Arizona Behavioral Health Epidemiology Profile July 2012 Prepared by The Arizona Criminal Justice Commission, on behalf of: The Substance Abuse Epidemiology Work Group The Governor s Office for Children, Youth and Families
Table of Contents Executive Summary and Introduction Executive Summary 1 Introduction 2 Methods Data Sources 3 Addressing Data Gaps 5 Data Dissemination 7 Prevalence of Mental Health Diagnoses and Psychological Distress Introduction to Mental Health Diagnoses and Psychological Distress 8 Any Mental Health Issue 10 Inpatient Hospital Discharges for Any Mental Health Issues by Demographics 11 Inpatient Hospital Discharges for Any Mental Health Issues by County 12 Emergency Department Visits for Any Mental Health Issues by Demographics 13 Emergency Department Visits for Any Mental Health Issues by County 14 Psychoses 15 Inpatient Hospital Discharges for Psychoses by Demographics 16 Inpatient Hospital Discharges for Psychoses by County 17 Emergency Department Visits for Psychoses by Demographics 18 i
Emergency Department Visits for Psychoses by County 19 Drug Psychoses 20 Inpatient Hospital Discharges for Drug Psychoses by Demographics 21 Inpatient Hospital Discharges for Drug Psychoses by County 22 Emergency Department Visits for Drug Psychoses by Demographics 23 Emergency Department Visits for Drug Psychoses by County 24 Alcohol Psychoses 25 Inpatient Hospital Discharges for Alcohol Psychoses by Demographics 26 Inpatient Hospital Discharges for Alcohol Psychoses by County 27 Emergency Department Visits for Alcohol Psychoses by Demographics 28 Emergency Department Visits for Alcohol Psychoses by County 29 Schizophrenia Psychoses 30 Inpatient Hospital Discharges for Schizophrenia Psychoses by Demographics 31 Inpatient Hospital Discharges for Schizophrenia Psychoses by County 32 Emergency Department Visits for Schizophrenia Psychoses by Demographics 33 Emergency Department Visits for Schizophrenia Psychoses by County 34 Manic-Depressive Psychoses 35 Inpatient Hospital Discharges for Manic-Depressive Psychoses by Demographics 36 Inpatient Hospital Discharges for Manic-Depressive Psychoses by County 37 Emergency Department Visits for Manic-Depressive Psychoses by Demographics 38 Emergency Department Visits for Manic-Depressive Psychoses by County 39 Neuroses 40 Inpatient Hospital Discharges for Neuroses by Demographics 41 Inpatient Hospital Discharges for Neuroses by County 42 Emergency Department Visits for Neuroses by Demographics 43 Emergency Department Visits for Neuroses by County 44 Anxiety Neuroses 45 Inpatient Hospital Discharges for Anxiety Neuroses by Demographics 46 ii
Inpatient Hospital Discharges for Anxiety Neuroses by County 47 Emergency Department Visits for Anxiety Neuroses by Demographics 48 Emergency Department Visits for Anxiety Neuroses by County 49 Depression Neuroses 50 Inpatient Hospital Discharges for Depression Neuroses by Demographics 51 Inpatient Hospital Discharges for Depression Neuroses by County 52 Emergency Department Visits for Depression Neuroses by Demographics 53 Emergency Department Visits for Depression Neuroses by County 54 Personality Disorders Neuroses 55 Inpatient Hospital Discharges for Personality Disorder Neuroses by Demographics 56 Inpatient Hospital Discharges for Personality Disorder Neuroses by County 57 Emergency Department Visits for Personality Disorder Neuroses by Demographics 58 Emergency Department Visits for Personality Disorder Neuroses by County 59 Drug Dependence Neuroses 60 Inpatient Hospital Discharges for Drug Dependence Neuroses by Demographics 61 Inpatient Hospital Discharges for Drug Dependence Neuroses by County 62 Emergency Department Visits for Drug Dependence Neuroses by Demographics 63 Emergency Department Visits for Drug Dependence Neuroses by County 64 Nondependent Abuse of Drugs Neuroses 65 Inpatient Hospital Discharges for Nondependent Drug Abuse Neuroses by Demographics 66 Inpatient Hospital Discharges for Nondependent Drug Abuse Neuroses by County 67 Emergency Department Visits for Nondependent Drug Abuse Neuroses by Demographics 68 Emergency Department Visits for Nondependent Drug Abuse Neuroses by County 69 Nondependent Alcohol Abuse Neuroses 70 Inpatient Hospital Discharges for Nondependent Alcohol Abuse Neuroses by Demographics 71 Inpatient Hospital Discharges for Nondependent Alcohol Abuse Neuroses by County 72 Emergency Department Visits for Nondependent Alcohol Abuse Neuroses by Demographics 73 Emergency Department Visits for Nondependent Alcohol Abuse Neuroses by County 74 iii
Alcohol Dependence Syndrome Neuroses 75 Inpatient Hospital Discharges for Alcohol Dependence Syndrome by Demographics 76 Inpatient Hospital Discharges for Alcohol Dependence Syndrome by County 77 Emergency Department Visits for Alcohol Dependence Syndrome by Demographics 78 Emergency Department Visits for Alcohol Dependence Syndrome by County 79 Depression Not Otherwise Specified (NOS) 80 Inpatient Hospital Discharges for Depression Not Otherwise Specified (NOS) by Demographics 81 Inpatient Hospital Discharges for Depression Not Otherwise Specified (NOS) by County 82 Emergency Department Visits for Depression Not Otherwise Specified (NOS) by Demographics 83 Emergency Department Visits for Depression Not Otherwise Specified (NOS) by County 84 Mental Retardation 85 Inpatient Hospital Discharges for Mental Retardation by Demographics 86 Inpatient Hospital Discharges for Mental Retardation by County 87 Emergency Department Visits for Mental Retardation by Demographics 88 Emergency Department Visits for Mental Retardation by County 89 Conclusions and Recommendations 90 iv
