Considering disability and health: Reflections on the Healthy People 2020 Midcourse Review.

The Healthy People 2020 (HP2020) Midcourse Review (MCR) presents an opportunity for professionals in the disability and health field to contemplate preliminary progress toward achieving specific health objectives. The MCR showed notable progress in access to primary care, appropriate services for complex conditions associated with disability, expansion of health promotion programs focusing on disability, improving mental health, and reducing the unemployment rate among job seekers with disabilities. This commentary presents potential considerations, at least in part, for such progress including increased access to health care, greater awareness of appropriate services for complex conditions, and opportunities for societal participation. Additional considerations are provided to address the lack of progress in employment among this population -- a somewhat different measure than that for unemployment. Continuing to monitor these objectives will help inform programs, policies, and practices that promote the health of people with disabilities as measured by HP2020.

Psychological and physical functioning difficulties associated with complex activity limitations among U.S. adults.

BACKGROUND: There is limited research that assesses psychological functioning categorically as a predictor of complex activity limitations either alone or in conjunction with physical functioning. OBJECTIVES: This paper assesses the impact of psychological and/or physical functioning difficulties as predictors of complex activity limitations among U.S. adults, using data from a national survey. METHODS: Data come from the 2006-2010 National Health Interview Survey among U.S. adults 18 or older (n = 124,337). We developed a combined physical/psychological exposure variable with six categories: 1) no/low psychological distress (LPD) and absence of physical functioning difficulties, 2) moderate psychological distress (MPD) only, 3) serious psychological distress (SPD) only, 4) physical functioning difficulty only, 5) MPD and physical functioning difficulties, and 6) SPD and physical functioning difficulties. Selected complex activity limitations include daily living, social and work limitations. RESULTS: Compared to adults with LPD and absence of physical functioning difficulties, the results demonstrated a clear and significant gradient of increasing risk of complex activity limitations beginning with MPD only, SPD only, physical functioning difficulty only, both MPD and physical functioning difficulties, and SPD and physical functioning difficulties. CONCLUSIONS: The data suggest a stronger risk of complex activity limitations when increasing psychological functioning difficulties coexist with physical functioning difficulties, leading to potential interference with a person's ability to accomplish major life activities measured in this study. The sizeable contribution of psychological distress to the prevalence of basic actions difficulty implies that the mental health component of functional limitations is important in the overall assessment of health and well-being.

Psychotropic medication use among adolescents: United States, 2005-2010.

Approximately 6.0% of U.S. adolescents aged 12-19 reported psychotropic drug use in the past month. The use of antidepressants (3.2%) and attention deficit hyperactive disorder (ADHD) drugs (3.2%) was highest, followed by antipsychotics (1.0%); anxiolytics, sedatives, and hypnotics (0.5%); and antimanics (0.2%). Males (4.2%) were more likely than females (2.2%) to use ADHD drugs. Females (4.5%) were more likely than males (2.0%) to use antidepressants. Psychotropic drug use was higher among non-Hispanic white (8.2%) adolescents than non-Hispanic black (3.1%) and Mexican-American (2.9%) adolescents. About one-half of U.S. adolescents using psychotropic drugs in the past month had seen a mental health professional in the past year (53.3%). Prior studies have shown an increase in psychotropic medication use among adolescents. However, most studies were based on clinical samples or high-risk populations. This report provides the estimate of any psychotropic medication use in the past month among U.S. noninstitutionalized adolescents aged 12-19 during 2005-2010, using National Health and Nutrition Examination Survey (NHANES) data. Psychotropic medication is a type of drug used to treat clinical psychiatric symptoms or mental disorders. Specific psychotropic drug types addressed are antidepressants; medications for attention deficit hyperactive disorder (ADHD); anxiolytics, sedatives, and hypnotics (ASH); antimanics; and antipsychotics. Adolescents using psychotropic drugs are further examined by sex, race and Hispanic origin, and mental health professional consultation.

Mood disorders and physical functioning difficulties as predictors of complex activity limitations in young U.S. adults.

