Mental Health and Suicide Epidemiology in Indiana Youth

Marion S. Greene, MPH, PhD(c)Reducing Depression and Suicide

Among Children and Adolescents in IndianaWednesday, January 24, 2018 IUPUI Campus Center Theatre

Indianapolis, Indiana

Mental health from a public health perspective Epidemiology of mental health disorders Consequences / Suicide Policy recommendations Conclusion

Mental Health vs. Mental Illness

Related terms and often explained in reference to each other, but mental health is so much more than merely the absence of mental illness

Mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community“ (WHO)

Mental Health vs. Mental Illness

Mental illness refers collectively to all of the diagnosable mental disorders

• Disorders characterized by abnormalities in cognition, emotion, mood, or behavior

• Signs and symptoms exist on a continuum from mild to severe

• Diagnosed according to specific criteria (e.g., DSM-5)

Mental Health is a Public Health Concern

Mental health disorders among children and adolescents are an important public health issue, because of their • Prevalence Rates are high and increasing

• Early onset some disorders start as early as 6 years

• Impact on the child, family, and society Suffering and economic costs

Mental Health is a Public Health Concern

Age at onset can be as early as age 6, but many do not receive treatment until years later

Not every child gets diagnosed and/or receives adequate mental healthcare

• Lacking access to services, inability to pay, stigma, parents feel overwhelmed

Mental disorders are among the most costly conditions to treat in children

• The burden of disease is an estimated total annual cost of $247 billion for mental disorders among persons under the age of 24 years

Mental Health is a Public Health Concern

Many youth are suffering from mood, anxiety, behavior, and substance use disorders

• Lifetime prevalence is close to 50%; i.e., nearly half of all adolescents experience a mental disorder at some point during their life

• Past-year prevalence is an estimated 13% to 20%; i.e., at least one in eight children experience a mental disorder in a given year

According to national data surveillance systems, prevalence of these conditions are increasing

Healthy People 2020 (https://www.healthypeople.gov/) Provides science-based, 10-year national objectives for

improving the health of all Americans Lead by U.S. Department of Health and Human Services and

involves representatives from numerous federal agencies• Identify nationwide health priorities• Provide measurable goals, objectives, and targets• Encourage interdisciplinary and interagency collaboration to collect

data and develop policies to attain these health goals

Mental Health is a Public Health Concern

Overarching goal focus on health equity and the elimination of disparities by addressing the social determinants of health To improve the health of all groups

Leading health indicators (26), a small set of high-priority health issues that represent significant threats to the public’s health and to the achievement of the overarching goal Adolescents who experience major depressive episodes (MDEs) Suicides (any age)

Mental Health is a Public Health Concern

Epidemiology of Mental Disorders

U.S. Lifetime Prevalence Ages 13-18

Nearly 50% of adolescents had at least 1 mental disorder and 19.3% had comorbidities

Mostly anxiety disorders (31.9%) Followed by behavior disorders

(19.6%) and mood disorders (14.3%) 11.4% suffer from a substance use

disorder (SUD) Differences by gender

• Most disorders more likely to occur in females

• Except behavior disorders (especially ADHD) and SUD

Differences by age • Generally higher rates as kids get

older

Merikangas, K. R., et al., 2010

Mental Health Indicators: Indiana-Level Data

Study by Merikangas et al. (2010) reports national findings Unfortunately no such detailed estimates available for the

state However, we do have data on some mental health indicators

among Indiana adolescents • Having had a major depressive episode in the past year• Having received treatment for depression in the past year• Reported improved functioning after receiving treatment• Initiated substance use in the past year

Behavioral Health Barometer: Indiana (SAMHSA, 2015)

Behavioral Health Barometer: Indiana (SAMHSA, 2015)

Nearly two thirds of Hoosier kids did not receive treatment for their depression!

