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Results from the 2012 NSDUH: Mental Health National Findings, SAMHSA, CBHSQ

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Results from the 2012
National Survey on Drug Use and Health:
Mental Health Findings

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality

Acknowledgments

This report was prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), and by RTI International (a trade name of Research Triangle Institute), Research Triangle Park, North Carolina. Work by RTI was performed under Contract No. HHSS283201000003C.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services. When using estimates and quotations from this report, citation of the source is appreciated.

Recommended Citation

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.

Electronic Access and Copies of Publication

This publication may be downloaded from http://store.samhsa.gov/home. Hard copies may be obtained from SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Originating Office

Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality
1 Choke Cherry Road, Room 2-1067
Rockville, MD 20857

December 2013

List of Figures

List of Tables

A.1 Weighted Statistical Imputation Rates (Percentages) for the 2012 NSDUH, by Interview Section

B.1 Demographic and Geographic Domains Forced to Match Their Respective U.S. Census Bureau Population Estimates through the Weight Calibration Process, 2012

B.2 Summary of 2012 NSDUH Suppression Rules

B.3 Weighted Percentages and Sample Sizes for 2011 and 2012 NSDUHs, by Final Screening Result Code

B.4 Weighted Percentages and Sample Sizes for 2011 and 2012 NSDUHs, by Final Interview Code

B.5 Response Rates and Sample Sizes for 2011 and 2012 NSDUHs, by Demographic Characteristics

B.6 Final SMI Prediction Models in the 2008-2012 MHSSs

Highlights

In 2012, an estimated 43.7 million adults aged 18 or older in the United States had any mental illness (AMI) in the past year. This represents 18.6 percent of all adults in this country. The percentage of adults with AMI in 2012 was similar to the estimate in 2011, but it was higher than the 2008 estimate (17.7 percent).
Among adults aged 18 or older in 2012, 9.6 million (4.1 percent) had serious mental illness (SMI) in the past year. The percentage of adults with past year SMI in 2012 was similar to that in 2008 (3.7 percent).
The percentage of adults in 2012 with AMI in the past year was highest for adults aged 26 to 49 (21.2 percent), followed by those aged 18 to 25 (19.6 percent), then by those aged 50 or older (15.8 percent). Similarly, the percentage of adults with past year SMI in 2012 was highest among adults aged 26 to 49 (5.2 percent), followed by those aged 18 to 25 (4.1 percent), then by those aged 50 or older (3.0 percent).
Women aged 18 or older were more likely than men aged 18 or older to have past year AMI (22.0 vs. 14.9 percent) and SMI (4.9 vs. 3.2 percent) in 2012.
Among the 43.7 million adults aged 18 or older in 2012 with AMI in the past year, 19.2 percent (8.4 million adults) met criteria for a substance use disorder (i.e., illicit drug or alcohol dependence or abuse). Among the 9.6 million adults with SMI in the past year, 27.3 percent also had past year substance dependence or abuse. In comparison, 6.4 percent of adults who did not have mental illness in the past year met criteria for a substance use disorder.
In 2012, an estimated 9.0 million adults (3.9 percent) aged 18 or older had serious thoughts of suicide in the past year. The estimated number and percentage remained stable between 2008 (8.3 million persons and 3.7 percent) and 2012.
Among adults aged 18 or older in 2012, 2.7 million (1.1 percent) made suicide plans in the past year, and 1.3 million (0.6 percent) attempted suicide in the past year.
Adults aged 18 or older with a past year substance use disorder were more likely than those without dependence or abuse to have serious thoughts of suicide in the past year (12.6 vs. 3.0 percent). Adults with a substance use disorder also were more likely to make suicide plans compared with adults without dependence or abuse (3.9 vs. 0.9 percent) and were more likely to attempt suicide compared with adults without dependence or abuse (2.3 vs. 0.4 percent).
In 2012, 34.1 million adults (14.5 percent of the population aged 18 or older) received mental health services (i.e., treatment or counseling) during the past 12 months. The number and the percentage were higher than those in 2011 (31.6 million persons and 13.6 percent).
Between 2002 and 2012, the percentage of adults using outpatient mental health services in the past year declined from 7.4 to 6.6 percent, and the percentage using prescription medication for a mental health problem increased from 10.5 to 12.4 percent.
Among the 43.7 million adults aged 18 or older with AMI in 2012, 17.9 million (41.0 percent) received mental health services in the past year. Among the 9.6 million adults with SMI in 2012, 6.0 million (62.9 percent) received mental health services in the past year.
Among the 8.4 million adults aged 18 or older in 2012 who had AMI in the past year and a past year substance use disorder, 46.3 percent received substance use treatment at a specialty facility or mental health care in the past year, including 7.9 percent who received both mental health care and specialty substance use treatment, 34.0 percent who received mental health care only, and 4.3 percent who received specialty substance use treatment only.
Among the 2.6 million adults aged 18 or older in 2012 with both SMI and a substance use disorder in the past year, 64.7 percent received substance use treatment at a specialty facility or mental health care in that time period, including 15.8 percent who received both mental health care and specialty substance use treatment, 44.0 percent who received mental health care only, and 4.6 percent who received specialty substance use treatment only.
In 2012, there were 2.2 million youths aged 12 to 17 (9.1 percent) who had major depressive episode (MDE) during the past year.
Among youths in 2012, females were more likely than males to have past year MDE (13.7 vs. 4.7 percent).
Among youths aged 12 to 17 in 2012 who had past year MDE, 34.0 percent used illicit drugs in the past year compared with 16.3 percent among youths who did not have past year MDE.
In 2012, youths aged 12 to 17 with MDE in the past year were more likely than those without MDE to have a substance use disorder in the past year (16.0 vs. 5.1 percent).
In 2012, 3.1 million youths aged 12 to 17 (12.7 percent) received treatment or counseling for problems with emotions or behavior in a specialty mental health setting (inpatient or outpatient care) in the past 12 months. The 2012 percentage was similar to those in 2002 through 2011 (ranging from 12.0 to 13.5 percent).
The most common reason for youths receiving specialty mental health services in 2012 was feeling depressed (50.7 percent).

1. Introduction

This report presents results pertaining to mental health from the 2012 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. This report presents national estimates of the prevalence of past year mental disorders and past year mental health service utilization for youths aged 12 to 17 and adults aged 18 or older. Among adults, estimates presented include rates and numbers of persons with any mental illness (AMI), serious mental illness (SMI), suicidal thoughts and behavior, major depressive episode (MDE), treatment for depression (among adults with MDE), and mental health service utilization. Estimates presented in this report for youths include MDE, treatment for depression (among youths with MDE), and mental health service utilization. Measures related to the co-occurrence of mental disorders with substance use or with substance use disorders also are presented for both adults and youths. The report focuses mainly on trends between 2011 and 2012 and differences across population subgroups in 2012.

Summary of NSDUH

NSDUH is the primary source of statistical information on the use of illegal drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years or older. The survey also includes several modules of questions that focus on mental health issues. Conducted by the Federal Government since 1971, the survey collects data through face-to-face interviews with a representative sample of the population at the respondent's place of residence. The survey is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, and is planned and managed by SAMHSA's Center for Behavioral Health Statistics and Quality (CBHSQ). Data collection and analysis are conducted under contract with RTI International.¹ This section briefly describes the survey methodology; a more complete description is provided in Appendix A.

NSDUH collects information from residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories) and from civilians living on military bases. The survey excludes homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals. Appendix C describes data sources that provide estimates of mental health indicators for populations outside of the NSDUH target population.

From 1971 through 1998, the survey employed paper-and-pencil data collection. Since 1999, the NSDUH interview has been carried out using computer-assisted interviewing (CAI). Most of the questions are administered with audio computer-assisted self-interviewing (ACASI). ACASI is designed to provide the respondent with a highly private and confidential mode for responding to questions in order to increase the level of honest reporting of illicit drug use and about other sensitive topics, including mental health issues. Less sensitive items are administered by interviewers using computer-assisted personal interviewing (CAPI).

Consistent with previous years, the 2012 NSDUH employed a State-based design with an independent, multistage area probability sample within each State and the District of Columbia. The eight States with the largest population (which together account for about half of the total U.S. population aged 12 or older) are designated as large sample States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) and have a sample size of about 3,600 each. For the remaining 42 States and the District of Columbia, the sample size is about 900 per State. In all States and the District of Columbia, the design oversampled youths and young adults; each State's sample was approximately equally distributed among three age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

Nationally, screening was completed at 153,873 addresses, and 68,309 completed interviews were obtained. The survey was conducted from January through December 2012. Weighted response rates for household screening and for interviewing were 86.1 and 73.0 percent, respectively. See Appendix B for more information on NSDUH response rates.

Limitations on Trend Measurement

Several important changes were made to the adult mental health section in the 2008 NSDUH questionnaire. These changes provide valuable new data on mental health, but they also affect the comparability of some of the measures that have been collected in NSDUH since 2004. A brief summary of the changes and their impact is provided below.

From 2004 to 2007, NSDUH collected data for adults aged 18 or older on lifetime and past year MDE. The survey also included the Kessler-6 (K6) distress scale that was used to generate estimates of serious psychological distress (SPD) in the past 12 months. However, the K6 scale does not directly measure the presence of a diagnosable mental, behavioral, or emotional disorder, nor does it capture information on functional impairment (i.e., difficulties that substantially interfere with or limit role functioning in one or more major life activities). Both of these measures are needed to determine whether a respondent can be categorized as having SMI or other categories of mental illness defined by levels of functional impairment (i.e., low/mild mental illness or moderate mental illness).