Table of Figures and Tables Introduction Any Mental Health Issue Table 1.0: Available Emergency Department and Hospital Inpatient Discharge Mental Health Indicators 9 Figure 1.1: State-Level Emergency Department and Hospital Visit Trends in Any Mental Disorder 10 Table 1.1: Number (N) and Rate of Hospital Discharges for Any Mental Disorder per 100,000 Population by Year and Demographic 11 Table 1.2: Number (N) and Rate of Hospital Discharges for Any Mental Disorder per 100,000 Population by Year and County 12 Table 1.3: Number (N) and Rate of Emergency Department Visits for Any Mental Disorder per 100,000 Population by Year and Demographic 13 Table 1.4: Number (N) and Rate of Emergency Department Visits for Any Mental Disorder per 100,000 Population by Year and County 14 Psychoses Figure 2.1: State-Level Emergency Department and Hospital Visit Trends in Any Psychoses 15 Drug Psychoses Table 2.1: Number (N) and Rate of Hospital Discharges for Any Psychoses per 100,000 Population by Year and Demographic 16 Table 2.2: Number (N) and Rate of Hospital Discharges for Any Psychoses per 100,000 Population by Year and County 17 Table 2.3: Number (N) and Rate of Emergency Department Visits for Any Psychoses per 100,000 Population by Year and Demographic 18 Table 2.4: Number (N) and Rate of Emergency Department Visits for Any Psychoses per 100,000 Population by Year and County 19 Figure 3.1: State-Level Emergency Department and Hospital Visit Trends in Any Drug Psychoses 20 Table 3.1: Number (N) and Rate of Hospital Discharges for Drug Psychoses per 100,000 Population by Year and Demographic 21 Table 3.2: Number (N) and Rate of Hospital Discharges for Drug Psychoses per 100,000 Population by Year and County 22 Table 3.3: Number (N) and Rate of Emergency Department Visits for Drug Psychoses per 100,000 Population by Year and Demographic 23 Table 3.4: Number (N) and Rate of Emergency Department Visits for Drug Psychoses per 100,000 Population by Year and County 24 v
Alcohol Psychoses Figure 4.1: State-Level Emergency Department and Hospital Visit Trends in Any Alcohol Psychoses 25 Table 4.1: Number (N) and Rate of Hospital Discharges for Alcohol Psychoses per 100,000 Population by Year and Demographic 26 Table 4.2: Number (N) and Rate of Hospital Discharges for Alcohol Psychoses per 100,000 Population by Year and County 27 Table 4.3: Number (N) and Rate of Emergency Department Visits for Alcohol Psychoses per 100,000 Population by Year and Demographic 28 Table 4.4: Number (N) and Rate of Emergency Department Visits for Alcohol Psychoses per 100,000 Population by Year and County 29 Schizophrenia Figure 5.1: State-Level Emergency Department and Hospital Visit Trends in Any Schizophrenia Psychoses 30 Manic-Depressive Psychoses Table 5.1: Number (N) and Rate of Hospital Discharges for Schizophrenia Psychoses per 100,000 Population by Year Demographic 31 Table 5.2: Number (N) and Rate of Hospital Discharges for Schizophrenia Psychoses per 100,000 Population by Year and County 32 Table 5.3: Number (N) and Rate of Emergency Department Visits for Schizophrenia Psychoses per 100,000 Population by Year and Demographic 33 Table 5.4: Number (N) and Rate of Emergency Department Visits for Schizophrenia Psychoses per 100,000 Population by Year and County 34 Figure 6.1: State-Level Emergency Department and Hospital Visit Trends in Any Manic-Depressive Psychoses 35 Table 6.1: Number (N) and Rate of Hospital Discharges for Manic-Depressive Psychoses per 100,000 Population by Year and Demographic 36 Table 6.2: Number (N) and Rate of Hospital Discharges for Manic-Depressive Psychoses per 100,000 Population by Year and County 37 Table 6.3: Number (N) and Rate of Emergency Department Visits for Manic-Depressive Psychoses per 100,000 Population by Year and Demographic 38 Table 6.4: Number (N) and Rate of Emergency Department Visits for Manic-Depressive Psychoses per 100,000 Population by Year and County 39 Neuroses Figure 7.1: State-Level Emergency Department and Hospital Visit Trends in Any Neuroses 40 Table 7.1: Number (N) and Rate of Hospital Discharges for Any Neuroses per 100,000 Population by Year and Demographic 41 Table 7.2: Number (N) and Rate of Hospital Discharges for Any Neuroses per 100,000 Population by Year and County 42 Table 7.3: Number (N) and Rate of Emergency Department Visits for Any Neuroses per 100,000 Population by Year and Demographic 43 vi
