and 

older were: 

Self-Referral Criminal Justice Other

32.0% 35.1% 32.8%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Nevada, Region 9, and the United States by Sex, 2012

179.8

274.2

383.2

63.7

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Nevada Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: Treatment Episode Data Set (TEDS), 20121

1

 TEDS data are collected by states as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states report all clients 

admitted to publicly financed treatment; however, states are inconsistent in applying the guidelines. States may structure and implement different quality controls 

over the data. For example, states may collect different categories of information to answer TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Nevadans Ages 50+ by Insurance Type 

In Nevada, 71.0 percent of older adult 

admissions to SUD treatment were 

uninsured, 5.4 percent had Medicaid, 

12.6 percent had Medicare, and 

11.0 percent had private insurance.

SUD Treatment Admissions Among 

Nevadans Ages 50+ by Primary 

Sources of Payment

Self-Pay Medicaid Other

27.7% 1.2% 71.1%

Self-pay data include private insurance.

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Nevada, Region 9, and the United States by Insurance 

Type, 2012

11.0%

5.4%

12.6%

71.0%

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Private Medicaid Medicare None

Nevada Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Nevada Nevada Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Nevadans Ages 50+

Alcohol was the most frequently cited 

substance used by older Nevadans 

in publicly financed SUD treatment in 

2012. It was mentioned as a substance 

of use in 61.3 percent of admissions 

among those ages 50+. This was 

higher than the regional rate and lower 

than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Nevada, Region 9, and the United States, 

2012

61.3%

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Nevada Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

Substances other than alcohol were 

cited as the primary substances of 

use for 38.7 percent of older adult 

admissions to publicly funded 

treatment in Nevada.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Nevada, Region 9, 

and the United States, 2012

38.7%

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Nevada Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

Nevada Nevada Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Adults in Region 9 in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder.

States may choose not to report some 

of the fields to TEDS, including information on SUD treatment admissions 

with a co-occurring disorder. These data 

were not reported by Nevada in 2012. 

Therefore, Exhibit 11 shows regional 

and national figures only.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Region 9 and the 

United States, 2012

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Nevada Nevada Profile 2016

7

MENTAL HEALTH

Older Nevadans Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). Exhibit 12 shows that older 

Nevadans experience FMD at a rate that 

is lower than the regional and national 

rates.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Nevada, Region 9, and the United States, 2013

12.1% 11.8%

6.4%

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Nevada Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Nevadans Reporting Frequent Mental Distress by Age Group and Sex

Older men in Nevada were more likely 

to indulge in binge drinking, but older 

women were more likely to report that 

they had FMD (14 days or more per 

30-day period). As Exhibit 13 shows, 

14.0 percent of women in the 50–64 age 

group and 8.7 percent in the 65+ age 

group reported FMD, while 9.6 percent 

of men in the 50–64 age group and 

3.7 percent in the 65+ age group 

reported FMD.

Exhibit 13. Nevadans Reporting Frequent Mental 

Distress by Age Group and Sex, 2013

10.9%

13.3%

9.6%

14.0%

3.7%

8.7%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

Nevada Nevada Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older Nevadans.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 9.3% 7.7% 11.6%

Dissatisfied or very 

dissatisfied 7.4% 9.6% 4.2%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 Nevada Nevada Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Nevadans Admitted to State Mental Health Services

Approximately 2.5 percent of the people served by the Nevada mental health system were ages 65 and 

older. This represents more than 750 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 Nevada Nevada Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States that receive CMHS Block Grants are required to report aggregate data to URS. URS 

reports include information about utilization of mental health services and client demographic and 

outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). States 

that receive Substance Abuse Prevention and Treatment Block Grant funds submit individual client data 

to TEDS. TEDS includes both admission and discharge data sets, and some 1.5 million admissions are 

reported annually. TEDS includes information about utilization of SUD treatment services and client 

demographic and outcome information. TEDS is an admission-based system, and TEDS admissions do 

not represent individuals. Thus, an individual admitted to treatment twice within a calendar year would 

be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

American Samoa
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

REGION 9’S POPULATION

Region 9 Population by Age Group

Detailed demographic U.S. Census Bureau 

data on older American Samoans are 

unavailable. Therefore, the estimates for 

Region 9 (which includes Arizona, California, 

Hawaii, and Nevada) are used instead. 

Region 9 is home to 49,792,644 people. Of 

these:

• 15,910,775 (32.0 percent) are over age 50.

• 9,388,613 (18.9 percent) are over age 60.

• 4,457,879 (9.0 percent) are over age 70.

• 1,714,781 (3.4 percent) are ages 80 and 

older.

Race/Ethnicity of Individuals in Region 9 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

76.4% 1.5% 5.6% 13.9% 0.6% 2.0% 21.5%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Region 9 Population by Age Group, 2014

3,323 3,369

3,829

3,456 3,297 3,207

2,345

1,254

679

3,183 3,218

3,569

3,355 3,283 3,315

2,586

1,489

1,036

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Adults in Region 9 Is Growing

Recent population projections for 

American Samoa are unavailable. Therefore, projections for Region 9 (calculated 

based on data from Arizona, California, 

Hawaii, and Nevada) are used instead. 

The U.S. Census Bureau estimates that 

18.7 percent of Region 9’s population 

will be 65 and older by the year 2030, 

an increase of 67.0 percent from 2015.

Projected Population in Region 9

Age Group 2015 2025 2030

Under 18 24.6% 24.5% 23.9%

18 to 44 37.0% 35.8% 35.7%

45 to 64 24.8% 22.4% 21.6%

65+ 13.6% 17.2% 18.7%

Source: U.S. Census Bureau, 2005

Exhibit 2. Region 9 Population by Age Group, 2000–

2030

0

5,000

10,000

15,000

20,000

25,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

American Samoa
2

American Samoa American Samoa Profile 2016

SUICIDE AMONG OLDER ADULTS IN REGION 9

Region 9 Suicide Rates Compared With National Rates

Recent suicide data for American Samoa 

are not available from the Centers for 

Disease Control and Prevention (CDC) 

mortality databases. Therefore, the rates 

for Region 9 (calculated based on data 

from Arizona, California, Hawaii, and 

Nevada) are used instead.

The suicide rate among individuals in 

Region 9 ages 50 and older is higher than 

the rate among younger age groups. In 

2013, the total suicide rate among all 

people ages 50+ was 18.8 per 100,000 

people (8.3 for women and 30.6 for men). 

The rate among those ages 50–64 was 

higher than the rate in the United States. 

States and territories vary in their 

reporting of suicides. The suicide rate is 

influenced by these reporting practices.

Exhibit 3. Suicide Rates in Region 9 and the United 

States, 2013

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population

Region 9 U.S.

Source: CDC, National Center for Health Statistics (NCHS), Underlying Cause of 

Death 1999-2013 on CDC WONDER Online Database, released 2015

Trends in Suicide Rates in Region 9

Recent suicide data for American 

Samoa are not available from the 

CDC mortality databases. Therefore, 

the rates for Region 9 are used 

instead.

The suicide rate among individuals in 

Region 9 ages 50+ fluctuated from 

a low of 16.4 per 100,000 in 2005 to 

a high of 19.5 per 100,000 in 2009. 

From 2004 to 2013, the rate was 

generally highest among those in the 

50–64 age group. 

How a state or territory reports 

suicides can vary from year to year. 

The number of suicides is generally 

low, so even a small difference in 

reported numbers may make the rate 

fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Region 9 by Age Group, 

2004–2013

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 American Samoa American Samoa Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER ADULTS IN REGION 9

30-Day Binge Drinking Among Older Adults in Region 9

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience falls 

and other accidents. Older people have a 

lower tolerance for alcohol. Binge drinking 

decreases with age and occurs more 

frequently among men than it does among 

women. Recent data for American Samoa 

are unavailable. Therefore, data for Region 

9 are used instead. As Exhibit 5 shows, 

15.5 percent of Region 9 men ages 50–64 

reported binge drinking in the past 30 

days, while 9.0 percent of those in the 65+ 

group reported similar behavior.

Exhibit 5. Binge Drinking Rates in Region 9 by Age 

Group and Sex, 2013

29.3%

15.5%

9.0%

14.9%

9.7%

3.6%

0%

5%

10%

15%

20%

25%

30%

35%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects 

the entrance into this age group of 

the baby boom cohort, whose 

rates of illicit drug use have been 

higher than those of older cohorts. 

Although territory-specific data are 

not available, the Behavioral Health 

Barometers for states in Region 9 

are available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data 

/population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

American Samoa American Samoa Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Adults in Region 9

Treatment Episode Data Set (TEDS) data for 

American Samoa in 2012 are unavailable. 

Therefore, data for Region 9 are used 

instead.