To address SAMHSA's need for estimates of SMI and AMI, as well as data on suicidal ideation and behavior, CBHSQ modified the NSDUH adult mental health items in 2008 to obtain these data. Items were added that assessed functional impairment due to mental health problems (abbreviated World Health Organization Disability Assessment Schedule [WHODAS]; Novak, 2007) and that assessed suicidal thoughts and behavior among adults. In 2008, CBHSQ also expanded the K6 questions to ask about the past 30 days (the time frame for which the K6 was originally designed). In addition, as part of the Mental Health Surveillance Study (MHSS), a clinical follow-up study was initiated in which a randomly selected subsample of adults (about 1,500 in 2008, 2011, and 2012, and 500 in 2009 and 2010) who had completed the NSDUH interview was administered a standard clinical interview by mental health clinicians via paper and pencil over the telephone to determine their mental illness status; the clinical interview was used as a "gold standard" for measuring mental illness among adults. Using both the clinical interview and the NSDUH CAI data for the respondents who completed the clinical interview, statistical models were developed that then were applied to data from all adult respondents who had completed the NSDUH CAI interviews (regardless of whether they had clinical interview data) to produce estimates of mental illness among the adult civilian, noninstitutionalized population. Subsequently, using the entire clinical interview sample of approximately 5,000 interviews that were collected in 2008 to 2012, CBHSQ developed a more accurate statistical model for adults. This revised model incorporated the NSDUH respondent's age, past year suicidal thoughts, past year MDE, and the variables that were specified in the 2008 model (i.e., the K6 and WHODAS). Results for SMI and AMI from this revised model were closer to the direct estimates of SMI and AMI from the clinical interviews in the MHSS than the previous model's results were, especially for young adults aged 18 to 25. See Section B.4.3 in Appendix B of this report for a more complete discussion of the revised 2012 model and estimates.

Updated estimates of AMI and SMI for 2008 to 2011 were produced using this revised model and are presented in this report and in a comprehensive set of tables of national mental health estimates.² These revised 2008 to 2011 NSDUH estimates of AMI and SMI are not comparable with 2008 to 2011 estimates of AMI and SMI shown in many NSDUH reports that were published prior to this report. Other mental health estimates for adults, such as MDE or suicidal thoughts and behaviors, were not affected.

Although the same information on MDE has been collected since 2004, the 2008 questionnaire changes for other mental health measures caused discontinuities in trends for MDE among adults; see Sections B.4.2 andB.4.4 in Appendix B for more information. A statistical adjustment to ensure comparability between past year and lifetime MDE estimates from 2005 onward was applied to estimates of lifetime and past year MDE that were affected by the 2008 questionnaire changes. This allowed trends in MDE among adults for 2005 onward to be included in reports since 2010. Because of these adjustments, estimates of past year and lifetime MDE for 2005 to 2008 in this report may differ from estimates published in NSDUH reports prior to 2010. Questionnaire changes in 2008 did not affect comparability of estimates based on adult mental health service utilization questions; therefore, estimates of mental health service utilization presented in this report reflect trends from 2002 to 2012.

The 2008 questionnaire changes did not affect youth MDE or the youth mental health service utilization items. In 2009, changes were made in the youth mental health utilization module; however, analyses determined that the changes did not affect estimates of MDE among youths in 2009 (see Section B.4.2 in Appendix B). The discussion of estimates for these measures in this report includes comparisons with prior years' data for youths.

The calculation of NSDUH person-level weights includes a calibration step that results in weights that are consistent with population control totals obtained from the U.S. Census Bureau (see Section A.3.3 in Appendix A). These control totals are based on the most recently available decennial census; the Census Bureau updates these control totals annually to account for population changes after the census. For the analysis weights in the 2002 through 2010 NSDUHs, the control totals were derived from the 2000 census data; for the 2011 and 2012 NSDUH weights, the control totals were based on data from the 2010 census. This shift to the 2010 census data could affect comparisons between mental health estimates for 2011 and onward and those from prior years. An analysis conducted for the 2011 report of the impact of this change in NSDUH weights showed that estimates of the number of substance users for some demographic groups were substantially affected, but that the percentages of substance users within these groups (i.e., rates) were unaffected. Mental health estimates were affected relatively less, and the effects were restricted to certain estimates and demographic subgroups (CBHSQ, 2012d). A portion of this analysis was repeated using revised SMI and AMI estimates for 2010 and 2011, and the results were similar to the 2011 analysis. Section B.4.5 in Appendix B summarizes the results of investigations of the change to using 2010 census control totals for NSDUH. This change in control totals does not affect comparisons of estimates between 2011 and 2012. However, some trends between 2012 and years prior to 2011 may need to be interpreted with caution because of the differences in how the control totals for each of these years were developed.

Format of Report and Data Presentation

Estimates presented in this report—including those mentioned previously for AMI and SMI—are based on data from the 2012 mental health detailed tables. In addition, the tables are accompanied by a glossary that covers key definitions used in this report and the mental health detailed tables.³ This report has separate chapters that discuss the national findings of mental disorders and service utilization for adults aged 18 or older, suicidal thoughts and behaviors among adults, mental disorders and service utilization for youths aged 12 to 17, and mental disorders that co-occurred with substance use or with substance use disorders for both adults and youths. Technical appendices in this report describe the survey (Appendix A), provide technical details on the statistical methods and measurement (Appendix B), discuss other sources of related data (Appendix C), and list the references cited in the report (Appendix D). A list of contributors to the production of this report also is provided (Appendix E).

Text, figures, and mental health detailed tables present prevalence measures for the population in terms of both the number of persons and the percentage of the population. Figures on mental disorders show prevalence estimates for the 12-month period prior to the survey (also referred to as the past year). Figures in which estimates are presented by year have footnotes indicating whether the 2012 estimates are significantly different from 2011 or earlier estimates.

During regular data collection and processing checks for the 2011 NSDUH, data errors were identified. These errors affected the data for Pennsylvania (2006 to 2010) and Maryland (2008 and 2009). Data and estimates for 2011 and subsequent years were not affected, including those for 2012. The errors had minimal impact on the national estimates. The only estimates appreciably affected in this report and the mental health detailed tables were estimates for the Northeast region. Cases with erroneous data were removed from data files, and the remaining cases were reweighted to provide representative estimates. Therefore, some estimates for 2010 and other prior years in the 2012 mental health findings report and the 2012 mental health detailed tables will differ from corresponding estimates found in some previous reports and tables. Further information is available inSection B.3.4 in Appendix B of this report.

Statistical tests have been conducted for all statements appearing in the text of the report that compare estimates between years or subgroups of the population. Unless explicitly stated that a difference is not statistically significant, all statements that describe differences are significant at the .05 level. Statistically significant differences are described using terms such as "higher," "lower," "increased," and "decreased." Statements that use terms such as "similar," "no difference," "same," or "remained steady" to describe the relationship between estimates denote that a difference is not statistically significant. When a set of estimates for survey years or population subgroups is presented without a statement of comparison, statistically significant differences among these estimates are not implied and testing may not have been conducted.

All estimates presented in the report have met the criteria for statistical reliability (see Section B.2.2 in Appendix B). Estimates that do not meet these criteria are suppressed and do not appear in tables, figures, or text. Suppressed estimates are not included in statistical tests of comparisons. For example, a statement that "whites had the highest prevalence" means that the rate among whites was higher than the rate among all nonsuppressed racial/ethnic subgroups, but not necessarily higher than the rate among a subgroup for which the estimate was suppressed.

Data are presented for racial/ethnic groups based on guidelines for collecting and reporting race and ethnicity data (Office of Management and Budget, 1997). Because respondents could choose more than one racial group, a "two or more races" category is included for persons who reported more than one category (i.e., white, black or African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, Other). Respondents choosing both Native Hawaiian and Other Pacific Islander but no other categories are classified as being in the "Native Hawaiian or Other Pacific Islander" category instead of the "two or more races" category. Except for the "Hispanic or Latino" group, the racial/ethnic groups include only non-Hispanics. The category "Hispanic or Latino" includes Hispanics of any race.

Other NSDUH Reports and Data

Data on substance use was released in a separate report in September 2013: Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings (CBHSQ, 2013). The 2011-2012 NSDUH State-level estimates for substance use and mental health are scheduled to be released in late 2013. Other reports using the 2012 NSDUH data and focusing on specific topics of interest will be made available on SAMHSA's Web site. The mental health detailed tables described previously are also available through the Internet at http://samhsa.gov/data/. The tables are organized into sections on mental health topics among adults and youths. Most tables are provided in several parts, showing population estimates (e.g., numbers of persons with mental disorders), prevalence estimates (e.g., percentages of persons with mental disorders), and standard errors of all nonsuppressed estimates. Additional methodological information on NSDUH, including the questionnaire, is available electronically at the same Web address.

Descriptive reports and in-depth analytic reports focusing on specific issues or populations and methodological information on NSDUH, including the questionnaire, are available at http://samhsa.gov/data/. In addition, CBHSQ makes public use data files available through the Substance Abuse and Mental Health Data Archive (SAMHDA) at http://www.datafiles.samhsa.gov. Currently, files are available from the 1979 to 2011 surveys. The 2012 NSDUH public use file will be available by the end of 2013. CBHSQ also makes confidential restricted-use data available in two ways. Restricted-use data, including State codes and other detailed variables, can be included in tables as part of the online Restricted-use Data Analysis System (R-DAS) where the data are not directly available, but estimates by State and other restricted variables that are specified by the user are public use. CBHSQ also makes restricted-use microdata files available through a data portal on the SAMHDA Web site. More details on both of these programs are available at http://www.datafiles.samhsa.gov.