Table 7.4: Number (N) and Rate of Emergency Department Visits for Any Neuroses per 100,000 Population by Year and County 44 Anxiety Figure 8.1: State-Level Emergency Department and Hospital Visit Trends in Any Anxiety Neuroses 45 Table 8.1: Number (N) and Rate of Hospital Discharges for Anxiety Neuroses per 100,000 Population by Year and Demographic 46 Table 8.2: Number (N) and Rate of Hospital Discharges for Anxiety Neuroses per 100,000 Population by Year and County 47 Table 8.3: Number (N) and Rate of Emergency Department Visits for Anxiety Neuroses per 100,000 Population by Year and Demographic 48 Table 8.4: Number (N) and Rate of Emergency Department Visits for Anxiety Neuroses per 100,000 Population by Year and County 49 Depression Figure 9.1: State-Level Emergency Department and Hospital Visit Trends in Any Depression Neuroses 50 Personality Disorders Drug Dependence Table 9.1: Number (N) and Rate of Hospital Discharges for Depression Neuroses per 100,000 Population by Year and Demographic 51 Table 9.2: Number (N) and Rate of Hospital Discharges for Depression Neuroses per 100,000 Population by Year and County 52 Table 9.3: Number (N) and Rate of Emergency Department Visits for Depression Neuroses per 100,000 Population by Year and Demographic 53 Table 9.4: Number (N) and Rate of Emergency Department Visits for Depression Neuroses per 100,000 Population by Year and County 54 Figure 10.1: State-Level Emergency Department and Hospital Discharge Trends in Personality Disorder Neuroses 55 Table 10.1: Number (N) and Rate of Hospital Discharges for Personality Disorder Neuroses per 100,000 Population by Year and Demographic 56 Table 10.2: Number (N) and Rate of Hospital Discharges for Personality Disorder Neuroses per 100,000 Population by Year and County 57 Table 10.3: Number (N) and Rate of Emergency Department Visits for Personality Disorder Neuroses per 100,000 Population by Year and Demographic 58 Table 10.4: Number (N) and Rate of Emergency Department Visits for Personality Disorder Neuroses per 100,000 Population by Year and County 59 Figure 11.1: State Level Emergency Department and Hospital Discharge Trends in Any Drug Dependence Neuroses 60 Table 11.1: Number (N) and Rate of Hospital Discharges for Drug Dependence Neuroses per 100,000 Population by Year and Demographic 61 Table 11.2: Number (N) and Rate of Hospital Discharges for Drug Dependence Neuroses per 100,000 Population by Year and County 62 vii
Table 11.3: Number (N) and Rate of Emergency Department Visits for Drug Dependence Neuroses per 100,000 Population by Year and Demographic 63 Non-Dependent Abuse of Drugs Table 11.4: Number (N) and Rate of Emergency Department Visits for Drug Dependence Neuroses per 100,000 Population by Year and County 64 Figure 12.1: State-Level Emergency Department and Hospital Discharge Trends in Nondependent Drug Abuse Neuroses 65 Table 12.1: Number (N) and Rate of Hospital Discharges for Nondependent Drug Abuse Neuroses per 100,000 Population by Year and Demographic 66 Table 12.2: Number (N) and Rate of Hospital Discharges for Nondependent Drug Abuse Neuroses per 100,000 Population by Year and County 67 Table 12.3: Number (N) and Rate of Emergency Department Visits for Nondependent Drug Abuse Neuroses per 100,000 Population by Year and Demographic 68 Table 12.4: Number (N) and Rate of Emergency Department Visits for Nondependent Drug Abuse Neuroses per 100,000 Population by Year and County 69 Non-Dependent Abuse of Alcohol Figure 13.1: State-Level Emergency Department and Hospital Discharge Trends in Any Nondependent Alcohol Abuse Neuroses 70 Table 13.1: Number (N) and Rate of Hospital Discharges for Nondependent Alcohol Abuse Neuroses per 100,000 Population by Year and Demographic 71 Table 13.2: Number (N) and Rate of Hospital Discharges for Nondependent Alcohol Abuse Neuroses per 100,000 Population by Year and County 72 Table 13.3: Number (N) and Rate of Emergency Department Visits for Nondependent Alcohol Abuse Neuroses per 100,000 Population by Year and Demographic Table 13.4: Number (N) and Rate of Emergency Department Visits for Nondependent Alcohol Abuse Neuroses per 100,000 Population by Year and County Alcohol Dependence Syndrome 73 74 Figure 14.1: State-Level Emergency Department and Hospital Discharge Trends in Any Alcohol Dependence Syndrome Neuroses 75 Table 14.1: Number (N) and Rate of Hospital Discharges for Alcohol Dependence Syndrome Neuroses per 100,000 Population by Year and Demographic 76 Table 14.2: Number (N) and Rate of Hospital Discharges for Alcohol Dependence Syndrome Neuroses per 100,000 Population by Year and County 77 Table 14.3: Number (N) and Rate of Emergency Department Visits for Alcohol Dependence Syndrome Neuroses per 100,000 Population by Year and Demographic 78 Table 14.4: Number (N) and Rate of Emergency Department Visits for Alcohol Dependence Syndrome Neuroses per 100,000 Population by Year and County 79 viii
Depression Not Otherwise Specified (NOS) Mental Retardation Figure 15.1: State-Level Emergency Department and Hospital Discharge Trends in Depression Not Otherwise Specified (NOS) 80 Table 15.1: Number (N) and Rate of Hospital Discharges for Depression NOS per 100,000 Population by Year and Demographic 81 Table 15.2: Number (N) and Rate of Hospital Discharges for Depression NOS per 100,000 Population by Year and County 82 Table 15.3: Number (N) and Rate of Emergency Department Visits for Depression NOS per 100,000 Population by Year and Demographic 83 Table 15.4: Number (N) and Rate of Emergency Department Visits for Depression NOS per 100,000 Population by Year and County 84 Figure 16.1: State-Level Emergency Department and Hospital Discharge Trends in Mental Retardation 85 Table 16.1: Number (N) and Rate of Hospital Discharges for Mental Retardation per 100,000 Population by Year and Demographic 86 Table 16.2: Number (N) and Rate of Hospital Discharges for Mental Retardation per 100,000 Population by Year and County 87 Table 16.3: Number (N) and Rate of Emergency Department Visits for Mental Retardation per 100,000 Population by Year and Demographic 88 Table 16.4: Number (N) and Rate of Emergency Department Visits for Mental Retardation per 100,000 Population by Year and County 89 ix
