National Household Probability Sample Research Articles

Use of COVIDTests.gov At-Home Test Kits Among Adults in a National Household Probability Sample — United States, 2022

At-home rapid antigen COVID-19 tests were first authorized by the Food and Drug Administration in late 2020 (1-3). In January 2022, the White House launched COVIDTests.gov, which made all U.S. households eligible to receive free-to-the-user at-home test kits distributed by the U.S. Postal Service (2). By May 2022, more than 70 million test kit packages had been shipped to households across the United States (2); however, how these kits were used, and which groups were using them, has not been reported. Data from a national probability survey of U.S. households (COVIDVu), collected during April-May 2022, were used to evaluate awareness about and use of these test kits (4). Most respondent households (93.8%) were aware of the program, and more than one half (59.9%) had ordered kits. Among persons who received testing for COVID-19 during the preceding 6 months, 38.3% used a COVIDTests.gov kit. Among kit users, 95.5% rated the experience as acceptable, and 23.6% reported being unlikely to have tested without the COVIDTests.gov program. Use of COVIDTests.gov kits was similar among racial and ethnic groups (42.1% non-Hispanic Black or African American [Black]; 41.5% Hispanic or Latino [Hispanic]; 34.8% non-Hispanic White [White]; and 53.7% non-Hispanic other races [other races]). Use of other home COVID-19 tests differed by race and ethnicity (11.8% Black, 44.4% Hispanic, 45.8% White, 43.8% other races). Compared with White persons, Black persons were 72% less likely to use other home test kits (adjusted relative risk [aRR]=0.28; 95% CI=0.16-0.50). Provision of tests through this well-publicized program likely improved use of COVID-19 home testing and health equity in the United States, particularly among Black persons. National programs to address availability and accessibility of critical health services in a pandemic response have substantial health value.

U.S. Citizen Children De Facto Deported to Mexico

AbstractBetween 2000 and 2015, the U.S. deported unprecedented numbers of Mexican immigrants. During the same period, the population of U.S.‐born children living in Mexico doubled in size. This study estimates the number of U.S.‐born children who emigrated to Mexico from the United States in order to accompany a deported parent: de facto deported children. The data come from the Mexican National Survey of Demographic Dynamics (ENADID), a national probability sample of households in Mexico collected in 2014 and 2018. About one in six U.S.‐born children living in Mexico in 2014/2018, amounting to an estimated 80,000–100,000 U.S.‐born children, were there because the U.S. government deported one or both of their parents. De facto deported U.S.‐born children are socioeconomically disadvantaged in Mexico compared to U.S.‐born children whose parents migrate to Mexico for other reasons. Women are overrepresented among deported people who bring their U.S.‐born children to Mexico, and when deported mothers bring their children, they are far less likely to do so with a partner than are deported fathers. U.S. policy should consider the interests of U.S. citizen children forced to live abroad when redesigning immigration and child welfare policies.

Prescription Drug Misuse among African Americans and Afro Caribbeans: Results from the National Survey of American Life

Background The misuse of prescription medications is an understudied topic among the non-Hispanic Black population in the U.S. Even less is known about the prevalence and correlates of misuse among African Americans and Afro-Caribbeans, despite documented differences in their substance use behaviors. Objectives We aimed to examine the prevalence and correlates of lifetime prescription drug misuse among African Americans and Afro Caribbeans using data from the National Survey of American Life. Methods A national household probability sample of non-institutionalized African Americans and Afro Caribbeans from the Collaborative Psychiatric Epidemiology Surveys was used. Pooled and ethnicity-stratified logistic regressions were estimated. Results Findings showed no significant differences between African Americans (6.36%) and Afro-Caribbeans (5.71%) in lifetime prescription drug misuse. Several correlates were found to be associated with misuse among only African American or Afro-Caribbean respondents. Conclusions While research has shown prescription drug misuse is an issue among Blacks overall, our results show that the role of ethnicity must not be overlooked, especially when tailoring prevention and intervention programs. Limitations of this study are discussed.

Ethnic Variations in Psychosocial and Health Correlates of Eating Disorders.

The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major depressive disorder (MDD) with eating disorders (EDs) across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES), a national household probability sample collected in 2001–2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income), BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs.

