Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016.

Major depression is a common and treatable mental disorder characterized by changes in mood, and cognitive and physical symptoms over a 2-week period (1). It is associated with high societal costs (2) and greater functional impairment than many other chronic diseases, including diabetes and arthritis (3). Depression rates differ by age, sex, income, and health behaviors (4). This report provides the most recent national estimates of depression among adults. Prevalence of depression is based on scores from the Patient Health Questionnaire (PHQ-9), a symptom-screening questionnaire that allows for criteria-based diagnoses of depressive disorders (5). Estimates for non-Hispanic Asian persons are presented for the first time.

Antidepressant Use Among Persons Aged 12 and Over:United States,2011-2014.

Antidepressants are one of the three most commonly used therapeutic drug classes in the United States (1). While the majority of antidepressants are taken to treat depression, antidepressants can also be taken to treat other conditions, like anxiety disorders. This Data Brief provides the most recent estimates of antidepressant use in the U.S. noninstitutionalized population, including prevalence of use by age, sex, race and Hispanic origin, and length of use. This report also describes trends in the prevalence of antidepressant use from 1999­2002 to 2011­2014.

Excess mortality among people who report lifetime use of illegal drugs in the United States: A 20-year follow-up of a nationally representative survey.

OBJECTIVE: The purpose of this study was to determine the mortality risks, over 20 years of follow-up in a nationally representative sample, associated with illegal drug use and to describe risk factors for mortality. METHODS: We analyzed data from the 1991 National Health Interview Survey, which is a nationally representative household survey in the United States, linked to the National Death Index through 2011. This study included 20,498 adults, aged 18-44 years in 1991, with 1047 subsequent deaths. A composite variable of self-reported lifetime illegal drug use was created (hierarchical categories of heroin, cocaine, hallucinogens/inhalants, and marijuana use). RESULTS: Mortality risk was significantly elevated among individuals who reported lifetime use of heroin (HR=2.40, 95% CI: 1.65-3.48) and cocaine (HR=1.27, 95% CI: 1.04-1.55), but not for those who used hallucinogens/inhalants or marijuana, when adjusting for demographic characteristics. Baseline health risk factors (smoking, alcohol use, physical activity, and BMI) explained the greatest amount of this mortality risk. After adjusting for all baseline covariates, the association between heroin or cocaine use and mortality approached significance. In models adjusted for demographics, people who reported lifetime use of heroin or cocaine had an elevated mortality risk due to external causes (poisoning, suicide, homicide, and unintentional injury). People who had used heroin, cocaine, or hallucinogens/inhalants had an elevated mortality risk due to infectious diseases. CONCLUSIONS: Heroin and cocaine are associated with considerable excess mortality, particularly due to external causes and infectious diseases. This association can be explained mainly by health risk behaviors.

Excess mortality due to depression and anxiety in the United States: results from a nationally representative survey.

OBJECTIVES: We compared the mortality of persons with and without anxiety and depression in a nationally representative survey and examined the role of socioeconomic factors, chronic diseases and health behaviors in explaining excess mortality. METHODS: The 1999 National Health Interview Survey was linked with mortality data through 2011. We calculated the hazard ratio (HR) for mortality by presence or absence of anxiety/depression and evaluated potential mediators. We calculated the population attributable risk of mortality for anxiety/depression. RESULTS: Persons with anxiety/depression died 7.9 years earlier than other persons. At a population level, 3.5% of deaths were attributable to anxiety/depression. Adjusting for demographic factors, anxiety/depression was associated with an elevated risk of mortality [HR=1.61, 95% confidence interval (CI)=1.40, 1.84]. Chronic diseases and health behaviors explained much of the elevated risk. Adjusting for demographic factors, people with past-year contact with a mental health professional did not demonstrate excess mortality associated with anxiety/depression while those without contact did. CONCLUSIONS: Anxiety/depression presents a mortality burden at both individual and population levels. Our findings are consistent with targeting health behaviors and physical illnesses as strategies for reducing this excess mortality among people with anxiety/depression.

Hospitalization, Readmission, and Death Experience of Noninstitutionalized Medicare Fee-for-service Beneficiaries Aged 65 and Over.