Executive Summary and Introduction Mental illness is a pressing concern throughout the nation, and Arizona is no exception. This report highlights the prevalence of behavioral health disorders in Arizona, including psychoses and neuroses, to allow for robust data-driven decision-making. In this update to the original Arizona Behavioral Health Epidemiology Profile, the most recent data available from the Arizona Department of Health Services (ADHS) are used herein to provide evidence of the behavioral healthcare needs of individuals residing in Arizona. In the previous version of this profile, data from the Arizona Health Survey administered by Saint Luke s Health Initiatives were included to provide self-reported measures of mental illness among the general adult population in Arizona (i.e., non-institutionalized adults). Since the publication of the first profile, Saint Luke s Health Initiatives has not administered the Arizona Health Survey, and thus, the self-report data collected through the Arizona Health Survey could not be updated in this profile. However, the additional data from the ADHS allow for continued monitoring of trends in emergency department visits and hospital discharges. Some of the findings include: Emergency Department Visits and Hospital Discharges Use of emergency departments for mental illness and substance abuse-related disorders is on the rise with rates of emergency department use catching up with and sometimes surpassing hospital discharges. For example, the rates of emergency department visits for schizophrenia, manic depressive psychoses and anxiety disorders all increased by more than four-fold between 2003 and 2010; the rate for depression-related neuroses also increased by more than four times; and the rate for drug dependence-related neuroses looks poised to surpass hospital discharges in the future. Middle-aged adults were the most likely to visit a hospital and an emergency department in connection with alcohol dependence syndrome (more than twice the rate of any other age group), while those aged 65 and older were discharged from hospitals for drug psychosis-related mental health issues at a rate nearly twice that of middle-aged adults. These findings provide further evidence of the need to screen patients for substance abuse and mental illness to ensure that individuals receive treatment for both health issues. Additionally, providing emergency department personnel with mental health first aid training to address the influx of patients presenting with mental illness and substance use/abuse is necessary, but preventing the utilization of the emergency department for these conditions should be paramount. Finally, the data highlight the need for prevention and treatment initiatives geared toward middle-aged and older adults and hint at the potential for reducing psychological distress by preventing marijuana use, prescription drug abuse and early alcohol initiation. 1
Introduction In 2004, the Governor s Office for Children, Youth and Families (GOCYF) received a Strategic Prevention Framework State Incentive Grant (SPF SIG) from the federal Center for Substance Abuse Prevention (CSAP) in the Substance Abuse and Mental Health Services Administration (SAMHSA). The SPF SIG required an assessment of the magnitude of substance abuse in Arizona to direct funding to address substance abuserelated problems. Thus, epidemiology profiles of the state were conducted in 2005, 2007 and 2009. This profile furthers earlier efforts in that it examines the scope of other behavioral health concerns outside of substance use/abuse. The Arizona Substance Abuse Epidemiology Work Group (Epi Work Group) produces epidemiological profiles and other reports of substance use/abuse and the consequences associated with such behaviors. This epidemiological profile is concerned with an examination of the most salient and timely findings of concern to policymakers, policy analysts, community coalitions and other interested parties surrounding the behavioral health of Arizona s youth and adults. The Epi Work Group reports to the Arizona Substance Abuse Partnership (ASAP), both of which are staffed by the Governor s Office for Children, Youth and Families (GOCYF). The Epi Work Group: Compiles and synthesizes information and data on substance abuse and its associated consequences and correlates, including mental illness and emerging trends, through a collaborative and cooperative data-sharing process; Assesses substance abuse treatment service capacity and prevention resources in Arizona and detail gaps in service availability; Serves as a resource to the ASAP and member agencies to support data-driven decision-making that makes the best use of the resources available to address substance abuse and related