Intimate Partner Violence and HIV Status among Ever-Married and Cohabiting Zimbabwean Women: An Examination of Partners' Traits.

This study examines the connection between intimate partner violence (IPV) and Human Immunodeficiency Virus status among married and cohabitating women in Zimbabwe using an African feminist framework. Stata 13.0 was used to analyze data from the 2010-2011 Zimbabwe Demographic and Health Survey, which used a national probability sample of households in the country of Zimbabwe. This study used logistic regression to analyze the 2,830 ever-married or cohabitating women who also answered the violence and spousal traits questionnaire as well as provided blood samples. The logistic regression revealed that women who had experienced any type of intimate partner violence (odds ratio=1.29, CI [1.00, 1.67]) or broken bones (odds ratio=2.39, CI [1.19, 4.77]) were more likely to be HIV positive; relative to those with bruises bruises (odds ratio=- .64 CI [.41, .99]) were less likely. Women with partners who are trackers (odds ratio=1.28, CI [1.04, 1.59]) were more likely to be HIV positive. Patriarchal, hypermasculist culture, shown through violence against women, contributes to the likelihood of HIV in wives and partners. A cultural shift at the highest levels may help to prevent IPV and reduce the spread of HIV.

Ethnic Groups Differ in How Poor Self-Rated Mental Health Reflects Psychiatric Disorders.

This study aimed to explore cross-ethnic variation in the pattern of the associations between psychiatric disorders and self-rated mental health (SRMH) in the USA. This cross-sectional study used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003, a national household probability sample. The study enrolled 18,237 individuals who were either Non-Hispanic White (n=7587), African American (n=4746), Mexican (n=1442), Cuban (n=577), Puerto Rican (n=495), Other Hispanic (n=1106), Vietnamese (n=520), Filipino (n=508), Chinese (n=600) or Other Asian (n=656). SRMH was the outcome. Independent variables were psychiatric disorders including major depressive disorder [MDD], general anxiety disorder [GAD], social phobia, alcohol abuse, binge eating disorders, panic disorder, and post-traumatic stress disorder [PTSD], measured by the Composite International Diagnostic Interview (CIDI). Demographic (age and gender) and socioeconomic (education and income) factors were covariates. The only psychiatric disorder which was universally associated with SRMH across all ethnic groups was MDD. More psychiatric disorders were associated with poor SRMH in Non-Hispanic Whites than any other ethnic groups. Among African Americans, demographic and socioeconomic factors could fully explain the associations between psychiatric disorders and SRMH. Among Mexican and Other Hispanics, demographic and socioeconomic factors could only explain the association between some but not all psychiatric disorders and SRMH. In all other ethnic groups, demographic and socioeconomic factors did not explain the link between psychiatric disorders and SRMH. Although SRMH is a useful tool for estimation of mental health needs of populations, poor SRMH may not have universal meanings across ethnically diverse populations. Ethnic groups differ in how their poor SRMH reflects psychiatric conditions and the role of demographic and socioeconomic factors in explaining such links. These ethnic differences may be a source of measurement bias in cross-ethnic health comparisons.

Romantic Relationship Characteristics and Adolescent Relationship Abuse in a Probability-Based Sample of Youth.

This study examines the longitudinal association between baseline adolescent romantic relationship characteristics and later adolescent relationship abuse (ARA). Data are from the first two waves of the National Survey on Teen Relationships and Intimate Violence (STRiV). Girls and boys ages 10 to 18 were recruited randomly from the children of adults participating in a larger national household probability sample panel. About three quarters of the sample identified as White, non-Hispanic. Controlling behavior by a romantic partner consistently predicted later ARA. Higher levels of controlling behavior in the relationship was associated with higher rates of sexual and/or physical ARA victimization and higher rates for similar acts of perpetration. More controlling behavior by the partner was also associated with higher rates of psychological ARA victimization (and higher rates for psychological ARA perpetration). Our results suggest that ARA prevention programs should have explicit discussions of the deleterious effects of controlling behavior with adolescents. Respondents reporting higher feelings of passionate love were also at higher risk of experiencing sexual and/or physical ARA victimization. This finding will need to be considered by clinicians and prevention specialist in their work with youth as a potential risk marker for ARA. Baseline reports of at least one form of ARA were predictive of 1-year follow-up rates of ARA in all of our models, underscoring a long line of research that past aggressive or violent behavior is one of the strongest predictors of current aggressive or violent behavior. We also observed that female respondents were twice as likely to be perpetrators of physical and/or sexual ARA as male respondents. Prevention messaging often is focused on girls as ARA victims and our results imply that messaging should also be directed toward girls as perpetrators.

