Mental distress and functional health in the United States.

INTRODUCTION: Mental illness prevalence is increasing in USA. Understanding the relationship between functional status and mental health is crucial in optimizing psychiatric treatment. METHODS: We used 2000-2014 BRFSS data to examine the relationship between functional health and frequent mental distress in 51 states. RESULTS: East-South-Central US (14.88%) had the highest prevalence of frequent mental distress and West-North-Central (9.42%) the lowest. Tennessee (15.7%) had the highest prevalence of frequent mental distress and North Dakota (7.4%) the lowest. East-South-Central had the highest prevalence on all functional limitation items. West Virginia had the highest prevalence of functional limitation (29.1%), use of special equipment (14.0%), blindness (8.6%), walking difficulty (23.0%), and difficulty running errands (12%). Females were more likely to report frequent mental distress in all states and more likely to report functional limitations in 32 states. Those who were divorced, smoker, unemployed, and of African American/American Indian/Alaskan native/other race were more likely to have a functional limitation. The prevalence of frequent mental distress increased steadily from 2000 for males and females but showed a decline from 2013 to 2014. The rate of increase was higher between 2008 and 2013 compared to previous years. CONCLUSIONS: Our study showed a high prevalence of mental distress and poor functional health in the US with a large variation between states and socio-demographic groups. Moreover, our findings showed a strong association between poor mental health and functional limitations. Our findings call for integrating mental and physical health research and clinical care to reduce the burden of mental health in the US.

A new source of data for public health surveillance: Facebook likes.

BACKGROUND: Investigation into personal health has become focused on conditions at an increasingly local level, while response rates have declined and complicated the process of collecting data at an individual level. Simultaneously, social media data have exploded in availability and have been shown to correlate with the prevalence of certain health conditions. OBJECTIVE: Facebook likes may be a source of digital data that can complement traditional public health surveillance systems and provide data at a local level. We explored the use of Facebook likes as potential predictors of health outcomes and their behavioral determinants. METHODS: We performed principal components and regression analyses to examine the predictive qualities of Facebook likes with regard to mortality, diseases, and lifestyle behaviors in 214 counties across the United States and 61 of 67 counties in Florida. These results were compared with those obtainable from a demographic model. Health data were obtained from both the 2010 and 2011 Behavioral Risk Factor Surveillance System (BRFSS) and mortality data were obtained from the National Vital Statistics System. RESULTS: Facebook likes added significant value in predicting most examined health outcomes and behaviors even when controlling for age, race, and socioeconomic status, with model fit improvements (adjusted R(2)) of an average of 58% across models for 13 different health-related metrics over basic sociodemographic models. Small area data were not available in sufficient abundance to test the accuracy of the model in estimating health conditions in less populated markets, but initial analysis using data from Florida showed a strong model fit for obesity data (adjusted R(2)=.77). CONCLUSIONS: Facebook likes provide estimates for examined health outcomes and health behaviors that are comparable to those obtained from the BRFSS. Online sources may provide more reliable, timely, and cost-effective county-level data than that obtainable from traditional public health surveillance systems as well as serve as an adjunct to those systems.

Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010.

BACKGROUND: Adverse childhood experiences (ACEs), including child abuse and family dysfunction, are linked to leading causes of adult morbidity and mortality. Most prior ACE studies were based on a nonrepresentative patient sample from one Southern California HMO. PURPOSE: To determine if ACE exposure increases the risk of chronic disease and disability using a larger, more representative sample of adults than prior studies. METHODS: Ten states and the District of Columbia included an optional ACE module in the 2010 Behavioral Risk Factor Surveillance Survey, a national cross-sectional, random-digit-dial telephone survey of adults. Analysis was conducted in November 2012. Respondents were asked about nine ACEs, including physical, sexual, and emotional abuse and household member mental illness, alcoholism, drug abuse, imprisonment, divorce, and intimate partner violence. An ACE score was calculated for each subject by summing the endorsed ACE items. After controlling for sociodemographic variables, weighted AORs were calculated for self-reported health conditions given exposure to zero, one to three, four to six, or seven to nine ACEs. RESULTS: Compared to those who reported no ACE exposure, the adjusted odds of reporting myocardial infarction, asthma, fair/poor health, frequent mental distress, and disability were higher for those reporting one to three, four to six, or seven to nine ACEs. Odds of reporting coronary heart disease and stroke were higher for those who reported four to six and seven to nine ACEs; odds of diabetes were higher for those reporting one to three and four to six ACEs. CONCLUSIONS: These findings underscore the importance of child maltreatment prevention as a means to mitigate adult morbidity and mortality.