issues in Arizona; and Identifies data gaps and addresses them in order to provide Arizona with a comprehensive picture of substance abuse in the State. Data gaps that hinder our ability to understand the scope of substance abuse and mental health prevalence in Arizona are being addressed through efforts to ensure data are made available to communities, agencies, and policymakers. The work of the ASAP, its Epi Work Group and numerous organizations and agencies can be credited with gathering and disseminating data. This report presents key data findings and highlights the work being done to support data-driven decision-making, including: The collection and distribution of sub-county data through a Drug Data Clearinghouse, known as the Community Data Project (CDP), a unique and informative website with interactive mapping and data file functions. The CDP allows users to select specific data elements and geographic units of analysis most relevant to their work and have those data delivered in a variety of formats that can be saved and imported into reports and other documents; An assessment of Arizona s substance abuse treatment service capacity and substance abuse prevention resources/programs that will facilitate an understanding of gaps between the needs of the State and the resources at hand to address these issues; and 2
A data dissemination plan that includes a newsletter, an Epi Work Group Facebook page to connect communities and coalitions, and webinars and trainings that provide technical assistance on the use of data for grant and report writing; program and project evaluation; prevention and intervention planning; and conveying community needs to decision-makers. This report should facilitate data-driven decision-making and solutions to the critical behavioral health issues facing Arizona. Its findings can be used to guide decisions about resource allocation and to inform the public about the prevalence of mental health conditions, which may serve to reduce the stigma associated with seeking treatment for substance abuse and mental illness. However, it is important to remember that the data contained in this report should be examined in relationship to indicators from other sources in order to examine mental illness and substance use/abuse in the full context in which these issues occur. For example, the Arizona Youth Survey (AYS) illustrates the risk and protective factors that influence the behaviors of youth in Arizona. Such information should be taken into consideration when creating policies and programs aimed at addressing mental illness and substance abuse in our communities. With continued, strong, coordinated efforts and decisions guided firmly by data, Arizona can improve the health and well-being of its populace and ensure a prosperous State. This report was made possible through a State Epidemiological Outcomes Workgroup (SEOW) subcontract awarded to Arizona by the SAMHSA, administered by Synectics for Management Decisions, Inc., and is a product of the Epi Work Group. M ethods Data Sources In order to provide an update to the previous version of the Arizona Behavioral Health Epidemiology Profile, more recent data (i.e., 2010) were obtained from the Arizona Department of Health Services (ADHS). Through the ADHS, data regarding hospital inpatient discharges and records of emergency department visits related to mental and substance use/abuse disorders are provided. According to the ADHS, Bureau of Public Health Statistics (Mrela & Torres, 2011), an inpatient discharge refers to a patient leaving a hospital after being admitted. Inpatient discharges refer to the number of events as the unit of analysis, not to the individual patient. Thus, a patient who has been hospitalized more than once in a calendar year will be counted each time s/he is discharged. Emergency Department (ED) and inpatient hospitalization discharge data are mutually exclusive. Data from ED visits include only those individuals who were not admitted to the hospital. Hospital discharge and ED visit records are available for all mental disorders combined, as well as for three subclasses of mental disorders: psychoses, neuroses, and mental retardation. Disorders classified as psychoses include drug psychoses, alcohol psychoses, schizophrenia, and manic depressive psychoses. Disorders classified as neuroses include anxiety, depression, personality disorders, drug dependence, alcohol dependence, and the nondependent abuse of drugs. 3
