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Non-specific Psychological Distress

Surveillance Data Sources

Health-Related Quality of Life—Behavioral Risk Factor Surveillance System (BRFSS)

The BRFSS is an annual state-based telephone survey of the U.S. civilian, non-institutionalized adult population. The Healthy Days measures used to assess health-related quality of life (HRQOL) have been a part of the BRFSS core questionnaire since 1993. For more details, including the Healthy Days questions and links to the data, refer to the following PDF file.

For public health surveillance purposes, the CDC Health-Related Quality of Life (HRQOL) measures have provided a generic HRQOL index operationalized as a person’s or group’s physical and mental health over time.1 The data from the mental health questions have been used to calculate frequent mental distress (FMD=14 to 30 mentally unhealthy days in the past 30 days) which has been used as a proxy for poor mental health. The CDC Healthy Days measures were developed with expert input and have been a part of the core BRFSS survey since 1993 and the National Health and Nutrition Examination Survey (NHANES) since 2000.

Kessler 6 (K6) for Serious Psychological Distress—Behavioral Risk Factor Surveillance System (BRFSS)

The BRFSS is an annual state-based telephone survey of the U.S. civilian, non-institutionalized adult population. The Kessler 6 (K6) is a standardized and validated measure of non-specific psychological distress. During 2007 and 2009, K-6 was added as an optional module on the BRFSS and was administered by 26 states, the District of Columbia and Puerto Rico. A score of 10 or more on the K6 is used to indicate non-specific serious psychological distress (SPD). This information can be used as an estimate of the prevalence of serious mental illness (SMI) in community populations2,3. The K6 instrument offers a useful tool for states to assess the potentially unmet mental health needs of a large proportion of adults within their jurisdiction.

Health-Related Quality of Life—National Health and Nutrition Examination Survey (NHANES)

NHANES is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. The HRQOL-4 questions are included in the Current Health Status questionnaire and are asked of participants age 12 and older. For more details, including the questions and links to the data, refer to the following PDF file.

Non-Specific Distress Battery—National Health Interview Survey (NHIS)

NHIS data are collected through personal household interviews. The Non-Specific Distress Battery is part of the adult questionnaire and has been administered since 1997. For more details, including the questions that make up the module and links to the data, refer to the following PDF file

Statistics

Behavioral Risk Factor Surveillance System Kessler 6 (K6)

For 2007 K6 data, based on a period of "in the past 30 days."

  • Approximately 40% of persons in 35 states had serious psychological distress (SPD, defined as a score of 10 or more on the K6)

  • Of respondents indicating they had SPD:

    • 37.7% received mental health services in the preceding year
    • 53.4% currently received no treatment
    • A greater percentage were likely to be women
    • Were more likely to be unmarried
    • Were more likely to live in poverty

  • Medically, respondents with SPD were more likely to be obese, to smoke, and to report being diagnosed with heart disease.

Behavioral Risk Factor Surveillance System (BRFSS) Health Related Quality of Life

For 2004–2008 Health-Related Quality of Life (HRQOL) data, based on a period of "in the past 30 days."

  • U.S. adults experienced an average of 3.6 physically unhealthy days.
  • U.S. adults experienced an average of 3.4 mentally unhealthy days.
  • U.S. adults experienced an average of 6.1 overall unhealthy days.
  • U.S. adults experienced an average of 2.2 days of activity limitation.
  • An estimated 10.8% of U.S. adults experienced 14 or more physically unhealthy days.
  • An estimated 6.7% of U.S. adults experienced 14 or more days of activity limitation.
  • An estimated 10.2% of U.S. adults experienced 14 or more mentally unhealthy days (Frequent Mental Distress or FMD).
  • The Appalachian and the Mississippi Valley regions have high and increasing FMD prevalence, and the upper Midwest had low and decreasing FMD prevalence.4

The figure below presents estimates of the number of respondents on the BRFSS who reported frequent mental distress (14 to 30 mentally unhealthy days in the past 30 days) by county, aggregated over 2003–2009. The prevalence for Alaska is estimated for the state as a whole because Alaska BRFSS did not record county codes. Kalawao County, Hawaii, was excluded as having no respondents. Data are weighted using sampling weights based on the state populations by sex, age group, and race. County-level rates were smoothed using a nonparametric spatial smoothing algorithm5. Counties with combined sample sizes (2003–2009) of less than 30 were masked in the accompanying figure.

Map displaying county level prevalence of frequent mental distress among US adults from 2003-2009

Data Source: CDC. Behavioral Risk Factor Surveillance System, 2003-2009

Learn more about national and state trend data on HRQOL by sex, age, and race-ethnicity.

References:

  1. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention’s healthy days measures—population tracking of perceived physical and mental health over time. Health Qual Life Outcomes 2003;1(37)1–8.
  2. Kessler, R.C., Barker, P.R., Colpe, L.J., Epstein, J.F., Gfroerer, J.C., Hiripi, E. Howes, M.J, Normand, S-L.T., Manderscheid, R.W., Walters, E.E., Zaslavsky, A.M. Screening for serious mental illness in the general population. Archives of General Psychiatry 2003;60(2):184–189.
  3. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walters EE, Zaslavsky A. Short screening scales to monitor population prevalances and trends in nonspecific psychological distress. Psychol Med 2002;32:959–976.
  4. Moriarty DG, Zack MM, Holt JB, Chapman DP, Safran MA. Geographic patterns of frequent mental distress: U.S. adults, 1993-2001 and 2003-2006. Am J Prev Med 2009:36;497–505.
  5. Mungiole M, Pickle LW, Simonson KH. 1999. Application of a weighted Headbanging algorithm to mortality data maps. Statistics in Medicine 18:3201–9.

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