Lack of Health Insurance Among Adults Aged 18 to 64 Years: Findings From the 2013 Behavioral Risk Factor Surveillance System.

INTRODUCTION: The objective of this study was to estimate the prevalence of lack of health insurance among adults aged 18 to 64 years for each state and the United States and to describe populations without insurance. METHODS: We used 2013 Behavioral Risk Factor Surveillance System data to categorize states into 3 groups on the basis of the prevalence of lack of health insurance in each state compared with the national average (21.5%; 95% confidence interval, 21.1%-21.8%): high-insured states (states with an estimated prevalence of lack of health insurance below the national average), average-insured states (states with an estimated prevalence of lack of health insurance equivalent to the national average), and low-insured states (states with an estimated prevalence of lack of health insurance higher than the national average). We used bivariate analyses to compare the sociodemographic characteristics of these 3 groups after age adjustment to the 2000 US standard population. We examined the distribution of Medicaid expansion among the 3 groups. RESULTS: Compared with the national age-adjusted prevalence of lack of health insurance, 24 states had lower rates of uninsured residents, 12 states had equivalent rates of uninsured, and 15 states had higher rates of uninsured. Compared with adults in the high-insured and average-insured state groups, adults in the low-insured state group were more likely to be non-Hispanic black or Hispanic, to have less than a high school education, to be previously married (divorced, widowed, or separated), and to have an annual household income at or below $35,000. Seventy-one percent of high-insured states were expanding Medicaid eligibility compared with 67% of average-insured states and 40% of low-insured states. CONCLUSION: Large variations exist among states in the estimated prevalence of health insurance. Many uninsured Americans reside in states that have opted out of Medicaid expansion.

Severity of psychological distress among adults with and without disabilities.

The aim of this study is to examine psychological distress and its individual symptoms between adults with and without disabilities, and among adults with disabilities, to examine whether an association exists between severity of distress and health-related factors. Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used for this study. Severity of psychological distress was assessed using the Kessler 6 scale of nonspecific psychological distress. Logistic regression analyses were performed to estimate predicted marginals and prevalence ratios. Nine percent of adults had mild to moderate psychological distress and 3.9% had serious psychological distress. The adjusted mean Kessler 6 total scores and individual item scores were higher for adults with disabilities, as was the average number of days that a mental health condition interfered with activities in the past 30 days. Among adults with disabilities, mild to moderate and serious psychological distress were particularly high among those who were unemployed or unable to work. Those who had either mild to moderate or serious psychological distress were significantly more likely than those with no psychological distress to be physically inactive, to smoke, and to report fair or poor health, life dissatisfaction, and inadequate social support. A dose-response relationship exists between categorical severity of psychological distress and examined health-related factors. These findings may inform the design of targeted public health strategies that aim to eliminate health disparities between people with and without disabilities.

A triple play: psychological distress, physical comorbidities, and access and use of health services among U.S. adults with disabilities.