Demographic and Socioeconomic Determinants of Physical and Mental Self-rated Health Across 10 Ethnic Groups in the United States.

The aim of this study was to explore ethnic differences in demographic and socioeconomic determinants of poor physical and mental self-rated health (SRH) in the United States. We used data from the Collaborative Psychiatric Epidemiology Surveys (CPES) 2001-2003, which included a national household probability sample of 18237 individuals including 520 Vietnamese, 508 Filipino, 600 Chinese, 656 other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 other Hispanic, 4746 African American, and 7587 non-Latino Whites. Demographic factors (age and gender), socioeconomic factors (education and income), body mass index (BMI), and physical and mental SRH were measured. Pearson correlation was used to explore correlates of physical and mental SRH across ethnic groups. While age was positively associated with poor physical SRH, ethnic groups differed in the effect of age on mental SRH. Age was positively associated with mental SRH among Vietnamese, Filipino, Chinese, Cuban, Puerto Rican, and African American individuals, but this was not so for other Asians, Mexicans, other Hispanics, and non-Hispanic Whites. Chinese and Cubans were the only groups where female gender was associated with poor physical and mental SRH. With other Asians being an exception, education and income were protective against poor physical and mental SRH in all ethnic groups. Ethnic groups also differed in how their mental and physical SRH reflect BMI. Demographic and socioeconomic determinants of physical and mental SRH vary across ethnic groups. Poor physical and mental SRH are differently shaped by social determinants across ethnic groups. These ethnic differences may cause bias in health measurement in ethnically diverse populations.

Ethnic Differences in Separate and Additive Effects of Anxiety and Depression on Self-rated Mental Health Among Blacks.

The aim of this study was to explore ethnic differences in the separate and additive effects of anxiety and depression on self-rated mental health (SRMH) of Blacks in the USA. With a cross-sectional design, we used data from a national household probability sample of African Americans (n = 3570) and Caribbean Blacks (n = 1621) who participated in the National Survey of American Life, 2001-2003. Demographic factors, socio-economic factors, 12-month general anxiety disorder (GAD) and major depressive disorder (MDD), and current SRMH were measured. In each ethnic group, three logistic regressions were used to assess the effects of GAD, MDD, and their combinations on SRMH. Among African Americans, GAD and MDD had separate effects on SRMH. Among Caribbean Blacks, only MDD but not GAD had separate effect on SRMH. Among African Americans, when the combined effects of GAD and MDD were tested, GAD but not MDD was associated with SRMH. The separate and additive effects of GAD and MDD on SRMH among Blacks depend on ethnicity. Although single-item SRMH measures are easy methods for the screening of mental health need, community-based programs that aim to meet the need for mental health services among Blacks in the USA should consider within-race ethnic differences in the applicability of such instruments.

Adolescent exposure to violence and adult illicit drug use

Informed by a strain theory perspective, this study utilizes data on adolescent exposure to violence (AEV) from a prospective, longitudinal, national household probability sample that originally consisted of 1,725 respondents, first interviewed as adolescents in 1977 and last interviewed in middle adulthood in 2003. Findings from bivariate correlations and logistic regression models indicate that AEV is associated with both adolescent and adult illicit drug use, but some of the association between AEV and adult illicit drug use becomes nonsignificant when controlling for adolescent illicit drug use. Specific types of AEV associated with adult illicit drug use differ by gender. Implications, limitations, and future research directions are discussed.

Does Encouragement by Others Increase Rape Reporting? Findings from a National Sample of Women.