OBJECTIVE: This report provides descriptive measures of hospitalization, readmission, and death among the noninstitutionalized population aged 65 and over using data from a national survey of the noninstitutionalized population linked to Medicare data and the National Death Index. The estimates are presented by self-reported demographic, socioeconomic, heath status, and other characteristics gathered during the interview with the survey participants. METHODS: Data are from the 2000­2005 National Health Interview Survey (NHIS) linked to 2000­2006 Medicare data and the National Center for Health Statistics 2011 Linked Mortality Files. Findings are based on in-home interviews with 25,593 linkage-eligible noninstitutionalized respondents aged 65 and over who were enrolled in fee-for-service (FFS) Medicare during the year following the interview. Among them, 1,100 died during the year following the interview, 5,456 were hospitalized with 3,490 hospitalized once, 1,192 hospitalized twice, and 774 hospitalized three or more times. Among those hospitalized, 1,491 were readmitted to the hospital within 30 days since the discharge. Both population-based and discharge-based measures are used to present the estimates. RESULTS: This is the first report presenting national estimates on hospitalization, readmission, and death using NHIS data linked to the Medicare claims and death data. Among noninstitutionalized Medicare FFS beneficiaries aged 65 and over, 4.5% died in the year following the interview and 21.6% were hospitalized, with a discharge rate of 348.4 per 1,000 population. Among those who were hospitalized and discharged alive, 17.3% were readmitted within 30 days after discharge. About one-quarter of the deceased died in the hospital (including 7.1% who died during a readmission stay).

Serious Psychological Distress Among Adults: United States, 2009-2013.

In every age group, women were more likely to have serious psychological distress than men. Among all adults, as income increased, the percentage with serious psychological distress decreased. Adults aged 18-64 with serious psychological distress were more likely to be uninsured (30.4%) than adults without serious psychological distress (20.5%). More than one-quarter of adults aged 65 and over with serious psychological distress (27.3%) had limitations in activities of daily living. Adults with serious psychological distress were more likely to have chronic obstructive pulmonary disease, heart disease, and diabetes than adults without serious psychological distress.

Depression in the U.S. household population, 2009-2012.

KEY FINDINGS: Data from the National Health and Nutrition Examination Survey, 2009-2012. During 2009-2012, 7.6% of Americans aged 12 and over had depression (moderate or severe depressive symptoms in the past 2 weeks). Depression was more prevalent among females and persons aged 40-59. About 3% of Americans aged 12 and over had severe depressive symptoms, while almost 78% had no symptoms. Persons living below the poverty level were nearly 2½ times more likely to have depression than those at or above the poverty level. Almost 43% of persons with severe depressive symptoms reported serious difficulties in work, home, and social activities. Of those with severe symptoms, 35% reported having contact with a mental health professional in the past year. Depression is a serious medical illness with mood, cognitive, and physical symptoms (1). Depression is associated with higher rates of chronic disease, increased health care utilization, and impaired functioning (2,3). Rates of treatment remain low, and the treatment received is often inadequate (1). This data brief examines both depression and depressive symptom severity in the past 2 weeks from a symptom-based questionnaire, by demographic characteristics, functioning difficulties, and recent contact with a mental health professional. Severity is categorized as severe, moderate, mild, or no depressive symptoms. Current depression is defined as severe or moderate symptoms; no depression is defined as mild or no symptoms.

Depression and obesity in the U.S. adult household population, 2005-2010.

Forty-three percent of adults with depression were obese as compared with 33% of adults without depression. Women with depression were more likely to be obese than women without depression. The relationship was consistent across all age groups among women and was also seen in men aged 60 and over. Non-Hispanic white women with depression were more likely to be obese than non-Hispanic white women without depression. This relationship was not seen in non-Hispanic black or Hispanic women or among men of any racial or ethnic background. As the severity of depression increased, the percentage of all adults and of women with obesity increased as well. Both moderate to severe depressive symptoms and antidepressant use were associated with increased obesity. Moderate to severe depressive symptoms were associated with a higher rate of obesity both in persons who were taking antidepressant medication and those who were not, and antidepressant use was associated with a higher rate of obesity in persons with moderate to severe depressive symptoms and those with mild or no depressive symptoms. Of the four categories, the highest prevalence of obesity (54.6%) was found in persons who had moderate or severe depressive symptoms and took antidepressant medication. In this study, it is not clear whether depression or obesity occurred first because they were both measured at the same time. Other studies have shown a bidirectional relationship, meaning obesity increases risk of depression and depression increases risk of obesity . Knowledge of these risks may help general medical practitioners and mental health professionals plan prevention and treatment.

