Mental Health and Alcohol Use

Transcription

1 Mental Health and Alcohol Use Mental Health Mental health has been defined as a state of successful performance of mental function resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. 1 In 24, the World Health Organization published its first report on mental health promotion, conceptualizing mental health as not merely the absence of mental illness but the presence of 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. 2 Mental illness has been defined as a separate concept. Mental disorders are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. 2 Mental disorders are common in the United States. An estimated 26.2 percent of Americans 18 years or older about one in four adults suffer from a diagnosable mental disorder in a given year. 3,4 Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion about six percent, or one in 17 who suffer from a serious mental illness. 4 In addition, mental disorders are the leading cause of disability in the United States. 5 Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for two or more disorders, with severity strongly related to comorbidity In the United States, mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). 6 The prevalence of mental illness differs between Whites and other racial/ethnic populations. The prevalence of any psychiatric disorder in the past 12 months is 15% for African Americans, 9% for Asian Americans, 16% for Latinos, and 21% for Whites. 7 Although African Americans and Latinos have a lower risk of lifetime prevalence of mental disorders than do Whites 8, they tend to have a longer course of illness and disability from mental illness. 9 Additionally, racial/ethnic minority populations are disproportionately represented in vulnerable populations, such as the homeless and incarcerated 1 and are underserved in the mental health care system. Furthermore, racial/ethnic minorities may be disproportionately affected by barriers such as limited English proficiency, remote geographic settings, stigma, fragmented services, cost, co-morbidity of mental illness and chronic diseases, cultural understanding of health care services, and incarceration. 11 Mental health and mental illnesses can be influenced by positive or negative social determinants of health, which include income, housing, stress, early childhood experiences, social exclusion, occupation, education level, sanitation, social support, discrimination (for example, racism), and lack of access to resources. Negative determinants are often Page 137

2 disproportionately distributed among people of color, placing them at greater risk for the development of mental illness. 12,13 In the last decade there have been major advancements in ongoing mental health surveillance as a domain of public health surveillance. 14 Recent studies suggest that primary care settings provide a unique opportunity for early detection and treatment of common mental disorders by identifying early warning signs and mitigating risk factors. 15 Mental Health and Receipt of Mental Health Services In 27, 8.9% of Alameda County adults experienced psychological distress in the past year. Women were much more likely to report psychological distress than men (11.% versus 6.7%). Adults below 4 years were over twice as likely to experience psychological distress than older adults (13.7% and 5.5% respectively). Table 7.1: Psychological Distress in the Past Year, Adults 18 Years and Older % LCL UCL Alameda County California Gender Female Male Age Group In Alameda County, nearly one in five (19.4%) adults reported that they needed professional help for emotional health or alcohol use in 27. A higher percentage of women perceived the need to see a professional for mental health issues than men (22.7% versus 15.8%). The percentage of adults who felt the need to see a mental health professional varied by age group as well nearly one in four (24.5%) adults years needed help, compared to 17.5% of older non-elderly adults, and only 9.6% of those 65 years or older. There were also racial/ethnic differences in mental health African Americans were about three times as likely to report the need to see a professional for their mental health as Asian/Pacific Islanders (33.1% versus 1.7%). Over one in five Whites (21.8%) and 15.6% of Latinos reported the need to see a professional for their mental health. Table 7.2: Adults Who Needed Professional Help for Mental Health Issues in the Past Year % LCL UCL Alameda County California Gender Female Male Age Group Race/Ethnicity AfrAmer API Latino White Page 138

3 Among adults who reported needing professional help for mental or alcohol use issues, 39.2% did not receive help. Women were more likely to not receive needed mental health services than men (4.8% versus 36.8% respectively). Adults 18-4 years and those 65 years or older (43.3% and 4.% respectively) were more likely to not receive needed mental health services compared to adults 4-64 years (33.9%). Among adolescents years, 14.1% had received psychological counseling in 27. Table 7.3: Adults Who Needed but Did Not Receive Mental Health Services % LCL UCL Alameda County California Gender Female Male Age Group Table 7.4: Adolescents Who Received Psychological Counseling in the Past Year % LCL UCL Alameda County California Emergency Department Visits for Mental Disorders Emergency department (ED) visits for mental disorders were most common between the Figure 7.1: Emergency Department Visits for Mental Disorders by Age Group and Gender ages of 15 and 64 years. Rates were highest among males years and females years. The most common primary diagnoses among both age groups were drug abuse, neurotic disorders, non-organic psychoses, and alcohol dependence. Alcohol dependence is less common among the younger age groups. Rate per 1, 1,6 1,4 1,2 1, Female Male < Source: OSPHD Emergency Department Files, From 26 to 28 there were 43,264 ED visits for mental disorders among Alameda County residents. The age-adjusted rate was per 1, population. It was highest among African Americans, followed by Whites and Latinos. Asians and Pacific Islanders had the lowest rates. Rate per 1, 1,8 1,6 1,4 1,2 1, Figure 7.2: Emergency Department Visits for Mental Disorders by Race/Ethnicity , ,156.1 All AfrAmer AmerInd Asian Latino PacIsl White Source: OSPHD Emergency Department Files, Page 139

