Download Mental Health Issues - Healthy Kansans 2020

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Mental Health
Issues
Mental Health Issues
HP 2020 Goal
Improve mental health through prevention
and by ensuring access to appropriate, quality
mental health services.
HP 2020 Objectives
Reduce the proportion
of persons who
experience major
depressive episodes
(MDEs).
Targets: 7.4% among
adolescents 12 to 17
years old
5.8% among adults 18
years old and older.
Increase the
proportion of adults
18 years old and older
Target: 78.2%
with major depressive
episodes who receive
treatment.
Mental disorders are responsible for a high
degree of burden due to illness.2 According to
the 1999 Surgeon General’s report on mental
health, only about 17 percent of U.S. adults are
considered to be in a state of optimal mental
health.1 Owing to this growing burden of mental
disorders, it is essential that effective preventive
and promotional measures be taken in mental
health to reduce the impact of mental disorders
on the individual and society.2
In 2010, about 8.5 percent of adults 18 years old
and older had 14 or more days of poor mental
health in the previous 30 days.17 In 2011 about 22
percent of Kansas high school students in grade
9-12 felt so sad or hopeless almost every day for
two weeks or more in a row during the previous
12 months that they stopped doing some usual
activities.29 Depression and anxiety, the two
Summary
Mental health and mental illness, terms that
describe the continuum of mental function,1
constitute an integral part of overall health.2 Thus,
to attain status of overall health, improvement
of the mental health of individuals is essential.
153
leading mental health issues, are prevalent
conditions in Kansas.17 Disparities are also seen
in the burden of these mental health issues in
the population sub-groups. Out of 105 counties
in Kansas, 99 counties are considered partial
or whole mental health professional shortage
areas.30
To improve the overall health of Kansans, it is
important to address leading mental health issues
and associated disparities through prevention
and by ensuring access to appropriate, quality
mental health services.
Definition and Introduction
Mental health and mental illness, terms that
describe the continuum of mental function,1
constitute an integral part of overall health,
which is defined as “a state of complete physical,
mental and social well-being and not merely the
absence of disease or infirmity.”2 Mental health
is “a state of well-being in which the individual
realizes his or her own abilities, can cope with
the normal stresses of life, can work productively
and fruitfully, and is able to make a contribution
to his or her community.”1,3 According to the 1999
Surgeon General’s report on mental health, only
about 17 percent of U.S. adults are considered
to be in a state of optimal mental health.1 The
emerging knowledge through research in this
field is indicating that positive mental health is
154
related to improved health outcomes.4 Mental
illness is defined as “collectively all diagnosable
mental disorders” or “health conditions that are
characterized by alterations in thinking, mood,
or behavior (or some combination thereof)
associated with distress and/or impaired
functioning.”2,4 Mental disorders are among the
most common causes of disability and resulting
disease burden and mental illness is among the
highest of all diseases. In any given year, an
estimated 13 million American adults (about 1 in
17) have a seriously debilitating mental illness.5,6
Mental health disorders are the leading cause of
disability in the United States, accounting for 25
percent of all years of life lost to disability and
premature mortality.7 Also, suicide is the 11th
leading cause of death in the United States,
causing about 30,000 deaths each year.8,9
Depression is the most common type of mental
illness, affecting more than 26 percent of the U.S.
adult population.5 It is associated with increased
risk of morbidity, mortality and impaired quality
of life.12 Depressive and related depressive
disorders are the cause of more than two-thirds
of suicides each year.13 Depression is a risk factor
for noncompliance of medical treatment and may
increase severity of a disease.12 It is also a costly
disease; an estimated $83 billion were spent on
direct and indirect cost in the United States.14
Studies indicate that mental disorders, especially
depressive disorders, are strongly related to the
occurrence, treatment outcomes, and course
of many chronic diseases including diabetes,
cancer, cardiovascular disease, asthma, and
obesity and associated risk behaviors such as
physical inactivity, smoking, excessive drinking,
and insufficient sleep.4,10 The Healthy People 2010
plan had included Mental Health as one of the 10
leading indicators for monitoring health status of
the nation and has recommended increasing the
proportion of adults with recognized depression
who receive treatment.