Implications of two-stage depression screening for identifying persons with thoughts of self-harm.

OBJECTIVE: Persons with thoughts of self-harm may need evaluation for suicide risk. We examine the prevalence of thoughts of self-harm and whether persons with thoughts of self-harm are identified when two-stage depression screening is used. METHODS: Data are from the 2005-2010 National Health and Nutrition Examination Surveys. Persons responding positively to question nine of the Patient Health Questionnaire-9 (PHQ-9) are identified as having thoughts of self-harm. We compare two depression cutoff scores for the Patient Health Questionnaire-2 (PHQ-2) to see what percentage of persons with thoughts of self-harm would be identified as needing further screening with the PHQ-9. RESULTS: The prevalence of thoughts of self-harm was 3.5%. Persons 12-17 years old, poor and reporting fair or poor health were more likely to report thoughts of self-harm. A cutoff score of three on the PHQ-2 identified 49% of persons with thoughts of self-harm for further screening with the PHQ-9. A cut point of two increased the proportion of persons with thoughts of self-harm continuing for further screening to 76%. CONCLUSIONS: Using a lower cutoff score, two, the PHQ-2 captures more persons with thoughts of self-harm. One quarter of persons with self-harm thoughts may not be identified for further screening when two-stage screening is used.

Mental illness surveillance among adults in the United States.

Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.

Antidepressant use in persons aged 12 and over: United States, 2005-2008.

In 2005­2008, 11% of Americans aged 12 and over took antidepressant medication. There were significant differences in antidepressant medication usage rates between groups. Females were 2½ times as likely as males to take antidepressants. Antidepressant use was higher in persons aged 40 and over than in those aged 12­39. Non-Hispanic white persons were more likely to take antidepressants than other race and ethnicity groups. Other studies have shown similar age, gender, and race and ethnicity patterns (2,3). There was no variation in antidepressant use by income group. Among persons taking antidepressants overall, there was no significant difference in length of use between males and females. Among persons taking antidepressants, males were more likely than females to have seen a mental health professional in the past year. About 8% of persons aged 12 and over with no current depressive symptoms took antidepressant medication. This group may include persons taking antidepressants for reasons other than depression and persons taking antidepressants for depression who are being treated successfully and do not currently have depressive symptoms.Slightly over one-third of persons aged 12 and over with current severe depressive symptoms were taking antidepressants. According to American Psychiatric Association guidelines, medications are the preferred treatment for moderate to severe depressive symptomatology (4). The public health importance of increasing treatment rates for depression is reflected in Healthy People 2020, which includes national objectives to increase treatment for depression in adults and treatment for mental health problems in children (5).

Depression and smoking in the U.S. household population aged 20 and over, 2005-2008.

KEY FINDINGS: Data from the National Health and Nutrition Examination Surveys, 2005-2008. Adults aged 20 and over with depression were more likely to be cigarette smokers than those without depression. Women with depression had smoking rates similar to men with depression, while women without depression smoked less than men. The percentage of adults who were smokers increased as depression severity increased. Among adult smokers, those with depression smoked more heavily than those without depression. They were more likely to smoke their first cigarette within 5 minutes of awakening and to smoke more than one pack of cigarettes per day. Adults with depression were less likely to quit smoking than those without depression.

Serious psychological distress, as measured by the K6, and mortality.