4 Hayward had the highest rate of ED visits for mental disorders in Alameda County, followed by Oakland, San Lorenzo, Sunol, Newark, San Leandro, and Berkeley. Dublin, Pleasanton, and Albany had the lowest rates; these were less than half the Hayward rate. Figure 7.3: Emergency Department Visits for Mental Disorders by City Hayward 1,15.6 Oakland 1,87.1 San Lorenzo 1,74.4 Sunol 1,58.1 Newark 1,27.2 San Leandro 1,19.5 Berkeley Castro Valley Alameda County Fremont Union City Alameda 759. Livermore Albany Pleasanton 54.9 Dublin , 1,5 Rate per 1, Source: OSPHD Emergency Department Files, Page 14

5 D a t a T a b l e s Table 7.5: Three-Year Emergency Department Visits for Mental Disorders by City, Region, Gender, and Race/Ethnicity All Female Male # Rate LCL UCL # Rate LCL UCL # Rate LCL UCL Alameda County 43, , , Alameda 1, Albany Berkeley 3, ,16.9 1, ,967 1,75.1 1,26.2 1,124. Castro Valley 1, , , ,87.8 Dublin Fremont 5, , , Hayward 6,196 1,15.6 1, , ,142 1, , , ,54 1, ,87.2 1,167.9 Livermore 1, Newark 1,339 1, , , , , ,84.2 Oakland 14,444 1,87.1 1,69.2 1,14.9 6, ,843 1,29.2 1, ,236.1 Pleasanton 1, San Leandro 3,72 1, ,55.9 1, ,25. 1,569 1,58.7 1,6. 1,111.3 San Lorenzo 863 1,74.4 1,2.3 1, , ,222. 1, ,331.8 Sunol 3 1, , , , ,51.1 Union City 1, North County 3, , ,9 1, ,51.3 Oakland Area 16,214 1,37.4 1,21.3 1,53.5 7, ,683 1,136. 1, ,16. Central County 11,749 1,76.2 1,56.6 1,95.7 5,824 1,58.6 1,31.2 1,86. 5,924 1,91.4 1,63.5 1,119.3 South County 8, , , Tri-Valley 3, , , AfrAmer AmerInd Asian # Rate LCL UCL # Rate LCL UCL # Rate LCL UCL Alameda County 1,672 1, ,54. 1, , Alameda 24 1, ,236. 1,63.7 <5 na na na Albany 4 2,652. 1, ,611.2 na na na Berkeley 1,9 3, ,26.5 3,418.7 <5 na na na Castro Valley 123 1, , , na na na Dublin <5 na na na Fremont 244 1,465. 1, , na na na Hayward 1,47 1,79.9 1,64.5 1, , Livermore 49 1, ,64. <5 na na na Newark 78 1, , ,175.5 <5 na na na Oakland 6,917 1, , , , , Pleasanton 33 1, ,66.4 na na na San Leandro 69 1, , , , , San Lorenzo 62 1, ,56.9 1,767.2 <5 na na na Sunol <5 na na na na na na <5 na na na Union City 133 1, ,417.2 <5 na na na North County 1,13 3,19.9 3,.2 3,381.7 <5 na na na Oakland Area 7,121 1, , , , Central County 1,841 1, , , , South County 456 1,43.1 1,27.6 1, Tri-Valley <5 na na na Latino PacIsl White # Rate LCL UCL # Rate LCL UCL # Rate LCL UCL Alameda County 6, ,365 1, , ,173.1 Alameda , ,24.1 1, Albany <5 na na na Berkeley <5 na na na 1, Castro Valley <5 na na na 1,111 1, ,57.3 1,196.9 Dublin na na na Fremont na na na 3,678 1,83.1 1, ,891.3 Hayward 1, ,462 1, , ,957.1 Livermore na na na 1, Newark na na na 819 1, , ,57.3 Oakland 2, ,32 1, ,56.3 Pleasanton <5 na na na San Leandro na na na 1,315 1, , ,495.7 San Lorenzo ,36.7 <5 na na na 456 1,42.1 1,266. 1,538.2 Sunol <5 na na na na na na ,455.2 Union City , ,52.7 2,325. 2,68.5 North County na na na 1, Oakland Area 2, , ,25.9 Central County 2, ,344 1,51.3 1, ,544.1 South County 1, ,342 1, , ,965.5 Tri-Valley , , Source: OSPHD Emergency Department Files, Page 141