2. Mental Illness and Mental Health Service Utilization among Adults

This chapter presents findings from the National Survey on Drug Use and Health (NSDUH) on past year mental illness in the United States, including the percentage of adults aged 18 or older with any mental illness (AMI), serious mental illness (SMI), and major depressive episode (MDE). In addition, this chapter includes estimates of the percentages of adults who received treatment for mental health problems in the past year overall and among those with AMI, SMI, and MDE. The chapter also presents data on the percentage of adults who had a perceived unmet need for mental health services in the past year.

As discussed in Chapter 1, an improved methodology for generating estimates of AMI and SMI was applied to all AMI and SMI estimates for 2008 through 2012. Therefore, estimates of AMI and SMI for 2008 to 2011 in this report are different from corresponding estimates in prior reports. This improved methodology is used to generate estimates of mental illness for each year from 2008 to 2012, which allows statements to be made in this chapter about trends in the prevalence of AMI or SMI among adults. In addition, estimates of MDE and overall mental health treatment are not affected by this change, but estimates of treatment among those with AMI or SMI are affected. For a more detailed explanation, see Section B.4.3 in Appendix B.

Any Mental Illness

AMI among adults aged 18 or older is defined as currently or at any time in the past 12 months having had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994).

In order to generate estimates of mental illness in the United States, the Substance Abuse and Mental Health Services Administration (SAMHSA) designed and implemented the Mental Health Surveillance Study (MHSS). Each year since 2008, a subsample of adults has been selected from the main study to participate in a follow-up telephone interview that obtains a detailed mental health assessment administered by a trained mental health clinician. The MHSS interview uses the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP) (First, Spitzer, Gibbon, & Williams, 2002). As noted previously, an improved prediction model was developed for the 2012 NSDUH using the clinical interview data that were collected from 2008 to 2012 to produce estimates of AMI for the entire NSDUH adult sample in these years.

In 2012, an estimated 43.7 million adults aged 18 or older in the United States had AMI in the past year. This represents 18.6 percent of all adults in this country (Figure 2.1). The percentage of adults with AMI in 2012 was similar to the estimate in 2011, but it was higher than the 2008 estimate (17.7 percent).

Figure 2.1 Any Mental Illness in the Past Year among Adults Aged 18 or Older, by Age and Gender: 2012

The percentage of adults in 2012 with AMI in the past year was highest for adults aged 26 to 49 (21.2 percent), followed by those aged 18 to 25 (19.6 percent), then by those aged 50 or older (15.8 percent) (Figure 2.1). The rate for AMI among 18 to 25 year olds increased from 2011 to 2012 (18.5 vs. 19.6 percent).
Adult women in 2012 were more likely than adult men to have AMI in the past year (22.0 vs. 14.9 percent) (Figure 2.1). Among all adult age groups (i.e., 18 to 25, 26 to 49, 50 or older), females also were more likely than their male counterparts to have AMI in the past year.
In 2012, the percentage of persons aged 18 or older with past year AMI varied by race/ethnicity. The percentage was 13.9 percent among Asians, 16.3 percent among Hispanics, 18.6 percent among blacks, 19.3 percent among whites, 20.7 percent among persons reporting two or more races, and 28.3 percent among American Indians or Alaska Natives. The estimate of past year AMI among Native Hawaiians or Other Pacific Islanders aged 18 or older could not be reported because of low precision (see Section B.2.2 in Appendix B).
In 2012, the percentage of adults with past year AMI was higher among unemployed adults (25.5 percent) than among those who were employed either part time (19.8 percent) or full time (15.2 percent). Adults who were employed part time also were more likely than those who were employed full time to have AMI in the past year.
The percentage of adults in 2012 with AMI in the past year was highest among those with a family income that was below the Federal poverty level (26.8 percent), followed by those with a family income at 100 to 199 percent of the Federal poverty level (21.8 percent), then by adults with a family income at 200 percent or more of the Federal poverty level (15.6 percent).
In 2012, the percentage of adults who had AMI in the past year was higher among those who were covered by Medicaid or the Children's Health Insurance Program (CHIP)⁴ (30.5 percent) than among those with no health insurance (22.3 percent), those with private health insurance (15.4 percent), and those with other forms of health insurance (19.5 percent). Having other forms of health insurance is defined as having Medicare, CHAMPUS, TRICARE, CHAMPVA, the VA, military health care, or any other type of health insurance.
The percentage of adults in 2012 with AMI in the past year was higher among those who had not completed high school (21.9 percent) than among adults with some college but no degree (19.7 percent), a high school degree but no further education (18.7 percent), or a college degree (15.9 percent).
The percentage of adults in 2012 with past year AMI was 33.6 percent among those on probation in the past year, which was higher than that among adults who were not on probation in the past year (18.3 percent). Similarly, among adults on parole or supervised release in the past year, the percentage having AMI was 33.4 percent, which was higher than the percentage having AMI among adults who were not on parole or supervised release in the past year (18.5 percent).

Serious Mental Illness

Public Law No. 102-321, the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992, established a block grant for States within the United States to fund community mental health services for adults with SMI. The law required States to include prevalence estimates in their annual applications for block grant funds. This legislation also required SAMHSA to develop an operational definition of SMI. SAMHSA defined SMI as persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV (APA, 1994) that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities.

In 2012, there were an estimated 9.6 million adults aged 18 or older in the United States with SMI in the past year. This represented 4.1 percent of all adults in this country in 2012 (Figure 2.2). The percentage of adults with past year SMI in 2012 was similar to that in 2008 (3.7 percent).

Figure 2.2 Serious Mental Illness in the Past Year among Adults Aged 18 or Older, by Age and Gender: 2012

The percentage of adults with past year SMI in 2012 was highest among adults aged 26 to 49 (5.2 percent), followed by those aged 18 to 25 (4.1 percent), then by those aged 50 or older (3.0 percent) (Figure 2.2).
Women aged 18 or older in 2012 were more likely than men to have SMI in the past year (4.9 vs. 3.2 percent) (Figure 2.2).
In 2012, the percentage of persons aged 18 or older with past year SMI varied by race/ethnicity. Percentages were 1.8 percent among Native Hawaiians or Other Pacific Islanders, 2.0 percent among Asians, 3.4 percent among blacks, 4.2 percent among whites, 4.2 percent among adults reporting two or more races, 4.4 percent among Hispanics, and 8.5 percent among American Indians or Alaska Natives.
The percentage of adults with past year SMI in 2012 was higher among unemployed adults (7.8 percent) than among those who were employed either part time (3.9 percent) or full time (2.7 percent). Adults who were employed part time also were more likely than those who were employed full time to have SMI in the past year.
In 2012, the percentage of adults with SMI in the past year was highest among those with a family income that was below the Federal poverty level (7.2 percent), followed by adults with a family income at 100 to 199 percent of the Federal poverty level (5.2 percent), then by adults with a family income at 200 percent or more of the Federal poverty level (3.0 percent).
The percentage of adults in 2012 with SMI in the past year was higher among those who were covered by Medicaid or CHIP⁵ (8.5 percent) than that among adults with no health insurance (6.1 percent), adults with private health insurance (2.7 percent), and those with other forms of health insurance (4.4 percent).
The percentage of adults with a college degree who had SMI in the past year (3.1 percent) was lower than the percentages for adults with less than a high school education (4.8 percent), adults with a high school degree but no further education (4.4 percent), and adults who completed some college but did not receive a degree (4.4 percent).
In 2012, the percentage of adults having past year SMI was higher among adults on probation in the past year (10.8 percent) than that among adults who were not on probation in the past year (3.9 percent). Similarly, among adults on parole or supervised release in the past year, 12.1 percent had past year SMI, which was higher than the percentage among adults who were not on parole or supervised release (4.0 percent).

Major Depressive Episode

A NSDUH module designed to obtain measures of lifetime and past year prevalence of MDE and treatment for depression has been administered to adults aged 18 or older since 2004. Some questions in the adult depression module differ slightly from questions in the adolescent depression module. Therefore, the MDE data for adults aged 18 or older should not be compared or combined with MDE data for youths aged 12 to 17.

MDE, as defined in NSDUH, is based on the definition of MDE in the DSM-IV (APA, 1994) and is measured for the lifetime and past year periods. Lifetime MDE is defined as having at least five or more of nine symptoms of depression in the same 2-week period in a person's lifetime, in which at least one of the symptoms was a depressed mood or loss of interest or pleasure in daily activities. Respondents who had MDE in their lifetime were defined as having past year MDE if they had a period of depression lasting 2 weeks or longer in the past 12 months while also having some of the other symptoms of MDE. It should be noted that, unlike the DSM-IV criteria for MDE, no exclusions were made in NSDUH for depressive symptoms caused by medical illness, bereavement, or substance use disorders. Treatment for MDE in adults is defined as seeing or talking to a health professional or other professional or using prescription medication for depression in the past year. The specific questions used to measure MDE and a discussion of measurement issues are included in Section B.4.4in Appendix B of this report.

Adding new adult mental health questions in 2008 (i.e., the past 30-day Kessler-6 or K6 scale, the functional impairment scale[s], and the suicidal thoughts and behavior items) may have affected how respondents reported their symptoms in the adult MDE module; for further discussion, see Sections B.4.2 and B.4.4 in Appendix B of this report and Sections B.4.4 and B.4.7 in Appendix B of the 2008 NSDUH national findings report (Office of Applied Studies, 2009). These changes in 2008 caused discontinuities in trends for MDE among adults. However, an adjustment was applied to estimates of MDE that were affected by these questionnaire changes to allow trends in MDE among adults for 2005 to 2012 to be included in this report.

In 2012, 6.9 percent of adults aged 18 or older (16.0 million people) had at least one MDE in the past year (Figure 2.3). The percentage of adults who had a past year MDE remained stable between 2005 (6.6 percent) and 2012 (6.9 percent).