BACKGROUND: There is established research that shows associations between basic physical functional difficulties and complex activity limitations. In addition, there is some research that shows associations between mood disorders and complex activity limitations. However, there is limited research looking at the joint association between mood disorders and physical functioning and complex activity limitations. Furthermore, because mood disorders and physical functioning limitations increase with age, there is a lack of information available on younger adults. OBJECTIVES: We assess the impact of mood disorders and physical function difficulties as predictors of complex activity limitations in young U.S. adults, using data from a national survey. METHODS: We use data from the Third National Health and Nutrition Examination Survey (NHANES III) among young U.S. adults 17 to 39 years of age. Selected basic actions difficulties include physical functioning difficulties (motor, visual, or hearing difficulties) and mood disorders (major depressive disorder, dysthymia, or bipolar disorder). Selected complex activity limitations include limitations in activities of daily living (ADLs) (walking inside the home, standing from a chair, getting into and out of bed, eating, and dressing), instrumental activities of daily living (IADLs) (doing chores around the house, preparing meals, and managing money), and/or specific major life activities (limitations in the kind or amount of work or housework they could perform, or being limited in any way because of an impairment or health problem). RESULTS: The prevalence of basic actions difficulty (physical functioning and/or mood disorder difficulties) among young adults is 34%. Among the young adults with basic actions difficulty, nearly 39% have mood disorders. The prevalence rates for ADL/IADL, major life activities, and any complex activity limitation are 8.6%, 8.1%, and 13.6%, respectively. Compared with young adults with no basic actions difficulties, the results showed that young adults with mood disorders alone had elevated adjusted odds ratios (2.5) for limitations in ADLs and/IADLs. For all the complex activity limitations analyzed, compared to those with no basic actions difficulties, young adults with physical functioning difficulties alone had substantially higher adjusted odds ratios (5.4-8.7) and young adults with comorbid mood disorder and physical functioning difficulties had the highest observed odds ratios (9.7-14.0). CONCLUSIONS: The data suggest a stronger risk of complex activity limitations when mood disorders coexist with physical functioning difficulties, leading to potential interference with a person's ability to accomplish the ADLs/IADLs or major life activities measured in this study. Given the magnitude of basic actions difficulty prevalence, and particularly the substantial contribution of mood disorders to this prevalence, further examination of the mental health component of basic actions difficulty is warranted. A possible area for future research could explore coordinated efforts to reduce physical and mental difficulties and facilitate the accomplishment of complex activities.

Trends in psychotropic medication use among U.S. adults.

PURPOSE: To examine trends and prevalence of prescription psychotropic medication use among noninstitutionalized US adults. METHODS: Prescription medication data from the third National Health and Nutrition Examination Survey (NHANES; 1988-1994; n = 20 050) and the 1999-2002 NHANES (n = 12 060), two nationally representative cross-sectional health examination surveys, were examined for persons aged > or =17 years. RESULTS: The age-adjusted prevalence of psychotropic medication use increased from 6.1% in 1988-1994 to 11.1% in 1999-2002 (p < 0.001). This was due to more than a three-fold increase in antidepressant use (2.5%, 1988-1994 vs. 8.1%, 1999-2002 (p < 0.001)). Significant increases between time periods for antidepressant use were seen for all age, gender, and race-ethnic groups although increases were less pronounced for males than females and non-Hispanic blacks and Mexican Americans than non-Hispanic whites. Prevalence of use remained relatively constant from 1988-1994 to 1999-2002 for anxiolytic/sedative/hypnotic (ASH) medications (3.5-3.8%), antipsychotics (0.8-1.0%), and antimanic agents (0.3-0.4%). The age-adjusted prevalence of multiple psychotropic medication use increased from 1.2% in 1988-1994 to 3.1% in 1999-2002 (p < 0.001). CONCLUSIONS: Psychotropic medication use among US adults increased since 1988-1994, specifically of antidepressants. Increases varied by gender and race-ethnicity indicating under-utilization for non-Hispanic blacks and Mexican Americans compared to non-Hispanic whites for both males and females.

Standardizing the comparison of systolic blood pressure vs. pulse pressure for predicting coronary heart disease.