Our study explores the role of victims' consultation with others about whether or not to report their rape to police. Three groups were observed within this sample of 435 rape victims from a national telephone household probability sample of women: those who did not consult with anyone about reporting (n = 364), those who consulted with someone and were encouraged to report to police (n = 40), and those who consulted with someone and were not encouraged to report (n = 31). Descriptive analyses indicated that the encouraged group was more likely to report to police than either of the other two groups (which did not differ from each other). Because there were no differences between the two consulting groups on demographic or rape-related variables, they were combined in subsequent analyses. Consulting with others about whether to report, peri-traumatic fear of injury or death, assault perpetration by a stranger, and concerns about contracting a sexually transmitted disease were significant predictors of reporting to police after controlling for other significant predictors in a multivariate regression analysis. Implications of these findings are discussed, including the benefits and consequences of formal rape reporting for victims, and the role that disclosure recipients may have in assisting victims post-rape (e.g., encouragement of reporting, emotional support).

Panel Conditioning and Subjective Well-being

The importance of panel, or longitudinal, survey data for analyzing subjective wellbeing, and especially its dynamics, is increasingly recognized. Analyses of such data, however, have to deal with two potential problems: (1) non-random attrition; and (2) panel conditioning. The former is a much researched topic. In contrast, panel conditioning has received much less attention from the research community. In this analysis, longitudinal survey data collected from members of a large national probability sample of households are used to examine whether self-reported measures of psychological well-being exhibit any tendency to change over time in a way that might reflect panel conditioning. Regression models are estimated that control for all time invariant influences as well as a set of time-varying influences. We find very little evidence that mean life satisfaction scores vary with length of time in the panel, especially once non-random attrition is controlled for. In contrast, scores on a measure of mental health do vary with time, and surprisingly men and women exhibit opposing patterns. For men, scores decline over time (though the estimates are not statistically robust), whereas for women the effects are both large and rise with time. Further, for both outcome measures there is a clear narrowing in the dispersion of reported scores over the first few waves of participation. The findings have implications for empirical research employing longitudinal data.

MAJOR DEPRESSIVE DISORDER AMONG OLDER AFRICAN AMERICANS, CARIBBEAN BLACKS, AND NON-HISPANIC WHITES: SECONDARY ANALYSIS OF THE NATIONAL SURVEY OF AMERICAN LIFE

Previous epidemiological and clinical research on mental disorders has treated Blacks as a homogenous group and yet Blacks of Caribbean descent and African Americans differ with respect to ethnicity, national heritage, living circumstances, and immigration status. The purpose of this article is to examine the prevalence of major depressive disorder (MDD) among African Americans, Caribbean Blacks, and non-Hispanic whites aged 50 and older with data on psychiatric and physical comorbidity, mental illness severity, and service use. Secondary analysis of data from the National Survey of American Life, a national household probability sample of African Americans, Caribbean Blacks, and non-Hispanic Whites in the United States, were used (n = 1,950). The response rate was 72.3%. Controlling for age, the lifetime prevalence rate of MDD was 12.1% and the 12-month rate was 5.2%. Older Whites and Caribbean Blacks had significantly higher lifetime prevalence than African Americans but 12-month rates were similar across the three groups. Rates of co-occurring psychiatric disorders and physical conditions were high and were similar for African Americans, Caribbean Blacks, and Whites. Most older adults had either moderate or severe 12-month MDD and most talked to at least one professional, most frequently a family doctor, psychiatrist, or other mental health professional. MDD among older adults is highly prevalent, often associated with other psychiatric disorders or chronic physical conditions, and is associated with high overall mental illness severity. Differences among older Blacks highlight the need for further research on this population to ensure appropriate treatment is being provided to these groups.

Substance use among women receiving post-rape medical care, associated post-assault concerns and current substance abuse: Results from a national telephone household probability sample

