Mental Health

Narrative

An individual is considered to have a mental disorder when he or she experiences changes in thinking, mood, or behavior as a result of distress or impairment.1 Approximately one in five adolescents has a mental disorder, of which mood disorders such as depression are among the most common.2 The American Psychiatric Association defines major depressive disorder as severe symptoms that interfere with an individual’s ability to work, sleep, study, eat, and enjoy life.3 Individuals who experience a major depressive episode (MDE) report at least 2 weeks of a depressed or irritated mood or loss of interest or pleasure in daily activities and have at least four of seven additional symptoms, such as altered sleeping patterns, fatigue, and feelings of worthlessness.4, 5 Mental disorders in adolescents may lead to struggles with school, drugs and alcohol, and family. Mental disorders, especially depression, are also a risk factor for suicide and have also been shown to be associated with the development of mood disorders in adulthood as well as chronic illnesses, such as diabetes, hypertension, stroke, cardiovascular disease, and cancer.6, 7, 8

According the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2012, 2.2 million adolescents aged 12–17 years (9.1 percent) had an MDE in the past year. Adolescent females were nearly three times as likely as adolescent males to have experienced a past-year MDE (13.7 versus 4.7 percent, respectively; Figure 1). The occurrence of past-year MDEs was greater among older adolescents of both sexes. For example, among female adolescents, 5.4 percent of those aged 12 years and more than 15 percent of those aged 15–17 years experienced past-year MDE. Substance dependence or abuse commonly co-occurs with an MDE. Among youth who experienced a past-year MDE, 16.0 percent had a substance use disorder compared to 5.1 percent of adolescents without a past-year MDE (Figure 2).

major depressive episode by age and sex

Figure 1 Source

substance abuse by major depressive episode

Figure 2 Source

The occurrence of an MDE in the past year among adolescents was higher among those who reported being in poor health. Among adolescents in fair or poor health, nearly one-fifth (17.8 percent) reported experiencing a past-year MDE compared to 12.4 percent of those in good health, 9.2 percent of those in very good health, and 6.2 percent of those in excellent health. With respect to race and ethnicity, past-year occurrence of an MDE ranged from 4.2 percent among non-Hispanic Asian youth to 11.3 percent of non-Hispanic adolescents of multiple races.

Risk factors for depression include stress, experiencing a significant loss, and having an existing emotional or behavioral disorder.9 Primary care providers can screen for depression in adolescents when systems following a collaborative care model are in place. By connecting primary care providers, case managers, and mental health specialists to each other and patients, systems can efficiently improve symptoms, adherence and response to treatment, remission, and recovery.10, 11 Other mental health interventions can be found at SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP), which is a database of interventions that have met minimum requirements for review and have been independently assessed and rated for quality and readiness for dissemination. NREPP is available to help the public learn more about evidence-based programs and practices to help determine which may best meet their needs.12

Data Sources

Figure 1. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: detailed tables. NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. Accessed March 14, 2014.

Figure 2. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: detailed tables. NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. Accessed March 14, 2014.

Endnotes

1 U.S. Department of Health and Human Services. Healthy People 2020 topics & objectives: mental health and mental disorders. Accessed April 1, 2014.

2 Kessler RC, Berglund R, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry. 2005;65(6):593–602.

3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

4 Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: mental health findings. NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. Accessed March 28, 2014.

5 Substance Abuse and Mental Health Services Administration. Mental disorders. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. Accessed February 17, 2015.

6 Rushton JL, Forcier M, Schectman RM. Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. Journal of the American Academy of Child & Adolescent Psychiatry. 2002;41(2):199–205.

7 Centers for Disease Control and Prevention. Suicide prevention: youth suicide. Accessed April 4, 2014.

8 U.S. Department of Health and Human Services. Healthy People 2020 leading health indicators: mental health. Accessed April 4, 2014.

9 Cash RE. Depression in children and adolescents: information for parents and educators. Bethesda, MD: National Association of School Psychologists; 2004.

10 Guide to Community Preventive Services. Improving mental health and addressing mental illness: collaborative care for the management of depressive disorders. Accessed April 15, 2014.

11 Richardson LP, Ludman E, McCauley E, Lindenbaum J, Larison C, Zhou C, Clarke G, Brent D, & Katon W. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. Journal of the American Medical Association. 2014 Aug 27;312(8):809-16.

12 National Registry of Evidence-based Programs and Practices. About NREPP. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. Accessed February 17, 2015.

Data

Statistical Significance Test

Calculate the difference between two estimates:

Calculated Z-Test Result 0.9567433 Not statistically significant

We follow statistical conventions in defining a significant difference by a p-value less than 0.05 where there is a less than 5% probability of observing a difference of that magnitude or greater by chance alone if there were really no difference between estimates. The 95% confidence interval includes a plausible range of values for the observed difference; 95% of random samples would include the true difference with fewer than 5% of random samples failing to capture the true difference.

This website allows comparisons between two estimates using the independent z-test for differences in rates or proportions. This test is appropriate for comparing independent populations across years (e.g., 2011 versus 2012) or subgroups (e.g., Male versus Female) on corresponding measures. To the extent possible, the functionality of this application has limited estimate comparisons based on appropriate use of the independent z-test. However, some tables present subgroup categories within broader categories that will allow comparisons between non-independent populations (e.g., low birth weight and very low birth weight). Users should exercise caution when interpreting these test results, which will frequently overstate statistical significance.

For some tables, the website does not allow for comparisons between two estimates, even though the data represent independent populations. Generally, this is because the standard errors were not publicly available at the time this website was created.

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