Frequent Mental Distress Among Adults, by Disability Status, Disability Type, and Selected Characteristics - United States, 2018.
ABSTRACT: Frequent mental distress, defined as 14 or more self-reported mentally unhealthy days in the past 30 days,* is associated with adverse health behaviors, increased use of health services, mental disorders (e.g., diagnosis of major depressive disorder), chronic diseases, and functional limitations (1). Adults with disabilities more often report depression and anxiety (2), reduced health care access (3), and health-related risk behaviors (4) than do adults without disabilities. CDC analyzed 2018 Behavioral Risk Factor Surveillance System (BRFSS) data to compare the prevalence of frequent mental distress among adults with disabilities with that among adults without disabilities and to identify factors associated with mental distress among those with disabilities. Nationwide, an estimated 17.4 million adults with disabilities reported frequent mental distress; the prevalence of reported mental distress among those with disabilities (32.9%) was 4.6 times that of those without disabilities (7.2%). Among adults with disabilities, those with both cognitive and mobility disabilities most frequently reported mental distress (55.6%). Adults with disabilities who reported adverse health-related characteristics (e.g., cigarette smoking, physical inactivity, insufficient sleep, obesity, or depressive disorders) or an unmet health care need because of cost also reported experiencing more mental distress than did those with disabilities who did not have these characteristics. Adults living below the federal poverty level reported mental distress 70% more often than did adults in higher income households. Among states, age-adjusted prevalence of mental distress among adults with disabilities ranged from 25.2% (Alaska) to 42.9% (New Hampshire). Understanding the prevalence of mental distress among adults with disabilities could help health care providers, public health professionals, and policy makers target interventions and inform programs and policies to ensure receipt of mental health screening, care, and support services to reduce mental distress among adults with disabilities.
Project description:OBJECTIVES:To investigate prevalence of mental health conditions, sensory impairments and physical disability in children, adults and older adults with co-occurring intellectual disabilities and autism, given its frequent co-occurrence, compared with the general population. DESIGN:Whole country cohort study. SETTING:General community. PARTICIPANTS:5709 people with co-occurring intellectual disabilities and autism, compared with 5?289?694 other people. OUTCOME MEASURES:Rates and ORs with 95% CIs for mental health conditions, visual impairment, hearing impairment and physical disability in people with co-occurring intellectual disabilities and autism compared with other people, adjusted for age, sex and interaction between age and co-occurring intellectual disabilities and autism. RESULTS:All four long-term conditions were markedly more common in children, adults and older adults with co-occurring intellectual disabilities and autism compared with other people. For mental health, OR=130.8 (95% CI 117.1 to 146.1); visual impairment OR=65.9 (95% CI 58.7 to 73.9); hearing impairment OR=22.0 (95% CI 19.2 to 25.2); and physical disability OR=157.5 (95% CI 144.6 to 171.7). These ratios are also greater than previously reported for people with either intellectual disabilities or autism rather than co-occurring intellectual disabilities and autism. CONCLUSIONS:We have quantified the more than double disadvantage for people with co-occurring intellectual disabilities and autism, in terms of additional long-term health conditions. This may well impact on quality of life. It raises challenges for staff working with these people in view of additional complexity in assessments, diagnoses and interventions of additional health conditions, as sensory impairments and mental health conditions in particular, compound with the persons pre-existing communication and cognitive problems in this context. Planning is important, with staff being trained, equipped, resourced and prepared to address the challenge of working for people with these conditions.
