From American Journal of Public Health

National Trends in Mental Health Disability, 1997–2009

Ramin Mojtabai, MD, PhD, MPH

Posted: 12/13/2011; American Journal of Public Health. 2011;101(11):2156-2163. © 2011 American Public Health Association

 

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Abstract and Introduction

Abstract

Objectives. I assessed recent trends in mental health disability in the US nonelderly adult population in the context of trends in physical disabilities and psychological distress.
Methods. Using data for 312364 adults aged 18 to 64 years from the US National Health Interview Survey, 1997 to 2009, I examined time trends in selfreported disability attributed to mental health conditions, disability attributed to other chronic problems, and significant psychological distress (measured by using the K6 instrument).
Results. The prevalence of self-reported mental health disability increased from 2.0% of the nonelderly adult population in the first 3 years (1997 to 1999) to 2.7% in the last 3 years (2007 to 2009), corresponding to an increase of almost 2 million disabled adults. Disability attributed to other chronic conditions decreased and significant psychological distress did not change appreciably. Change in self-reported mental health disability was more pronounced in adults who also reported disability attributed to other chronic conditions or significant psychological distress but who had no mental health contacts in the past year.
Conclusions. These findings highlight the need for improved access to mental health services in the community and for better integration of these services with primary care.

Introduction

Mental illness is often associated with significant impairment in role functioning and in relationships.[1–5] Much of the social and economic burden of mental illness is attributed to this impairment in role functioning.[6] Although the number of individuals with mental health conditions who receive treatment in the community has increased dramatically over the past few decades,[7–9] there is no consensus as to whether these changes represent a genuine increase in the prevalence of mental illness.[10,11]

Studies of trends in the community prevalence of mental disorders have produced conflicting results.[7,12–14] One study found no change in the prevalence of common mental disorders in the United States between the early 1990s and the early 2000s,[7] whereas another study found an increase in the prevalence of depression during this time span.[13] Other studies have reported increased prevalence of depression in specific subgroups of the population, such as young women[14] or middle-aged women.[12] An analysis of 3 general population surveys conducted in1957,1976, and1996 also revealed an increase in the proportion of respondents who reported an "impending nervous breakdown" during this time span, suggesting an increase in the prevalence of psychological distress over time.[15] However, less information is available on national trends in mental health disability, partly because of the paucity of useful data sources.

Reports based on US Supplemental Security Income and Social Security Disability Insurance data have recorded increases in the number of disabled as a result of mental illness over the past few decades.[16,17] A recent report revealed a more than 2-fold increase in the number of individuals who received disability payments because of mental health problems between 1987 and 2007.[16] Sickness benefits data from Great Britain have also recorded dramatic increases in disability attributed to "depression and neurotic conditions" between the mid 1980s and mid 1990s.[18] However, disability benefits data are likely impacted by various extraneous factors, including economic cycles and changes in disability eligibility criteria.

I used recent data from a multiwave, nationally representative survey of the US general population to assess trends in self-reported mental health disability and significant psychological distress and to explore parallel trends in disability attributed to other chronic health problems. More specifically, I used data from 13 years of the US National Health Interview Survey (NHIS)[19] from1997 to 2009 to assess trends in self-reported disability and distress in the adult population. An earlier report based on the NHIS recorded an increase in self-reported mental illness disability in workingaged adults from1988 to 1996.[20] By contrast, a report based on older (‡65 years) participants of the NHIS in 1997 to 2004 found a decline in the prevalence of both severe mental distress and self-reported disability among participants with such distress.[21] However, mood and anxiety disorders are less common in the older populations,[22,23] and time trends of mental health disability in these populations may not be representative of trends in younger adults. In the present report, I focused on adults aged18 to 64 years and included more recent survey waves. Furthermore, I assessed trends in disability and psychological distress within specific population subgroups.

 
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Table 1. Association of Survey Year With Mental Health and Other Chronic Condition Disability in Multivariate Logistic Regression Analyses of Nonelderly Adults: US National Health Interview Survey, 1997–2009

Mental Health Disability Other Chronic Condition Disability
Variables AOR (95% CI) P AOR (95% CI) P
Survey yeara 1.41 (1.23, 1.62) <.001 0.89 (0.84, 0.94) <.001
Gender
   Women (Ref) 1.00 1.00
   Men 0.71 (0.65, 0.77) <.001 0.74 (0.71, 0.76) <.001
   Age, y
   18–24 1.00 1.00
   25–34 1.48 (0.24, 1.76 <.001 1.60 (1.47, 1.73) <.001
   35–44 2.09 (1.76, 2.48) <.001 2.87 (2.65, 3.11) <.001
   45–54 2.54 (2.14, 3.03) <.001 5.23 (4.83, 5.65) <.001
   55–64 2.18 (1.81, 2.62) <.001 8.30 (7.66, 8.99) <.001
Race/ethnicity
   Non-Hispanic White 1.00 1.00
   Non-Hispanic Black 0.57 (0.50, 0.64) <.001 0.81 (0.77, 0.85) <.001
   Hispanic 0.51 (0.45, 0.58) <.001 0.58 (0.55, 0.61) <.001
   Other 0.79 (0.58, 1.08) .051 0.80 (0.69, 0.93) <.001
Family income/federal poverty level ratio
   < 1 (Ref) 1.00 1.00
   1 to < 2 0.57 (0.51, 0.64) <.001 0.75 (0.71, 0.79) <.001
   2 to < 4 0.29 (0.26, 0.33) <.001 0.48 (0.46, 0.51) <.001
   ‡4 0.17 (0.15, 0.19) <.001 0.32 (0.30, 0.34) <.001

Note. AOR = adjusted odds ratio; CI = confidence interval. AORs were obtained from logistic regression analyses with all the variables in the table included in the models.
aSurvey year was transformed by subtracting 1997 from each year value and dividing the resulting number by 12 so that 1997 had a value of 0 and 2009 a value of 1.