Behavioral Health Barometer: Indiana (SAMHSA, 2015)

Suicide

“Death caused by self-directed injurious behavior with any intent to die as a result of the behavior”

Complex human behavior linked to psychiatric and psychological factors, biologic factors, a history of trauma, and societal and cultural factors

Suicide

Risk factors for suicidal thoughts and attempts include Mental illness, especially depression Family history of suicide attempts Exposure to violence Trauma / ACE’s Acute loss or rejection Being bullied Feelings of hopelessness or helplessness

Suicide

One of the leading causes of death among adolescents Third leading cause of death in ages 5 to 14

• After accidents (unintentional injury) and cancer Second leading cause of death in ages 15 to 24

• After accidents (unintentional injury)

Centers for Disease Control and Prevention, National Center for Health Statistics (ICD-10: U03,X60-X84,Y87.0)

Indiana Suicide Deaths by DemographicsNumber of Youth Suicide Deaths in Indiana, 2000 – 2016 combined (total 800 deaths; ages 5-19)

* No Indiana estimates for 2013 available due to low response rateCenters for Disease Control and Prevention, Youth Risk Behavior Survey 2003-2015

1 in 10 high school students attempted suicide

Statistically significant differences only by sexual identity

One third of high school students who self-identified as gay, lesbian, or bisexual attempted suicide

Females, minorities, and younger students seem to be more affected not statistically significant, but that may (or may not) be a functionof small survey sample

Attempted Suicide in Indiana High School Students in Past Year

% 95% CIGender Female 10.9% 8.3-14.1

Male 8.7% 6.0-12.5Race / Ethnicity

White 8.7% 6.5-11.5Black 14.5% 8.8-23.1Hispanic 15.5% 8.9-25-8

Grade 9th 12.8% 8.5-18.710th 11.4% 8.6-14.911th 10.0% 6.4-15.212th 5.0% 2.7-9.0

Sexual Identity

Heterosexual 6.8% 5.0-9.2GLB 34.2% 27.5-41.5

Total 9.9% 7.7-12.7Centers for Disease Control and Prevention, Youth Risk Behavior Survey 2015

Policy Recommendations

Assessment: Ongoing surveillance efforts are critical to 1. Document the impact of these issues2. Identify high-risk groups3. Inform policy, prevention, and resource allocation

Prevention: Develop, implement, promote evidence-based prevention programs that target specific high-risk groups

Treatment: Provide access to affordable and culturally sensitive behavioral health resources and services

Awareness: Increase knowledge and awareness in public to reduce stigma

Conclusion

Mental disorders and suicide rates are increasing• Nearly half of all adolescents will experience a mental disorder during their

lifetime, mostly anxiety Suicide is one of the leading causes of death among adolescents

• Deaths most likely to involve whites, non-Hispanics, males Attempted suicides also on the rise

• Mostly prevalent among gay/lesbian/bisexual youth• Seem to be higher among females and minorities

Surveillance efforts (aka systematic data collection) are crucial And yes, mental health is a public health concern

Contact InfoMarion Greene1050 Wishard Blvd.Indianapolis, IN 46202

317-278-3247msgreene@iu.edu

References

American Academy of Child and Adolescent Psychiatry. (2015). Suicide in children and teens. Available at https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teen-Suicide-010.aspx

Centers for Disease Control and Prevention (CDC). 1991-2015 High School Youth Risk Behavior Survey Data. Available at http://nccd.cdc.gov/youthonline/

Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 2000-2016 on CDC WONDER Online Database, released December 2017. Data are from the Compressed Mortality File 2000-2016 Series 20 No. 2V, 2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/cmf-icd10.html

Merikangas, K. R., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry 49(10): 980-989.

Perou, R., et al. (2013). Mental health surveillance among children—United States, 2005–2011. MMWR Surveill Summ 62(Suppl 2): 1-35.Substance Abuse and Mental Health Services Administration. (2015). Behavioral health barometer: Indiana. Volume 4. Available at

https://www.samhsa.gov/data/population-data-nsduh/reports?tab=33U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and

Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

U.S. Department of Health and Human Services. (2016). Health United States 2016. Available at https://www.cdc.gov/nchs/data/hus/hus16.pdf#019

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2018). Healthy People 2020. Available at https://www.healthypeople.gov/