Mental Health and Illness Status in
Kansas
Diagnosed Depression, Current Depression
and Anxiety
Depression and anxiety, the two leading mental
health issues, are prevalent conditions in Kansas.
Disparities are seen in the burden of these
conditions among various socio-demographic
subgroups and among those with other chronic
diseases and disability.15
The types of depression include major depression
disorder (MDD), minor depression, dysthymia
and bipolar disorder. Depression symptoms
include persistent sad, anxious or “empty”
mood; feelings of hopelessness, pessimism,
guilt, worthlessness, or helplessness; loss of
interest or pleasure in hobbies and activities that
were once enjoyed, including sex; decreased
energy, fatigue or being “slowed down”;
difficulty concentrating, remembering or making
decisions; insomnia, early-morning awakening
or oversleeping; appetite and/or weight loss or
overeating and weight gain; thoughts of death
or suicide, or suicide attempts; restlessness or
irritability; persistent physical symptoms that do
not respond to treatment, such as headaches,
digestive disorders and chronic pain.16
adapted set of PHQ questions are referred as
PHQ-8. The population-based mental health
information obtained through the application
of this PHQ-8 tool is used to develop a scoring
system to define different levels of severity
of depression. Based on this scoring system,
different levels of severity of depression are
defined as no depression (score 0-4), mild
(score 5-9), moderate (score 10-14), moderately
severe (score 15-19), and severe depression
(score ≥ 20). In addition, based on this scoring
system, depression is classified into two groups
- current depression (score ≥ 14) and no current
depression (score < 14).
Anxiety disorders are considered the most
prevalent mental disorder among adults in the
United States.19,20 In a given year, an estimated
40 million or 18.1 percent of adults are affected
with an anxiety disorder.19,20 It is estimated that
half of American adults diagnosed with major
depression are also diagnosed with a type of
anxiety disorder.21 Individuals with an anxiety
disorder tend to make more frequent trips to
the doctors, and are six times more likely to be
hospitalized for psychiatric disorders.20 Despite
being in the presence of health care professionals,
the symptoms of an anxiety disorder can easily
In Kansas, a population-based health surveillance
system17 – the Behavioral Risk Factor Surveillance
System (BRFSS) collects information on ever
being diagnosed with depression (includes major
depression, dysthymia, or minor depression).
In addition, Kansas BRFSS also uses eight
questions to collect information on mood status
and depressive symptoms of the individuals.
These questions are adapted and modified from
the Patient Health Questionnaire - Version 9
(PHQ)11,18 and include eight of the nine criteria’s
for the diagnosis of depression listed in the
Diagnostic and Statistical Manual disorders,
Fourth Edition Text Revision (DSM-IV-TR). This
155
be masked with physical illnesses therefore proper treatment of the disorder is difficult.14,20 Scientific
literature shows that people suffering from both a major depression and general anxiety disorder have
significantly greater disability as opposed to those suffering from just one of the disorders.22 The type of
anxiety disorders include acute stress disorder (ASD), generalized anxiety disorders (GAD), obsessivecompulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), social anxiety
disorder (also known as social phobia), and specific phobias such as fear of heights and spiders.23
Kansas BRFSS also collected population-based information on ever being diagnosed with anxiety.17
About 1 in 7 (14.7%) Kansans 18 years old and older have ever been diagnosed with depression and
about 1 in 14 (7.6%) have current depression (Score ≥ 14 based on PHQ-8 tool). About 1 in 10 (10.3%)
Kansans 18 years old and older have ever been diagnosed with anxiety.15,17
Prevalence of Ever Being Diagnosed With Depression, Current Depression and Ever
Being Diagnosed With Anxiety among Adults Ages 18 Years and Older, Kansas 2006,
2008 & 2010
Sources: 2006-2010 Kansas Behavioral Risk Factor Surveillance System, Bureau of Health Promotion, KDHE.