PURPOSE: Among adults with disabilities, we examined whether increasing levels of psychological distress were associated with higher estimated prevalences of chronic conditions, obesity, health care access, and use of preventive services. METHODS: We analyzed data from the 2007 Behavioral Risk Factor Surveillance System. The Kessler-6 scale was used to assess psychological distress. RESULTS: Increasing levels of psychological distress were associated with an increased prevalence of chronic diseases and conditions, and decreased access to health care and utilization of preventive services in keeping with what has been established for non-disabled populations. Among adults with disabilities, aged 18-64 years and 65 years or older, increasing levels of distress were also associated with increased receipt of mental health treatment. However, compared to adults aged 18-64 years, larger proportions of older adults reported non-receipt of mental health treatment (mild to moderate psychological distress: 58.0% versus 70.6%; serious psychological distress: 40.5% versus 54.5%). CONCLUSIONS: While adults with disabilities who had increased levels of psychological distress were more likely to receive mental health services, they also had higher estimated prevalences of chronic conditions, barriers to health care, and non-receipt of preventive cancer screenings.

Effects of Massachusetts health reform on the use of clinical preventive services.

BACKGROUND: Expansion of health insurance coverage, and hence clinical preventive services (CPS), provides an opportunity for improvements in the health of adults. The degree to which expansion of health insurance coverage affects the use of CPS is unknown. OBJECTIVE: To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS. DESIGN: We used a difference-in-differences framework to examine change in healthcare access and use of CPS among working-aged adults pre-reform (2002-2005) and post-reform (2007-2010) in Massachusetts compared with change in other New England states (ONES). SETTING: Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys. PARTICIPANTS: A total of 208,831 survey participants aged 18 to 64 years. INTERVENTION: Massachusetts health reform enacted in 2006. MEASUREMENTS: Four healthcare access measures outcomes and five CPS. KEY RESULTS: The proportions of adults who had health insurance coverage, a healthcare provider, no cost barrier to healthcare, an annual routine checkup, and a colorectal cancer screening increased significantly more in Massachusetts than those in the ONES. In Massachusetts, the prevalence of cervical cancer screening in pre-reform and post-reform periods was about the same; however, the ONES had a decrease of -1.6 percentage points (95 % confidence interval [CI] -2.5, -0.7; p <0.001). As a result, the prevalence of cervical cancer screening in Massachusetts was increased relative to the ONES (1.7, 95 % CI 0.2, 3.2; p = 0.02). Cholesterol screening, influenza immunization, and breast cancer screening did not improve more in Massachusetts than in the ONES. LIMITATIONS: Data are self-reported. CONCLUSIONS: Health reform may increase healthcare access and improve use of CPS. However, the effects of health reform on CPS use may vary by type of service and by state.

Examination of the Factorial Structure of Adverse Childhood Experiences and Recommendations for Three Subscale Scores.

OBJECTIVE: The purpose of the current investigation is to assess and validate the factor structure of the Behavioral Risk Factor Surveillance System's (BRFSS) Adverse Childhood Experience (ACE) module. METHOD: ACE data available from the 2009 BRFSS survey were fit using exploratory factor analysis (EFA) to estimate an initial factorial structure. The exploratory solution was then validated using confirmatory factor analysis (CFA) with data from the 2010 BRFSS survey. Lastly, ACE factors were tested for measurement invariance using multiple group factor analysis. RESULTS: EFA results suggested that a 3-factor solution adequately fit the data. Examination of factor loadings and item content suggested the factors represented the following construct areas: Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse. Subsequent CFA results confirmed the 3-factor solution and provided preliminary support for estimation of an overall latent ACE score summarizing the responses to all available items. Measurement invariance was supported across both gender and age. CONCLUSIONS: Results of this study provides support for the use of the current ACE module scoring algorithm, which uses the sum of the number of items endorsed to estimate exposure. However, the results also suggest potential benefits to estimating 3 separate composite scores to estimate the specific effects of exposure to Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse.

Change in health insurance coverage in Massachusetts and other New England States by perceived health status: potential impact of health reform.