Figure 2.3 Major Depressive Episode in the Past Year among Adults Aged 18 or Older, by Age and Gender: 2012

Among adults aged 18 or older, the percentage having past year MDE in 2012 was lowest for those aged 50 or older (5.5 percent), followed by those aged 26 to 49 (7.6 percent), then by those aged 18 to 25 (8.9 percent) (Figure 2.3).
In 2012, the percentage of adults with past year MDE was higher among women than among men (8.4 vs. 5.2 percent) (Figure 2.3). Among women, the percentage having MDE was lowest among women aged 50 or older (6.5 percent), followed by women aged 26 to 49 (9.4 percent), then by those aged 18 to 25 (11.6 percent).
Past year MDE among adults varied by race/ethnicity in 2012. The percentage of adults with past year MDE was 3.2 percent among Asians, 6.3 percent among blacks, 7.0 percent among Hispanics, 7.1 percent among whites, 7.7 percent among adults reporting two or more races, and 10.0 percent among American Indians or Alaska Natives. The percentage among Native Hawaiians or Other Pacific Islanders could not be reported because of low precision (see Section B.2.2 in Appendix B).
Among adults in 2012, the percentage having past year MDE was higher among unemployed persons (11.4 percent) and persons who were employed part time (7.9 percent) than among those who were employed full time (5.0 percent).
Among the 16.0 million adults aged 18 or older who had MDE in the past year, 10.9 million (68.0 percent) received treatment (i.e., saw or talked to a medical doctor or other professional or used prescription medication) for depression in the same time period (Figure 2.4).

Figure 2.4 Receipt of Treatment for Major Depressive Episode in the Past Year among Adults Aged 18 or Older Who Had a Major Depressive Episode in the Past Year, by Age and Gender: 2012

Adults aged 50 years or older in 2012 with past year MDE were most likely to receive treatment for depression in the past year (76.8 percent), followed by those aged 26 to 49 with past year MDE (68.8 percent), then by those aged 18 to 25 with past year MDE (49.8 percent) (Figure 2.4).
In 2012, women aged 18 or older who had MDE in the past year were more likely than their male counterparts to have received treatment for depression in the past year (72.4 vs. 60.3 percent) (Figure 2.4).
Among adults aged 18 or older in 2012 with past year MDE, about half of those with no health insurance coverage (50.2 percent) received treatment for depression in the past year. This percentage was lower than those for adults with past year MDE who had private insurance (68.6 percent), those who were covered by Medicaid or CHIP⁶ (77.9 percent), or those with other forms of health insurance (79.4 percent).
Among adults aged 18 or older in 2012 with past year MDE, there were similar rates for receiving treatment in the past year by poverty level (69.6 percent for those with a family income that was below the Federal poverty level, 64.2 percent for those with a family income at 100 to 199 percent of the Federal poverty level, and 69.2 percent for those with a family income at 200 percent or more of the Federal poverty level).
Adults aged 18 or older in 2012 with past year MDE who saw or talked to a health professional or other professional about depression in the past year were seen most commonly by general practitioners or family doctors (58.5 percent), followed by psychiatrists or psychotherapists (34.4 percent), then by counselors (24.6 percent) or psychologists (24.3 percent) (Figure 2.5).

Figure 2.5 Type of Professional Seen among Adults Aged 18 or Older with a Major Depressive Episode Who Received Treatment in the Past Year: 2012

¹ Religious or Spiritual Advisor includes ministers, priests, or rabbis.
² Other Medical Doctor includes cardiologists, gynecologists, urologists, and other medical doctors who are not general practitioners or family doctors.
³ Other Mental Health Professional includes mental health nurses and other therapists where type is not specified.

In 2012, 45.0 percent of adults with past year MDE received treatment for depression through a combination of seeing or talking to a health professional or other professional and using prescription medication. In contrast, 14.1 percent saw or talked to a health professional or other professional only, and 6.6 percent used prescription medication only.

Mental Health Service Utilization among Adults

This section presents data on the receipt of mental health services among adults aged 18 or older, the perceived unmet need for mental health services among adults, and reasons for not receiving mental health services among adults with an unmet need. Adults are asked whether they received treatment or counseling for any problem with emotions, "nerves," or mental health in the past year in any inpatient or outpatient setting or used prescription medication in the past year for a mental or emotional condition, not including treatment for use of alcohol or illicit drugs. The treatment questions in this module do not ask specifically about treatment for a particular disorder. Consequently, references to treatment or counseling for any problem with emotions, nerves, or mental health are described broadly as "mental health service use" or receiving/needing "mental health care."

Questions in NSDUH on mental health service utilization are asked of all adults and are not limited to those with a mental health disorder. Questions for adults about treatment for MDE also are asked in a section of the interview that is separate from these other questions about mental health service utilization. Thus, respondents could indicate receipt of treatment for depression in the adult MDE section without having indicated in the mental health service utilization section that they received services for any problems with emotions, nerves, or mental health.

Estimates of the receipt of mental health services are presented by level of mental illness for adults. These include AMI and three levels of mental illness among those with AMI: low (mild) mental illness, moderate mental illness, and SMI. Definitions for AMI and SMI among persons aged 18 or older were described previously. Low (mild) mental illness was defined as mental illness with mild impairment in carrying out major life activities; moderate mental illness was defined as mental illness with moderate impairment in carrying out major life activities (see Section B.4.3 in Appendix B for additional details on the procedures for constructing these measures).⁷ As noted previously, estimates of the receipt of mental health services among adults with AMI, SMI, or other levels of mental illness for 2008 to 2011 are based on an improved methodology to generate estimates of mental illness and therefore are different from corresponding estimates in prior reports. The improved methodology is used to generate estimates of mental illness for each year from 2008 to 2012, which allows statements to be made about trends in mental health service utilization among adults by level of mental illness.

Also described in this section are estimates of the perceived unmet need for mental health services and reasons for not receiving mental health services among adults aged 18 or older with an unmet need. Unmet need is established using a question that asks whether a respondent perceived a need for, but did not receive, mental health treatment or counseling at any time in the 12 months prior to the NSDUH interview. This measure also includes persons who received some type of mental health service in the past 12 months but reported a perceived need for additional services they did not receive.

It is important to note that because the survey covers the U.S. civilian, noninstitutionalized population, persons residing in long-term psychiatric or other institutions continuously throughout the year were not included in the NSDUH sampling frame (see Section A.1 in Appendix A and Section B.1 in Appendix B). However, persons who were hospitalized or institutionalized for a period of time during the survey period, but who resided in households for most of the survey period were included in the sample.

In 2012, 34.1 million persons aged 18 or older (14.5 percent of the population aged 18 or older) received mental health treatment or counseling during the past 12 months (Figure 2.6). The number and the percentage were higher than those in 2011 (31.6 million persons and 13.6 percent).

Figure 2.6 Past Year Mental Health Service Use among Adults Aged 18 or Older, by Type of Care: 2002-2012

⁺ Difference between this estimate and the 2012 estimate is statistically significant at the .05 level.

The use of mental health services in the past year varied by age for adults. The percentages who used mental health services were higher among adults aged 26 to 49 (15.2 percent) and those aged 50 or older (14.8 percent) than among those aged 18 to 25 (12.0 percent).
Among adults aged 18 or older in 2012, women were more likely than men to use mental health services in the past year (18.6 vs. 10.2 percent).
Among racial/ethnic groups, the rates of past year mental health service use among adults aged 18 or older in 2012 were 4.4 percent for Asians, 5.3 percent for Native Hawaiians or Other Pacific Islanders, 7.1 percent for Hispanics, 10.2 percent for blacks, 14.2 percent for persons reporting two or more races, 15.4 percent for American Indians or Alaska Natives, and 17.8 percent for whites.
In 2012, the percentage of adults using mental health services in the past year was higher among adults aged 18 or older who were covered by Medicaid or CHIP⁸ (21.4 percent) compared with percentages of adults with private health insurance (14.2 percent), adults without health insurance coverage (10.4 percent), and adults with other forms of health insurance coverage (16.4 percent).
In 2012, the type of mental health service most commonly used by adults in the past year was prescription medication (12.4 percent or 29.0 million adults), followed by outpatient services (6.6 percent or 15.5 million adults), then by inpatient services (0.8 percent or 1.9 million adults) (Figure 2.6). Percentages of adults who used outpatient services or inpatient services in 2012 were similar to those in 2011 (6.7 and 0.8 percent, respectively). However, there was an increase between 2011 and 2012 in the percentage of adults who received prescription medication (11.5 vs. 12.4 percent). Note that respondents could report using more than one type of mental health care.
Between 2002 and 2012, the percentage of adults using outpatient services in the past year declined from 7.4 to 6.6 percent, and the percentage using prescription medication increased from 10.5 to 12.4 percent (Figure 2.6).
In 2012, adult women aged 18 or older were more likely than adult men to use outpatient mental health services (8.6 vs. 4.5 percent) or prescription medication (15.9 vs. 8.6 percent) for mental health problems in the past year.
Among adults aged 18 or older in 2012 who reported using mental health services in the past year, 66.7 percent used one type of care (inpatient, outpatient, or prescription medication), 30.7 percent used two types of care, and 2.6 percent used all three types of care.
Among adults aged 18 or older in 2012 who used outpatient mental health services in the past year, several types of locations were reported where services were received. These included an office of a private therapist, psychologist, psychiatrist, social worker, or counselor that was not part of a clinic (55.1 percent); an outpatient mental health clinic or center (23.5 percent); a doctor's office that was not part of a clinic (20.1 percent); or an outpatient medical clinic (6.6 percent).
In 2012, the most likely sources of payment for outpatient mental health services among adults aged 18 or older who used outpatient mental health services in the past year were private health insurance (40.7 percent) and self-payment or payment by a family member living in the household (37.2 percent), followed by Medicare (13.5 percent), then by Medicaid (10.1 percent) or an employer (6.3 percent).
Among the 43.7 million adults aged 18 or older with AMI in 2012, 17.9 million (41.0 percent) received mental health services in the past year (Figure 2.7). Also, among the 9.6 million adults aged 18 or older with SMI in 2012, 6.0 million (62.9 percent) received mental health services in the past year. Mental health services were received by 45.9 and 29.0 percent of adults with moderate mental illness and low (mild) mental illness, respectively.