6 Alcohol Use: Binge Drinking Binge drinking is a common pattern of excessive alcohol use in the United States. The National Institute of Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person s blood alcohol concentration (BAC) to.8 grams percent or above. This typically happens when men consume five or more drinks, and when women consume four or more drinks, in about two hours. Most people who binge drink are not alcohol dependent. 1,2 According to national surveys, approximately 92% of U.S. adults who drink excessively report binge drinking in the past 3 days. 3 Although college students commonly binge drink, 7% of binge drinking episodes involve adults 25 years or older. 4 The prevalence of binge drinking among men is two times the prevalence among women. 5 Binge drinkers are 14 times more likely to report alcohol-impaired driving than non-binge drinkers. 4 About 9% of the alcohol consumed by youth under the age of 21 years in the United States is in the form of binge drinks. 6 About 75% of the alcohol consumed by adults in the United States is in the form of binge drinks. 6 The proportion of current drinkers that binge is highest among those 18-2 years (51%). 4 Binge drinking is associated with many health problems, including but not limited to unintentional injuries (for example, car crashes, falls, burns, drowning); intentional injuries (for example, firearm injuries, sexual assault, domestic violence); alcohol poisoning; sexually transmitted diseases; and unintended pregnancy. It is also linked to children born with fetal alcohol spectrum disorders; high blood pressure, stroke, and other cardiovascular diseases; liver disease; neurological damage; sexual dysfunction; and poor control of diabetes. 1 Evidence-based interventions to prevent binge drinking and its adverse consequences include increasing alcoholic beverage costs and excise taxes; limiting the number of retail alcohol outlets that sell alcoholic beverages in a given area; consistent enforcement of laws against underage drinking and alcohol-impaired driving; and screening and counseling for alcohol misuse Table 7.6: Binge Drinking Comparison HP21 12 Alameda County California 13 Binge Drinking Prevalence (Percentage) Men were 1.4 times as likely to binge drink in the past year than women (31.9% and 23.4% respectively). Figure 7.4: Adult Binge Drinking Prevalence by Gender Percentage Female Male Page 142

7 Binge drinking is substantially more common among young adults years than older adults. Over half (51.4%) of adults years reported binge drinking in the past year, a significantly higher percentage than those 4-64 years (21.1%). Among those years, over one-third (35.5%) reported binge drinking. Those 65 years or older were significantly less likely to binge drink than younger adults (11.% and 51.4% respectively). Figure 7.5: Adult Binge Drinking Prevalence by Age Group Percentage In Alameda County, 27.5% of adults reported binge drinking in the past year. The multirace group had a significantly higher rate of binge drinking (57.3%) than all other racial/ethnic groups except Whites, who had the next highest rate (33.6%). Asian/Pacific Islanders had the lowest binge drinking prevalence (17.4%); rates for African Americans and Latinos were 2.9% and 27.6% respectively. Percentage Figure 7.6: Adult Binge Drinking Prevalence by Race/Ethnicity All Races AfrAmer API Latino Multirace White Low- and moderate-income adults were less likely to binge drink (24.9% and 19.2% respectively) than high-income adults (31.1%). Percentage Figure 7.7: Adult Binge Drinking Prevalence by Poverty Level % 1-199% 2-299% 3+% Percentage of Federal Poverty Level Page 143

8 D a t a T a b l e s Table 7.7: Binge Drinking Prevalence, Adults 18 Years and Older % LCL UCL Alameda County California Gender Female Male Age Group Race/Ethnicity AfrAmer API Latino Multirace White Poverty Level -99% % % % Page 144