Project description:OBJECTIVE:To examine the association between disability exclusion and psychological distress. DESIGN:Cross-sectional study. SETTING:Population-based study of individuals living in households across Australia. PARTICIPANTS:Respondents were persons aged 15 and over living with a disability. PRIMARY OUTCOME MEASURES:Reporting an experience of discrimination or avoidance behaviour due to a respondent's disability. High or very high levels of psychological distress measured using the Kessler K10 instrument. METHODOLOGY:Using the Survey of Disability, Ageing and Carers, we calculated the prevalence of persons with a disability experiencing psychological distress, disaggregated by experiences of disability exclusion, including discrimination and avoidance. Logistic regression models were fitted to examine the association between disability exclusion and psychological distress, once extensive controls and adjustments for survey design and presence of psychosocial disabilities were considered. RESULTS:About 62% of persons citing an experience of disability discrimination were in psychological distress, compared with 27% of those citing no discrimination. Furthermore, 53% of those who actively avoided social, familial or economic activities because of their disability experienced psychological distress, compared with 19% of those who did not avoid these situations. After controlling for demographic characteristics and disabling conditions, reporting an experience of disability discrimination or disability avoidance increased the odds of psychological distress by 2.2 (95% CI 1.74 to 2.26) and 2.6 (95% CI 2.28 to 2.97) times, respectively. Those who experienced both avoidance and discrimination were 3.7 (95% CI 2.95 to 4.72) times more likely to be in psychological distress than those experiencing neither. Avoidance and discrimination in healthcare settings were also found to be strongly associated with experiencing psychological distress. CONCLUSIONS:Given new policy initiatives to improve disability care, coupled with the increasing speed of population ageing, the onus is on governments and its citizenry to address disability exclusion to offset potential mental health impacts.
Project description:BACKGROUND:The prevalence of disabilities is rising steadily, reflecting an aging population and an increasing burden of chronic conditions affecting quality of life. There are scant national data on the prevalence of disability among individuals with chronic obstructive pulmonary disease (COPD). The main objective was to estimate the prevalence of common disabilities among US-based individuals diagnosed with COPD. METHODS:Data from the BRFSS, a national telephone survey examining health-related behaviors in 2016-2017 were analyzed. The study population consisted of individuals with self-reported COPD (N = 38352 in 2016 and N = 35423 in 2017). The prevalence of disabilities in hearing, vision, cognition, mobility, and independent living were obtained and adjusted with sampling weights. Healthcare access measures were described by type of disability. RESULTS:Mobility disability had the highest prevalence of 45.9 (44.8-47.0) % in 2016 and 48.4 (47.3-49.5) % in 2017 among respondents with COPD. The prevalence of disabilities was highest among those 45-64 years old, except for hearing and cognition. Hearing disabilities were most prevalent among males with COPD while cognitive and mobility disabilities were most prevalent among females with COPD. While differences in the prevalence of disabilities were observed, access to health care was similar by disability type and age group among respondents. CONCLUSION:Contrary to expectation, the highest prevalence of disabilities was found not to be among those 65 years old and above. Further research is needed to explain this age-specific shift in the burden of disability, as long-term care planning and prevention support systems should be informed by the demographical patterns of disabilities among individuals with COPD.
Project description:BACKGROUND:There is limited evidence on the extent of the perceived need and barriers to professional mental health service delivery to university students with mental distress in low- and middle-income countries (LMICs). This study was designed to assess the prevalence of mental distress, perceived need for professional mental health care and barriers to the delivery of services to affected undergraduate university students in Ethiopia. METHODS:A multi-stage sampling technique was used to recruit 1135 undergraduate university students. Symptoms of mental distress were evaluated using the Self-Reported Questionnaire (SRQ-20) and a score of above seven was used to identify positive cases. The perceived need for professional mental health care was assessed using a single 'yes or no' response item and barriers to mental health care were assessed using Barriers to Access to Care Evaluation (BACE-30) tool. Percentage, frequency, mean, and standard deviation were employed to summarize demographic characteristics of the participants and to identify common barriers to mental health care service. Moreover, the association of demographic variables with total mean scores of BACE-III sub-scales was modeled using multiple linear regression. RESULTS:The prevalence of mental distress symptoms was 34.6% and the perceived need for professional mental health care was 70.5% of those with mental distress. The top five barriers to receiving professional mental health service were (a) thinking the problem would get better with no intervention, (b) being unsure where to go to get professional help, (c) wanting to solve the problem without intervention, (d) denying a mental health problem existed, and (e) preferring to get alternative forms of mental care. Coming from a rural background, being a second and fourth-year student, and a family history of mental illness were significantly associated with barriers to receive professional mental health service. CONCLUSION:The high prevalence of mental distress, the paucity of mental health care, and the report of barriers to access what professional mental health care there is among Ethiopian undergraduate students is a call to address the disparity.