Figure 2.7 Receipt of Mental Health Services among Adults Aged 18 or Older, by Level of Mental Illness: 2012

Rates of mental health service use were similar in 2011 and 2012 among adults with SMI (64.9 and 62.9 percent, respectively) and among adults with AMI (40.8 and 41.0 percent, respectively).
Among adults with SMI in 2012, the rate of mental health service use was lower among adults aged 18 to 25 (53.1 percent) than that among adults aged 26 to 49 (63.5 percent) and those aged 50 or older (66.3 percent).
In 2012, among all adults aged 18 or older with past year AMI, 35.3 percent used prescription medication, 22.4 percent used outpatient services, and 3.0 percent used inpatient services for a mental health problem in the past year. The percentages of adults with past year SMI who used prescription medication, outpatient services, and inpatient services were 57.8, 39.0, and 6.2 percent, respectively. Respondents could report that they used more than one type of service.
Among the 17.9 million adults aged 18 or older in 2012 with past year AMI who reported receiving mental health services in the past year, 56.2 percent received one type of care (inpatient, outpatient, or prescription medication), 39.3 percent received two types of care, and 4.5 percent received all three types of care (Figure 2.8).

Figure 2.8 Number of Types of Mental Health Services Received among Adults Aged 18 or Older with Past Year Any Mental Illness Who Received Mental Health Services in the Past Year: 2012

Note: The three types of mental health care are receiving inpatient care, outpatient care, or prescription medication.

Among the 6.0 million adults aged 18 or older in 2012 with past year SMI who reported receiving mental health services in the past year, 43.5 percent received one type of care (inpatient, outpatient, or prescription medication), 49.3 percent received two types of care, and 7.2 percent received all three types of care (Figure 2.9).

Figure 2.9 Number of Types of Mental Health Services Received among Adults Aged 18 or Older with Past Year Serious Mental Illness Who Received Mental Health Services in the Past Year: 2012

Note: The three types of mental health care are receiving inpatient care, outpatient care, or prescription medication.

Among adults aged 18 or older in 2012 who reported receiving mental health services in the past year, the percentages receiving one type of mental health service (inpatient, outpatient, or prescription medication) were 43.5 percent among adults with past year SMI, 57.2 percent among adults with past year moderate mental illness, and 67.3 percent among adults with past year low (mild) mental illness.
Among adults aged 18 or older, receipt of prescription medication for mental health problems varied by level of mental illness in the past year. In 2012, 57.8 percent of adults with SMI, 38.3 percent of adults with moderate mental illness, and 24.0 percent of adults with low (mild) mental illness received prescription medication for their mental health problems in the past year.
In 2012, there were 11.5 million adults aged 18 or older (4.9 percent of all adults) who reported an unmet need for mental health care in the past year. These included 5.4 million adults who did not receive any mental health services in the past year. Among adults who did receive some type of mental health service in the past year, 17.8 percent (6.1 million) reported an unmet need for mental health care. (Unmet need among adults who received mental health services may reflect a delay in care or a perception of insufficient care.)
Among the 5.4 million adults aged 18 or older in 2012 who reported an unmet need for mental health care and did not receive mental health services in the past year, several reasons were reported for not receiving mental health care. These included an inability to afford the cost of care (45.7 percent), believing at the time that the problem could be handled without treatment (28.2 percent), not knowing where to go for services (22.8 percent), and not having the time to go for care (14.3 percent) (Figure 2.10).

Figure 2.10 Reasons for Not Receiving Mental Health Services in the Past Year among Adults Aged 18 or Older with an Unmet Need for Mental Health Care Who Did Not Receive Mental Health Services: 2012

3. Suicidal Thoughts and Behavior

This chapter presents findings from the 2012 National Survey on Drug Use and Health (NSDUH) on the prevalence of suicidal thoughts and behavior among civilian, noninstitutionalized adults aged 18 or older in the United States. The data in this chapter are based on a set of questions that have been included in the NSDUH questionnaire since 2008. These questions ask all adult respondents if at any time during the past 12 months they had serious thoughts of suicide, and among those who had serious thoughts of suicide, whether they planned or attempted suicide in the past year. If an attempt was made, additional items ask whether the respondent received medical attention or was hospitalized as a result of a suicide attempt.

Some estimates discussed in this chapter are based on suicide survivors and may therefore be underestimates. However, the annual number of reported deaths by suicide is small relative to the annual number of persons reporting suicide thoughts, plans, and attempts in the United States. In 2010, for example, suicide was listed as the cause of death in fewer than 40,000 deaths among persons of all ages in the United States (Murphy, Xu, & Kochanek, 2013). In comparison, more than 1 million adults in 2010 reported making a suicide attempt in the past 12 months (Center for Behavioral Health Statistics and Quality, 2012b).

Having serious thoughts of suicide increases the risk of a person making an actual suicide attempt. A history of prior suicide attempts is one of the strongest predictors for death by suicide (Kessler, Berglund, Borges, Nock, & Wang, 2005; Suominen et al., 2004; U.S. Department of Health and Human Services, 2012). Thus, suicidal thoughts and behaviors are important public health concerns in the United States.

Suicidal Thoughts and Behavior among Adults

In 2012, an estimated 9.0 million adults (3.9 percent) aged 18 or older had serious thoughts of suicide in the past year (Figure 3.1). The estimated number and percentage remained stable between 2008 (8.3 million persons and 3.7 percent) and 2012.

Figure 3.1 Suicidal Thoughts in the Past Year among Adults Aged 18 or Older, by Age and Gender: 2012

In 2012, the percentage of adults having serious thoughts of suicide was highest among persons aged 18 to 25 (7.2 percent), followed by persons aged 26 to 49 (4.2 percent), then by persons aged 50 or older (2.4 percent) (Figure 3.1).
In 2012, male and female adults had similar rates of having serious thoughts of suicide in the past year (3.6 and 4.1 percent, respectively).
Among adults aged 18 or older in 2012, 2.7 million persons (1.1 percent) made suicide plans in the past year (Figure 3.2). The percentage of adults who made suicide plans in the past year was higher among persons aged 18 to 25 (2.4 percent) than among persons aged 26 to 49 (1.3 percent) and those aged 50 or older (0.6 percent). Moreover, among adults aged 18 to 25, the percentage of adults who made suicide plans in 2012 was higher than that in 2011 (1.9 percent).

Figure 3.2 Suicidal Thoughts and Behavior in the Past Year among Adults Aged 18 or Older: 2012

In 2012, 1.3 million adults (0.6 percent) aged 18 or older attempted suicide in the past year (Figure 3.2). Among these persons who attempted suicide, 1.0 million also reported making suicide plans, and 0.3 million did not make suicide plans.
In 2012, the percentages of adults aged 18 or older having serious thoughts of suicide in the past year were 1.5 percent among Native Hawaiians or Other Pacific Islanders, 3.3 percent among Asians, 3.5 percent among Hispanics, 3.6 percent among blacks, 4.0 percent among whites, 5.5 percent among persons reporting two or more races, and 5.9 percent among American Indians or Alaska Natives.
Among adults aged 18 or older in 2012, those who completed college were less likely to have serious thoughts of suicide (2.9 percent) than their counterparts who had not completed high school (4.5 percent), were high school graduates but had no further education (4.0 percent), or had completed some college but had not received a degree (4.4 percent).
In 2012, adults who were unemployed in the past year were more likely than those who were employed full time or part time to have serious thoughts of suicide (7.2 vs. 3.2 and 4.0 percent, respectively), make suicide plans (2.6 vs. 0.8 and 1.2 percent, respectively), or attempt suicide (1.2 vs. 0.4 and 0.6 percent, respectively).
Adults with Medicaid or those who were covered by the Children’s Health Insurance Program (CHIP)⁹ in 2012 were more likely than those with private health insurance to have serious thoughts of suicide (6.5 vs. 2.9 percent), make suicide plans (2.2 vs. 0.7 percent), or attempt suicide (1.2 vs. 0.3 percent) in the past year.
In 2012, adults with annual family incomes at 200 percent or more of the Federal poverty level were less likely to have serious thoughts of suicide in the past year (3.0 percent) than their counterparts with family incomes below the Federal poverty level (5.8 percent) and their counterparts with family incomes between 100 and 199 percent of the Federal poverty level (5.0 percent).

College Students

In 2012, full-time college students aged 18 to 22 were less likely than other adults aged 18 to 22 to have serious thoughts of suicide (6.6 vs. 9.0 percent) (Figure 3.3), make suicide plans (2.2 vs. 3.1 percent), attempt suicide (1.1 vs. 2.2 percent), or receive medical attention as a result of a suicide attempt in the past year (0.5 vs. 1.0 percent).

Figure 3.3 Suicidal Thoughts in the Past Year among Full-Time College Students Aged 18 to 22 and Other Adults Aged 18 to 22, by Gender: 2012

¹ Other adults include respondents aged 18 to 22 not enrolled in school, enrolled in college part time, enrolled in other grades either full or part time, or enrolled with no other information available.

