Adult Mental Health Syndromes and Drug Use (Tables 13.5 and 13.6)

This section focuses on the prevalence of four selected mental health syndromes and their co-occurrence with substance use among the adult civilian, noninstitutionalized population. The data in this section are drawn from a module of the NHSDA survey questionnaire concerning mental health status during the 12-month period prior to the interview. This module, which was developed by the Institute for Social Research at the University of Michigan (Kessler et al., 1994), was used to estimate the presence during the past year of four clinical mental health syndromes defined in the third, revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) (APA, 1987).30 Questions in the mental health portion of the interview covered four of the most common mood and anxiety syndromes: major depressive episode, generalized anxiety disorder, agoraphobia, and panic attack. Each of these syndromes is defined in Appendix A.

The mental health questions in the NHSDA for detecting the presence of these four mental health syndromes do not provide the same level of detail and certainty that a full diagnostic interview would provide. For this reason, the estimates presented in this section should not be interpreted as percentages of adults who would meet diagnostic criteria for these mental health syndromes. Rather, these estimates should be interpreted to indicate a high probability of having a given syndrome.

In addition, NHSDA data on the co-occurrence of drug use and mental syndromes may be important for identifying potential overlaps in the service needs of substance users or people with these mental health syndromes, but it is not possible to determine whether or to what extent substance use has caused these mental health syndromes, or whether the observed associations between drug use and these syndromes can be explained by some other related behavioral or environmental factor. Similarly, it is not possible to determine from these data whether these mental health syndromes preceded some people's substance use, and the extent to which people may be using substances in an attempt to prevent or alleviate symptoms of these syndromes (i.e., "self-medicating").

Demographic Correlates of Adult Mental Health Syndromes. Table 13.5 reports the percentages having each of the four syndromes by demographic groups. About 11% of civilian, noninstitutionalized adults had one or more of these four syndromes in the past year. As has been the case since the 1994 NHSDA, major depressive episode in 1997 was the most commonly reported syndrome among the four. An estimated 8% of adults in 1997 screened positive for major depressive episode in the past year compared with rates between 2% and 3% for the other three syndromes.

Demographic correlates of these syndromes in 1997 were similar to correlates observed in prior survey years. For example, adult women were significantly more likely than adult men to have "one or more of the four syndromes" (14% vs. 8%, respectively). In addition, women had a significantly higher rate of probable major depressive episode (10%) compared with the rate among men (6%). Rates of probable generalized anxiety disorder, agoraphobia, and panic attack also were significantly higher amongwomen than men. These findings are consistent with other population studies, such as the National Comorbidity Survey (Kessler et al., 1994).31

Rates of one or more of the four syndromes and major depressive episode were significantly higher among white adults compared with blacks and Hispanics. Whites also were more likely than Hispanics to have experienced a panic attack. In contrast, blacks had a significantly higher rate of agoraphobia compared with whites and Hispanics.

In general, there appeared to be an inverse association between educational level and the likelihood of experiencing past year mental health syndromes. The patterns defining these relationships, however, varied according to the specific syndrome. Adults who were college graduates were less likely than adults in the other education categories to have experienced one of more of these syndromes; differences in rates of any of the four syndromes were not significant between the other educational groups. This pattern also held for agoraphobia. A similar pattern held for major depressive episode, except that the rates of this syndrome did not differ significantly between college graduates and adults who had graduated from high school. Rates of major depressive episode also differed significantly between high school graduates and adults with some college education.

With respect to employment status, the most notable patterns were the relatively high rates of major depressive disorder and agoraphobia among unemployed persons and high rates of generalized anxiety disorder among both unemployed persons and those in the "other" employment category. Persons employed full-time were generally the least likely to experience mental health syndromes.

The cross-sectional design of the NHSDA limits the ability to determine the exact nature of the relationships between these mental health syndromes and current employment. For example, people who were unemployed and depressed for all 52 weeks in the past year would include those who were unemployed as a consequence of being depressed and vice versa. Similarly, lower rates of these syndromes among full-time employed adults may be due in part to a "healthy worker" phenomenon, such that adults who are incapacitated by these syndromes are not in the labor force.

Mental Health Syndromes and Substance Use. Table 13.6 compares estimates of drug use among adults with the four mental health syndromes relative to the total adult population rates. Although significance testing was done comparing levels of substance use among individuals with each syndrome to those without the syndrome, the drug use estimates for people without a given syndrome were very similar to the overall adult population estimates. For example, 9% of adults who did not have a major depressive episode used illicit drugs in the past year (data not shown in Table 13.6) compared with a total adult population estimate of 10%.

Adults who had a major depressive episode in the past year-the most prevalent mental health syndrome of the four-were significantly more likely to be past year users of most of the drugs shown in Table 13.6 compared with adults who did not have this syndrome. The only nonsignificant differences were for PCP use and nonmedical use of sedatives. The same patterns in rates of drug use were observed for panic attack.

More than one in five adults with a major depressive episode used one or more illicit drugs in the past year, and almost one in four adults were drunk on alcohol on 3 or more days in the past year. The rates of pastyear use of almost all substances were more than twice the rates for adults in the civilian, noninstitutionalized population as a whole. In particular, although the prevalence of past year heroin use was low among adults with a major depressive episode (1.2%), it was four times the rate for the total adult population (0.3%).

Rates of past year use of most illicit drugs among adults who had a panic attack in the past year were similar to those among adults with a major depressive episode. About 9% of adults who had a panic attack in the past year also used psychotherapeutics nonmedically, however, and about 7% used tranquilizers nonmedically in the past year. This latter finding is consistent with the nature of the syndrome and the pharmacological action of tranquilizers. In addition, nearly 30% of adults who had a panic attack were drunk or high on alcohol on 3 or more days in the past year.

Relatively few significant differences in past year drug use were observed for adults who had generalized anxiety disorder or agoraphobia compared with adults who did not have these syndromes. Adults with generalized anxiety disorder, however, were significantly more likely to have used any illicit drugs, marijuana, or cigarettes in the past year compared with adults who did not have this syndrome. Similarly, the prevalence of past year cigarette use was significantly higher among adults with agoraphobia relative to those who did not.

One uncharacteristic finding was that the prevalence of nonmedical tranquilizer use was significantly lower among adults with agoraphobia compared with those without this syndrome. As shown in Table 6.7, however, the lifetime prevalence of nonmedical tranquilizer use was higher among whites compared with blacks, but blacks were significantly more likely than whites to have had agoraphobia in the past year (see Table 13.5). Therefore, the finding of a significantly higher rate of nonmedical tranquilizer use among adults without agoraphobia may be due to demographic factors that are related both to agoraphobia and to nonmedical tranquilizer use. Multivariate analyses that control for the potentially confounding effects of race/ethnicity or other demographic characteristics may be useful for identifying independent relationships between mental health syndromes and drug use.

30 The fourth edition of this manual (DSM-IV) (APA, 1994) has been available since 1994. As noted above, however, the mental health items that were used in the NHSDA were based on the earlier DSM-III-R criteria.

31 For brevity, subsequent references to these syndromes do not refer to their "probable" occurrence. The reported prevalences of these syndromes, however, are not meant to imply that these are the percentages of the adult population with a diagnosis.

This page was last updated on December 30, 2008.