9 References Mental Health 1. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Services, National Institutes of Health, National Institute of Mental Health. Mental Health: A Report of the Surgeon General Executive Summary. Rockville (MD) World Health Organization. Promoting Mental Health: Concepts, Emerging Evidence, Practice (Summary Report). Geneva National Institutes of Health. The Numbers Count: Mental Disorders in America. Available at: [ nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml] 4. Kessler RC, Chiu WT, Demler O, et al. Prevalence, Severity, and Comorbidity of Twelve-Month DSM-IV Disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry 62(6): June World Health Organization. The Global Burden of Disease: 24 Update, Table A2: Burden of Disease in DALYs by Cause, Sex, and Income Group in WHO regions, Estimates for 24. Geneva. 28. Available at: [ int/healthinfo/global_burden_disease/gbd_report_24update_annexa.pdf] 6. American Psychiatric Association. Diagnostic and Statistical Manual on Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Press Alegria M, Woo M, Takeuchi D, et al. Ethnic Group Differences in Mental Health and Service Use: Findings From the Collaborative Psychiatric Epidemiology Surveys. In: Ruiz P, Primm A, eds., Disparities in Psychiatric Care: Clinical and Crosscultural Perspectives. Bethesda, MD: Wolters Kluwer Lippincott Williams and Wilkins Breslau J, Aguilar-Gaxiola S, Kendler KS, et al. Specifying Race-Ethnic Differences in Risk for Psychiatric Disorder in a USA National Sample. Psychol Med 36(1): U.S. Department of Health and Human Services, New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Final Report. 23. Available at: [ gov/reports/finalreport/toc.html] 1. U.S. Department of Health and Human Services. Mental Health: Culture, Race, and Ethnicity. 21. Available at: [ 11. Primm AB, Vasquez MJT, Mays RA, et al. The Role of Public Health in Addressing Racial and Ethnic Disparities in Mental Health and Mental Illness. Prev Chronic Dis 7(1). 21. Available at: [ jan/9_125.htm] 12. Manderscheid RW, Ryff CD, Freeman EJ, et al. Evolving Definitions of Mental Illness and Wellness. Prev Chronic Dis 7(1). 21. Available at: [ 13. Secretary s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 22. Phase I Report: Recommendations for the Framework and Format of Healthy People 22. Available at: [ www. healthypeople.gov/hp22/advisory/default.asp]. 14. Freeman EJ, Colpe LJ, Strine TW, et al. Public Health Surveillance for Mental Health. Prev Chronic Dis 7(1). 21. Available at: [ 15. Druss BG, Mays RA Jr, Edwards VJ, et al. Primary Care, Public Health, and Mental Health. Prev Chronic Dis 7(1). 21. Available at: [ Alcohol Use: Binge Drinking 1. Center for Disease Control and Prevention. Alcohol and Public Health. Quick Stats. Binge Drinking. Available at: [ Page 145

10 2. National Institute of Alcohol Abuse and Alcoholism. NIAAA Council Approves Definition of Binge Drinking. NIAAA Newsletter 3: Available at: [ 3. Town M, Naimi TS, Mokdad AH, et al. Health Care Access among U.S. Adults Who Drink Alcohol Excessively: Missed Opportunities for Prevention. Prev Chronic Dis 3(2). 26. Available at: [ apr/5_182.htm] 4. Naimi TS, Brewer RD, Mokdad A, et al. Binge Drinking among U.S. Adults. JAMA 289(1): Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Prevalence Data. Atlanta, GA. Available at: [ 6. U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention. Drinking in America: Myths, Realities, and Prevention Policy. Washington, DC. 25. Available at: [ org/documents/drinking_in_america.pdf] 7. Babor TF, Caetano, R., Casswell S, et al. Alcohol and Public Policy: No Ordinary Commodity. New York: Oxford University Press Centers for Disease Control and Prevention. The Community Guide. Alcohol Abuse and Misuse Prevention. Interventions Directed to the General Population. Atlanta, GA. 28. Available at: [ org/alcohol/default.htm] 9. National Research Council and Institute of Medicine. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press U.S. Department of Health and Human Services, Office of the Surgeon General. The Surgeon General s Call to Action to Prevent and Reduce Underage Drinking. 27. Available at: [ 11. U.S. Preventive Services Task Force. Screening and Behavioral Counseling Interventions in Primary Care To Reduce Alcohol Misuse: Recommendation Statement. Ann Intern Med 14: National Center for Health Statistics, Office of Disease Prevention, Office of Public Health and Science, Office of the Secretary. Healthy People 21 Midcourse Review. December California Health Interview Survey. CHIS 27 Data from AskCHIS. Available at: [ Page 146