Male full-time college students aged 18 to 22 were less likely than other male adults aged 18 to 22 to have serious thoughts of suicide (5.5 vs. 7.7 percent) (Figure 3.3) and to make suicide plans (1.5 vs. 2.6 percent). However, similar percentages of males who were full-time college students and those were not in college full time attempted suicide (0.9 and 1.6 percent, respectively) or received medical attention as a result of a suicide attempt in the past year (0.5 and 0.7 percent, respectively).
Female full-time college students aged 18 to 22 were less likely than other female adults aged 18 to 22 to have serious thoughts of suicide (7.6 vs. 10.4 percent) (Figure 3.3), attempt suicide (1.3 vs. 2.8 percent), or receive medical attention as a result of a suicide attempt in the past year (0.5 vs. 1.3 percent). However, similar percentages of females who were full-time college students and those who were not in college full time made suicide plans in the past year (2.7 and 3.7 percent, respectively).

Criminal Justice Populations

In 2012, the rate of serious thoughts of suicide in the past year among adults aged 18 or older who were on parole or a supervised release from jail in the past 12 months (9.7 percent) was higher than that among their counterparts who were not on parole or a supervised release from jail during this period (3.8 percent).
Probation status was associated with serious thoughts of suicide. In 2012, the rate of serious thoughts of suicide in the past year among adults aged 18 or older who were on probation during the past 12 months (9.6 percent) was higher than that among their counterparts who were not on probation during this period (3.7 percent).

Suicidal Thoughts and Behavior among Adults Who Used Substances

Illicit Drug Use

In 2012, adults aged 18 or older who used illicit drugs in the past year had higher rates of serious thoughts, plans, and attempts of suicide compared with all adults in the general population (i.e., including users and nonusers of illicit drugs in the past year). Among adults who used illicit drugs in the past year, 9.4 percent had serious thoughts of suicide (Figure 3.4), 3.2 percent made a suicide plan, and 1.6 percent attempted suicide in the past year. Corresponding rates among all adults aged 18 or older were 3.9, 1.1, and 0.6 percent, respectively.

Figure 3.4 Suicidal Thoughts in the Past Year among Adults Aged 18 or Older, by Past Year Use of Selected Illicit Drugs: 2012

⁺ Difference between this estimate and the estimate for all adults aged 18 or older is statistically significant at the .05 level.
Note: Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.

Percentages of adults in 2012 who had serious thoughts of suicide in the past year were 9.6 percent among past year users of marijuana, 14.2 percent among past year users of hallucinogens, 14.7 percent among past year users of cocaine, and 17.4 percent among past year users of inhalants (Figure 3.4).
In 2012, 12.8 percent of adults who were nonmedical users of psychotherapeutic drugs in the past year had serious thoughts of suicide in that period. Rates of serious thoughts of suicide in the past year among adults who were nonmedical users of specific categories of prescription drugs in the past year were 13.0 percent for pain relievers, 14.0 percent for tranquilizers, 18.1 percent for stimulants, and 20.9 percent for sedatives (Figure 3.4).
Percentages of adults in 2012 who made suicide plans in the past year were 3.3 percent among past year users of marijuana, 5.0 percent among past year users of cocaine, 5.8 percent among past year users of hallucinogens, and 7.2 percent among past year users of inhalants.
In 2012, 4.9 percent of adults who were nonmedical users of psychotherapeutic drugs in the past year made suicide plans in that period. Percentages of adults who made suicide plans in the past year among past year nonmedical users of specific categories of prescription drugs were 5.0 percent for pain relievers, 5.6 percent for tranquilizers, 5.9 percent for sedatives, and 8.7 percent for stimulants.
Percentages of adults in 2012 who made suicide attempts in the past year were 1.7 percent among past year users of marijuana, 2.8 percent among past year users of heroin, 3.1 percent among past year users of cocaine, 3.7 percent among past year users of hallucinogens, and 4.3 percent among past year users of inhalants.
In 2012, 2.2 percent of adults who were nonmedical users of psychotherapeutic drugs in the past year attempted suicide in that period. Percentages of adults who attempted suicide in the past year among past year nonmedical users of specific categories of prescription drugs were 2.1 percent for pain relievers, 2.4 percent for tranquilizers, 4.0 percent for stimulants, and 5.7 percent for sedatives.

Cigarette and Alcohol Use

In 2012, among adults aged 18 or older who smoked cigarettes in the past year, 6.4 percent had serious thoughts of suicide, 2.1 percent made suicide plans, and 1.1 percent attempted suicide in the past year.
Among adults aged 18 or older in 2012 who were binge alcohol users in the past month, 5.4 percent had serious thoughts of suicide, 1.5 percent made suicide plans, and 1.0 percent attempted suicide in the past year. Binge alcohol use is defined as having five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.
Among adults who were heavy alcohol users in the past month, 6.6 percent had serious thoughts of suicide, 1.9 percent made suicide plans, and 1.0 percent attempted suicide in the past year. Heavy alcohol use is defined as having five or more drinks on the same occasion on each of 5 or more days in the past 30 days.

Suicidal Thoughts and Behavior among Adults with Substance Dependence or Abuse and Adults with Major Depressive Episode

In 2012, among adults aged 18 or older who had substance dependence or abuse in the past year, 2.6 million (12.6 percent) had serious thoughts of suicide, 0.8 million (3.9 percent) made suicide plans, and 0.5 million (2.3 percent) attempted suicide in the past year.
Among adults with past year alcohol dependence or abuse, 2.0 million (12.0 percent) had serious thoughts of suicide. Among adults with past year illicit drug dependence or abuse, 1.2 million (19.3 percent) had serious thoughts of suicide.
Adults aged 18 or older who had past year substance dependence or abuse were more likely than those without substance dependence or abuse to have serious thoughts about suicide (12.6 vs. 3.0 percent), make suicide plans (3.9 vs. 0.9 percent), or attempt suicide (2.3 vs. 0.4 percent) in the past year (Figure 3.5).

Figure 3.5 Suicidal Thoughts and Behavior in the Past Year among Adults Aged 18 or Older, by Substance Dependence or Abuse: 2012

Among the 16.0 million adults with a past year major depressive episode (MDE), 4.3 million (26.9 percent) had serious thoughts of suicide. MDE is based on the criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) and is described in Section B.4.4 in Appendix B.

4. Major Depressive Episode and Mental Health Service Utilization among Youths

This chapter presents findings from the National Survey on Drug Use and Health (NSDUH) on past year major depressive episode (MDE), MDE accompanied by severe impairment in one or more role domains, and the percentage receiving treatment for depression among youths aged 12 to 17 in the United States. This chapter also presents findings on mental health service utilization by youths for any emotional and behavioral problems (excluding those caused by alcohol or illicit drug use).

Major Depressive Episode (MDE), MDE with Severe Impairment, and Treatment

A module of questions designed to obtain measures of lifetime and past year prevalence of MDE, severe impairment caused by MDE in the past year, and treatment for MDE in the past year has been administered to youths aged 12 to 17 since 2004. As described in the next paragraph, some questions in the adolescent depression module differ slightly from questions in the adult depression module to make them more appropriate for youths. Therefore, these data should not be compared or combined with MDE data for adults aged 18 or older.

MDE is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had at least four of seven additional symptoms reflecting the criteria as described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994). Unlike the DSM-IV criteria for MDE, however, no exclusions were made in NSDUH for depressive symptoms caused by medical illness, bereavement, or substance use disorders. Severe impairment is defined by the level of role interference reported to be caused by MDE. The role domains (i.e., chores at home, school or work, close relationships with family, or social life) for youths aged 12 to 17 are slightly modified from those for adults to be made age appropriate. Treatment for MDE among youths is defined as seeing or talking to a medical doctor or other professional or using prescription medication for depression in the past year. The specific questions used to measure MDE and a discussion of measurement issues are included in Section B.4.4 of Appendix B.

In 2012, 9.1 percent of the population aged 12 to 17 (2.2 million youths) had MDE during the past year (Figure 4.1). This was higher than the percentages in 2006 to 2011 (ranging from 7.9 to 8.3 percent) and was similar to the percentages in 2004 (9.0 percent) and 2005 (8.8 percent).

Figure 4.1 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Severe Impairment, Age, and Gender: 2012

Note: Respondents with an unknown level of impairment were included in the estimates for Major Depressive Episode without Severe Impairment.

In 2012, 6.3 percent of the population aged 12 to 17 (1.5 million youths) had past year MDE with severe impairment in one or more role domains (Figure 4.1). This was higher than the percentages in 2010 and 2011 (5.7 percent in each year) and in 2006 and 2007 (5.5 percent in each year), but it was similar to the percentages in 2008 (6.0 percent) and 2009 (5.8 percent).
In 2012, past year MDE and past year MDE with severe impairment among youths generally increased with age. Among 12 year olds, 3.7 percent had past year MDE, and 2.1 percent had past year MDE with severe impairment. Corresponding 2012 rates for past year MDE and past year MDE with severe impairment among 16 year olds were 11.8 and 8.5 percent, respectively, and 10.9 and 7.5 percent, respectively, among 17 year olds (Figure 4.1).
Among youths aged 12 to 17 in 2012, females were more likely than males to have past year MDE (13.7 vs. 4.7 percent) and past year MDE with severe impairment (9.8 vs. 3.0 percent) (Figure 4.1).
The rate of past year MDE among female youths in 2012 (13.7 percent) was higher than in 2009 to 2011 and in 2006 and 2007 (ranging from 11.7 to 12.1 percent), but it was similar to the percentages in 2004, 2005, and 2008 (Figure 4.2). The rate of past year MDE with severe impairment among female youths in 2012 (9.8 percent) was higher than in 2009 to 2011 and 2006 and 2007 (ranging from 8.2 to 8.6 percent), but it was similar to the percentage in 2008 (9.2 percent).

Figure 4.2 Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Gender: 2004-2012

⁺ Difference between this estimate and the 2012 estimate is statistically significant at the .05 level.

