During 2017–2019, 52.9 ED visits per 1,000 persons were related to a diagnosed mental health disorder (MHD) in the United States per year.
Approximately one half of mental health–related visits had a diagnosis of a psychoactive substance use disorder at a rate of 27.1 visits per 1,000 persons per year, followed by an anxiety, stress-related, or other nonpsychotic mental disorder (14.4), mood (affective) disorder (12.6), other MHD (5.3), and schizophrenia, schizotypal, delusional, or other nonmood psychotic disorder (4.0).
NCHS partnered with the Census Bureau on an experimental data system called the Household Pulse Survey to monitor recent changes in mental health, telemedicine and health care access during the pandemic.
The latest data collected from May 26 through June 7, 2021 shows 3 out of 10 U.S. (28.8%) reported symptoms of an anxiety or a depressive disorder in the past 7 days. This is the lowest percentage since the start of the Household Pulse Survey more than a year ago. However, the percentage is almost 60% for those with a disability.
The data also shows that 20.6% of U.S. adults took prescription medication for mental health and 9.5% received counseling or therapy in the last 4 weeks.
HOST: We now continue our conversation with Ben Zablotsky, health statistician with the Division of Health Interview Statistics on children’s mental health in the United States.
HOST: You mentioned social media and the Internet – what about more traditional environmental issues that might contribute to mental health issues among children, such as family structure. Does NCHS have any data on how family structure, including maybe divorce, might impact mental health?
BEN ZABLOTSKY: So in the past, the National Survey of Children’s Health was run out of our center, and we did have some questions about family structure as it relates to whether a parent had divorced or separated. And we looked at this within kind of the lens of “stressful life event.” And we do know generally that, yes, children who experience the stressful life events which can include changes to the family structure have been associated with higher rates of mental health conditions. But other things that we can look at now right within the NHIS have to do with general adversity that a child might be dealing with as it relates to food security or the availability of health resources. And so those items are also associated with mental health and actually in 2021, we have a longer list of stressful life events that are being asked of parents that can then be looked at in the lens of health. And that could be something that is worth exploring further.
HOST: In a general sense, are there any groups of children at higher risk than others at developing mental illness?
BEN ZABLOTSKY: So I would certainly say again that older children are more likely to experience some of these internalizing mental health disorders that talked about in terms of depression and anxiety. Certainly there are children who are dealing with a more adverse living situation who have a higher chance of developing a mental health disorder, but some conditions genetically are actually more likely to occur in boys than girls. So you see that autism spectrum disorder is an example of that, you see higher rates of ADHD among boys versus girls. And generally when someone has accessibility to services, you might see higher rates of diagnosis because they are able to see someone who can actually say “Oh yes, that is what this child has. Here’s a treatment plan we can move forward with.”
HOST: You mentioned autism and ADHD. Thirty, forty years ago you didn’t really hear about these conditions. There’s some that might think that this might be over-diagnosed since they’re relatively new conditions. Do you have any data about that?
BEN ZABLOTSKY: So the prevalence of autism spectrum disorder has changed over the years because the criteria for defining the condition itself has changed. So a lot of the increase you saw in some more recent years have actually been just that – that it wasn’t necessarily as difficult to get a diagnosis based on the criteria of the DSM – but I think there’s also a lot to be said about the awareness of these conditions. And there have been campaigns within the CDC itself to increase awareness of developmental disabilities generally, and I think that also attributes quite a bit to the increased rate that we’ve seen.
HOST: And we can certainly have a whole separate podcast on those topics alone – maybe we’ll wait till your next publication on that. Are there any other topics you’d like to discuss before we sign off?
BEN ZABLOTSKY: When we’re talking about mental health I think it’s certainly worth talking about mental health within the context of COVID-19 and how the NHIS can capture that. I think one of the challenges of the NHIS is that it is a very large survey, but it’s also cross-sectional so it’s not possible to follow children longitudinally. But what we can do is look at estimates that come out of 2019 and come out of 2020 and start to get a picture of how things might be changing for children in this age of COVID-19. And some things we can look at or just access to care and potentially the use of telemedicine to receive services. You know, I’ve talked a lot about treatment generally – a lot of the treatment in 2019, you know looking at the 2019 data, was face-to-face treatment that these individuals were receiving. But a lot of times, you know, a lot of treatment is received through the schools and with schools being virtual, it’s quite likely that some children have lost out in some of the care they normally receive. So I want to certainly look at that avenue of research moving forward because there’s a lot that’s happened obviously and one thing we don’t want to lose sight of is how children’s mental health have been affected.
HOST: Well you raise a good point, because with the shuttering of schools and the isolation felt by some children and the disadvantages some children have, are you planning to directly look at the correlation between virtual learning and mental health issues that were tied to the pandemic?