In 2012, there were 29,351 admissions of 

individuals in Region 9 ages 50 and older 

to substance use disorder (SUD) treatment 

in state-funded treatment programs, a 

rate of 184.5 per 100,000 people ages 

50+. This rate was lower than the national 

average. Men made up 69.9 percent of these 

admissions. Of all admissions, 57.9 percent 

were White/Caucasian, 23.0 percent were 

Black/African American, and 19.4 percent 

were Hispanic.

The principal sources of referral to treatment 

among those ages 50 and older were: 

Self-Referral Criminal Justice Other

55.4% 21.5% 23.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Sex, 2012

274.2

383.2

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: TEDS, 20121

1

 TEDS data are collected by states and territories as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states and 

territories report all clients admitted to publicly financed treatment; however, states and territories are inconsistent in applying the guidelines. States and territories 

may structure and implement different quality controls over the data. For example, states and territories may collect different categories of information to answer 

TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

TEDS data for American Samoa in 2012 

are unavailable. Therefore, data for 

Region 9 are used instead.

In Region 9, 53.4 percent of older adult 

admissions to SUD treatment were 

uninsured, 25.4 percent had Medicaid, 

10.9 percent had Medicare, and 

10.2 percent had private insurance.

SUD Treatment Admissions Among 

American Samoans Ages 50+ by 

Primary Sources of Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 American Samoa American Samoa Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Individuals in Region 9 

Ages 50+

TEDS data for American Samoa in 

2012 are unavailable. Therefore, data 

for Region 9 are used instead.

Alcohol was the most frequently cited 

substance used by older individuals 

in Region 9 in publicly financed SUD 

treatment in 2012. It was mentioned 

as a substance of use in 40.3 percent 

of admissions among those ages 50+. 

This was lower than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Region 9 and the United States, 2012

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

TEDS data for American Samoa in 

2012 are unavailable. Therefore, data 

for Region 9 are used instead.

Substances other than alcohol were 

cited as the primary substances of 

use for 59.7 percent of older adult 

admissions to publicly funded 

treatment in Region 9.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Region 9 and the 

United States, 2012

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

American Samoa American Samoa Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Adults in Region 9 in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

TEDS data for American Samoa in 

2012 are unavailable. Therefore, 

Exhibit 11 shows regional and national 

figures only.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Region 9 and the 

United States, 2012

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 American Samoa American Samoa Profile 2016

7

MENTAL HEALTH

Older Adults in Region 9 Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). 

Recent BRFSS data for American Samoa 

were unavailable. Therefore, data for 

Region 9 are used instead. Exhibit 12 

shows that older adults in Region 9 

experience FMD at a rate that is higher 

than the national rate.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Region 9 and the United States, 2013

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Adults in Region 9 Reporting Frequent Mental Distress by Age Group 

and Sex

Older men in Region 9 were more likely 

to indulge in binge drinking, but older 

women were more likely to report that 

they had FMD (14 days or more per 

30-day period). As Exhibit 13 shows, 

15.2 percent of women in the 50–64 age 

group and 9.5 percent in the 65+ age 

group reported FMD, while 13.7 percent 

of men in the 50–64 age group and 

7.4 percent in the 65+ age group 

reported FMD.

Exhibit 13. Individuals in Region 9 Reporting Frequent 

Mental Distress by Age Group and Sex, 2013

10.1%

12.6%

13.7%

15.2%

7.4%

9.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

American Samoa American Samoa Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older adults in Region 9.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 12.4% 11.0% 14.9%

Dissatisfied or very 

dissatisfied 5.8% 7.1% 3.8%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 American Samoa American Samoa Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older American Samoans Admitted to Territory Mental Health Services

Approximately 5.6 percent of the people served by the American Samoa mental health system were in the 

65–74 age group (data were unavailable for ages 75 and over). This represents 4 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 American Samoa American Samoa Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States and territories that receive CMHS Block Grants are required to report aggregate data to 

URS. URS reports include information about utilization of mental health services and client demographic 

and outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). 

States and territories that receive Substance Abuse Prevention and Treatment Block Grant funds submit 

individual client data to TEDS. TEDS includes both admission and discharge data sets, and some 

1.5 million admissions are reported annually. TEDS includes information about utilization of SUD 

treatment services and client demographic and outcome information. TEDS is an admission-based 

system, and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment 

twice within a calendar year would be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Commonwealth 

of the Northern

Mariana Islands
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

REGION 9’S POPULATION

Region 9 Population by Age Group

Detailed demographic U.S. Census Bureau 

data on older Northern Mariana Islanders 

are unavailable. Therefore, the estimates for 

Region 9 (which includes Arizona, California, 

Hawaii, and Nevada) are used instead. 

Region 9 is home to 49,792,644 people. Of 

these:

• 15,910,775 (32.0 percent) are over age 50.

• 9,388,613 (18.9 percent) are over age 60.

• 4,457,879 (9.0 percent) are over age 70.

• 1,714,781 (3.4 percent) are ages 80 and 

older.

Race/Ethnicity of Individuals in Region 9 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

76.4% 1.5% 5.6% 13.9% 0.6% 2.0% 21.5%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Region 9 Population by Age Group, 2014

3,323 3,369

3,829

3,456 3,297 3,207

2,345

1,254

679

3,183 3,218

3,569

3,355 3,283 3,315

2,586

1,489

1,036

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Adults in Region 9 Is Growing

Recent population projections for the 

Commonwealth of the Northern Mariana 

Islands are unavailable. Therefore, 

projections for Region 9 (calculated based 

on data from Arizona, California, Hawaii, 

and Nevada) are used instead.

The U.S. Census Bureau estimates that 

18.7 percent of Region 9’s population 

will be 65 and older by the year 2030, an 

increase of 67.0 percent from 2015.

Projected Population in Region 9

Age Group 2015 2025 2030

Under 18 24.6% 24.5% 23.9%

18 to 44 37.0% 35.8% 35.7%

45 to 64 24.8% 22.4% 21.6%

65+ 13.6% 17.2% 18.7%

Source: U.S. Census Bureau, 2005

Exhibit 2. Region 9 Population by Age Group, 2000–

2030

0

5,000

10,000

15,000

20,000

25,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

Commonwealth of the 

Northern Mariana Islands
2

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

SUICIDE AMONG OLDER ADULTS IN REGION 9

Region 9 Suicide Rates Compared With National Rates

Recent suicide data for the 

Commonwealth of the Northern Mariana 

Islands are not available from the Centers 

for Disease Control and Prevention (CDC) 

mortality databases. Therefore, the rates 

for Region 9 (calculated based on data 

from Arizona, California, Hawaii, and 

Nevada) are used instead.

The suicide rate among individuals in 

Region 9 ages 50 and older is higher than 

the rate among younger age groups. In 

2013, the total suicide rate among all 

people ages 50+ was 18.8 per 100,000 

people (8.3 for women and 30.6 for men). 

The rate among those ages 50–64 was 

higher than the rate in the United States. 

States and territories vary in their 

reporting of suicides. The suicide rate is 

influenced by these reporting practices.

Exhibit 3. Suicide Rates in Region 9 and the United 

States, 2013

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population

Region 9 U.S.

Source: CDC, National Center for Health Statistics (NCHS), Underlying Cause of 

Death 1999-2013 on CDC WONDER Online Database, released 2015

Trends in Suicide Rates in Region 9

Recent suicide data for the 

Commonwealth of the Northern 

Mariana Islands are not available 

from the CDC mortality databases. 

Therefore, the rates for Region 9 are 

used instead.

The suicide rate among individuals in 

Region 9 ages 50+ fluctuated from 

a low of 16.4 per 100,000 in 2005 to 

a high of 19.5 per 100,000 in 2009. 

From 2004 to 2013, the rate was 

generally highest among those in the 

50–64 age group. 

How a state or territory reports 

suicides can vary from year to year. 

The number of suicides is generally 

low, so even a small difference in 

reported numbers may make the rate 

fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Region 9 by Age Group, 

2004–2013

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER ADULTS IN REGION 9

30-Day Binge Drinking Among Older Adults in Region 9

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are more 

likely to take risks such as driving while 

intoxicated and to experience falls and other 

accidents. Older people have a lower tolerance for alcohol. Binge drinking decreases 

with age and occurs more frequently among 

men than it does among women. Recent 

data for the Commonwealth of the Northern 

Mariana Islands are unavailable. Therefore, 

data for Region 9 are used instead. As Exhibit 

5 shows, 15.5 percent of Region 9 men ages 

50–64 reported binge drinking in the past 30 

days, while 9.0 percent of those in the 65+ 

group reported similar behavior.

Exhibit 5. Binge Drinking Rates in Region 9 by Age 

Group and Sex, 2013

29.3%

15.5%

9.0%

14.9%

9.7%

3.6%

0%

5%

10%

15%

20%

25%

30%

35%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects 

the entrance into this age group of 

the baby boom cohort, whose 

rates of illicit drug use have been 

higher than those of older cohorts. 