PURPOSE: The K6 is a 6-item scale of nonspecific psychological distress included in many nationally representative health surveys. This study examines whether persons with serious psychological distress (SPD), as measured by the K6, have a greater risk of mortality than persons without SPD and whether K6 scores have a dose-response relationship with mortality. METHODS: The data used are the combined 1997-2000 National Health Interview Surveys linked with the National Death Index through 2002. We examined the relationship between K6 score and mortality using a cut-off of 13 for SPD and then a 5-level categorical variable. Cox proportional hazards models were adjusted for potential confounders, including sociodemographic factors, health behaviors, and physical illness. RESULTS: The age- and sex-adjusted mortality hazard ratio associated with SPD was 2.2 (1.9, 2.5). After adjusting for covariates, SPD remained related to increased mortality, hazard ratio, 1.30 (1.13, 1.49). Adjusted mortality hazard ratios for the categorical variable demonstrated a dose-response effect with hazard ratios of 1.00, 1.10, 1.22, 1.51, and 1.54. All 4 exposure categories were statistically significantly different from the reference group. CONCLUSIONS: SPD as measured by the K6 is associated with increased mortality, even after adjusting for potential confounders; scores were related to increased mortality in a dose-response fashion.

Measures of cognitive functioning in the 1994-2000 Second Longitudinal Study of Aging.

OBJECTIVES: This report describes in detail the measures of cognitive functioning administered in the Second Longitudinal Study of Aging (LSOA II) and proposes a three-category cognitive impairment variable for analysts' use that is derived from the individual measures. METHODS: LSOA II self-respondents completed an 11-question cognitive functioning measure based on the Telephone Interview of Cognitive Status (TICS) instrument. Proxy respondents answered nine questions drawn from the short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Using cut points provided in the literature as a guide, a single three-level categorical measure of cognitive impairment was created: probable, possible, and no cognitive impairment. RESULTS: The cognitive functioning measures administered in LSOA II retain many of the favorable psychometric properties of the original TICS and IQCODE. The constructed cognitive impairment (CI) variable demonstrates good construct validity, and prevalence rates are generally consistent with those from other published studies. CONCLUSIONS: The categorical CI variable is easy to use and interpret and allows analysts the option of combining self- and proxy-respondent data in investigations of associations between CI and health outcomes, including continuing independence, progressive impairment, health care utilization patterns, and mortality.

Depression in the United States household population, 2005-2006.

KEY FINDINGS: Data from the National Health and Nutrition Examination Survey, 2005-2006. In any 2-week period, 5.4% of Americans 12 years of age and older experienced depression. Rates were higher in 40-59 year olds, women, and non-Hispanic black persons than in other demographic groups. Rates of depression were higher among poor persons than among those with higher incomes. Approximately 80% of per sons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life. Only 29% of all persons with depression reported contacting a mental health professional in the past year, and among the subset with severe depression, only 39% reported contact. Depression is a common and debilitating illness. It is treatable, but the majority of persons with depression do not receive even minimally adequate treatment. Depression is characterized by changes in mood, self-attitude, cognitive functioning, sleep, appetite, and energy level. The World Health Organization found that major depression was the leading cause of disability worldwide. Depression causes suffering, decreases quality of life, and causes impairment in social and occupational functioning. It is associated with increased health care costs as well as with higher rates of many chronic medical conditions. Studies have shown that a high number of depressive symptoms are associated with poor health and impaired functioning, whether or not the criteria for a diagnosis of major depression are met.

Characteristics of adults with serious psychological distress as measured by the K6 scale: United States, 2001-04.

OBJECTIVE: This report estimates the prevalence of serious psychological distress (SPD) in the noninstitutionalized adult population of the United States, as measured by the K6 scale of nonspecific psychological distress, and describes the characteristics of adults with and without SPD. These findings are compared with results from previous studies of the characteristics of adults with serious mental illnesses that cause significant disability, such as severe major depression, bipolar disorder, and schizophrenia. METHODS: The estimates in this report were derived from the Family Core and Sample Adult components of the 2001-04 National Health Interview Survey, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Estimates were calculated using the SUDAAN statistical package to account for the complex survey design. RESULTS: The prevalence of SPD was higher among adults 45-64 years old than younger adults 18-44 years or older adults 65 years and over. Adults with SPD were more likely to be female, have less than a high school diploma, and live in poverty, and less likely to be married than adults without SPD. Moreover, those with SPD were more likely to be obese and to be current smokers. They have a higher prevalence of ever being diagnosed with heart disease, diabetes, arthritis, and stroke than persons without SPD. Adults with SPD were more likely to report needing help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). They also used more medical care services such as doctor visits and visits to mental health professionals than adults without SPD. CONCLUSIONS: The associations between SPD and sociodemographic characteristics, health status, and health care utilization are similar to the relationships found between serious mental illnesses (for example, major depression or schizophrenia) and these same variables. Persons with SPD demonstrate disadvantage in both socioeconomic status and health outcomes.