The rate of past year MDE among male youths in 2012 (4.7 percent) was similar to the percentages in 2004 to 2011 (ranging from 4.2 to 5.0 percent) (Figure 4.2). The rate of past year MDE with severe impairment among male youths in 2012 (3.0 percent) was similar to the percentages in 2006 to 2011 (ranging from 2.6 to 3.2 percent).
In 2012, 37.0 percent of youths aged 12 to 17 with past year MDE and 41.0 percent with past year MDE with severe impairment received treatment for depression (i.e., saw or talked to a medical doctor or other professional or used prescription medication). These percentages were similar to those in 2011 (38.4 and 43.5 percent, respectively).
Among youths in 2012 with past year MDE, 19.6 percent saw or talked to a health professional only, 2.4 percent used prescription medication only, and 13.7 percent received treatment from both sources for depression in the past year. These percentages were similar to those in 2011 (19.9, 2.6, and 13.6 percent, respectively).
Among female youths in 2012 with past year MDE, 21.5 percent saw or talked to a health professional only, 2.2 percent used prescription medication only, and 15.2 percent received treatment from both sources for depression in the past year (Figure 4.3). These percentages for female youths were similar to those in 2011 (20.7, 2.0, and 14.5 percent, respectively).

Figure 4.3 Type of Treatment Received for Major Depressive Episode in the Past Year among Youths Aged 12 to 17, by Gender: 2012

Note: Health Professionals include general practitioner or family doctor; other medical doctor (e.g., cardiologist, gynecologist, urologist); psychologist; psychiatrist or psychotherapist; social worker; counselor; other mental health professional (e.g., mental health nurse or other therapist where type is not specified); and nurse, occupational therapist, or other health professional.

Among male youths in 2012 with past year MDE, 14.4 percent saw or talked to a health professional only, 2.9 percent used prescription medication only, and 9.6 percent received treatment from both sources for depression in the past year (Figure 4.3). These percentages for male youths were similar to those in 2011 (17.8, 4.2, and 11.1 percent, respectively).

Mental Health Service Utilization

In 2000, NSDUH initiated mental health service utilization modules for respondents aged 12 to 17 and those aged 18 or older. These modules ask about services for emotional and behavioral problems that were not caused by substance use. The mental health service utilization questions for youths aged 12 to 17 are different from those asked of adults aged 18 or older. The youth module was revised in 2009 to include updates to the sources of youth mental health services in an education setting (i.e., school system) and a new question on mental health service utilization in a juvenile justice setting.

The youth mental health service utilization module asks respondents aged 12 to 17 whether they received any treatment or counseling within the 12 months prior to the interview for problems with emotions or behavior in several settings: (a) the specialty mental health setting (inpatient or outpatient care); (b) the education setting (talked with a school social worker, psychologist, or counselor about an emotional or behavioral problem; participated in a program for students with emotional or behavioral problems while in a regular school; or attended a school for students with emotional or behavioral problems); (c) the general medical setting (pediatrician or family physician care for emotional or behavioral problems); or (d) the juvenile justice setting (received services for an emotional or behavioral problem in a detention center, prison, or jail). Youths also are asked about the number of nights spent in overnight facilities, the number of visits they had to outpatient mental health or general medical providers for mental health treatment or counseling, and the reason(s) for the most recent stay or visit.

In 2012, 3.1 million youths aged 12 to 17 (12.7 percent) received treatment or counseling for problems with emotions or behaviors in a specialty mental health setting (inpatient or outpatient care) in the past 12 months. The 2012 percentage was similar to those in 2002 through 2011 (ranging from 12.0 to 13.5 percent).
In 2012, 3.2 million youths (12.9 percent) received mental health services in an education setting, which was higher than the 2011 estimate (2.9 million youths or 11.9 percent).
In 2012, 629,000 youths (2.5 percent) received mental health services in a general medical setting. Additionally in 2012, 1.4 million youths (5.5 percent) received mental health services in both a specialty setting and a nonspecialty setting (i.e., either an education or a general medical setting). These numbers and percentages were similar to those in 2011.
In 2012, 83,000 youths (0.3 percent) received mental health services in a juvenile justice setting in the past 12 months. Estimates were greater for male than for female youths, with 57,000 males (0.4 percent) and 26,000 females (0.2 percent) having received mental health services in a juvenile justice setting. The number and percentage of female youths receiving mental health services in a juvenile justice setting decreased between 2011 (54,000 or 0.4 percent) and 2012 (26,000 or 0.2 percent).
Of the 3.1 million youths aged 12 to 17 in 2012 who received specialty mental health services, the most likely reason for receiving services was feeling depressed (50.7 percent), followed by having problems with home or family (29.1 percent), then by breaking rules and "acting out" (24.2 percent), thinking about or attempting suicide (23.8 percent), feeling very afraid and tense (22.7 percent), which was followed by having problems at school (19.7 percent) and having trouble controlling anger (18.9 percent) (Figure 4.4).

Figure 4.4 Reasons for Receiving Specialty Mental Health Services among Youths Aged 12 to 17 Who Received Mental Health Services in the Past Year: 2012

Youths in 2012 who received inpatient specialty mental health services in the past year were more likely than those who received outpatient specialty mental health services to report that they received services because they thought about or attempted suicide (47.3 vs. 22.0 percent).
Of the 3.2 million youths aged 12 to 17 in 2012 who received mental health services in the education setting, the most likely reason for receiving services was feeling depressed (37.9 percent), followed by having problems at school (24.4 percent), then having problems with friends (20.3 percent), breaking rules and "acting out" (19.9 percent), having problems with home or family (18.1 percent), and feeling very afraid and tense (16.7 percent).
Of the 629,000 youths aged 12 to 17 in 2012 who received mental health services in a general medical setting, the most likely reason for receiving services was feeling depressed (51.2 percent), followed by feeling very afraid and tense (19.6 percent), having thoughts of or attempting suicide (19.2 percent), having eating problems (18.9 percent, which was an increase from 12.4 percent in 2011), breaking rules and "acting out" (13.7 percent), some other reason (12.1 percent), having problems at school (11.2 percent), having problems with home or family (9.5 percent), having problems controlling anger (8.6 percent), and having problems with friends (6.3 percent).
Female youths aged 12 to 17 were more likely than male youths in 2012 to use outpatient specialty mental health services (14.5 vs. 8.7 percent), education services (15.2 vs. 10.7 percent), and general medical-based services (3.4 vs. 1.7 percent) (Figure 4.5). Similar percentages of female and male youths received inpatient specialty mental health services (2.5 and 2.3 percent, respectively). Between 2011 and 2012, the percentage of male youths receiving outpatient specialty mental health services decreased from 9.7 to 8.7 percent, and the percentage of female youths receiving services in an education setting increased from 13.0 to 15.2 percent.

Figure 4.5 Past Year Mental Health Service Use among Youths Aged 12 to 17, by Gender: 2012

Of the 2.8 million youths aged 12 to 17 in 2012 who received outpatient specialty mental health services in the past 12 months, 16.4 percent reported having 1 visit, 14.2 percent reported having 2 visits, 30.6 percent reported having 3 to 6 visits, 24.8 percent reported having 7 to 24 visits, and 14.0 percent reported having 25 or more visits (Figure 4.6).

Figure 4.6 Number of Outpatient Visits in the Past Year among Youths Aged 12 to 17 Who Received Outpatient Specialty Mental Health Services: 2012

Of the 588,000 youths aged 12 to 17 in 2012 who received inpatient or residential specialty mental health services in the past 12 months, 37.5 percent reported staying overnight 1 night, 13.6 percent reported staying overnight 2 nights, 17.0 percent reported staying overnight 3 to 6 nights, 21.9 percent reported staying overnight 7 to 24 nights, and 10.0 percent reported staying overnight 25 or more nights.

5. Co-Occurrence of Mental Illness and Substance Use

This chapter presents findings from the 2012 National Survey on Drug Use and Health (NSDUH) on the co-occurrence of mental illness and mental health problems with substance use and substance use disorders (illicit drug or alcohol dependence or abuse) in the United States. Findings presented for adults aged 18 or older include the co-occurrence of substance use and substance use disorders with past year mental illness and major depressive episode (MDE). Also, the utilization of substance use and mental health services among adults with co-occurring mental illness and substance use is discussed. Findings for youths aged 12 to 17 are presented on the co-occurrence of MDE with substance use and substance use disorders.

Mental illness, as discussed in Chapter 2, is defined as the presence of a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Levels of any mental illness (AMI) considered in this report include serious mental illness (SMI), moderate mental illness, and low (mild) mental illness, which are differentiated by their level of functional impairment. Functional impairment is the interference with or limitation of one or more major life activities. Definitions for these mental health measures and other measures used in this chapter are included in a glossary as part of the 2012 mental health detailed tables.¹⁰ Procedures in NSDUH for estimating these levels of mental illness in the past year among adults are described in Section B.4.3 in Appendix B.

Substance Use among Adults with Mental Illness

In 2012, the use of illicit drugs in the past year was more likely among adults aged 18 or older with past year AMI (26.7 percent) than it was among adults who did not have mental illness in the past year (13.2 percent) (Figure 5.1). This pattern was similar for most specific types of illicit drug use, including the use of marijuana, cocaine, hallucinogens, inhalants, or heroin and the nonmedical use of prescription-type psychotherapeutics.

Figure 5.1 Past Year Substance Use among Adults Aged 18 or Older, by Any Mental Illness: 2012

¹ Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.