Although territory-specific data are 

not available, the Behavioral Health 

Barometers for states in Region 9 

are available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data 

/population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Adults in Region 9

Treatment Episode Data Set (TEDS) data for 

the Commonwealth of the Northern Mariana 

Islands in 2012 are unavailable. Therefore, 

data for Region 9 are used instead.

In 2012, there were 29,351 admissions of 

individuals in Region 9 ages 50 and older 

to substance use disorder (SUD) treatment 

in state-funded treatment programs, a 

rate of 184.5 per 100,000 people ages 

50+. This rate was lower than the national 

average. Men made up 69.9 percent of these 

admissions. Of all admissions, 57.9 percent 

were White/Caucasian, 23.0 percent were 

Black/African American, and 19.4 percent 

were Hispanic.

The principal sources of referral to treatment 

among those ages 50 and older were: 

Self-Referral Criminal Justice Other

55.4% 21.5% 23.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Sex, 2012

274.2

383.2

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: TEDS, 20121

1

 TEDS data are collected by states and territories as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states and 

territories report all clients admitted to publicly financed treatment; however, states and territories are inconsistent in applying the guidelines. States and territories 

may structure and implement different quality controls over the data. For example, states and territories may collect different categories of information to answer 

TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

TEDS data for the Commonwealth of the 

Northern Mariana Islands in 2012 are 

unavailable. Therefore, data for Region 9 

are used instead.

In Region 9, 53.4 percent of older adult 

admissions to SUD treatment were 

uninsured, 25.4 percent had Medicaid, 

10.9 percent had Medicare, and 

10.2 percent had private insurance.

SUD Treatment Admissions Among 

Northern Mariana Islanders Ages 50+ 

by Primary Sources of Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Individuals in Region 9 

Ages 50+

TEDS data for the Commonwealth of 

the Northern Mariana Islands in 2012 

are unavailable. Therefore, data for 

Region 9 are used instead.

Alcohol was the most frequently cited 

substance used by older individuals 

in Region 9 in publicly financed SUD 

treatment in 2012. It was mentioned 

as a substance of use in 40.3 percent 

of admissions among those ages 50+. 

This was lower than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Region 9 and the United States, 2012

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

TEDS data for the Commonwealth of 

the Northern Mariana Islands in 2012 

are unavailable. Therefore, data for 

Region 9 are used instead.

Substances other than alcohol were 

cited as the primary substances of 

use for 59.7 percent of older adult 

admissions to publicly funded 

treatment in Region 9.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Region 9 and the 

United States, 2012

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Adults in Region 9 in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

TEDS data for the Commonwealth of 

the Northern Mariana Islands in 2012 

are unavailable. Therefore, Exhibit 11 

shows regional and national figures 

only.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Region 9 and the 

United States, 2012

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

7

MENTAL HEALTH

Older Adults in Region 9 Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). 

Recent BRFSS data for the Commonwealth of the Northern Mariana Islands 

were unavailable. Therefore, data for 

Region 9 are used instead. Exhibit 12 

shows that older adults in Region 9 

experience FMD at a rate that is higher 

than the national rate.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Region 9 and the United States, 2013

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Adults in Region 9 Reporting Frequent Mental Distress by Age Group 

and Sex

Older men in Region 9 were more likely 

to indulge in binge drinking, but older 

women were more likely to report that 

they had FMD (14 days or more per 

30-day period). As Exhibit 13 shows, 

15.2 percent of women in the 50–64 age 

group and 9.5 percent in the 65+ age 

group reported FMD, while 13.7 percent 

of men in the 50–64 age group and 

7.4 percent in the 65+ age group 

reported FMD.

Exhibit 13. Individuals in Region 9 Reporting Frequent 

Mental Distress by Age Group and Sex, 2013

10.1%

12.6%

13.7%

15.2%

7.4%

9.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older adults in Region 9.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 12.4% 11.0% 14.9%

Dissatisfied or very 

dissatisfied 5.8% 7.1% 3.8%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015

Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Northern Mariana Islanders Admitted to Territory Mental Health Services

Two people served by the the Commonwealth of the Northern Mariana Islands mental health system were 

ages 65 and older. 

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 Northern Mariana Islands

Commonwealth of the Northern Mariana Islands Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States and territories that receive CMHS Block Grants are required to report aggregate data to 

URS. URS reports include information about utilization of mental health services and client demographic 

and outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). 

States and territories that receive Substance Abuse Prevention and Treatment Block Grant funds submit 

individual client data to TEDS. TEDS includes both admission and discharge data sets, and some 

1.5 million admissions are reported annually. TEDS includes information about utilization of SUD 

treatment services and client demographic and outcome information. TEDS is an admission-based 

system, and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment 

twice within a calendar year would be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Federated States 

of Micronesia
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

REGION 9’S POPULATION

Region 9 Population by Age Group

Detailed demographic U.S. Census Bureau 

data on older Micronesians are unavailable. 

Therefore, the estimates for Region 9 (which 

includes Arizona, California, Hawaii, and 

Nevada) are used instead. Region 9 is home 

to 49,792,644 people. Of these:

• 15,910,775 (32.0 percent) are over age 50.

• 9,388,613 (18.9 percent) are over age 60.

• 4,457,879 (9.0 percent) are over age 70.

• 1,714,781 (3.4 percent) are ages 80 and 

older.

Race/Ethnicity of Individuals in Region 9 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

76.4% 1.5% 5.6% 13.9% 0.6% 2.0% 21.5%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Region 9 Population by Age Group, 2014

3,323 3,369

3,829

3,456 3,297 3,207

2,345

1,254

679

3,183 3,218

3,569

3,355 3,283 3,315

2,586

1,489

1,036

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

Recent population projections for the 

Federated States of Micronesia are 

unavailable. Therefore, projections for 

Region 9 (calculated based on data 

from Arizona, California, Hawaii, and 

Nevada) are used instead. 

The U.S. Census Bureau estimates that 

18.7 percent of Region 9’s population 

will be 65 and older by the year 2030, 

an increase of 67.0 percent from 2015.

Projected Population in Region 9

Age Group 2015 2025 2030

Under 18 24.6% 24.5% 23.9%

18 to 44 37.0% 35.8% 35.7%

45 to 64 24.8% 22.4% 21.6%

65+ 13.6% 17.2% 18.7%

Source: U.S. Census Bureau, 2005

The Number of Older Adults in Region 9 Is Growing

Exhibit 2. Region 9 Population by Age Group, 2000–2030

0

5,000

10,000

15,000

20,000

25,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

Federated States of Micronesia
2

Federated States of Micronesia Federated States of Micronesia Profile 2016

SUICIDE AMONG OLDER ADULTS IN REGION 9

Region 9 Suicide Rates Compared With National Rates

Recent suicide data for the Federated 

States of Micronesia are not available 

from the Centers for Disease Control and 

Prevention (CDC) mortality databases. 

Therefore, the rates for Region 9 

(calculated based on data from Arizona, 

California, Hawaii, and Nevada) are used 

instead.

The suicide rate among individuals in 

Region 9 ages 50 and older is higher than 

the rate among younger age groups. In 

2013, the total suicide rate among all 

people ages 50+ was 18.8 per 100,000 

people (8.3 for women and 30.6 for men). 

The rate among those ages 50–64 was 

higher than the rate in the United States. 

States and territories vary in their 

reporting of suicides. The suicide rate is 

influenced by these reporting practices.

Exhibit 3. Suicide Rates in Region 9 and the United 

States, 2013

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population

Region 9 U.S.

Source: CDC, National Center for Health Statistics (NCHS), Underlying Cause of 

Death 1999-2013 on CDC WONDER Online Database, released 2015

Trends in Suicide Rates in Region 9

Recent suicide data for the Federated 

States of Micronesia are not available 

from the CDC mortality databases. 

Therefore, the rates for Region 9 are 

used instead.

The suicide rate among individuals in 

Region 9 ages 50+ fluctuated from 

a low of 16.4 per 100,000 in 2005 to 

a high of 19.5 per 100,000 in 2009. 

From 2004 to 2013, the rate was 

generally highest among those in the 

50–64 age group. 

How a state or territory reports 

suicides can vary from year to year. 

The number of suicides is generally 

low, so even a small difference in 

reported numbers may make the rate 

fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Region 9 by Age Group, 

2004–2013

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015

Federated States of Micronesia Federated States of Micronesia Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER ADULTS IN REGION 9

30-Day Binge Drinking Among Older Adults in Region 9

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are more 

likely to take risks such as driving while 

intoxicated and to experience falls and other 

accidents. Older people have a lower tolerance for alcohol. Binge drinking decreases 

with age and occurs more frequently among 

men than it does among women. Recent 

data for the Federated States of Micronesia 

are unavailable. Therefore, data for Region 9 

are used instead. As Exhibit 5 shows, 

15.5 percent of Region 9 men ages 50–64 

reported binge drinking in the past 30 days, 

while 9.0 percent of those in the 65+ group 

reported similar behavior.