BEN ZABLOTSKY: So that’s one thing that’s tricky to look at within our survey ’cause we don’t have a lot of data on the specific schools the children are attending and the resources they had prior to COVID and receiving. But I certainly think that understanding various services – and we ask questions about special education-related services – we have to understand how those might have changed and certainly will have changed when we are dealing with something like virtual schooling.
HOST: Well that also would be a great topic for its own podcast so thanks very much Ben.
HOST: May is Mental Health Month in the United States. In recent years, mental health awareness has grown as a major public health issue, with suicide being one of the leading causes of death in the country. The arrival of the COVID-19 pandemic in 2020 placed even more of a spotlight on the subject, and NCHS collects data on topics such as anxiety and depression as well as mental health treatment in the U.S. during the pandemic, all part of the new national Household Pulse Survey. During the period April 14-26, Pulse data showed that over 27 percent of adults suffered from anxiety in the past week, and that almost 23 percent suffered from depression. A third, or 32 percent of adults, suffered from both.
These numbers are the lowest in over a year, but still pose a significant impact on American society and on the American health care system. 21 percent of adults used prescription drugs for mental health problems in the past four weeks, and nearly 10 percent received mental health counseling. However, the number of suicides and the rate of suicide in the U.S. declined in 2019 and appeared to also decline in 2020, which runs somewhat counter to the fact that 1 in 4 adults either used prescription drugs or received counseling for mental health issues, while another 10 percent needed mental health treatment but did not receive it.
Mental health concerns are also significant among children, and last week the country observed “Children’s Mental Health Awareness Week.” Suicide is the 2nd leading cause of death among children between ages 10 and 14, and there is a great deal of concern about the impact of the pandemic on children’s mental health.
NCHS has several measures that provide insight into children’s mental health in the U.S. And joining us today is Benjamin Zablotsky, a health statistician for the Division of Health Interview Statistics at NCHS.
HOST: What did the data tell us about the scope of mental health concerns among children in the U.S.?
BEN ZABLOTSKY: Sure, I think when we are talking about mental health concerns, we can break that down into two separate things – two different bins if you will. The first would be the prevalence of mental health disorders in the United States. And this includes developmental disabilities like autism spectrum disorder and intellectual disabilities, but it also includes behavioral and mental disorders like ADHD, anxiety, and depression. And when we look at the prevalence of conditions we see about one in five or one in six, depending on what you look at, that seems to be about the prevalence of mental health concerns. But I think we need to look beyond just the prevalence of these disorders. The other “bin” I would talk about as it relates to mental health concerns is also what percentage of children are receiving treatment for mental health. And when we’re talking about mental health treatment, we talk about whether a child is on a pharmaceutical medication or receiving counseling or therapy – and we look at those two things to get a sense of what percentage of the child population is on mental health treatment. And the report I wrote in 2019 found that about 14% of children have received either a therapy or a mental health-related medication in the past 12 months.
HOST: So there’s a lot of information out there. Now, are teenagers at particular risk of mental health problems compared to adults, given all the changes they’re going through?
BEN ZABLOTSKY: I would say that older children are more likely to be diagnosed with anxiety and depression, and they’re typically along the same lines in terms of prevalence as adults. And a lot of this just has to do with the stresses of being a teenager – it’s a challenging time. Teenagers tend to experience a lot of transitions during that time period as it relates to school and their own development. So yeah, I would say certainly teenagers are more likely to experience the mental health conditions than their younger peers, and sometimes comparable to those of adults.
HOST: Is there any sense that these issues have worsened or become more prevalent over time?
BEN ZABLOTSKY: You know, people have looked at things like the prevalence of developmental disabilities over time and we have seen an increase in the prevalence of some of those disorders. As it relates to teenagers and mental health, as it relates to both anxiety and depression, I believe there are some findings that have found higher rates of those two conditions – depression and anxiety – and some of it might be tied to the introduction of social media and the prevalence of bullying generally, including the kind of the more present cyber-bullying that wasn’t something that necessarily existed, you know, a few decades ago.
HOST: So the social media and the cyber-bullying – is that something you’ve done any research on yourself?
BEN ZABLOTSKY: I haven’t looked at that personally but we actually are now including some questions on the National Health Interview Survey on bullying to get a sense of that from the parent perspective, and interestingly enough later this year as part of a CDC data modernization initiative, the Division of Health Interview Statistics is going to be launching a survey of adolescents. These are actually people who were the subjects at the National Health Interview Survey, and we are going to be including some questions on cyber-bullying and bullying in general. This should be really great to look at to get a sense of that from the adolescent perspective.
HOST: You mentioned some of your research – could you talk a little bit more about some of the studies you’ve been involved in and what you found?
