Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001

doi:10.1016/j.amepre.2003.11.002

American Journal of Preventive Medicine

Volume 26, Issue 3, April 2004, Pages 213-216

https://doi.org/10.1016/j.amepre.2003.11.002 Get rights and content

Abstract

Background

Given the increased emphasis on chronic diseases in the United States, physicians and health survey analysts are now gathering information on patients' subjective measures of health, also known as health-related quality-of-life measures. Studies indicate that these measures can be more powerful predictors of chronic disease–related morbidity and mortality than objective measures.

Methods

The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the non-institutionalized U.S. population aged 18 years or older. This study examined frequent mental distress (FMD), defined as self-reported 14 or more mentally unhealthy days in the past 30 days, and its association with adverse health behaviors and lack of healthcare coverage.

Results

In 2001, approximately 10% of adults reported FMD. Persons reporting FMD had a higher prevalence of smoking, drinking heavily, physical inactivity, and obesity than did persons without FMD. They were also more often without healthcare coverage. In addition, persons with FMD were more likely to engage in multiple adverse behaviors than were persons without FMD.

Conclusions

Persons reporting FMD are at higher risk of chronic diseases because they engage in risky health behaviors and lack healthcare coverage. This study provides further support that mental health screening as well as physical health screening is important in clinical practice. Further research is needed to identify therapeutic or mental health–promoting interventions to reduce mental distress and reinforce healthy behaviors.

Introduction

W ith the increase in the prevalence of chronic and degenerative diseases in the United States came the recognition that a patient's subjective perceptions of living with chronic disease (e.g., reported pain, anxiety, depression, low energy levels, and overall physical and mental health) as well as objective medical knowledge are important elements in guiding the course of medical care.1 Therefore, health care is slowly shifting away from relying solely on objective measures of health and moving toward incorporating the patients' subjective views, known as health-related quality of life (HRQOL).1, 2 For this reason, many health surveys include questions to capture this information.3 Although a new and evolving area of research, studies indicate that HRQOL measures can be more powerful predictors of morbidity and mortality than objective measures.4

The current study examined self-perceived mental health, an HRQOL measure in the Behavioral Risk Factor Surveillance System (BRFSS). Mental health has received much attention in recent years. The Global Burden of Disease,5 published in 1996, indicated that health professionals significantly underestimate the effect of mental illness because they traditionally measure the overall health status of populations by mortality rates without regard to disability rates. One of the overarching themes in the Surgeon General's 1999 report on mental health was that the mind and body are inseparable.6 Mental health is a priority area in both the Healthy People 20007 and Healthy People 20108 objectives. Finally, the U.S. Preventive Service Task Force (USPSTF) recently suggested that healthcare professionals screen patients for depression.9, 10 This study examined self-perceived frequent mental distress (FMD) and its association with adverse health behaviors and the lack of healthcare coverage.

Section snippets

Methods

The BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized people, aged 18 years or older, in the United States, Puerto Rico, Virgin Islands, and Guam. The BRFSS monitors the prevalence of key health- and safety-related behaviors and characteristics.11 Trained interviewers administer identical core questionnaires to an independent probability sample of adults aged 18 years and older, and data from all states are pooled to produce national estimates. The

Results

Approximately 10% (95% confidence interval [CI], 9.8−10.2) of adults reported FMD. Adults with FMD were significantly more likely to be younger than 55 years than aged 55 years or older; to be women than men; to have at most a high school diploma than to have more than a high school diploma; to be previously married or not married than married; and to be unemployed or unable to work than employed (Table 1).

People reporting FMD were significantly more likely than people without FMD to report

Discussion

Unlike previous studies that used HRQOL to determine service needs, intervention outcomes, and morbidity and mortality,14 the current study focused on FMD and its association with adverse health risks (e.g., obesity, physical inactivity, smoking, and drinking heavily) and healthcare coverage. It was found that people reporting 14 or more mentally unhealthy days in the past 30 days (i.e., people reporting FMD) had higher prevalence of adverse behavior–related risk factors than people who did not

Acknowledgements

We thank the state Behavioral Risk Factor Surveillance Survey (BRFSS) coordinators for their participation in data collection for this analysis and BRFSS branch staff members for their assistance in developing the database.

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It was measured by asking the single question used on the Behavioral Risk Factor Surveillance System (Centers for Disease Control and Prevention, 2008): “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” We generated a dichotomous variable as with previous studies (Brown et al., 2003; Centers for Disease Control and Prevention, 2004; Jiang et al., 2011; Strine et al., 2004): less than 14 days vs. 14 or more days. First, we calculated the internal consistency (Cronbach's alpha) of the RG-J scale and 4 sub-scales separately by sex.
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Research articleRisk behaviors and healthcare coverage among adults by frequent mental distress status, 2001

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Soc Sci Med

J Clin Epidemiol

Chest

Am J Prev Med

Am J Prev Med

Asking survey respondents about health status: judgment and response issues

Self-rated health and mortalitya review of twenty-seven community studies

J Health Soc Behav

The global burden of disease

Screening for depression in adultsa summary of the evidence for the U.S. Preventive Services Task Force

Ann Intern Med

Design, characteristics, and usefulness of state-based behavioral risk factor surveillance1981–1987

Public Health Rep

Measuring health-related quality of life for public health surveillance

Public Health Rep

Retest reliability of surveillance questions on health related quality of life

J Epidemiol Community Health

Using the U.S. Behavioral Risk Factor Surveillance System's health related quality of life survey tool in a Canadian city

Can J Public Health

Research article
Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001