Exhibit 5. Binge Drinking Rates in Region 9 by Age 

Group and Sex, 2013

29.3%

15.5%

9.0%

14.9%

9.7%

3.6%

0%

5%

10%

15%

20%

25%

30%

35%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects 

the entrance into this age group of 

the baby boom cohort, whose 

rates of illicit drug use have been 

higher than those of older cohorts. 

Although territory-specific data are 

not available, the Behavioral Health 

Barometers for states in Region 9 

are available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data 

/population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

Federated States of Micronesia Federated States of Micronesia Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Adults in Region 9

Treatment Episode Data Set (TEDS) data for 

the Federated States of Micronesia in 2012 

are unavailable. Therefore, data for Region 9 

are used instead.

In 2012, there were 29,351 admissions of 

individuals in Region 9 ages 50 and older 

to substance use disorder (SUD) treatment 

in state-funded treatment programs, a 

rate of 184.5 per 100,000 people ages 

50+. This rate was lower than the national 

average. Men made up 69.9 percent of these 

admissions. Of all admissions, 57.9 percent 

were White/Caucasian, 23.0 percent were 

Black/African American, and 19.4 percent 

were Hispanic.

The principal sources of referral to treatment 

among those ages 50 and older were: 

Self-Referral Criminal Justice Other

55.4% 21.5% 23.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Sex, 2012

274.2

383.2

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: TEDS, 20121

1

 TEDS data are collected by states and territories as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states and 

territories report all clients admitted to publicly financed treatment; however, states and territories are inconsistent in applying the guidelines. States and territories 

may structure and implement different quality controls over the data. For example, states and territories may collect different categories of information to answer 

TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

TEDS data for the Federated States of 

Micronesia in 2012 are unavailable. 

Therefore, data for Region 9 are used 

instead.

In Region 9, 53.4 percent of older adult 

admissions to SUD treatment were 

uninsured, 25.4 percent had Medicaid, 

10.9 percent had Medicare, and 

10.2 percent had private insurance.

SUD Treatment Admissions Among 

Micronesians Ages 50+ by Primary 

Sources of Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015

Federated States of Micronesia Federated States of Micronesia Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Individuals in Region 9 

Ages 50+

TEDS data for the Federated States of 

Micronesia in 2012 are unavailable. 

Therefore, data for Region 9 are used 

instead.

Alcohol was the most frequently cited 

substance used by older individuals 

in Region 9 in publicly financed SUD 

treatment in 2012. It was mentioned 

as a substance of use in 40.3 percent 

of admissions among those ages 50+. 

This was lower than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Region 9 and the United States, 2012

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

TEDS data for the Federated States of 

Micronesia in 2012 are unavailable. 

Therefore, data for Region 9 are 

used instead.

Substances other than alcohol were 

cited as the primary substances of 

use for 59.7 percent of older adult 

admissions to publicly funded 

treatment in Region 9.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Region 9 and the 

United States, 2012

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

Federated States of Micronesia Federated States of Micronesia Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Adults in Region 9 in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

TEDS data for the Federated States of 

Micronesia in 2012 are unavailable. 

Therefore, Exhibit 11 shows regional 

and national figures only.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Region 9 and the 

United States, 2012

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015

Federated States of Micronesia Federated States of Micronesia Profile 2016

7

MENTAL HEALTH

Older Adults in Region 9 Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). 

Recent BRFSS data for the Federated 

States of Micronesia were unavailable. 

Therefore, data for Region 9 are used 

instead. Exhibit 12 shows that older 

adults in Region 9 experience FMD at 

a rate that is higher than the national 

rate.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Region 9 and the United States, 2013

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Adults in Region 9 Reporting Frequent Mental Distress by Age Group 

and Sex

Older men in Region 9 were more likely 

to indulge in binge drinking, but older 

women were more likely to report that 

they had FMD (14 days or more per 

30-day period). As Exhibit 13 shows, 

15.2 percent of women in the 50–64 age 

group and 9.5 percent in the 65+ age 

group reported FMD, while 13.7 percent 

of men in the 50–64 age group and 

7.4 percent in the 65+ age group 

reported FMD.

Exhibit 13. Individuals in Region 9 Reporting Frequent 

Mental Distress by Age Group and Sex, 2013

10.1%

12.6%

13.7%

15.2%

7.4%

9.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

Federated States of Micronesia Federated States of Micronesia Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older adults in Region 9.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 12.4% 11.0% 14.9%

Dissatisfied or very 

dissatisfied 5.8% 7.1% 3.8%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015

Federated States of Micronesia Federated States of Micronesia Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Micronesians Admitted to Territory Mental Health Services

Approximately 3.6 percent of the people served by the Federated States of Micronesia mental health 

system were ages 65 and older. This represents more than approximately 20 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 Federated States of Micronesia Federated States of Micronesia Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States and territories that receive CMHS Block Grants are required to report aggregate data to 

URS. URS reports include information about utilization of mental health services and client demographic 

and outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). 

States and territories that receive Substance Abuse Prevention and Treatment Block Grant funds submit 

individual client data to TEDS. TEDS includes both admission and discharge data sets, and some 

1.5 million admissions are reported annually. TEDS includes information about utilization of SUD 

treatment services and client demographic and outcome information. TEDS is an admission-based 

system, and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment 

twice within a calendar year would be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Guam
September 2016

OLDER ADULTS BEHAVIORAL HEALTH PROFILE

REGION 9’S POPULATION

Region 9 Population by Age Group

Detailed demographic U.S. Census Bureau 

data on older Guamanians are unavailable. 

Therefore, the estimates for Region 9 (which 

includes Arizona, California, Hawaii, and 

Nevada) are used instead. Region 9 is home 

to 49,792,644 people. Of these:

• 15,910,775 (32.0 percent) are over age 50.

• 9,388,613 (18.9 percent) are over age 60.

• 4,457,879 (9.0 percent) are over age 70.

• 1,714,781 (3.4 percent) are ages 80 and 

older.

Race/Ethnicity of Individuals in Region 9 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

76.4% 1.5% 5.6% 13.9% 0.6% 2.0% 21.5%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Region 9 Population by Age Group, 2014

3,323 3,369

3,829

3,456 3,297 3,207

2,345

1,254

679

3,183 3,218

3,569

3,355 3,283 3,315

2,586

1,489

1,036

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Adults in Region 9 Is Growing

Recent population projections for Guam 

are unavailable. Therefore, projections 

for Region 9 (calculated based on data 

from Arizona, California, Hawaii, and 

Nevada) are used instead. 

The U.S. Census Bureau estimates that 

18.7 percent of Region 9’s population 

will be 65 and older by the year 2030, 

an increase of 67.0 percent from 2015.

Projected Population in Region 9

Age Group 2015 2025 2030

Under 18 24.6% 24.5% 23.9%

18 to 44 37.0% 35.8% 35.7%

45 to 64 24.8% 22.4% 21.6%

65+ 13.6% 17.2% 18.7%

Source: U.S. Census Bureau, 2005

Exhibit 2. Region 9 Population by Age Group, 2000–2030

0

5,000

10,000

15,000

20,000

25,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

Guam
2

GuamGuam Profile 2016

SUICIDE AMONG OLDER ADULTS IN REGION 9

Region 9 Suicide Rates Compared With National Rates

Recent suicide data for Guam are not 

available from the Centers for Disease 

Control and Prevention (CDC) mortality 

databases. Therefore, the rates for Region 

9 (calculated based on data from Arizona, 

California, Hawaii, and Nevada) are used 

instead.

The suicide rate among individuals in 

Region 9 ages 50 and older is higher than 

the rate among younger age groups. In 

2013, the total suicide rate among all 

people ages 50+ was 18.8 per 100,000 

people (8.3 for women and 30.6 for men). 

The rate among those ages 50–64 was 

higher than the rate in the United States. 

States and territories vary in their 

reporting of suicides. The suicide rate is 

influenced by these reporting practices.

Exhibit 3. Suicide Rates in Region 9 and the United 

States, 2013

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population

Region 9 U.S.

Source: CDC, National Center for Health Statistics (NCHS), Underlying Cause of 

Death 1999-2013 on CDC WONDER Online Database, released 2015

Trends in Suicide Rates in Region 9

Recent suicide data for Guam are 

not available from the CDC mortality 

databases. Therefore, the rates for 

Region 9 are used instead.

The suicide rate among individuals in 

Region 9 ages 50+ fluctuated from 

a low of 16.4 per 100,000 in 2005 to 

a high of 19.5 per 100,000 in 2009. 

From 2004 to 2013, the rate was 

generally highest among those in the 

50–64 age group. 