BEN ZABLOTSKY: Sure. So as I was mentioning I kind of think of two different domains that my research lies in. The first part is looking at the prevalence of mental health conditions generally, and most of that work has been focused around developmental disabilities. And using the NHIS we explored how there might have been changes in the prevalence over time in children in the United States between (ages) 3 and 17. And we actually did find a significant increase in the prevalence of developmental disabilities over time, with the current prevalence being about one in six children in the United States. And then some of the other work that I do which focuses on the treatment side of things – which I think is really important just to make the point that even though we’re talking about the prevalence of these disorders, we’re really only talking for the most part about the prevalence “diagnosed” disorders. And so it’s quite possible that children could be receiving treatment for their mental health that’s not affiliated or to a specific disorder. So that mental health treatment side, we are finding in a report that used data from 2019 that about 14% of children are receiving mental health treatment, either in the form of taking a medication for their mental health or receiving counseling or therapy from a mental health professional in the past 12 months.
HOST: So often times mental health is something that’s viewed as kind of a silent problem, and therefore it’s assumed that people who need treatment aren’t getting it. Would you say that your data support that or does it show that on contrary kids are actually getting treatment for some of these problems?
BEN ZABLOTSKY: Right. So there are situations where if you were to kind of do a crosstab of children who have a diagnosed condition and a child who has received mental health treatment, it’s not a one-to-one match. So there are certainly situations where children who don’t have a diagnosis are still receiving mental health treatment, and a lot of times it might be a situation where the child doesn’t have access to services to get a diagnosis but they certainly can find resources in the community to get treatment of some sort to help in the treatment of the diagnosis that just might be not actually diagnosed by a professional.
HOST: Next week we will continue our discussion with Ben Zablotsky about his research on mental health issues facing children in the U.S.
This week, NCHS released the latest quarterly data on infant mortality in the U.S., showing a rate of an estimated 5.50 infant deaths per 1,000 live births in the one-year period ending in mid-year 2020, the lowest rate on record.
NCHS also released the latest monthly data on drug overdose deaths in the country, for the one-year period ending in October 2020. Over 91,000 Americans died from drug overdoses during this period, a 30% increase from the same period a year ago.
Finally, NCHS released an analysis of total fertility rates by educational attainment, which showed that women with no high school diploma are giving birth at above-replacement levels whereas women with the highest educational attainment are giving birth at levels considerably below replacement.
The latest Household Pulse Survey shows 1 out of 3 U.S. adults (32.1%) had symptoms of an anxiety or a depressive disorder in the past week. This is the lowest percentage since the start of the survey a year ago. Also, more than half of 18-29 year olds experienced the same symptoms.
Almost 10% of U.S. adults say they needed counseling or therapy, but did not get it the past month. This is a 1.2 percentage decrease from more than a year ago.
Almost 1 out of 4 U.S. adults (24%) delayed or did not get needed medical care in the past month due to the pandemic. This estimate is almost 5 percentage points lower than the estimate from March 17-29, 2021.
25% of U.S. adults had an appointment with a health professional over video or phone in the past month.
2 out of 5 U.S. adults with a disability (40.5%) had an appointment with a health professional over video or phone in the past month.
To rapidly monitor recent changes in mental health, NCHS partnered with the Census Bureau on an experimental data system called the Household Pulse Survey. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S. The data collection period for Phase 1 of the Household Pulse Survey occurred between April 23, 2020 and July 21, 2020. Phase 2 data collection occurred between August 19, 2020 and October 26, 2020. Phase 3 data collection occurred between October 28, 2020 and March 29, 2021. Data collection for Phase 3.1 of the survey began on April 14, 2021 and will continue through July 5, 2021.
NCHS partnered with the Census Bureau on an experimental data system called the Household Pulse Survey to monitor recent changes in monitor trends in mental health, health insurance coverage, and problems accessing care. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S.
The data collection period for Phase 1 of the Household Pulse Survey occurred between April 23, 2020 and July 21, 2020. Phase 2 data collection occurred between August 19, 2020 and October 26, 2020. Phase 3 of the Household Pulse Survey began data collection on October 28, 2020.
Highlights from recent data (February 17-March 1, 2021) in the Household Pulse Survey show:
Nearly 2 in 5 adults (38.9%) experienced symptoms associated with anxiety disorder and/or depressive disorder in the last 7 days. This percentage is the lowest since October 2020.
One in 9 adults (11.9%) said they needed counseling or therapy for their mental health but did not get it in the last 4 weeks.
More than 3 in 10 adults (31.9%) delayed or did not get needed medical care in the last four weeks because of the coronavirus pandemic; This is a significant decrease from February 3-15 (34.2%).
During 2016–2018, the percentage of children and adolescents aged 4–17 years with serious emotional or behavioral difficulties was higher among those living in nonmetropolitan areas (6.7%) than among those living in metropolitan areas (5.3%).
Among boys, those living in nonmetropolitan areas (8.5%) were more likely to have serious emotional or behavioral difficulties than those living in metropolitan areas (6.6%), but the difference among girls was smaller and not significant.
Among children and adolescents living in either metropolitan or nonmetropolitan areas, boys were more likely than girls to have serious emotional or behavioral difficulties.