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Table 2. Results of Stratified Analyses of the Association of Survey Year With Mental Health Disability in Nonelderly Adults: US National Health Interview Survey, 1997–2009

No. (%) Trend Within the Stratum Statistical Tests for Comparison of Trends Across Strata
OR (99% CI) P
Gender F(1, 6339) = 0.20; P =.653
   Women 171 987 (50.9) 1.53 (1.31, 1.78) <.001
   Men 140 377 (49.2) 1.46 (1.17, 1.81) <.001
Age, y F(4, 6336) = 2.66; P =.031
   18–24 40 230 (15.5) 1.54 (0.98, 2.43) 0.014
   25–34 73 450 (22.0) 1.71 (1.26, 2.32) <.001
   35–44 78 890 (24.5) 1.41 (1.11, 1.79) <.001
   45–54 68 994 (22.5) 1.22 (0.96, 1.53) 0.031
   55–64 50 800 (15.6) 1.81 (1.37, 2.38) <.001
Race/ethnicity F(3, 6331) = 1.41; P =.239
   Non-Hispanic White 191 220 (72.6) 1.56 (1.33, 1.81) <.001
   Non-Hispanic Black 45 997 (12.4) 1.54 (1.08, 2.18) 0.002
   Hispanic 58 968 (13.6) 1.33 (0.93, 1.90) 0.038
   Other 4160 (1.4) 2.72 (1.16, 6.42) 0.003
Family income/federal poverty level ratio F(3, 6294) = 2.01; P =.11
   < 1 39 667 (11.7) 1.60 (1.27, 2.02) <.001
   1 to < 2 45 662 (16.1) 1.46 (1.11, 1.90) <.001
   2 to < 4 76 242 (30.8) 1.37 (1.06, 1.77) 0.001
   ‡ 4 91 701 (41.5) 1.12 (0.83–1.51) 0.318
Other chronic condition disability F(1, 6339) = 10.76; P =.001
   Present 63 621 (19.7) 1.75 (1.49, 2.06) <.001
   Absent 248 743 (80.3) 1.26 (1.03, 1.55) 0.003
Insurance coverage F(2, 5993) = 0.47, P =.626
   All of past y 209 066 (77.4) 1.70 (1.44, 2.01) <.001
   Some of past y 26 195 (9.0) 1.50 (1.03, 2.18) 0.006
   None of past y 42 150 (13.6) 1.53 (1.05, 2.24) 0.004
Psychological distress F(2, 6338) = 3.51; P =.03
   No distress (K6 = 0) 152 687 (49.6) 1.05 (0.52, 2.14) 0.854
   Some distress (K6 = 1–12) 148 524 (47.3) 1.39 (1.17, 1.64) <.001
   Significant distress (K6 ‡ 13) 11 153 (3.1) 1.80 (1.43, 2.26) <.001
Mental health professional contact in past y F(1, 6339) = 5.67; P =.017
   Any contact 23 539 (7.1) 1.20 (0.99, 1.45) 0.017
   No contact 285 350 (92.9) 1.50 (1.26, 1.79) <.001
Mental health professional contact and other chronic condition disability F(3, 6337) = 8.14; P <.001
   Any contact and other disability 8765 (2.5) 1.19 (0.92, 1.53) 0.079
   Any contact and no other disability 14 774 (4.6) 1.17 (0.86, 1.60) 0.197
   No contact and other disability 54 429 (17.3) 1.97 (1.58, 2.45) <.001
   No contact and no other disability 230 921 (75.6) 1.16 (0.88, 1.52) 0.166
Mental health professional contact and psychological distress F(5, 6335) = 3.95; P =.001
   Any contact and no distress 3990 (1.3) 0.79 (0.23, 2.69) 0.615
   Any contact and some distress 15 513 (4.7) 1.22 (0.93, 1.60) 0.058
   Any contact and significant distress 4036 (1.1) 1.35 (0.96, 1.90) 0.024
   No contact and no distress 146 231 (48.1) 1.00 (0.43, 2.32) 0.997
   No contact and some distress 132 129 (42.8) 1.33 (1.08, 1.63) <.001
   No contact and significant distress 6990 (2.0) 2.33 (1.67, 3.24) <.001

Note. CI = confidence interval; OR = odds ratio. ORs were obtained from logistic regression analyses. Analyses in each stratum assessed the association of the transformed survey year variable (independent variable) with mental health disability (dependent variable). Survey year was transformed by subtracting 1997 from each year value and dividing the resulting number by 12 so that 1997 had a value of 0 and 2009 a value of 1.

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Authors and Disclosures

Ramin Mojtabai, MD, PhD, MPH

The author is with the Department of Mental Health, Bloomberg School of Public Health, and the Department of Psychiatry, Johns Hopkins University, Baltimore, MD.
Correspondence should be sent to
Ramin Mojtabai, MD, PhD, MPH, Room 797 Hampton House, 624 North Broadway, Baltimore, MD 21205 (e-mail: rmojtaba@ jhsph.edu).

 
 

American Journal of Public Health. 2011;101(11):2156-2163. © 2011 American Public Health Association

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