How a state or territory reports 

suicides can vary from year to year. 

The number of suicides is generally 

low, so even a small difference in 

reported numbers may make the rate 

fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Region 9 by Age Group, 

2004–2013

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 GuamGuam Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER GUAMANIANS

30-Day Binge Drinking Among Guamanians

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience 

falls and other accidents. Older people 

have a lower tolerance for alcohol. Binge 

drinking decreases with age and occurs 

more frequently among men than it does 

among women. As Exhibit 5 shows, 

25.5 percent of Guam men ages 50–64 

reported binge drinking in the past 30 

days, while 22.5 percent of those in the 

65+ group reported similar behavior.

38.9%

25.5%

22.5%

11.3%

3.3% 2.6% 0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects 

the entrance into this age group of 

the baby boom cohort, whose 

rates of illicit drug use have been 

higher than those of older cohorts. 

Although territory-specific data are 

not available, the Behavioral Health 

Barometers for states in Region 9 

are available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data 

/population-data-nsduh 

/reports?tab=33). 0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Exhibit 5. Binge Drinking Rates in Guam by Age Group 

and Sex, 2013

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

GuamGuam Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Adults in Region 9

Treatment Episode Data Set (TEDS) data for 

Guam in 2012 are unavailable. Therefore, 

data for Region 9 are used instead.

In 2012, there were 29,351 admissions of 

individuals in Region 9 ages 50 and older 

to substance use disorder (SUD) treatment 

in state-funded treatment programs, a 

rate of 184.5 per 100,000 people ages 

50+. This rate was lower than the national 

average. Men made up 69.9 percent of these 

admissions. Of all admissions, 57.9 percent 

were White/Caucasian, 23.0 percent were 

Black/African American, and 19.4 percent 

were Hispanic.

The principal sources of referral to treatment 

among those ages 50 and older were: 

Self-Referral Criminal Justice Other

55.4% 21.5% 23.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Sex, 2012

274.2

383.2

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: TEDS, 20121

1

 TEDS data are collected by states and territories as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states and 

territories report all clients admitted to publicly financed treatment; however, states and territories are inconsistent in applying the guidelines. States and territories 

may structure and implement different quality controls over the data. For example, states and territories may collect different categories of information to answer 

TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

TEDS data for Guam in 2012 are 

unavailable. Therefore, data for Region 9 

are used instead.

In Region 9, 53.4 percent of older adult 

admissions to SUD treatment were 

uninsured, 25.4 percent had Medicaid, 

10.9 percent had Medicare, and 

10.2 percent had private insurance.

SUD Treatment Admissions Among 

Guamanians Ages 50+ by Primary 

Sources of Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 GuamGuam Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Individuals in Region 9 

Ages 50+

TEDS data for Guam in 2012 are 

unavailable. Therefore, data for Region 

9 are used instead.

Alcohol was the most frequently cited 

substance used by older individuals 

in Region 9 in publicly financed SUD 

treatment in 2012. It was mentioned 

as a substance of use in 40.3 percent 

of admissions among those ages 50+. 

This was lower than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Region 9 and the United States, 2012

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

TEDS data for Guam in 2012 are 

unavailable. Therefore, data for 

Region 9 are used instead.

Substances other than alcohol were 

cited as the primary substances of 

use for 59.7 percent of older adult 

admissions to publicly funded 

treatment in Region 9.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Region 9 and the 

United States, 2012

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

GuamGuam Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Adults in Region 9 in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

TEDS data for Guam in 2012 are 

unavailable. Therefore, Exhibit 11 

shows regional and national figures 

only.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Region 9 and the 

United States, 2012

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 GuamGuam Profile 2016

7

MENTAL HEALTH

Older Guamanians Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). 

Exhibit 12 shows that Guamanians in 

the 50–64 age group experience FMD 

at a rate that is lower than the regional 

and national rates, while those in the 

65+ age group experience it at a rate 

that is lower than the regional rate and 

higher than the national rate.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Guam, Region 9, and the United States, 2013

10.3%

10.9%

7.5%

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Guam Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Guamanians Reporting Frequent Mental Distress by Age Group and Sex

As Exhibit 13 shows, in Guam, 

10.0 percent of women in the 50–64 

age group and 6.2 percent in the 65+ 

age group reported FMD, while 

11.8 percent of men in the 50–64 age 

group and 9.0 percent in the 65+ age 

group reported FMD.

Exhibit 13. Guamanians Reporting Frequent Mental 

Distress by Age Group and Sex, 2013

10.1%

10.5%

11.8%

10.0%

9.0%

6.2%

0%

2%

4%

6%

8%

10%

12%

14%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

GuamGuam Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older Guamanians.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 27.4% 23.4% 3.5%

Dissatisfied or very 

dissatisfied 8.8% 9.2% 8.0%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 GuamGuam Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Guamanians Admitted to Territory Mental Health Services

Approximately 8.5 percent of the people served by the Guam mental health system were ages 65 and older. 

This represents more than 490 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 GuamGuam Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States and territories that receive CMHS Block Grants are required to report aggregate data to 

URS. URS reports include information about utilization of mental health services and client demographic 

and outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). 

States and territories that receive Substance Abuse Prevention and Treatment Block Grant funds submit 

individual client data to TEDS. TEDS includes both admission and discharge data sets, and some 

1.5 million admissions are reported annually. TEDS includes information about utilization of SUD 

treatment services and client demographic and outcome information. TEDS is an admission-based 

system, and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment 

twice within a calendar year would be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Marshall Islands
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

REGION 9’S POPULATION

Region 9 Population by Age Group

Detailed demographic U.S. Census Bureau 

data on older Marshallese are unavailable. 

Therefore, the estimates for Region 9 (which 

includes Arizona, California, Hawaii, and 

Nevada) are used instead. Region 9 is home 

to 49,792,644 people. Of these:

• 15,910,775 (32.0 percent) are over age 50.

• 9,388,613 (18.9 percent) are over age 60.

• 4,457,879 (9.0 percent) are over age 70.

• 1,714,781 (3.4 percent) are ages 80 and 

older.

Race/Ethnicity of Individuals in Region 9 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

76.4% 1.5% 5.6% 13.9% 0.6% 2.0% 21.5%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Region 9 Population by Age Group, 2014

3,323 3,369

3,829

3,456 3,297 3,207

2,345

1,254

679

3,183 3,218

3,569

3,355 3,283 3,315

2,586

1,489

1,036

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Adults in Region 9 Is Growing

Recent population projections for 

the Marshall Islands are unavailable. 

Therefore, projections for Region 9 

(calculated based on data from Arizona, 

California, Hawaii, and Nevada) are used 

instead. 

The U.S. Census Bureau estimates that 

18.7 percent of Region 9’s population 

will be 65 and older by the year 2030, 

an increase of 67.0 percent from 2015.

Projected Population in Region 9

Age Group 2015 2025 2030

Under 18 24.6% 24.5% 23.9%

18 to 44 37.0% 35.8% 35.7%

45 to 64 24.8% 22.4% 21.6%

65+ 13.6% 17.2% 18.7%

Source: U.S. Census Bureau, 2005

Exhibit 2. Region 9 Population by Age Group, 2000–2030

0

5,000

10,000

15,000

20,000

25,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

September 2016

Marshall Islands
2

Marshall Islands Marshall Islands Profile 2016

SUICIDE AMONG OLDER ADULTS IN REGION 9

Region 9 Suicide Rates Compared With National Rates

Recent suicide data for the Marshall 

Islands are not available from the Centers 

for Disease Control and Prevention (CDC) 

mortality databases. Therefore, the rates 

for Region 9 (calculated based on data 

from Arizona, California, Hawaii, and 

Nevada) are used instead.

The suicide rate among individuals in 

Region 9 ages 50 and older is higher than 

the rate among younger age groups. In 

2013, the total suicide rate among all 

people ages 50+ was 18.8 per 100,000 

people (8.3 for women and 30.6 for men). 

The rate among those ages 50–64 was 

higher than the rate in the United States. 

States and territories vary in their 

reporting of suicides. The suicide rate is 

influenced by these reporting practices.

Exhibit 3. Suicide Rates in Region 9 and the United 

States, 2013

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population

Region 9 U.S.

Source: CDC, National Center for Health Statistics (NCHS), Underlying Cause of 

Death 1999-2013 on CDC WONDER Online Database, released 2015

Trends in Suicide Rates in Region 9

Recent suicide data for the Marshall 

Islands are not available from the 

CDC mortality databases. Therefore, 

the rates for Region 9 are used 

instead.

The suicide rate among individuals in 

Region 9 ages 50+ fluctuated from 

a low of 16.4 per 100,000 in 2005 to 

a high of 19.5 per 100,000 in 2009. 

From 2004 to 2013, the rate was 

generally highest among those in the 

50–64 age group. 