It is important to note that based on PHQ-8 scores, about 24 percent of Kansas adults 18 years old and
older have mild to severe depression as compared to 14.7 percent of Kansas adults who have doctor
diagnosed depression.15 Thus, a considerable percentage of adults has some degree of depression
without being diagnosed by a physician.
Diagnosed Depression, Current Depression and Anxiety Among Kansas Socio-Demographic
Groups
Disparities in the prevalence of ever being diagnosed with depression are seen among various sociodemographic sub groups in Kansas.15 About 1 in 5 females has ever been diagnosed with depression
as compared to 1 in 10 males.15,17 Higher prevalence of ever being diagnosed with depression is seen
among adults 35 to 64 years old, those who are divorced or separated, unemployed, unable to work,
and with lower education and income status.15,17 A higher prevalence of ever being diagnosed with
depression is seen among adults without health care coverage as compared to adults with health care
coverage.15,17 About 1 in 3 adults who needed to see a doctor in the previous 12 months but did not
because of the cost has depression.15,17
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Severity Levels of Depression Among Adults 18 Years and Older, Kansas 2010
Source: 2010 Kansas Behavioral Risk Factor Surveillance System, Bureau of Health Promotion, KDHE.
Disparities are also seen in the prevalence of
current depression in Kansas.15 About 1 in 10
females are currently depressed as compared
to 1 in 17 males.15,17 The prevalence of current
depression is also higher among adults who are
divorced or separated as compared to adults who
are married; among adults with less than high
school education as compared to adults who are
college graduates; among adults 35 to 54 years
old; those with lower income; and those who are
unable to work.15,17 A higher prevalence of current
depression is seen among adults without health
care coverage as compared to adults who have
health care coverage.15,17 In Kansas 1 in 4 adults
who needed to see a doctor in the previous 12
months but could not because of the cost has
current depression.15,17
Similar disparity patterns are seen for the
prevalence of ever being diagnosed with anxiety;
however, there is no statistical difference in
the prevalence of ever being diagnosed with
anxiety among adults with different educational
levels. About 1 in 8 Kansas females have ever
been diagnosed with anxiety as compared to 1
in 13 males.15,17 The prevalence of ever being
diagnosed with anxiety is higher among adults
who have lower annual household income (<
$15,000) and are unable to work as compared
to adults with higher annual household income
(>= $50,000) and who are employed.15,17 The
prevalence of ever being diagnosed with anxiety
is also higher among adults who are divorced
or separated and who are never married as
compared to adults who are married; and among
those who reside in an urban region of the state
as compared to adults who reside in a frontier
region.15,17 In Kansas 1 in 5 adults who needed
to see a doctor in the previous 12 months but did
not because of the cost has anxiety.15,17
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Diagnosed Depression, Current Depression
and Anxiety Among Kansas Adults with
Chronic Diseases, Chronic Disease Risk
Factors and Those Living with a Disability
Disparities in the prevalence of ever being
diagnosed with depression, current depression
and ever being diagnosed with anxiety are seen
among those with other chronic diseases, chronic
disease risk factors and among those living with
a disability.15
The prevalence of being ever diagnosed with
depression is higher among those with chronic
diseases such as current asthma and stroke.15,17
The higher prevalence is also seen among obese
adults, current cigarette smokers and those
who do not participate in leisure time physical
activity.15 In Kansas 1 in 3 adults who rate their
health as fair or poor has ever been diagnosed
with depression as compared to 1 in 8 who rate
their health as excellent, very good or good.15,17
The prevalence of ever being diagnosed with
depression is also higher among adults living with
disability as compared to adults living without a
disability.15
The prevalence of current depression is higher
among those with chronic diseases such as
stroke and current asthma.15,17 The prevalence
is also higher among current cigarette smokers,
obese adults and those who do not participate
in leisure time physical activity.15,17 In Kansas 1
in 4 adults who rate their health as fair or poor
has current depression as compared to 1 in 20
who rate their health as excellent, very good or
good. The prevalence of current depression is
also higher among adults living with disability as
compared to adults living without a disability.15
Higher prevalence of ever being diagnosed
with anxiety is seen among those with chronic
disease such as current asthma, coronary
heart disease, and stroke. Higher prevalence of
ever being diagnosed with anxiety is also seen
among current smokers.15,17 In Kansas 1 in 5
adults who rate their health as fair or poor are