OBJECTIVES: We examined the impact of Massachusetts health reform and its public health component (enacted in 2006) on change in health insurance coverage by perceived health. METHODS: We used 2003-2009 Behavioral Risk Factor Surveillance System data. We used a difference-in-differences framework to examine the experience in Massachusetts to predict the outcomes of national health care reform. RESULTS: The proportion of adults aged 18 to 64 years with health insurance coverage increased more in Massachusetts than in other New England states (4.5%; 95% confidence interval [CI] = 3.5%, 5.6%). For those with higher perceived health care need (more recent mentally and physically unhealthy days and activity limitation days [ALDs]), the postreform proportion significantly exceeded prereform (P < .001). Groups with higher perceived health care need represented a disproportionate increase in health insurance coverage in Massachusetts compared with other New England states--from 4.3% (95% CI = 3.3%, 5.4%) for fewer than 14 ALDs to 9.0% (95% CI = 4.5%, 13.5%) for 14 or more ALDs. CONCLUSIONS: On the basis of the Massachusetts experience, full implementation of the Affordable Care Act may increase health insurance coverage especially among populations with higher perceived health care need.

Associations between Overall and Abdominal Obesity and Suicidal Ideation among US Adult Women.

Obesity is associated with increased risks for mental disorders. This study examined associations of obesity indicators including body mass index (BMI), waist circumference, and waist-height ratio with suicidal ideation among U.S. women. We analyzed data from 3,732 nonpregnant women aged ≥20 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. We used anthropometric measures of weight, height, and waist circumference to calculate BMI and waist-height ratio. Suicidal ideation was assessed using the Item 9 of the Patient Health Questionnaire-9. Odds ratios with 95% conference intervals were estimated using logistic regression analyses after controlling for potential confounders. The age-adjusted prevalence of suicidal ideation was 3.0%; the prevalence increased linearly across quartiles of BMI, waist circumference, and waist-height ratio (P for linear trend <0.01 for all). The positive associations of waist circumference and waist-height ratio with suicidal ideation remained significant (P < 0.05) after adjustment for sociodemographics, lifestyle-related behavioral factors, and having either chronic conditions or current depression. However, these associations were attenuated after both chronic conditions and depression were entered into the models. Thus, the previously reported association between obesity and suicidal ideation appears to be confounded by coexistence of chronic conditions and current depression among women of the United States.

The relationship of level of positive mental health with current mental disorders in predicting suicidal behavior and academic impairment in college students.

OBJECTIVE: To investigate whether level of positive mental health complements mental illness in predicting students at risk for suicidal behavior and impaired academic performance. PARTICIPANTS: A sample of 5,689 college students participated in the 2007 Healthy Minds Study and completed an Internet survey that included the Mental Health Continuum-Short Form and the Patient Health Questionnaire screening scales for depression and anxiety disorders, questions about suicide ideation, plans, and attempts, and academic impairment. RESULTS: Just under half (49.3%) of students were flourishing and did not screen positive for a mental disorder. Among students who did, and those who did not, screen for a mental disorder, suicidal behavior and impaired academic performance were lowest in those with flourishing, higher among those with moderate, and highest in those with languishing mental health. CONCLUSIONS: Positive mental health complements mental disorder screening in mental health surveillance and prediction of suicidal behavior and impairment of academic performance.

The association between depression and anxiety and use of oral health services and tooth loss.

OBJECTIVE: The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss. METHODS: Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI). RESULTS: The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss was 56.1% (SE, 0.4%) for no tooth loss, 29.6% (SE, 0.3%) for 1-5 missing teeth, 9.7% (SE, 0.2%) for 6-31 missing teeth and 4.6% (SE, 0.1%) for total tooth loss. Adults with current depression had a significantly higher prevalence of nonuse of oral health services in the past year than those without this disorder (P < 0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support. In logistic regression analyses employing tooth loss as a dichotomous outcome (0 versus ≥1) and as a nominal outcome (0 versus 1-5, 6-31, or all), adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P < 0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services). The adjusted odds of being in the 1-5 teeth removed, 6-31 teeth removed, or all teeth removed categories versus 0 teeth removed category were increased for adults with current depression versus those without (AOR = 1.35; 95% CI = 1.14-1.59; AOR = 1.83; 95% CI = 1.51-2.22; and AOR = 1.44; 95% CI = 1.11-1.86, respectively). The adjusted odds of being in the 1-5 teeth removed and 6-31 teeth removed categories versus 0 teeth removed category were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders. CONCLUSIONS: Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.