How a state or territory reports 

suicides can vary from year to year. 

The number of suicides is generally 

low, so even a small difference in 

reported numbers may make the rate 

fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Region 9 by Age Group, 

2004–2013

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 Marshall Islands Marshall Islands Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER ADULTS IN REGION 9

30-Day Binge Drinking Among Older Adults in Region 9

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience falls 

and other accidents. Older people have a 

lower tolerance for alcohol. Binge drinking 

decreases with age and occurs more 

frequently among men than it does among 

women. Recent data for the Marshall 

Islands are unavailable. Therefore, data 

for Region 9 are used instead. As Exhibit 5 

shows, 15.5 percent of Region 9 men ages 

50–64 reported binge drinking in the past 

30 days, while 9.0 percent of those in the 

65+ group reported similar behavior.

Exhibit 5. Binge Drinking Rates in Region 9 by Age 

Group and Sex, 2013

29.3%

15.5%

9.0%

14.9%

9.7%

3.6%

0%

5%

10%

15%

20%

25%

30%

35%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects 

the entrance into this age group of 

the baby boom cohort, whose 

rates of illicit drug use have been 

higher than those of older cohorts. 

Although territory-specific data are 

not available, the Behavioral Health 

Barometers for states in Region 9 

are available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data 

/population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

Marshall Islands Marshall Islands Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Adults in Region 9

Treatment Episode Data Set (TEDS) data for 

the Marshall Islands in 2012 are unavailable. 

Therefore, data for Region 9 are used 

instead.

In 2012, there were 29,351 admissions of 

individuals in Region 9 ages 50 and older 

to substance use disorder (SUD) treatment 

in state-funded treatment programs, a 

rate of 184.5 per 100,000 people ages 

50+. This rate was lower than the national 

average. Men made up 69.9 percent of these 

admissions. Of all admissions, 57.9 percent 

were White/Caucasian, 23.0 percent were 

Black/African American, and 19.4 percent 

were Hispanic.

The principal sources of referral to treatment 

among those ages 50 and older were: 

Self-Referral Criminal Justice Other

55.4% 21.5% 23.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Sex, 2012

274.2

383.2

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: TEDS, 20121

1

 TEDS data are collected by states and territories as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states and 

territories report all clients admitted to publicly financed treatment; however, states and territories are inconsistent in applying the guidelines. States and territories 

may structure and implement different quality controls over the data. For example, states and territories may collect different categories of information to answer 

TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

TEDS data for the Marshall Islands in 

2012 are unavailable. Therefore, data for 

Region 9 are used instead.

In Region 9, 53.4 percent of older adult 

admissions to SUD treatment were 

uninsured, 25.4 percent had Medicaid, 

10.9 percent had Medicare, and 

10.2 percent had private insurance.

SUD Treatment Admissions Among 

Marshallese Ages 50+ by Primary 

Sources of Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Marshall Islands Marshall Islands Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Individuals in Region 9 

Ages 50+

TEDS data for the Marshall Islands in 

2012 are unavailable. Therefore, data 

for Region 9 are used instead.

Alcohol was the most frequently cited 

substance used by older individuals 

in Region 9 in publicly financed SUD 

treatment in 2012. It was mentioned 

as a substance of use in 40.3 percent 

of admissions among those ages 50+. 

This was lower than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Region 9 and the United States, 2012

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

TEDS data for the Marshall Islands in 

2012 are unavailable. Therefore, data 

for Region 9 are used instead.

Substances other than alcohol were 

cited as the primary substances of 

use for 59.7 percent of older adult 

admissions to publicly funded 

treatment in Region 9.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Region 9 and the 

United States, 2012

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

Marshall Islands Marshall Islands Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Adults in Region 9 in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder.

TEDS data for the Marshall Islands 

in 2012 are unavailable. Therefore, 

Exhibit 11 shows regional and national 

figures only.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Region 9 and the 

United States, 2012

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Marshall Islands Marshall Islands Profile 2016

7

MENTAL HEALTH

Older Adults in Region 9 Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). 

Recent BRFSS data for the Marshall 

Islands were unavailable. Therefore, 

data for Region 9 are used instead. 

Exhibit 12 shows that older adults in 

Region 9 experience FMD at a rate that 

is higher than the national rate.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Region 9 and the United States, 2013

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Adults in Region 9 Reporting Frequent Mental Distress by Age Group 

and Sex

Older men in Region 9 were more likely 

to indulge in binge drinking, but older 

women were more likely to report that 

they had FMD (14 days or more per 

30-day period). As Exhibit 13 shows, 

15.2 percent of women in the 50–64 age 

group and 9.5 percent in the 65+ age 

group reported FMD, while 13.7 percent 

of men in the 50–64 age group and 

7.4 percent in the 65+ age group 

reported FMD.

Exhibit 13. Individuals in Region 9 Reporting Frequent 

Mental Distress by Age Group and Sex, 2013

10.1%

12.6%

13.7%

15.2%

7.4%

9.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

Marshall Islands Marshall Islands Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older adults in Region 9.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 12.4% 11.0% 14.9%

Dissatisfied or very 

dissatisfied 5.8% 7.1% 3.8%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 Marshall Islands Marshall Islands Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Marshallese Admitted to Territory Mental Health Services

One person served by the Marshall Islands mental health system was in the 65–74 age group (data were 

unavailable for ages 75 and over).

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 Marshall Islands Marshall Islands Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States and territories that receive CMHS Block Grants are required to report aggregate data to 

URS. URS reports include information about utilization of mental health services and client demographic 

and outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). 

States and territories that receive Substance Abuse Prevention and Treatment Block Grant funds submit 

individual client data to TEDS. TEDS includes both admission and discharge data sets, and some 

1.5 million admissions are reported annually. TEDS includes information about utilization of SUD 

treatment services and client demographic and outcome information. TEDS is an admission-based 

system, and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment 

twice within a calendar year would be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

Republic of Palau
OLDER ADULTS BEHAVIORAL HEALTH PROFILE

REGION 9’S POPULATION

Region 9 Population by Age Group

Detailed demographic U.S. Census Bureau 

data on older Palauans are unavailable. 

Therefore, the estimates for Region 9 (which 

includes Arizona, California, Hawaii, and 

Nevada) are used instead. Region 9 is home 

to 49,792,644 people. Of these:

• 15,910,775 (32.0 percent) are over age 50.

• 9,388,613 (18.9 percent) are over age 60.

• 4,457,879 (9.0 percent) are over age 70.

• 1,714,781 (3.4 percent) are ages 80 and 

older.

Race/Ethnicity of Individuals in Region 9 

Ages 50+

White AI/AN Black Asian NH/PI Other Hispanic

76.4% 1.5% 5.6% 13.9% 0.6% 2.0% 21.5%

Source: U.S. Census Bureau, 2015

AI/AN stands for American Indian and Alaska Native. 

NH/PI stands for Native Hawaiian and Other Pacific Islander.

Exhibit 1. Region 9 Population by Age Group, 2014

3,323 3,369

3,829

3,456 3,297 3,207

2,345

1,254

679

3,183 3,218

3,569

3,355 3,283 3,315

2,586

1,489

1,036

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

0 to 9 10 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80+

Male Female

Population in 1,000s

Source: U.S. Census Bureau, 2015

The Number of Older Adults in Region 9 Is Growing

Recent population projections for 

the Republic of Palau are unavailable. 

Therefore, projections for Region 9 

(calculated based on data from Arizona, 

California, Hawaii, and Nevada) are used 

instead. 

The U.S. Census Bureau estimates that 

18.7 percent of Region 9’s population 

will be 65 and older by the year 2030, 

an increase of 67.0 percent from 2015.

Projected Population in Region 9

Age Group 2015 2025 2030

Under 18 24.6% 24.5% 23.9%

18 to 44 37.0% 35.8% 35.7%

45 to 64 24.8% 22.4% 21.6%

65+ 13.6% 17.2% 18.7%

Source: U.S. Census Bureau, 2005

Exhibit 2. Region 9 Population by Age Group, 2000–2030

0

5,000

10,000

15,000

20,000

25,000

2000 2005 2010 2015 2020 2025 2030

Under 18 18 to 44 45 to 64 65+

Population in 1,000s

September 2016

Republic of Palau
2

Republic of Palau Republic of Palau Profile 2016

SUICIDE AMONG OLDER ADULTS IN REGION 9

Region 9 Suicide Rates Compared With National Rates

Recent suicide data for the Republic of 

Palau are not available from the Centers 

for Disease Control and Prevention (CDC) 

mortality databases. Therefore, the rates 

for Region 9 (calculated based on data 

from Arizona, California, Hawaii, and 

Nevada) are used instead.

The suicide rate among individuals in 

Region 9 ages 50 and older is higher than 

the rate among younger age groups. In 

2013, the total suicide rate among all 

people ages 50+ was 18.8 per 100,000 

people (8.3 for women and 30.6 for men). 