ObjectiveTo examine post-rape substance use, associated post rape medical and social concern variables, and past year substance abuse among women reporting having received medical care following a most recent or only lifetime incident of rape. MethodUsing a subsample of women who received post-rape medical care following a most recent or only rape incident (n=104) drawn from a national household probability sample of U.S. women, the current study described the extent of peritraumatic substance use, past year substance misuse behaviors, post-rape HIV and pregnancy concerns, and lifetime mental health service utilization as a function of substance use at time of incident. ResultsOne-third (33%) of women seeking post-rape medical attention reported consuming alcohol or drugs at the time of their rape incident. Nearly one in four (24.7%) and one in seven (15%) women seeking medical attention following their most recent rape incident endorsed drug (marijuana, illicit, non-medical use of prescription drugs, or club drug) use or met substance abuse criteria, respectively, in the past year. One in twelve (8.4%) women reported at least monthly binge drinking in the past year. Approximately two-thirds of women reported seeking services for mental health needs in their lifetime. Post-rape concerns among women reporting peritraumatic substance use were not significantly different from those of women not reporting such use. ConclusionsSubstance use was reported by approximately one-third of women and past year substance abuse was common among those seeking post-rape medical care. Implications for service delivery, intervention implementation, and future research are discussed.

Correlates of Reasons for Not Reporting Rape to Police

Rape tactics, rape incident characteristics, and mental health problems (lifetime depression, PTSD, and substance abuse) were investigated as correlates of eight different reasons for not reporting a rape to police among women who had experienced but did not report a rape to police (n = 441) within a national telephone household probability sample. Rape tactics (nonmutually exclusive) included drug or alcohol-facilitated or incapacitated rape (DAFR/IR; n = 119) and forcible rape (FR; n = 376). Principal Components Analysis (PCA) was conducted to extract a dominant set of patterns among the eight reasons for not reporting, and to reduce the set of dependent variables. PCA results indicated three unique factors: Not Wanting Others to Know, Nonacknowledgment of Rape, and Criminal Justice Concerns. Hierarchical regression analyses showed DAFR/IR and FR were both positively and significantly associated with Criminal Justice Concerns, whereas DAFR/IR, but not FR, was associated with Nonacknowledgment as a reason for not reporting to police. Neither DAFR/IR nor FR emerged as significant predictors of Others Knowing after controlling for fear of death or injury at the time of the incident. Correlations among variables showed that the Criminal Justice Concerns factor was positively related to lifetime depression and PTSD and the Nonacknowledgement factor was negatively related to lifetime PTSD. Findings suggest prevention programs should educate women about the definition of rape, which may include incapacitation due to alcohol or drugs, to increase acknowledgement and decrease barriers to police reporting.

Value Added

We welcome Sorlie's1 appraisal of the Add Health-NHANES discordance. His tenure within the NHLBI,2 its longstanding sponsorship of NHANES, and his intimate knowledge of blood pressure methodology within NHANES indicate his command of NHANES' strengths. The combination of a national probability sampling strategy, high response rate, large sample, clinical equipment, physician staff, and standardized data collection protocol is unusual in epidemiologic studies of cardiovascular disease. However, such combinations are not limited to NHANES and do not conclusively indicate methodological superiority. As described in our original paper,3 Add Health is characterized by some distinctly advantageous variations on these design features. The advantages of Add Health's national probability sampling of adolescents from school rosters (vs. residents from households within population sampling units) may be debatable, but school roster-based sampling is an unlikely contributor to potential overestimation of blood pressure and hypertension. Indeed, the school-roster sampling frame may have led to the selection of slightly better educated, socioeconomically advantaged, and healthier Add Health participants (presumably, with lower blood pressures), compared with the small number of adolescents who never attended school. Add Health's sample size and oversampling of typically underrepresented groups also allow for study of potentially important disparities in blood pressure and hypertension among its representative population of young adults (20 times larger than in NHANES). In contrast, NHANES' national household probability sample lacks sufficient data for estimating mean blood pressure or hypertension prevalence in young adult Asian/Pacific Islanders or Hispanics other than Mexican Americans. Moreover, in a convenience sample of 22 adults aged 24–32 years (55% female; 27% black, 27% white, 23% Hispanic, 23% other race/ethnicity), Add Health's oscillometric method of in-home systolic/diastolic blood pressure (SBP/DBP) measurement produced values strongly correlated with and similar to those estimated by a physician using a mercury sphygmomanometer,4 stethoscope, and manual auscultation; Pearson rSBP = 0.80, rDBP = 0.89, and mean (standard deviation) NHANES-Add Health difference in SBP/DBP = −3 (7)/4 (4) mm Hg.5 These findings are consistent with 2008 guidelines—affirming that in-home, oscillometric measures are accurate, reliable, and easy to collect; often lower than in-office, sphygmomanometric measures (like those in NHANES); closer to 24-hour ambulatory measures (that best predict cardiovascular disease); and useful in detecting masked hypertension.6 With these characteristics of blood pressure measurement in mind, we highlight the 2:1 ratio of measured to self-reported hypertension that we3 found in Add Health, because it is in line with expectations that measurement will capture subclinical hypertension unknown to otherwise healthy young adults. Surprisingly, this pattern is reversed in NHANES, where prevalence of measured versus self-reported hypertension is 4% versus 9%.3 We therefore disagree with Sorlie's1 rationale for “stick[ing] with NHANES as the best” alternative for estimating the true mean blood pressure and prevalence of hypertension in US adults aged 24–32 years. Investigators can overcome sparse-to-no information within this NHANES age group by using the quality-controlled blood pressure, medical history, and prescription medication data collected at Add Health Wave IV.7 Within-study analyses of these publicly available data are already yielding important insights into evolution of health disparities among young adults that NHANES is unable to provide. ACKNOWLEDGMENTS This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth).