Are racial and ethnic minorities less willing to participate in health research?

BACKGROUND: It is widely claimed that racial and ethnic minorities, especially in the US, are less willing than non-minority individuals to participate in health research. Yet, there is a paucity of empirical data to substantiate this claim. METHODS AND FINDINGS: We performed a comprehensive literature search to identify all published health research studies that report consent rates by race or ethnicity. We found 20 health research studies that reported consent rates by race or ethnicity. These 20 studies reported the enrollment decisions of over 70,000 individuals for a broad range of research, from interviews to drug treatment to surgical trials. Eighteen of the twenty studies were single-site studies conducted exclusively in the US or multi-site studies where the majority of sites (i.e., at least 2/3) were in the US. Of the remaining two studies, the Concorde study was conducted at 74 sites in the United Kingdom, Ireland, and France, while the Delta study was conducted at 152 sites in Europe and 23 sites in Australia and New Zealand. For the three interview or non-intervention studies, African-Americans had a nonsignificantly lower overall consent rate than non-Hispanic whites (82.2% versus 83.5%; odds ratio [OR] = 0.92; 95% confidence interval [CI] 0.84-1.02). For these same three studies, Hispanics had a nonsignificantly higher overall consent rate than non-Hispanic whites (86.1% versus 83.5%; OR = 1.37; 95% CI 0.94-1.98). For the ten clinical intervention studies, African-Americans' overall consent rate was nonsignificantly higher than that of non-Hispanic whites (45.3% versus 41.8%; OR = 1.06; 95% CI 0.78-1.45). For these same ten studies, Hispanics had a statistically significant higher overall consent rate than non-Hispanic whites (55.9% versus 41.8%; OR = 1.33; 95% CI 1.08-1.65). For the seven surgery trials, which report all minority groups together, minorities as a group had a nonsignificantly higher overall consent rate than non-Hispanic whites (65.8% versus 47.8%; OR = 1.26; 95% CI 0.89-1.77). Given the preponderance of US sites, the vast majority of these individuals from minority groups were African-Americans or Hispanics from the US. CONCLUSIONS: We found very small differences in the willingness of minorities, most of whom were African-Americans and Hispanics in the US, to participate in health research compared to non-Hispanic whites. These findings, based on the research enrollment decisions of over 70,000 individuals, the vast majority from the US, suggest that racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research. Hence, efforts to increase minority participation in health research should focus on ensuring access to health research for all groups, rather than changing minority attitudes.

Characteristics of primary care visits for individuals with severe mental illness in a national sample.

Individuals with severe mental illness (SMI) are at risk for inadequate general medical and preventive care, but little is known about their visits for primary care. We performed a cross-sectional analysis of primary care physician visits from the National Ambulatory Medical Care Survey (NAMCS) 1993-1998 and compared visit characteristics for patients with and without SMI. SMI was defined from ICD-9 diagnoses and medications. Primary care visits for patients with SMI were more likely to be return visits, were longer, and were more likely to have scheduled follow-up than for patients without SMI. Obesity, diabetes, and smoking were reported approximately twice as frequently in visits for patients with SMI compared to patients without SMI. The percent of visits with preventive counseling and counseling targeted at chronic medical conditions was similar for both groups. Likely appropriate to their complex needs, patients with SMI using primary care tend to have more return visits, longer time with the physician and are more often scheduled for follow-up care; their preventive counseling appears similar to non-SMI visits.