Project description:To investigate the prevalence of comorbid mental health conditions and physical disabilities in a whole country population of adults aged 25+ with?and without reported autism.Secondary analysis of Scotland's Census, 2011 data. Cross-sectional study.General population.94% of Scotland's population, including 6649/3 746 584 adults aged 25+ reported?to have autism.Prevalence of six comorbidities: deafness or partial hearing loss, blindness or partial sight loss, intellectual disabilities, mental health conditions, physical disability and other condition; ORs (95% CI) of autism predicting these comorbidities, adjusted for age and gender; and OR for age and gender in predicting comorbidities within the population with reported autism.Comorbidities were common: deafness/hearing loss-17.5%; blindness/sight loss-12.1%; intellectual disabilities-29.4%; mental health conditions-33.0%; physical disability-30.7%; other condition-34.1%. Autism statistically predicted all of the conditions: OR 3.3 (95% CI 3.1 to 3.6) for deafness or partial hearing loss, OR 8.5 (95% CI 7.9 to 9.2) for blindness or partial sight loss, OR 94.6 (95% CI 89.4 to 100.0) for intellectual disabilities, OR 8.6 (95% CI 8.2 to 9.0) for mental health conditions, OR 6.2 (95% CI 5.8 to 6.6) for physical disability and OR 2.6 (95% CI 2.5 to 2.8) for other condition. Contrary to findings within the general population, female gender predicted all conditions within the population with reported autism, including intellectual disabilities (OR=1.4).Clinicians need heightened awareness of comorbidities in adults with autism to improve detection and suitable care, especially given the added complexity of assessment in this population and the fact that hearing and visual impairments may cause additional difficulties with reciprocal communication which are also a feature of autism; hence posing further challenges in assessment.
Project description:BACKGROUND:Mental distress is a major public health problem which includes anxiety, depression and somatic symptoms such as sleeping problems, fatigue and headache. University students are consistently reported to have higher levels of mental distress compared to the general population. Although university students with mental distress have significantly impaired cognitive functioning, learning disabilities and poor academic performance, the burden of this problem in Tanzania is unknown. This study aimed to determine prevalence and factors associated with mental distress among undergraduate students in northern Tanzania. METHODS:A cross-sectional study was conducted among undergraduate students at Kilimanjaro Christian Medical University College from April-July 2018. Simple random sampling technique using probability proportional to size was used to sample students from their respective classes. Mental distress was screened using the self-reporting questionnaire (SRQ-20). Data was analyzed using Stata version 15.1. Frequencies and percentages were used to summarize categorical variables while mean and standard deviation for numeric variables. Multivariable logistic regression was used to determine factors associated with mental distress adjusted for potential confounders. RESULTS:A total of 402 undergraduate students participated in this study, 14% screened positive for mental distress. Residing off-campus (OR?=?0.44, 95%CI 0.20-0.96) and perceived availability of social support (OR?=?0.22, 95%CI 0.11-0.45) reduced the odds of mental distress while students with family history of mental distress (OR?=?2.60, 95%CI 1.04-6.57) and those with decreased grades than anticipated (OR?=?3.61, 95%CI 1.91-6.83) had higher likelihood of mental distress. CONCLUSION:One in every ten students screened was positive for mental distress. Those who reported a family history of mental illness and lower grades than anticipated had higher response of mental distress. To relieve students from stress and frustrations related to studies and their lives in general, this study recommends awareness creation, counselling to help those with mental health issues, establishment of student drop-in centers for such services and promotion of social and recreational activities at the college.