The use of cigarettes in the past month was more likely among adults aged 18 or older with AMI compared with adults who did not have mental illness (34.4 vs. 21.4 percent).
Among adults aged 18 or older with AMI in the past year, 27.6 percent were binge alcohol users in the past month, which was higher than the percentage among adults who did not have mental illness in the past year (23.9 percent). Binge alcohol use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.
Adults aged 18 or older with AMI in the past year were more likely than adults who did not have mental illness to be heavy alcohol users in the past month (9.2 vs. 6.6 percent). Heavy alcohol use is defined as drinking five or more drinks on the same occasion on 5 or more days in the past 30 days.
Illicit drug use in the past year was associated with the level of mental illness. The rate of illicit drug use in the past year among adults aged 18 or older was highest among adults with past year SMI (32.1 percent), followed by adults with moderate mental illness (27.6 percent), then by those with low (mild) mental illness (23.8 percent), then by those who did not have past year mental illness (13.2 percent).
Adults aged 18 or older with SMI were more likely than those who did not have mental illness in the past year to be past month cigarette users (39.9 vs. 21.4 percent).
Adults aged 18 or older in 2012 with SMI in the past year were more likely than those without mental illness to be past month binge alcohol users (29.5 vs. 23.9 percent) or heavy alcohol users (10.7 vs. 6.6 percent).

Mental Illness and Substance Use Disorder among Adults

Among the 20.7 million adults with a past year substance use disorder, 40.7 percent (8.4 million adults) had co-occurring mental illness in 2012 (Figure 5.2). In comparison, among adults without a substance use disorder, 16.5 percent had mental illness.

Figure 5.2 Past Year Substance Dependence or Abuse and Mental Illness among Adults Aged 18 or Older: 2012

SUD = substance use disorder.
¹ Statistics on mental illness are provided in Chapter 2 of this report.

Among the 43.7 million adults aged 18 or older in 2012 with AMI in the past year, 19.2 percent (8.4 million adults) met criteria for substance dependence or abuse (Figure 5.2). In comparison, 6.4 percent of adults who did not have mental illness in the past year (12.3 million adults) met criteria for a substance use disorder.
Among adults aged 18 or older in 2012 with AMI in the past year, the percentage who met criteria for substance dependence or abuse was highest among those aged 18 to 25 (34.5 percent), followed by those aged 26 to 49 (22.6 percent), then by those aged 50 or older (8.6 percent). Similarly, the prevalence of substance dependence or abuse in the past year among adults with SMI was highest among those aged 18 to 25 (39.9 percent), followed by those aged 26 to 49 (29.4 percent), then by those aged 50 or older (18.0 percent).
Among the 20.7 million adults aged 18 or older in 2012 with a past year substance use disorder, 12.6 percent (2.6 million adults) also had SMI (Figure 5.3).

Figure 5.3 Past Year Substance Dependence or Abuse and Serious Mental Illness among Adults Aged 18 or Older: 2012

SMI = serious mental illness; SUD = substance use disorder.
¹ Statistics on mental illness are provided in Chapter 2 of this report.

Substance dependence or abuse in the past year was associated with the level of mental illness. In 2012, 27.3 percent of adults aged 18 or older with SMI in the past year also had past year substance dependence or abuse, followed by 18.9 percent of adults with moderate mental illness, then by 15.9 percent of adults with low (mild) mental illness, then by 6.4 percent of adults who did not have mental illness (Figure 5.4).

Figure 5.4 Past Year Substance Dependence or Abuse among Adults Aged 18 or Older, by Level of Mental Illness: 2012

In 2012, 11.6 percent of adults aged 18 or older with SMI in the past year also met criteria for illicit drug dependence or abuse in the past year, as did 6.9 percent of adults with moderate mental illness, 5.4 percent of adults with low (mild) mental illness, and 1.7 percent of adults who did not have mental illness (Figure 5.5).

Figure 5.5 Past Year Illicit Drug Dependence or Abuse among Adults Aged 18 or Older, by Level of Mental Illness: 2012

In 2012, 21.6 percent of adults aged 18 or older with SMI in the past year also had past year alcohol dependence or abuse, followed by 15.5 percent of adults with moderate mental illness, then by 12.8 percent of adults with low (mild) mental illness, then by 5.3 percent of adults who did not have mental illness (Figure 5.6).

Figure 5.6 Past Year Alcohol Dependence or Abuse among Adults Aged 18 or Older, by Level of Mental Illness: 2012

Co-Occurring Mental Illness and Substance Use Disorder among Adults, by Demographic and Socioeconomic Characteristics

The prior section described the prevalence of mental illness among the subgroup of adults with a past year substance use disorder as well as the prevalence of substance use disorders among the subgroup of adults with mental illness. This section presents findings on the prevalence of the co-occurrence of substance use disorders with mental illness among all adults as a whole and among demographic and socioeconomic subgroups of adults in the United States.

In 2012, 3.6 percent of all adults aged 18 or older (8.4 million adults) had co-occurring mental illness and substance use disorder (Figure 5.7).

Figure 5.7 Co-Occurring Mental Illness and Substance Use Disorder in the Past Year among Adults Aged 18 or Older, by Age and Gender: 2012

The percentage of adults with co-occurring mental illness and substance use disorder in 2012 was highest among adults aged 18 to 25 (6.8 percent), followed by those aged 26 to 49 (4.8 percent), then by those aged 50 or older (1.3 percent) (Figure 5.7).
In 2012, the percentage of adult males with past year co-occurring mental illness and substance use disorder was higher than that among adult females (4.1 vs. 3.1 percent) (Figure 5.7).
In 2012, the percentage of adults aged 18 or older with past year mental illness and substance use disorder was 1.1 percent among Asians, 3.3 percent among blacks, 3.4 percent among Hispanics, 3.8 percent among whites, 4.3 percent among persons reporting two or more races, and 14.0 percent among American Indians or Alaska Natives.
Among adults aged 18 or older in 2012, those who graduated from college were less likely to have past year mental illness and substance use disorder (2.7 percent) than their counterparts who had not completed high school (4.1 percent), those who had graduated from high school but had no further education (3.7 percent), and those who had some college education but no degree (4.1 percent).
The percentage of adults aged 18 or older with co-occurring mental illness and substance use disorder in 2012 was higher among adults who were unemployed (8.0 percent) than among adults who were employed full time (3.4 percent) or part time (4.1 percent) (Figure 5.8).

Figure 5.8 Co-Occurring Mental Illness and Substance Use Disorder in the Past Year among Adults Aged 18 or Older, by Employment Status: 2012

¹ The Other Employment category includes students, persons keeping house or caring for children full time, retired or disabled persons, or other persons not in the labor force.

Among adults aged 18 or older in 2012 whose family income was below the Federal poverty level, 5.6 percent (2.1 million adults) had past year mental illness and substance use disorder. In contrast, 4.2 percent of adults whose family income was between 100 and 199 percent of the Federal poverty level and 2.9 percent of adults whose family income was at or above 200 percent of the Federal poverty level had past year mental illness and substance use disorder.
In 2012, the percentage of adults with co-occurring mental illness and substance use disorder was highest among persons without health insurance (6.1 percent) and among persons who were covered by Medicaid or the Children's Health Insurance Program (CHIP)¹¹ (5.3 percent), followed by persons with private health insurance (2.8 percent), then by persons with other forms of health insurance (2.2 percent).
In 2012, 1.1 percent of all adults aged 18 or older (2.6 million adults) had co-occurring SMI and substance use disorder.
In 2012, the percentage of adults with both SMI and substance use disorder was similar among adults aged 18 to 25 (1.6 percent) and adults aged 26 to 49 (1.5 percent), but it was lower for adults aged 50 or older (0.5 percent).
The percentages of adults in 2012 with co-occurring SMI and substance use disorder in the past year were similar for males and females (1.2 and 1.0 percent, respectively).
The percentage of adults with past year SMI and substance use disorder was 0.3 percent among Asians, 0.3 percent among Native Hawaiians or Other Pacific Islanders, 0.9 percent among blacks, 1.2 percent among Hispanics, 1.2 percent among whites, 1.2 percent among persons reporting two or more races, and 4.8 percent among American Indians or Alaska Natives.
Among adults aged 18 or older in 2012, the percentages with past year SMI and substance use disorder were 0.8 percent for adults who had graduated from college, 1.1 percent for those who had some college education but no degree, 1.3 percent for those who had graduated from high school but had no further education, and 1.3 percent for those who had not completed high school.
In 2012, the percentage of adults with SMI and substance use disorder in the past year was higher among adults who were unemployed (3.0 percent) than among adults who were employed full time (0.8 percent) and among adults who were employed part time (1.0 percent).
The percentage of adults in 2012 with SMI and substance use disorder in the past year was higher among adults whose family income was below the Federal poverty level (2.1 percent or 795,000 adults) than it was among adults whose family income was between 100 and 199 percent of the Federal poverty level or those whose family income was at or above 200 percent of the Federal poverty level (1.4 and 0.8 percent, respectively).
In 2012, 2.1 percent of adults without health insurance and 2.1 percent of adults who were covered by Medicaid or CHIP¹² had co-occurring SMI and substance use disorder in the past year. Percentages of adults with co-occurring SMI and substance use disorder were lower among adults with other forms of health insurance (0.8 percent) and among adults with private health insurance (0.7 percent).

Major Depressive Episode and Substance Use among Adults

In 2012, adults aged 18 or older who had past year MDE were more likely than those without past year MDE to have used illicit drugs in the past year (28.5 vs. 14.8 percent) (Figure 5.9). A similar pattern was observed for specific types of past year illicit drug use, such as the use of marijuana, cocaine, hallucinogens, inhalants, or heroin and the nonmedical use of prescription-type psychotherapeutics.

CIENCIASMEDICASNEWS

viernes, 23 de mayo de 2014

Results from the 2012 NSDUH: Mental Health National Findings, SAMHSA, CBHSQ

Results from the 2012National Survey on Drug Use and Health:Mental Health Findings