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6. Mental Disorders

This chapter presents findings from the National Survey on Drug Use and Health (NSDUH) on past year serious mental illness, any mental illness, serious thoughts of suicide, and major depressive episode (i.e., depression) for adults aged 18 or older. Estimates of depression among youths aged 12 to 17 also are included. In addition to the findings, a brief description of each measure is provided. Note that all estimates presented in this chapter are either completely new or have been revised (with the exception of youth depression) and thus should not be compared with estimates shown in previous State reports. For more details, see Section A.11 in Appendix A.

6.1 Serious Mental Illness among Adults

Public Law No. 102-321, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act of 1992, established a block grant for States within the United States to fund community mental health services for adults with serious mental illness. The law required States to include prevalence estimates in their annual applications for block grant funds. This legislation also required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop an operational definition of serious mental illness.

SAMHSA defined serious mental illness among adults as persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994) that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities.

Nationally in 2008-2009, 4.6 percent of adults aged 18 or older had serious mental illness in the past year (Table B.23). Rhode Island had the highest rate (7.2 percent), while Hawaii and South Dakota had the lowest rate (3.5 percent). Across age groups, the highest rates of past year serious mental illness occurred among 18 to 25 year olds (7.4 percent nationally), ranging from 6.0 percent in Georgia to 9.1 percent in Rhode Island. Arkansas, Indiana, Rhode Island, Utah, and West Virginia ranked in the highest fifth for all age groups (18 to 25 and 26 or older), as well as among persons aged 18 or older (Figures 6.1 to 6.3). The District of Columbia, North Dakota, Pennsylvania, South Dakota, and Virginia ranked in the lowest fifth across these same age groups (18 to 25, 26 or older, and 18 or older).

6.2 Any Mental Illness among Adults

Any mental illness among adults aged 18 or older is defined as currently or at any time in the past year having had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration at any time during the past year to meet diagnostic criteria specified within the DSM-IV (APA, 1994). Adults who had a diagnosable mental, behavioral, or emotional disorder in the past year, regardless of their level of functional impairment, were defined as having any mental illness.

In 2008-2009, the national rate of past year any mental illness among adults aged 18 or older was 19.7 percent (Table B.24). The highest rate among persons aged 18 or older occurred in Rhode Island (24.2 percent); the lowest rate occurred in Maryland (16.7 percent). Among persons aged 18 or older, Arkansas, Idaho, Indiana, Rhode Island, Utah, and West Virginia ranked in the highest fifth for both serious mental illness and any mental illness (Figures 6.1 and 6.4). Across age groups, the highest rate of past year any mental illness occurred among 18 to 25 year olds (30.5 percent nationally), ranging from 26.1 percent in Maryland to 38.1 percent in Utah. Idaho, Indiana, Rhode Island, and Utah ranked in the highest fifth in the 18 to 25, 26 or older, and 18 or older age groups (Figures 6.4 to 6.6). States in the lowest fifth across these same age groups were Florida, Maryland, North Dakota, Pennsylvania, and South Dakota.

6.3 Serious Thoughts of Suicide among Adults

Responding to a need for national and State-level data on the prevalence of suicidal thoughts and behavior, a set of questions was added beginning with the 2008 NSDUH questionnaire. These questions include asking all adult respondents aged 18 or older if at any time during the past 12 months they had serious thoughts of suicide.

In 2008-2009, 3.7 percent of adults aged 18 or older had serious thoughts of suicide in the past year in the United States (Table B.25). State-level estimates ranged from 2.8 percent in Georgia to 5.4 percent in Utah. Having serious thoughts of suicide in the past year was highest among young adults aged 18 to 25 (6.4 percent nationwide) in 2008-2009, ranging from 5.2 percent in Georgia to 8.0 percent in Wisconsin. Idaho, Maine, Utah, Vermont, and Washington were among the States with the highest rates among young adults aged 18 to 25, older adults aged 26 or older, and all adults aged 18 or older. Only the District of Columbia had a rate in the lowest fifth among 18 to 25 year olds and in the highest fifth among persons aged 26 or older and among persons 18 or older (Figures 6.7 to 6.9).

6.4 Youth and Adult Depression

Whether a person has a major depressive episode is determined from the criteria specified for major depression in the DSM-IV (APA, 1994). The questionnaire allows for the production of various estimates related to major depressive episode, including lifetime and past year prevalence, treatment, and role impairment. For this report, estimates were produced only for past year major depressive episode (i.e., depression).

Nationwide in 2008-2009, 6.5 percent of adults aged 18 or older had a major depressive episode in the past year (Table B.26). This rate was unchanged from 2007-2008 (6.6 percent) (Table C.23). Estimates at the State level ranged from 5.2 percent in Pennsylvania to 9.5 percent in Rhode Island. Between 2007-2008 and 2008-2009, rates of depression increased in Rhode Island among young adults aged 18 to 25 (from 9.1 to 11.1 percent), persons aged 26 or older (from 7.3 to 9.2 percent) and persons aged 18 or older (from 7.6 to 9.5 percent). No increases (or decreases) were observed in any other State or age group.

In 2008-2009, 8.2 percent of youths aged 12 to 17 experienced depression nationwide during the past year (Table B.26). This rate remained unchanged from the rate in 2007-2008 (Table C.23). These rates ranged from 6.8 percent in the District of Columbia and Pennsylvania to 10.3 percent in Oregon. At the State level, there were no changes in the rates of depression among youths between 2007-2008 and 2008-2009.

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Figure 6.1 Serious Mental Illness in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.1

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.2 Serious Mental Illness in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.2

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.3 Serious Mental Illness in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.3

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.4 Any Mental Illness in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.4

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.5 Any Mental Illness in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.5

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.6 Any Mental Illness in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.6

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.7 Had Serious Thoughts of Suicide in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.7

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.8 Had Serious Thoughts of Suicide in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.8

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.9 Had Serious Thoughts of Suicide in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.9

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.10 Had at Least One Major Depressive Episode in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.10

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.11 Had at Least One Major Depressive Episode in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.11

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.12 Had at Least One Major Depressive Episode in Past Year among Persons Aged 18 to 25, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.12

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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Figure 6.13 Had at Least One Major Depressive Episode in Past Year among Persons Aged 26 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs

Figure 6.13

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

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