Two additional diagnosis categories provided by ADHS that do not fall under the psychoses or neuroses umbrellas are: a) mental retardation and b) depression not otherwise specified or not elsewhere classified (NOS). Beginning in 2006, the category of Depression NOS was added to the diagnostic categories. Depression NOS has no specifically manic-depressive or other psychotic depressive features and does not appear to be associated with the features specified under neurotic depression. Data from ADHS are not inclusive of discharges from Department of Defense, Indian Health Service, Veteran s Administration or state-licensed psychiatric hospitals. All discharges are specific to residents of Arizona. Thus, hospital discharges of individuals whose primary residence is located in another state or country are not included in this report. Patient s racial/ethnic background is available for hospital discharges but not for ED visits. Data available at the county level are based on patients zip code of residence and not the location of the hospital to which the patient was admitted. Diagnostic groupings are based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The ICD-9-CM diagnostic categories used to identify specific mental disorders are available online at: http://www.azdhs.gov/plan/hip/for/mental/2007 /mental107.xls. Data reported by the Arizona Department of Health Services (ADHS) include first-listed diagnoses. Given that there is one first-listed diagnosis per discharge, this is the same as the number of discharges. All-listed diagnoses reported by ADHS include first-listed diagnoses as well as secondary diagnoses (with up to nine total diagnoses recorded per discharge). Tabulations of hospital inpatient data by first-listed diagnosis and all-listed diagnoses utilize the diagnostic categories available at http://www.azdhs.gov/plan/hip/cat/icd9primary.xls and http://www.azdhs.gov/plan/hip/cat /icd9procedure.xls, respectively. This information is useful for stakeholders who want to know the total number of times that a condition(s) has/have been reported for hospitalized patients. The discharge record may include more than one diagnosis of psychosis or neurosis or a combination of diagnostic categories for both neuroses and psychoses. Therefore, the sum of all occurrences of psychotic and neurotic disorders is greater than the total number of discharges for mental disorders when counting all-listed diagnoses. These data are available at: http://www.azdhs.gov/plan/hip/for/mental/index.htm. This profile specifically includes diagnoses that include a mention of the mental disorders examined in this profile in any of the nine total diagnoses recorded per discharge (regardless of the order in which diagnostic codes were listed). In the previous version of the profile, data collected through Saint Luke s Health Initiatives 2010 administration of the Arizona Health Survey (AHS) was included to provide self-reported information relevant to mental health, psychological distress and the co-occurrence of mental health issues and substance use/abuse. Saint Luke s Health Initiative has not administered the AHS since that time. Thus, there has been no update to the AHS data. Rather than republish the same data, no AHS data appear in this updated profile. 4
Addressing Data Gaps According to its purpose, the Epi Work Group identifies substance consumption and consequence patterns in the State. Originally created in 2004 to meet the requirements of the Strategic Prevention Framework State Incentive Grant (SPF SIG), the Epi Work Group s primary goal is to bring data to bear on the substance abuse issues facing Arizona. In this vein, the Epi Work Group continues to enhance the state s data collection infrastructure and data-sharing mechanisms. In the course of the Epi Work Group s efforts, a variety of data and research needs have been identified, some of which presented significant gaps in Arizona s knowledge of its substance consumption and consequence patterns. The 2005, 2007 and 2009 Substance Abuse Epidemiology Profile (Profile) noted several data collection needs, many of which the Epi Work Group and the State have been able to address. Other data gaps remain. The following information notes some of the actions taken to improve data collection since the 2009 Profile, indicates the work necessary to improve the state s ability to make data-driven decisions, and reports on how the GOCYF, the Epi Work Group and other stakeholders will continue to further these efforts. Sub-County Data The Epi Work Group seeks to acquire and provide survey data at a sub-county level, or administrative or archival data that can be disaggregated to a sub-county level, whenever possible. In most instances, survey, administrative, and archival data are readily available at a county level, but this may not accurately describe the circumstances at a municipal- or neighborhood-level. Further, the costs of sampling so that smaller geographic areas can be reliably estimated are often prohibitive. When the 2009 Substance Abuse Epidemiology Profile was published, Arizona did not have an institutionalized drug data clearinghouse that centralized the storage and dissemination of state and local alcohol and drug-related data. The Epi Work Group was responsible for collecting data from a variety of national, state, and local sources, and facilitating the dissemination of these data to substance abuse preventionists, policymakers, and practitioners statewide. The Epi Work Group and the GOCYF recognized the need for improved data collection and coordination between Arizona s communities and tribal nations and a public access drug data prevention resource hub for the dissemination of local consumption, consequence and context data. To address this need, Arizona devised a strategy to assess sub-county estimates and present this information to communities who depend upon data to make decisions about the needs of their communities. Utilizing monies from the SPF SIG, Arizona s Statistical Analysis Center (SAC), housed at the Arizona Criminal Justice Commission (ACJC), has created and maintains a Drug Data Clearinghouse to serve Arizona drug prevention practitioners and policymakers as part of an initiative known as the Community Data Project (CDP), which can be found on the SAC page of the ACJC website. 5
