Definition

Percentage of adults aged 18 years and older who reported seven or more days when their mental health was not good in the past 30 days.

Numerator

Number of survey respondents who reported seven or more days when their mental health was not good in the past 30 days.

Denominator

Total number of survey respondents excluding those with missing, "Don't know/Not sure," and "Refused" responses.

Data Interpretation Issues

Question Text: "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health NOT good?" Beginning in 2011, BRFSS data include both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. This methodology utilizes additional demographic information (such as education, race, and marital status) in the weighting procedure. Both of these methodology changes were implemented to account for an increased number of U.S. households without landline phones and an under-representation of certain demographic groups that were not well-represented in the sample. More details about these changes can be found at: [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf]. As with all surveys, some error results from non-response (e.g., refusal to participate in the survey or to answer specific questions), and measurement (e.g., social desirability or recall bias). Error was minimized by use of strict calling protocols, good questionnaire design, standardization of interviewer behavior, interviewer training, and frequent, on-site interviewer monitoring and supervision.

Why Is This Important?

Mental health is one of the 12 Healthy People 2020 Leading Health Indicators. Mental health refers to an individual's ability to negotiate the daily challenges and social interactions of life without experiencing undue emotional or behavioral incapacity. Mental health and mental disorders can be influenced by numerous conditions including biologic and genetic vulnerabilities, acute or chronic physical dysfunction, and environmental conditions and stresses. Approximately 32% of the U.S. population is affected by mental illness in any given year.^1^ The BRFSS mental health question is an attempt to obtain a global measure of recent mental and emotional distress.[[br]][[br]] ---- 1. Kessler, R.C., Chiu, W.T., Demler, O., Merikangas, K. R., Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). ''Archives of General Psychiatry'', 62(6), 617-627.

Other Objectives

One of Utah's 42 Community Health Indicators One of the Council of State & Territorial Epidemiologists (CSTE), Chronic Disease Indicators: "Recent mental health among adults aged 18+ years." (CSTE reports mean number of mentally unhealthy days in the previous 30 days) Related to HP2020 Objective MHMD-4: Reduce the proportion of persons who experience major depressive episode (MDEs).

How Are We Doing?

In 2017, approximately 18.2% (crude rate) of Utah adults reported seven or more days when their mental health was not good in the past 30 days. This percentage was higher for adults with lower education and lower income levels. Older adults are less likely to report poor mental health status. In order to analyze the BRFSS data by race, we combined years 2015-2017 using the new BRFSS methodology. According to this analysis using age-adjusted rates, Utah's Pacific Islander population reported the highest percentage of seven or more days when their mental health was not good in the past 30 days (22.7%) while Utah Asian adults reported the lowest percentage (12.5%).

How Do We Compare With the U.S.?

Looking at age-adjusted rates for 2017, fewer Utah adults reported seven or more days when their mental health was not good in the past 30 days (17.5%) when compared to adults in the U.S. as a whole (18.3%).

Available Services

The Utah Department of Human Services Division of Substance Abuse and Mental Health (DSAMH) is the state agency responsible for ensuring that mental health services are available statewide. The Division also acts as a resource by providing general information, research results, and statistics to the public regarding substances of abuse and mental health services. The Division contracts with Community Mental Health Centers (CMHC) to provide these services and monitors these centers through site visits, a year-end review process, and a peer review process. Address:[[br]] Department of Human Services[[br]] Division of Substance Abuse and Mental Health[[br]] 195 North 1950 West[[br]] Salt Lake City, Utah 84116 Phone: 801-538-3939[[br]] Fax: 801-538-9892[[br]] [https://dsamh.utah.gov/]

Relevant Population Characteristics

In Utah, seven or more days when mental health was not good in the past 30 days was related to age, sex, income, and education. The percentage of people reporting at least 7 mentally unhealthy days out of the past 30 decreased with increasing age, income, and education, and was higher for women than for men.

Health Care System Factors

Health insurance coverage for mental health problems is often inadequate for persons requiring long-term out-patient psychotherapy. Many psychotherapeutic medications (such as antidepressants and anti-anxiety drugs) are prescribed by primary care physicians. Primary care visits are an opportunity to identify and treat some mental health problems.

Health Status Outcomes

Persons who are depressed are at risk for suicide and substance abuse. Depression has also been linked to physical disease, such as heart disease. Persons with mental disorders are often less successful at negotiating the challenges of educational completion and career advancement. As a result, they are at risk for problems associated with poverty.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

Age adjusted to the U.S. 2000 standard population.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

Age-adjusted to the U.S. 2000 standard population based on 3 age groups: 18-34, 35-49, and 50+.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

Age-adjusted to the U.S. 2000 standard population. Note: At the time of this update, the BRFSS U.S. dataset did not include an age variable but did include five age categories up to age 80+ (vs. the typical weighting scheme that includes 85+). Comparisons with both weighting schemes were compared using Utah data, and the difference was about 1/100 of a percentage point.

Data Notes

Age-adjusted to U.S. 2000 standard population. *Use caution in interpreting; the estimate has a coefficient of variation >30% and is therefore deemed unreliable by Utah Department of Health standards. A description of the Utah Small Areas may be found on IBIS at the following URL: [https://ibis.health.utah.gov/resource/Guidelines.html].

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

Age-adjusted to the U.S. 2000 standard population. U.S. data are the average for all states and the District of Columbia but do not include the U.S. territories. In 2002 the U.S. data includes only 22 states that asked the question. Starting in 2009, the BRFSS included both landline and cell phone respondent interviews along with a new weighting methodology called iterative proportional fitting, or raking. More details about these changes can be found at: [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf]. Note: At the time of this update, the BRFSS U.S. dataset did not include an age variable but did include five age categories up to age 80+ (vs. the typical weighting scheme that includes 85+). Comparisons with both weighting schemes were compared using Utah data, and the difference was about 1/100 of a percentage point.

References and Community Resources

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA): [http://www.samhsa.gov/] National Institute of Mental Health: [http://www.nimh.nih.gov/] "Mental Health: A Report of the Surgeon General": [http://www.surgeongeneral.gov/library/mentalhealth/home.html] More information on the Behavioral Risk Factor Surveillance System may be found on the website of the Centers for Disease Control and Prevention - [http://www.cdc.gov/brfss/]