ever been diagnosed with anxiety as compared
to 1 in 12 who rate their health as excellent, very
good or good.15,17 The prevalence of ever being
diagnosed with anxiety is also higher among
adults living with disability as compared to adults
living without a disability.15
Depression Treatment in Kansas
About 2 in 5 (43.5%) Kansas adults ages 18 years
and older who have symptoms of depression
during a period of two weeks and longer in
the previous 12 months receive treatment for
depression (any treatment or hospitalization for
sadness, discouragement or lack of interest at
any time in the past 12 months).15 The top three
reasons for not receiving treatment are no reason
for not seeking treatment (27.5%), inability to
afford the treatment (23.0%), and not feeling the
need or feeling symptoms are not severe enough
to receive the treatment (21.1%).15
One of the 10 leading health indicators for Healthy
People 2010 was to increase the proportion of
adults with recognized depression who receive
treatment to 64 percent. Further efforts are
needed in Kansas to meet this objective.
158
Prevalence of Serious Psychological
Distress in Kansas
Serious Psychological Distress (SPD) is a
nonspecific measure of psychological distress
that has been psychometrically validated and
shown to be able to distinguish community
DSM-IV cases from non-cases.24,25,26,27 SPD is
determined using Kessler 6 (K6) scale. This scale
is widely used nationally and internationally in
epidemiological studies and surveys assessing
mental illness. Another measure of mental
illness is Frequent Mental Distress (FMD).
FMD is calculated by number of days reported
as mental health was not good in past 30 days
by respondents and categorized as positive for
14 or more days. Kansas BRFSS has provided
information on the population level prevalence of
SPD and FMD among adults ages 18 years and
older. About 2.5 percent of Kansans 18 years old
and older have SPD and about 8.6 percent have
FMD.28
Serious Psychological Distress Among
Socio-Demographic Groups in Kansas
Prevalence of serious psychological distress
is higher among adults who have less than
high school education as compared to those
who are college graduates; among those with
annual household income less than $15,000 as
compared to those with higher annual household
income; among adults who are unable to work
as compared to adults who were self-employed
or employed for wages, retired, homemakers
or students; and among divorced or separated
individuals as compared to married, members of
unmarried couple and never married individuals.28
Higher prevalence of SPD is seen among
adults without health insurance or coverage
as compared to those with health insurance or
coverage.28
Serious Psychological Distress Among
Adults with Chronic Diseases, Chronic
Disease Risk Factors and Those Living with
a Disability in Kansas
Higher prevalence of SPD is seen among
adults with arthritis as compared to adults
without arthritis; among adults with diabetes as
compared to adults without diabetes; among
adults with hypertension as compared to adults
without hypertension; among adults with current
asthma as compared to adults without current
asthma; among adults with coronary heart
disease as compared to those who did not have
coronary heart disease; and among adults who
have had a stroke as compared to those who did
not have a stroke. Higher prevalence of SPD is
observed in current smokers as compared to nonsmokers; among those who do not participate
in any physical activity or exercise other than
their regular job (leisure time physical activity)
as compared to those who participate in leisure
time physical activity; and among those who are
inactive as compared to those who participate
in recommended level of physical activity and in
insufficient physical activity. Higher prevalence
of SPD is observed among people living with a
disability as compared to people living without a
disability.28
159
Serious Psychological Distress Treatment in Kansas
Only about half of adults with SPD (49.7%) receive medicine or treatment from a doctor or other health
professional. Fewer than half of adults with FMD (41.5%) receive medicine or treatment from a doctor
or other health professional.28
Other Measures
Mental Health and Youth in Kansas
In 2011 1 in 5 (21.9%) Kansas high school students in grade 9-12 felt so sad or hopeless almost every
day for two weeks or more in a row during the previous 12 months that they stopped doing some usual
activities.29 The prevalence of feeling sad or hopeless is higher among female students as compared
to male students.29
Kansas Mental Health Professional Shortage Areas
Out of 105 counties in Kansas, 99 counties are considered partial or whole mental health professional
shortage areas.30
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References
1. U.S. Department of Health and Human Services. Mental Health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and
Human Services, Substance abuse and Mental Health, National Institutes of Health, National Institute of Mental Health; 1999. Available at: http://
profiles.nlm.nih.gov/ps/access/NNBBHV.pdf. Accessed October 30, 2014.