The rate among those ages 50–64 was 

higher than the rate in the United States. 

States and territories vary in their 

reporting of suicides. The suicide rate is 

influenced by these reporting practices.

Exhibit 3. Suicide Rates in Region 9 and the United 

States, 2013

12.0

8.9

19.1 18.4

13.0

10.6

19.0

16.1

0

5

10

15

20

25

All Under 50 50 to 64 65+

Suicide Rate per 100,000 Population

Region 9 U.S.

Source: CDC, National Center for Health Statistics (NCHS), Underlying Cause of 

Death 1999-2013 on CDC WONDER Online Database, released 2015

Trends in Suicide Rates in Region 9

Recent suicide data for the Republic 

of Palau are not available from the 

CDC mortality databases. Therefore, 

the rates for Region 9 are used 

instead.

The suicide rate among individuals in 

Region 9 ages 50+ fluctuated from 

a low of 16.4 per 100,000 in 2005 to 

a high of 19.5 per 100,000 in 2009. 

From 2004 to 2013, the rate was 

generally highest among those in the 

50–64 age group. 

How a state or territory reports 

suicides can vary from year to year. 

The number of suicides is generally 

low, so even a small difference in 

reported numbers may make the rate 

fluctuate widely.

Exhibit 4. Trends in Suicide Rates in Region 9 by Age Group, 

2004–2013

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

All ages Under 50 50+ 50 to 64 65+

Suicide Rate per 100,000 Population

Source: CDC, NCHS, Underlying Cause of Death 1999-2013 on CDC WONDER 

Online Database, released 2015
Alabama ALABAMA Profile 2015 Republic of Palau Republic of Palau Profile 2016

3

SUBSTANCE USE DISORDER AND SUBSTANCE USE DISORDER 

TREATMENT AMONG OLDER ADULTS IN REGION 9

30-Day Binge Drinking Among Older Adults in Region 9

Binge drinking, defined as five or more 

drinks for men and four or more drinks for 

women on a single occasion, can lead to 

serious health problems. Such problems 

include neurological damage, cardiovascular 

disease, liver disease, stroke, and poor 

control of diabetes. Binge drinkers are 

more likely to take risks such as driving 

while intoxicated and to experience falls 

and other accidents. Older people have a 

lower tolerance for alcohol. Binge drinking 

decreases with age and occurs more 

frequently among men than it does among 

women. Recent data for the Republic of 

Palau are unavailable. Therefore, data for 

Region 9 are used instead. As Exhibit 5 

shows, 15.5 percent of Region 9 men ages 

50–64 reported binge drinking in the past 

30 days, while 9.0 percent of those in the 

65+ group reported similar behavior.

Exhibit 5. Binge Drinking Rates in Region 9 by Age 

Group and Sex, 2013

29.3%

15.5%

9.0%

14.9%

9.7%

3.6%

0%

5%

10%

15%

20%

25%

30%

35%

18 to 49 50 to 64 65+

Male Female

Proportion of Population Engaging in Binge Drinking

Source: Behavioral Risk Factor Surveillance System (BRFSS), 2013

Illicit Drug Use Among Older Americans

Nationally, the rate of illicit drug use 

among older adults ages 50–64 more 

than doubled from 2002 to 2013. 

This development partially reflects 

the entrance into this age group of 

the baby boom cohort, whose 

rates of illicit drug use have been 

higher than those of older cohorts. 

Although territory-specific data are 

not available, the Behavioral Health 

Barometers for states in Region 9 

are available for download from the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA) 

website (www.samhsa.gov/data 

/population-data-nsduh 

/reports?tab=33).

Exhibit 6. Illicit Drug Use Among Older Americans, 

2002–2013

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

50 to 54 55 to 59 60 to 64

Proportion Using in Past Month

Source: National Survey on Drug Use and Health (NSDUH), 2013

Illicit drug use includes illegal drugs and prescription drugs used nonmedically. SAMHSA 

provides a list of drugs included in its survey in the NSDUH methodological summary.
4

Republic of Palau Republic of Palau Profile 2016

Admissions to Substance Use Disorder Treatment Among Older Adults in Region 9

Treatment Episode Data Set (TEDS) data 

for the Republic of Palau in 2012 are 

unavailable. Therefore, data for Region 9 are 

used instead.

In 2012, there were 29,351 admissions of 

individuals in Region 9 ages 50 and older 

to substance use disorder (SUD) treatment 

in state-funded treatment programs, a 

rate of 184.5 per 100,000 people ages 

50+. This rate was lower than the national 

average. Men made up 69.9 percent of these 

admissions. Of all admissions, 57.9 percent 

were White/Caucasian, 23.0 percent were 

Black/African American, and 19.4 percent 

were Hispanic.

The principal sources of referral to treatment 

among those ages 50 and older were: 

Self-Referral Criminal Justice Other

55.4% 21.5% 23.1%

Exhibit 7. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Sex, 2012

274.2

383.2

104.8 120.3

0

50

100

150

200

250

300

350

400

450

Region 9 U.S.

Male Female

SUD Admission Rate per 100,000 Population

Source: TEDS, 20121

1

 TEDS data are collected by states and territories as a condition of the Substance Abuse Prevention and Treatment Block Grant. Guidelines suggest that states and 

territories report all clients admitted to publicly financed treatment; however, states and territories are inconsistent in applying the guidelines. States and territories 

may structure and implement different quality controls over the data. For example, states and territories may collect different categories of information to answer 

TEDS questions. Information is then “walked over” to TEDS definitions.

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions Among Individuals in Region 9 Ages 50+ by 

Insurance Type 

TEDS data for the Republic of Palau in 

2012 are unavailable. Therefore, data for 

Region 9 are used instead.

In Region 9, 53.4 percent of older adult 

admissions to SUD treatment were 

uninsured, 25.4 percent had Medicaid, 

10.9 percent had Medicare, and 

10.2 percent had private insurance.

SUD Treatment Admissions Among 

Palauans Ages 50+ by Primary Sources 

of Payment

Self-Pay Medicaid Other

Data not 

available

Data not 

available

Data not 

available

Exhibit 8 and the accompanying text reflect the type of 

health insurance (if any) clients had at admission; the table 

above represents primary sources of payment.

Exhibit 8. SUD Treatment Admissions of Adults Ages 50+ 

in Region 9 and the United States by Insurance Type, 2012

10.2%

25.4%

10.9%

53.4%

14.9%

20.4%

10.8%

53.9%

0%

10%

20%

30%

40%

50%

60%

Private Medicaid Medicare None

Region 9 U.S.

Proportion of SUD Treatment Admissions of Adults Ages 50+ by Insurance Type

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Republic of Palau Republic of Palau Profile 2016

5

Alcohol Use Disorder Treatment Admissions Among Individuals in Region 9 

Ages 50+

TEDS data for the Republic of Palau in 

2012 are unavailable. Therefore, data 

for Region 9 are used instead.

Alcohol was the most frequently cited 

substance used by older individuals 

in Region 9 in publicly financed SUD 

treatment in 2012. It was mentioned 

as a substance of use in 40.3 percent 

of admissions among those ages 50+. 

This was lower than the national rate.

Exhibit 9. Alcohol Use Treatment Admissions of Adults 

Ages 50+ in Region 9 and the United States, 2012

40.3%

62.1%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Primary Alcohol Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.

SUD Treatment Admissions for Non-Alcohol Substance Use

TEDS data for the Republic of Palau in 

2012 are unavailable. Therefore, data 

for Region 9 are used instead.

Substances other than alcohol were 

cited as the primary substances of 

use for 59.7 percent of older adult 

admissions to publicly funded 

treatment in Region 9.

Exhibit 10. Non-Alcohol Substance Use Treatment 

Admissions of Adults Ages 50+ in Region 9 and the 

United States, 2012

59.7%

37.9%

0%

10%

20%

30%

40%

50%

60%

70%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Other Primary Substance Use Disorder

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
6

Republic of Palau Republic of Palau Profile 2016

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse 

and Abuse by Older Adults

SAMHSA periodically releases reports from the Drug Abuse Warning Network (DAWN). DAWN, discontinued 

in 2011, consisted of a nationwide network of hospital emergency departments (EDs) primarily located in 

large metropolitan areas. DAWN data consist of professional reviews of ED records to determine the extent 

to which alcohol and other substance abuse was involved in ED visits. According to the November 25, 2010, 

DAWN Report:

• In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by adults 

aged 50 or older; in 2008, there were 256,097 such visits, representing an increase of 121.1 percent 

• One fifth (19.7 percent) of ED visits involving pharmaceutical misuse and abuse among older adults were 

made by persons aged 70 or older 

• Among ED visits made by older adults, pain relievers were the type of pharmaceutical most commonly 

involved (43.5 percent), followed by drugs used to treat anxiety or insomnia (31.8 percent) and 

antidepressants (8.6 percent) 

• Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half 

(52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the 

hospital 

Bulleted text in italics above is taken from SAMHSA’s Center for Behavioral Health Statistics and Quality. (2010, November 25). The DAWN Report: Drugrelated emergency department visits involving pharmaceutical misuse and abuse by older adults. Rockville, MD: SAMHSA.

CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS

Older Adults in Region 9 in SUD Treatment With Co-Occurring Mental Disorders

The national literature shows a strong 

relationship between substance use 

and mental disorders. Studies show 

that 30–80 percent of individuals with a 

substance use or mental disorder also 

have a co-occurring disorder. 

TEDS data for the Republic of Palau 

in 2012 are unavailable. Therefore, 

Exhibit 11 shows regional and national 

figures only.

Exhibit 11. SUD Treatment Admissions of Adults Ages 50+ 

With a Co-Occurring Mental Disorder in Region 9 and the 

United States, 2012

22.8%

33.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Region 9 U.S.

Proportion of Treatment Admissions 50+ With Co-Occurring Disorders

Source: TEDS, 2012

Data include only those clients reported to SAMHSA.
Alabama ALABAMA Profile 2015 Republic of Palau Republic of Palau Profile 2016

7

MENTAL HEALTH

Older Adults in Region 9 Reporting Frequent Mental Distress

BRFSS, a household survey conducted 

in all 50 states and several territories, 

asks the following question: “Now 

thinking about your mental health, 

which includes stress, depression, 

and problems with emotions, for how 

many days during the past 30 days 

was your mental health not good?” 

Those individuals reporting 14 or more 

“Yes” days in response to this question 

experience frequent mental distress 

(FMD). 

Recent BRFSS data for the Republic of 

Palau were unavailable. Therefore, data 

for Region 9 are used instead. Exhibit 

12 shows that older adults in Region 9 

experience FMD at a rate that is higher 

than the national rate.

Exhibit 12. Individuals Reporting Frequent Mental Distress 

in Region 9 and the United States, 2013

11.3%

14.4%

8.6%

12.3%

13.0%

7.2%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18 to 49 50 to 64 65+

Region 9 U.S.

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013

Older Adults in Region 9 Reporting Frequent Mental Distress by Age Group 

and Sex

Older men in Region 9 were more likely 

to indulge in binge drinking, but older 

women were more likely to report that 

they had FMD (14 days or more per 

30-day period). As Exhibit 13 shows, 

15.2 percent of women in the 50–64 age 

group and 9.5 percent in the 65+ age 

group reported FMD, while 13.7 percent 

of men in the 50–64 age group and 

7.4 percent in the 65+ age group 

reported FMD.

Exhibit 13. Individuals in Region 9 Reporting Frequent 

Mental Distress by Age Group and Sex, 2013

10.1%

12.6%

13.7%

15.2%

7.4%

9.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Male Female

18 to 49 50 to 64 65+

Proportion Reporting Frequent Mental Distress

Source: BRFSS, 2013
8

Republic of Palau Republic of Palau Profile 2016

Other Measures of Mental Health

BRFSS collected other measures showing risk factors for mental and/or physical illness. These included:

• Social and Emotional Support (2010). BRFSS asked, “How often do you get the social and emotional 

support you need?” The possible responses were always, usually, sometimes, rarely, or never. 

• Life Satisfaction (2010). BRFSS asked, “In general, how satisfied are you with your life?” The possible 

responses were very satisfied, satisfied, dissatisfied, or very dissatisfied.

Exhibit 14 presents the results of these surveys among older adults in Region 9.

Exhibit 14. BRFSS Measures, 2010

Indicator Ages 50+ Ages 50–64 Ages 65+

Rarely or never get social 

or emotional support 12.4% 11.0% 14.9%

Dissatisfied or very 

dissatisfied 5.8% 7.1% 3.8%

Source: BRFSS, 2010

Individuals With Frequent Mental Distress Report High Rates of Poor Physical 

Health

Older Americans who experienced FMD 

were more likely to report that their 

physical health was poor (14 days or 

more in the past 30-day period when 

physical health was “not good”). As 

shown in Exhibit 15, although nearly 

11 percent of older Americans with no 

mental distress reported poor physical 

health, more than 50 percent of those 

with FMD reported poor physical health.

Exhibit 15. Individuals Ages 50+ in the United States 

Reporting Poor Physical Health by Level of Mental 

Distress, 2013

10.8%

18.1%

52.4%

0%

10%

20%

30%

40%

50%

60%

No mental distress Some mental distress Frequent mental distress

Proportion Reporting Poor Physical Health

Source: BRFSS, 2013
Alabama ALABAMA Profile 2015 Republic of Palau Republic of Palau Profile 2016

9

Relationship Among Mental Distress, Diabetes, Stroke, Heart Attack, 

High Blood Pressure, and Coronary Disease

Older Americans who experience FMD 

are more likely to report that they have 

health problems. People with FMD 

were more than twice as likely to report 

having a stroke than those with some 

or no mental distress. They experienced 

coronary disease and heart attack at 

more than 1.6 times, diabetes at more 

than 1.4 times, and high blood pressure 

at nearly 1.2 times the rate of those with 

some or no mental distress.

Exhibit 16. Individuals Ages 50+ in the United States 

With Mental Distress and Serious Health Problems, 2013

10.1%

13.3% 13.2%

25.9%

60.6%

4.7%

7.6% 7.8%

17.7%

51.1%

0%

10%

20%

30%

40%

50%

60%

70%

Stroke Coronary disease Heart attack Diabetes High blood pressure

Frequent mental distress Some or no mental distress

Proportion Reporting Health Problems by Mental Health Category

Source: BRFSS, 2013

Older Palauans Admitted to Territory Mental Health Services

Approximately 7.0 percent of the people served by the Republic of Palau mental health system were ages 

65 and older. This represents approximately 10 adults.

Source: Center for Mental Health Services (CMHS) Uniform Reporting System (URS) Output Tables, 2014
10 Republic of Palau Republic of Palau Profile 2016

DATA SOURCES

BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (www.cdc.gov/brfss). BRFSS, managed by CDC, 

is the largest ongoing telephone health survey system in the world, tracking health conditions and risk 

behaviors in the United States annually since 1984. Data are collected on a monthly basis in all 50 states, 

the District of Columbia, and participating territories. BRFSS data are collected by local jurisdictions and 

reported to CDC.

CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH 

STATISTICS, UNDERLYING CAUSE OF DEATH 1999-2013 ON CDC WONDER ONLINE DATABASE, 

RELEASED 2015 (http://wonder.cdc.gov/ucd-icd10.html). The WONDER online database “contains 

mortality and population counts for all U.S. counties. Data are based on death certificates for U.S. 

residents. Each death certificate identifies a single underlying cause of death and demographic data. 

The number of deaths, crude death rates or age-adjusted death rates, and 95% confidence intervals 

and standard errors for death rates can be obtained by place of residence (total U.S., region, state and 

county), age group (single-year-of age, 5-year age groups, 10-year age groups and infant age groups), 

race, Hispanic ethnicity, gender, year, cause-of-death (4-digit ICD-10 code or group of codes), injury 

intent and injury mechanism, drug/alcohol induced causes and urbanization categories. Data are also 

available for place of death, month and week day of death, and whether an autopsy was performed.”

CENTER FOR MENTAL HEALTH SERVICES UNIFORM REPORTING SYSTEM (www.samhsa.gov/data 

/us_map). States and territories that receive CMHS Block Grants are required to report aggregate data to 

URS. URS reports include information about utilization of mental health services and client demographic 

and outcome information.

NATIONAL SURVEY ON DRUG USE AND HEALTH (https://nsduhweb.rti.org). The NSDUH, managed 

by SAMHSA, is “an annual nationwide survey involving interviews with approximately 70,000 randomly 

selected individuals aged 12 and older.” NSDUH data are most frequently used by state planners 

to assess the need for SUD treatment. NSDUH data also include information about mental health 

conditions.

TREATMENT EPISODE DATA SET (www.samhsa.gov/data/client-level-data-teds/reports?tab=19). 

States and territories that receive Substance Abuse Prevention and Treatment Block Grant funds submit 

individual client data to TEDS. TEDS includes both admission and discharge data sets, and some 

1.5 million admissions are reported annually. TEDS includes information about utilization of SUD 

treatment services and client demographic and outcome information. TEDS is an admission-based 

system, and TEDS admissions do not represent individuals. Thus, an individual admitted to treatment 

twice within a calendar year would be counted as two admissions.

U.S. CENSUS BUREAU (www.census.gov/people). Two main sources of Census Bureau data were used 

in this report: (1) population estimates and (2) population projections.