The foundation of the CDP s Drug Data Clearinghouse are the indicators included in the 2005, 2007 and 2009 Substance Abuse Epidemiology Profile, a variety of federal, state, and local data sources. Staff members at the ACJC s SAC have created an electronic data warehouse that contains both current and historical data for these indicators at the smallest unit of analysis publicly available (e.g., state, county, city, zip code, census block, etc.). The CDP is a one-stop, web-based resource that can be used to enhance data-driven decision-making, programmatic monitoring, and reporting consistency by allowing access to Arizona s substance abuse and crime-related data. The CDP provides data at multiple levels, including gender, race/ethnicity, and geography as well as across time to enable users to examine substance abuse and related consequence trends. Reflecting its consumer-focused design, the CDP interactively creates tables, graphs and maps, which can be downloaded and saved. Additionally, data can be downloaded into an Excel spreadsheet format for further manipulation (e.g., adjusting the color scheme to accommodate the user s individualized needs). Potential uses for the CDP are numerous. For example, the ACJC has used the CDP to develop Community Profiles for 26 communities previously funded by the Strategic Prevention Framework State Incentive Grant (SPF SIG), which reflect the problems each profiled community faces while accounting for what progress has been made over time. Each Community Profile includes a youth Drug Severity Index (DSI) score that represents a snapshot of the overall severity of youth substance use in a geographic area. Data include indicators of adult and youth substance use/abuse, substance abuse-related consequences which reveal correlative outcomes of substance-use problems--and contextual factors such as individual/peer-, school-, family-, and community-level risk and protective factors. The CDP can be used to tell a story by providing a comprehensive and robust picture of the impact of substance abuse, to maximize the return on investment of prevention and intervention programs, and to allow stakeholders to make informed decisions. The CDP can be used in numerous ways, including project/program evaluation; grant writing/reporting; prevention and intervention planning; and for conveying community needs to decision-makers. The ACJC, with the assistance of the Epi Work Group and with funding from the State Epidemiological Outcomes Workgroup (SEOW) subcontract from the Substance Abuse and Mental Health Services Administration (SAMHSA) administered by Synectics for Management Decisions, Inc., is responsible for updating the data maintained in the Drug Data Clearinghouse. Additionally, the Epi Work Group identifies additional data sources relevant to the work of ASAP, its work groups, and state and local substance abuse prevention practitioners and policymakers. Substance Abuse Prevention Resources and Substance Abuse Treatment Service Capacity The 2005 and 2007 Substance Abuse Epidemiology Profile included an assessment of prevention resources available in the State. While Epi recommended that these assessments continue and that data at the lowest geographic level possible be utilized (closest to program delivery), the Arizona Drug and Gang Prevention Resource Center, whose staff assisted with these efforts in the past, was defunded by the Arizona State Legislature in 2009. Thus, the 2009 Profile did not include this information, but recognized the need for accurate and timely information on the prevention resources available in the state, including measures of program effectiveness and the behavioral objectives targeted by these resources. 6
Recently, the Arizona Department of Health Services (ADHS) collected data on a broad array of prevention services available through the State. The GOCYF, the Epi Work Group, and the Southwest Interdisciplinary Research Center (SIRC) at Arizona State University (ASU) are assessing gaps in the available substance abuse prevention resources available to meet the needs of Arizona s communities and residents by comparing prevalence and consequence data to the prevention services available in a specific region. Information on the location and specific services offered by treatment facilities will be a valuable resource for communities making treatment referrals as well as for identifying disparities between treatment need relative to treatment service availability. Combined, information on the prevention and treatment resources available within Arizona s communities will facilitate an understanding of gaps between the needs of the State and the resources to address these issues. Data Dissemination The Epi Work Group, the GOCYF, and the SIRC at Arizona State University (ASU) will facilitate educating communities, policymakers and other key stakeholders about the numerous uses of the CDP, including grant and report writing; program and project evaluation; prevention and intervention planning; and conveying community needs to decision-makers. The Epi Work Group has created a data dissemination plan that includes a Facebook page, bimonthly newsletter, webinars, trainings and community outreach activities to ensure that stakeholders are aware of the importance of using the CDP and data in all efforts. 7