Whether systolic blood pressure (SBP) or pulse pressure (PP) is more predictive of coronary heart disease remains controversial. The authors analyzed 6032 participants in the first National Health and Nutritional Examination Survey (NHANES I) followed up for an average of 16 years. Blood pressure was measured at baseline and coronary heart disease outcomes were determined from hospital or mortality records. Cox proportional hazard analyses were used to estimate the multivariate-adjusted relative risk (RR) for increases of 10 mm Hg or 1 SD in SBP and PP, and the RR associated with PP was greater than the RR associated with SBP when using an increase of 10 mm Hg. However, when using an increase of 1 SD, the RR associated with SBP was larger than for PP. Although both are predictors, the authors conclude that SBP has a larger RR than PP for coronary heart disease events.

Depression and bone mineral density in young adults: results from NHANES III.

OBJECTIVE: The purpose of this cross-sectional population-based study was to assess the association of major depressive episode (MDE) and dysthymia with bone mineral density (BMD) in young adults. METHODS: Data are from a nationally representative sample of 5,171 people aged 20 to 39 years from the Third National Health and Nutrition Examination Survey. Total proximal femoral BMD was measured using dual energy x-ray absorptiometry. MDE and dysthymia were measured using the Diagnostic Interview Schedule. RESULTS: MDE was associated with lower BMD in multivariate models in men (mean BMD = 1.038 vs. 1.068 g/cm(2); odds ratio (OR) per 1 SD decline in BMD = 1.65, 95% confidence interval (CI) = 1.08-2.52; p = 0.02) but not in women (mean BMD = 0.982 vs. 0.979 g/cm(2); OR = 0.96, 95% CI = 0.71-1.30; p =.79). The same divergence by gender was seen for dysthymia. CONCLUSION: The relationship between BMD and MDE or dysthymia in young adults varies by gender.

Prescription psychotropic medication use among the U.S. adult population: results from the third National Health and Nutrition Examination Survey, 1988-1994.

OBJECTIVE: We estimated prescription psychotropic medication use among US adults. METHODS: We examined household interview data from the third National Health and Nutrition Examination Survey (1988-1994) for persons 17 years and older (n=20,050). STUDY DESIGN AND SETTING: An estimated 10 million adults (5.5%) reported psychotropic medication use during a 1-month period. The use of anxiolytics, sedatives, and hypnotics (ASH) was most common (3.2%), followed by antidepressants (2.3%), antipsychotics (0.7%), and antimanics (0.1%). Psychotropic medication use was more prevalent among women than men (P<.001), non-Hispanic whites than non-Hispanic blacks (P<.001) and Mexican Americans (P<.001), and older rather than younger age groups (P<.001). Psychotropic medication use was also most common among those below the federal poverty level, those with no high school education, and among insured persons. Only 1% of adults used two or more psychotropic medications monthly. CONCLUSION: Many adults use psychotropic medications on a monthly basis. ASH users comprised the largest proportion of psychotropic medication users. Patterns of use varied by several socio-demographic factors.

Prevalence of mood disorders in a national sample of young American adults.

BACKGROUND: Availability of nationally representative mood disorder prevalence estimates in the United States, based on structured psychiatric interviews is limited. This report estimates overall lifetime prevalence of major depressive episode, dysthymia, and bipolar disorder using the Third National Health and Nutrition Examination Survey (NHANES III) and compares these estimates to the Epidemiologic Catchment Area Study (ECA) conducted 10 years earlier. Additionally, prevalence estimate breakdowns by selected sociodemographic and health characteristics are investigated. METHODS: NHANES III, conducted from 1988 to 1994, is a large nationally representative cross-sectional sample of the United States. A population-based sample of 8,602 men and women 17-39 years of age were eligible to participate, of whom 7,667 (89.1 %) completed interviews. Mood disorder assessments came from the Diagnostic Interview Schedule (DIS) administered as one component of the NHANES III. RESULTS: Lifetime prevalence estimates were assessed for six mood measures: 1) major depressive episode (MDE) 8.6%, 2) major depressive episode with severity (MDE-s) 7.7%, 3) dysthymia 6.2%, 4) MDE-s with dysthymia 3.4%, 5) any bipolar disorder 1.6%, and 6) any mood disorder 11.5%. All estimates except for MDE and MDE-s were significantly higher than comparable ECA estimates. CONCLUSIONS: These data provide recent national prevalence estimates. Based on their overall magnitudes, subgroup excesses, and observed increases compared to the ECA, continued monitoring of these estimates is warranted.