Mental illness surveillance among adults in the United States.

Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.

PHQ-8 Days: a measurement option for DSM-5 Major Depressive Disorder (MDD) severity.

BACKGROUND: Proposed draft diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) suggest that dimensional assessments can supplement dichotomous diagnoses by incorporating measures of severity, frequency, and duration, providing the ability to monitor changes in symptoms over time and to guide appropriate treatment. METHODS: This report is based on data from the Behavioral Risk Factor Surveillance System 2006 from 198,678 survey participants who responded to all eight Patient Health Questionnaire (PHQ-8) items. We evaluated use of the days version of the PHQ-8 to determine an optimal cut-point for identifying respondents with depression and to evaluate the performance characteristics of the PHQ-8 at this cut-point. RESULTS: A PHQ-8 score of 55 or more days was determined to be the optimal cut-point when compared to the DSM-derived PHQ-8 algorithm for a major depressive episode (five or more symptoms present "more than half the days," at least one of which must be anhedonia or depression). In the full sample, the sensitivity and the specificity of this cut-point were 0.91 (0.90-0.93) and 0.99 (0.99-0.99), respectively. CONCLUSION: The days version of the PHQ-8 may be a valuable dimensional alternative to the traditional PHQ-8 by offering finer granularity of dimensionality (a score of 0 to 112).

Psychological distress severity of adults reporting receipt of treatment for mental health problems in the BRFSS.

OBJECTIVE: Although effective mental health treatments exist, few population data are available on treatment receipt by persons with psychological distress. This study aimed to understand the association between symptoms and treatment receipt with data from the U.S Behavioral Risk Factor Surveillance System (BRFSS) survey. METHODS: In the 2007 survey, psychological distress was assessed with the Kessler-6 scale, and respondents were asked about receipt of mental health treatment. Data from 197,914 respondents were analyzed. RESULTS: In the overall population 87.5% of respondents reported no psychological distress, 8.5% mild to moderate psychological distress, and 3.9% serious psychological distress. Those with serious distress were nearly ten times as likely to receive treatment (adjusted odds ratio=9.58, 95% confidence interval=8.53-10.75) as those with no distress. One in ten persons (10.7%) in the study population reported receiving treatment. CONCLUSIONS: Distinct U.S. subpopulations exist by treatment and symptom status. Better understanding of all these groups is essential for improving population-based mental health care.

Change in level of positive mental health as a predictor of future risk of mental illness.

OBJECTIVES: We sought to describe the prevalence of mental health and illness, the stability of both diagnoses over time, and whether changes in mental health level predicted mental illness in a cohort group. METHODS: In 2009, we analyzed data from the 1995 and 2005 Midlife in the United States cross-sectional surveys (n = 1723), which measured positive mental health and 12-month mental disorders of major depressive episode, panic, and generalized anxiety disorders. RESULTS: Population prevalence of any of 3 mental disorders and levels of mental health appeared stable but were dynamic at the individual level. Fifty-two percent of the 17.5% of respondents with any mental illness in 2005 were new cases; one half of those languishing in 1995 improved in 2005, and one half of those flourishing in 1995 declined in 2005. Change in mental health was strongly predictive of prevalence and incidence (operationalized as a new, not necessarily a first, episode) of mental illness in 2005. CONCLUSIONS: Gains in mental health predicted declines in mental illness, supporting the call for public mental health promotion; losses of mental health predicted increases in mental illness, supporting the call for public mental health protection.