Saving the National Children's Study From Its Saviors

Saving the National Children's Study From Its Saviors

Race and Ethnic Self-Identification Influences on Physical and Mental Health Statuses Among Blacks

We examine if commonly used distress measures, rates of psychiatric disorders, and chronic health conditions are affected by alternate measures of race-ethnicity for African Americans and Caribbean blacks. We examined two alternative self-identification measures to investigate if their influence might differ. A study on national household probability sample of non-institutionalized African Americans (n = 3,570) and blacks from Caribbean countries, who now live in the United States (n = 1,621), was conducted between February 2001 and June 2003, using a slightly modified version of the Composite International Diagnostic Interview. The method used to measure black race and ethnicity has influence on physical and mental health outcomes. The distributions of depressive symptoms are not affected, while the distributions of DSM IV disorders and chronic health conditions vary by race and ethnic self-identifications among the African American and Caribbean black populations. There are serious implications of using alternate measures of race-ethnicity on the distribution of physical and mental health morbidity among African Americans and Caribbean blacks. The conceptualization and assessment of race-ethnicity should be carefully considered when studying mental and physical health statuses and service needs in the American black population.

Statistical and practical issues in the design of a national probability sample of births for the Vanguard Study of the National Children's Study

The National Children's Study is a national household probability sample designed to identify 100,000 children at birth and follow the sampled children for 21 years. Data from the study will support examining numerous hypotheses concerning genetic and environmental effects on the health and development of children. The goals of the study present substantial challenges. For example, the need for preconception, prenatal, and postnatal data requires identifying women in the early stages of pregnancy, the collection of many types of data, and the retention of the children over time. In this paper, we give an overview of the sample design used in a pilot study called the Vanguard Study, and highlight the approaches used to address these challenges. We will also describe the rationale for the sampling choices made at each stage, the unique organizational structure of the NCS and issues we expect to face during implementation.

PTSD, depression, and their comorbidity in relation to suicidality: cross-sectional and prospective analyses of a national probability sample of women

A growing body of literature implicates major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) as risk factors for suicidal ideation (SI) and suicide attempts (SA), though research has not adequately examined their differential contributions to increasing suicide risk prospectively or cross-sectionally. The contribution of these disorders and their comorbidity to SI and SA was examined using a national household probability sample of women (N=3,085) and covarying for trauma history, substance abuse, and demographic variables. Cross-sectional analyses indicated that lifetime comorbidity of MDD and PTSD were associated with much higher prevalence of SI than either diagnosis alone; prevalence of SI was elevated and comparable for PTSD and MDD only. Comorbid diagnosis and PTSD only groups displayed greater prevalence of SA than those with MDD only. Lastly, a 2-year prospective analysis indicated that PTSD only at baseline was predictive of greater subsequent SI risk than MDD only, though comorbid diagnosis did not differ from either PTSD only or MDD only. PTSD appears to be a particularly strong predictor of SI and SA. Overall, only 16% of women with lifetime SA did not have a history of MDD or PTSD, highlighting the importance of assessing these variables when assessing suicide risk.