2. World Health Organization. Strengthening Mental Health Promotion. Fact sheet no. 220. Geneva,CH: World Health Organization; 2001.
3. U.S. Department of Health and Human Services. Mental Health and Mental Disorders. Healthy People 2020 website. U.S. Department of Health
and Human Services. Available at: http://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders. Accessed
October 30, 2014.
4. National Center for Chronic Disease Prevention and Health Promotion. Mental Health Basics. Centers of Disease Control and Prevention website.
2013. Available at: http://www.cdc.gov/mentalhealth/basics.htm. Accessed October 30, 2014.
5. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity
Survey Replication. Arch Gen Psychiatry. 2005;62:617–627.
6. U.S. Census Bureau, Population Division. US Census Bureau population estimates by demographic characteristics: National population
estimates—characteristics. Table 2 (NC-EST2004-02): Annual estimates of the population by selected age groups and sex for the United States:
April 1, 2000, to July 1, 2004; A18. Washington: US Census Bureau; 2005 Jun 9.
7. The World Health Organization (WHO). The world health report 2004: Changing history. Annex Table 3: Burden of disease in DALYs by cause, sex,
and mortality stratum in WHO regions, Estimates for 2002; A126-A127. Geneva, CH: WHO; 2004.
8. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIP). Web-based injury statistics query and
reporting system (WISQARS) [Internet]. Atlanta: CDC; 2010. Available at: http://www.cdc.gov/ncipc/wisqars.
9. National Institutes of Health, National Institute of Mental Health (NIMH). NIMH strategic plan (revised 2008) [Internet]. Bethesda, MD: NIMH; 2008
[cited 2010 May 6]. Available at: http://www.nimh.nih.gov/about/strategic-planning-reports/index.shtml.
10.Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis. 2005;2(1):A14.
11.Kroneke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16:
606-613.
12.Martin A, Rief W, Klaiberg A, Braehler E. Validity of the brief Patient Health Questionnaire (PHQ-9) mood scale in the general population. General
Hospital Psychiatry. 2006;28:71-77.
13.U.S. Department of Health and Human Services. Mental Health: Leading Health Indicator. Healthy People 2010 website. 2010. Available at: http://
www.healthypeople.gov/2010/?visit=1. Accessed February, 2012.
14.Greenburg PE, Kessler RC, Birnbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and
2000? Journal of Clinical Psychiatry. 2003;64:1465-1475.
15.Kansas Department of Health and Environment. Depression and Anxiety Status in Kansas: 2010 Behavioral Risk Factor Surveillance System.
Topeka, KS: Bureau of Health Promotion, Kansas Department of Health and Environment; 2012. Available at: http://www.kdheks.gov/brfss/
PDF/2010_Kansas_Depression_and_Anxiety_Status.pdf. Accessed October 30, 2014.