Project description:BACKGROUND:Disabilities affect more than 1 in 5 US adults, and those with disabilities face multiple barriers in accessing health care. A digital gap, defined as the disparity caused by differences in the ability to use advanced technologies, is assumed to be prevalent among individuals with disabilities. OBJECTIVE:This study examined the associations between disability and use of information technology (IT) in obtaining health information and between trust factors and IT use. We hypothesized that compared to US adults without disabilities, those with disabilities are less likely to refer to the internet for health information, more likely to refer to a health care provider to obtain health information, and less likely to use IT to exchange medical information with a provider. Additionally, we hypothesized that trust factors, such as trust toward health information source and willingness to exchange health information, are associated with IT use. METHODS:The primary database was the 2013 Health Information National Trends Survey 4 Cycle 3 (N=3185). Disability status, the primary study covariate, was based on 6 questions that encompassed a wide spectrum of conditions, including impairments in mobility, cognition, independent living, vision, hearing, and self-care. Study covariates included sociodemographic factors, respondents' trust toward the internet and provider as information sources, and willingness to exchange medical information via IT with providers. Study outcomes were the use of the internet as the primary health information source, use of health care providers as the primary health information source, and use of IT to exchange medical information with providers. We conducted multivariate logistic regressions to examine the association between disability and study outcomes controlling for study covariates. Multiple imputations with fully conditional specification were used to impute missing values. RESULTS:We found presence of any disability was associated with decreased odds (adjusted odds ratio [AOR] 0.65, 95% CI 0.43-0.98) of obtaining health information from the internet, in particular for those with vision disability (AOR 0.27, 95% CI 0.11-0.65) and those with mobility disability (AOR 0.51, 95% CI 0.30-0.88). Compared to those without disabilities, those with disabilities were significantly more likely to consult a health care provider for health information in both actual (OR 2.21, 95% CI 1.54-3.18) and hypothetical situations (OR 1.80, 95% CI 1.24-2.60). Trust toward health information from the internet (AOR 3.62, 95% CI 2.07-6.33), and willingness to exchange via IT medical information with a provider (AOR 1.88, 95% CI 1.57-2.24) were significant predictors for seeking and exchanging such information, respectively. CONCLUSIONS:A potential digital gap may exist among US adults with disabilities in terms of their recent use of the internet for health information. Trust toward health information sources and willingness play an important role in people's engagement in use of the internet for health information. Future studies should focus on addressing trust factors associated with IT use and developing tools to improve access to care for those with disabilities.
Project description:Disability among older adults is a public health concern. To date there are no in-depth and comprehensive analyses on older adults' disabilities in Bangladesh. This study investigated gender differences in the prevalence of disability and the socio-demographic factors associated with disability among older adults in Bangladesh.This research used a sample of 4176 elderly males and females aged 60 years and over from a nationally representative data set- Bangladesh's 2010 Household Income and Expenditure Survey. The study used both household level and individual level data and applied a wealth index, which was constructed based on household assets using principal component analysis. The Washington Group's short set of questions on disability were used to measure disability. Chi-square tests and ordinal logistic regression models were fit.Forty-two percent of older had some form of functional disability, including 5% of elderly with severe/extreme functional disability. Seven percent of older adults had a self-care disability, including 3% of elderly with a severe/extreme form of self-care disability. Elderly females suffered from all the studied disabilities, including functional and self-care disabilities in higher percentages, and had higher odds ratios of having both functional disability and self-care disability compared to elderly males. The study also identified some significant factors affecting functional disability and self-care disability, namely age, having a chronic condition, wealth status and place of residence, including divisional differences.Programs aimed at reducing functional disability among seniors, particularly elderly females, should be granted the highest priority in Bangladesh.
Project description:OBJECTIVES:The National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and (2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS. DESIGN:Multisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage. SETTING:Conducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology. PARTICIPANTS:A total of 34 802 adults (>18 years) were interviewed. MAIN OUTCOME MEASURE:Prevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0. RESULTS:The weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40-59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly two-thirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD. CONCLUSION:Around 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes.
Project description:BACKGROUND:We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. METHODS AND FINDINGS:WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n?=?51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD?=?0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2-51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. CONCLUSIONS:More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.