Changes in mental well-being in the transition to late life: findings from MIDUS I and II.

The number of adults aged 65 years and older is increasing rapidly, creating public health challenges. We used data from the 1995 and 2005 national surveys of Midlife in the United States (MIDUS) to compare changes in mental well-being of participants (n = 1007) of 3 age cohorts (ages 45-54 years, 55-64 years, and 65-74 years in 1995). Older adults experienced a slight decline in mental well-being not seen among younger participants and not explained by demographic variables, physical ailments, mental illnesses, or chronic conditions.

Determining prevalence and correlates of psychiatric treatment with Andersen's behavioral model of health services use.

OBJECTIVE: This study examined the prevalence and correlates of use of health professional services for the treatment of mental or emotional problems by using Andersen's Behavioral Model of Health Services Use. METHODS: In the 2007 Behavioral Risk Factor Surveillance System 169,546 community-dwelling respondents from 35 states, the District of Columbia, and Puerto Rico answered questions about their sociodemographic characteristics; perceived need; nonspecific psychological distress, as measured with the Kessler-6 scale; and use of professional treatment of mental or emotional problems. RESULTS: Evaluated need (psychological distress) was significantly associated with receipt of treatment for mental or emotional problems, as were predisposing factors (age, gender, race or ethnicity, marital status, and education), enabling and impeding factors (income, health insurance, and emotional support), and perceived need (number of mentally and physically unhealthy days and self-rated health). CONCLUSION: Constituents in the public mental health system should seriously consider that health services utilization is socially patterned and not just an individual behavior.

Psychological distress and mental health treatment among persons with and without active duty military experience, Behavioral Risk Factor Surveillance System, United States, 2007.

OBJECTIVES: To examine self-reported psychological distress (K-6 scale) and mental health treatment among persons with and without active duty U.S. military experience (ADME) currently residing in private residences in the U.S. METHODS: Analysis of 2007 Behavioral Risk Factor Surveillance System data from 35 states, District of Columbia, and Puerto Rico (n = 202,029 for those answering all K-6 questions, the treatment question, and the ADME question) RESULTS: Adjusting for age, sex, race/ethnicity, and education, overall mean K-6 scores of those with and without ADME were similar (p = 0.3223); however, more of those with, vs. without, ADME reported current mental health treatment (11.7 % vs. 9.6 %, p = 0.0001). Those with ADME receiving such treatment had a higher mean K-6 score (7.7) than those without ADME receiving such treatment (6.9) (p = 0.0032). CONCLUSIONS: Community-dwelling persons with ADME have similar demographically-adjusted mean K-6 psychological distress scores, but greater likelihood of recent mental health treatment, compared to those without ADME.

Rural-urban variations in psychological distress: findings from the Behavioral Risk Factor Surveillance System, 2007.

OBJECTIVES: To describe rural and urban differences in the prevalence and correlates of psychological distress in the United States. METHODS: We analyzed 2007 Behavioral Risk Factor Surveillance System (BRFSS) data from 62,913 respondents residing in 94 counties in 24 states, and District of Columbia that administered the Kessler-6 (K6) psychological distress questionnaire and met the BRFSS weighting criterion. Using the Rural Urban Classification Codes (RUCC), 94 counties fell into four groups (two metropolitan and two non-metropolitan) out of the nine-part RUCC scheme; these levels were collapsed into two distinct categories of urban and rural. RESULTS: Unadjusted estimates indicate that urban county residents have a 22 % higher likelihood of having either MPD or SPD than rural residence (odds ratio [OR]: 1.22, 95 % confidence interval [CI]: 1.09-1.36). This association was slightly attenuated after adjusting for sociodemographic characteristics 17 % higher (OR: 1.17, 95 % CI: 1.04-1.31). CONCLUSION: This is the first study to our knowledge reporting rural and urban prevalence of psychological distress derived from population-based, county-level data for 94 counties in the United States.