Screening for Serious Mental Illness in the National Survey on Drug Use and Health (NSDUH)

Abstract

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004. Statistically significant difference between Sample A and Sample B estimate (P ! .05). yLow precision; no estimate reported. Public Law (Pub. L.) No. 102-321, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act (1), created the Substance Abuse and Mental Health Services Administration (SAMHSA) and established a block grant program for U.S. states to fund community mental health services for adults with serious mental illness (SMI). The criteria for SMI require adults (18 years and older) to have at least one 12-month DSM disorder, other than a substance use disorder, resulting in functional impairment that substantially interferes with or limits one or more major life activities (2). Since then, national SMI estimates have been generated from mental disorder diagnosis and impairment data yielded from the National Comorbidity Survey (3) and, most recently, the National Comorbidity Survey–Replication (NCS-R) (4). Although the NCS-R is a large, in-depth psychiatric epidemiology study, it is not conducted frequently enough to produce annual or biennial estimates, nor is it designed to generate state level estimates. To address these data needs, SAMHSA’s National Survey on Drug Use and Health (NSDUH) was nominated as the vehicle to collect adult SMI prevalence estimates for the agency. A methodological study to examine the accuracy of a variety of psychiatric symptom and impairment screeners to predict SMI in NSDUH was conducted in 2000 (5). The study obtained clinical assessments on a small sample of NSDUH respondents in the Boston area. All of the scales used in the methodology study were included in a new mental health module added to the 2001 NSDUH (before the results from the methodological study were available) with the expectation that the study would be completed in time to be used to generate SMI estimates based on the 2001 NSDUH data. Ultimately, one scale, the K6 measure of non-specific psychological distress (K6), was determined to be the most