16.National Institute of Mental Health. Depression. National Institute of Mental Health website. 2012. Available at: http://www.nimh.nih.gov/health/
publications/depression/complete-index.shtml. Accessed February, 2012.
17.2010 Kansas Behavioral Risk Factor Surveillance System, Bureau of Health Promotion, Kansas Department of Health and Environment. Available
at: http://www.kdheks.gov/brfss/index.html.
18.Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD. The PHQ Primary Care Study. Journal of the
American Medical Association. 1999;282(18):1737-1744.
19.Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity and comorbidity of 12-month DSM-IV disorders in the National Comorbidity
Survey replication. Archives of General Psychiatry. 2005;62:617-627.
20.Anxiety Disorders Association of America. Statistics and Facts about Anxiety Disorders. Anxiety Disorders Association of America website. 2012.
Available at: http://www.adaa.org/about-adaa/press-room/facts-statistics. Accessed February, 2012.
21.Anxiety Disorders Association of America. Anxiety and Depression: What to do when you have both. Anxiety Disorders Association of America
website. Available at: http://www.adaa.org/GettingHelp/MFarchives/MonthlyFeatures(september).asp. Accessed February, 2012.
22.Grant BF, Hasin DS, Stinson FS, et al. Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in
the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine. 2005;35(12):1747-59.
23.National Institute of Mental Health. Anxiety Disorders. National Institute of Mental Health website. 2006. Available at: http://www.nimh.nih.gov/
health/topics/anxiety-disorders/index.shtml. Accessed February, 2012.
24.Shih M, Hootman JM, Strine TW, Chapman DP, Brady TJ. Serious Psychological Distress in U.S. Adults with Arthritis. Journal of General Internal
Medicine. 2006;21:1160–1166.
25.Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological
distress. Psychol Med. 2002; 32(6):959-76.
26.Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60:184–9.
27.Furukawa TA, Kessler RC, Slade T, Andrews G. The performance of the K6 and K10 screening scales for psychological distress in the Australian
national survey of mental health and well-being. Psychol Med. 2003;33:357–62
28.Kansas Department of Health and Environment. Mental Illness and Stigma Status in Kansas: 2009 Behavioral Risk Factor Surveillance System.
Topeka, KS: Bureau of Health Promotion, KDHE; 2011. Available at: http://www.kdheks.gov/brfss/PDF/2009_Mental_Illness_Stigma_Report.pdf.
29.2011 Kansas Youth Risk Behavior Survey. Kansas State Department of Education. Available at: http://www.kshealthykids.org/HKS_Menus/HKS_
Home.htm.
30.Mental Health HPSAs - 2012. Bureau of Community Health Systems. Kansas Department of Health and Environment. Available at: http://www.
kdheks.gov/olrh/SD.htm.
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Strengths and Assets
Strengths
There are several promising practices that
are in the early stages, but the work needs
additional support to continue and be successful.
These programs include Mental Health First
Aid, Psychological First Aid, Crisis Intervention
Training, and Strategic Brief Intervention and
Referral to Treatment. There is strong movement
toward integration between primary care and
behavioral health with at least 11 community
mental health centers and 10 safety net clinics
in 13 communities. Substance use disorder
providers are also working on integration and
collaboration.
Assets
●● Values of Kansans – compassionate
and hardworking, resulting in caring,
concern, and action that happens oneon-one and among families, friends, faith
communities, and organizations
●● Widespread belief that recovery is
possible
●● Consumer involvement in policy
development and planning, consumer-run
organizations, National Alliance on Mental
Illness - Kansas
●● Comprehensive Community Mental Health
Center system - though under-funded, it
is an ultimate safety net because every
county is covered
●● Strong Association of Community Mental
Health Centers in Kansas
●● Integration of mental health and
substance abuse programs at the state
level
●● Multiple promising practices and programs
currently under development, including
primary care-behavioral health integration
initiative; community education programs
like mental health first aid, psychological
first aid, and crisis intervention training;
and strategic brief intervention and
referral to treatment (SBIRT)
162