Prevalence of Mental Health Diagnoses and Psychological Distress Introduction to Mental Health Diagnoses and Psychological Distress This report provides an overview of a variety of behavioral health indicators for the state of Arizona. Data for this report were gathered from the Arizona Department of Health Services (ADHS). Mental disorder data from ADHS are available through emergency department (ED) and hospital inpatient discharge diagnoses for 16 mental disorders, including an overall diagnosis of any mental health issue. Data in this report are organized topically, based on diagnosis type with data from inpatient and emergency department discharges presented together. The 16 mental health disorders provided for the ED visit and hospital inpatient discharge data are listed in Table 1.0. Subtypes of mental disorders subsumed by larger categories are indented in the table for ease of interpretation. Note that larger categories include all cases of mental health disorders in their subordinate category; thus, larger categories are the sum of the cases of subordinate categories. For example, the category any mental health issue is the sum of all other categories cases, and the category psychoses includes cases from drug psychoses, alcohol psychoses, schizophrenia, and manic depressive psychoses. Data presented in this report represent all mentions of each diagnosis, which capture the total number of individuals with a particular diagnosis (regardless of whether the disorder was the primary reason for the ED or inpatient visit). Up to nine diagnoses can be recorded per visit for any one patient, and the same individual may have visited the hospital and been discharged on more than one occasion. 8
Table 1.0: Emergency Department and Hospital Inpatient Discharge Mental Health Indicators 1. Any Mental Health Issue 2. Psychoses 3. Drug Psychoses 4. Alcohol Psychoses 5. Schizophrenia 6. Manic-Depressive Psychoses 7. Neuroses 8. Anxiety 9. Depression 10. Personality Disorders 11. Drug Dependence 12. Non-Dependent Abuse of Drugs 13. Non-Dependent Abuse of Alcohol 14. Alcohol Dependence Syndrome 15. Depression 16. Mental Retardation Data for ED and hospital inpatient visits are provided at various demographic levels and by county; hospital inpatient visits are provided by gender, age group and race/ethnicity, while ED visits are available by gender and age group. Throughout this report, in all cases, rates for mental illness among younger individuals (particularly children under 15) are notably lower than those for older individuals and adults. Though children under 15 are included as a comparison, rates of mental illness among children of this age, especially severe mental illnesses such as schizophrenia or drug-related psychoses, would not be expected to be comparable to adults. 9
Any Mental Health Issue According to the ADHS, in 2010, there were a total of 183,646 hospital inpatient discharges and 337,880 emergency department visits in Arizona for mental health issues. Data presented in Figure 1.1 indicate that the rates of hospital inpatient discharges and emergency department visits for mental disorders were nearly identical in 2004. Data for 2003 include hospital discharges and emergency department visits for only half of the year. Thus, they should not be used for comparison purposes. While the rate of hospital discharges related to mental disorders grew modestly between 2004 and 2010, the rate of emergency department visits increased at a much more dramatic pace; the rate of emergency department visits more than doubled between 2004 and 2010 (2,598.2 vs. 5,286.0 per 100,000 population, respectively). In contrast, inpatient hospital discharges increased by about 16 percent over the same time period (from a rate of 2,476.4 in 2004 to 2,873.1. in 2010). Figure 1.1: State-Level Emergency Department and Hospital Visit Trends in Any Mental Disorder Rate of Emergency Department Visits and Hospital Discharges for Any Mental Disorder per 100,000 Population (2003-2010) 6000.0 5000.0 Rate per 100,000 4000.0 3000.0 2000.0 1000.0 0.0 2003 2004 2005 2006 ED 1141.2 2598.2 2940.7 3151.0 3550.6 4012.0 4550.7 5286 Hospital 2265.6 2476.4 2519.9 2566.9 2518.6 2590.6 2666.9 2873.1 Source: Arizona Department of Health Services; http://www.azdhs.gov/plan/hip/for/mental/index.htm Up to nine diagnoses are coded for each discharge. All mentions include all occurrences of the diagnosis regardless of the order on the medical record. 10
Inpatient Hospital Discharges for Any Mental Health Issue by Demographics Data regarding discharges from inpatient hospital visits, seen in Table 1.1, indicate that females were slightly more likely than males to present to a hospital with a mental health issue. From 2007 to 2010, the rate of hospital inpatient discharges for any mental health issue increased at a slightly greater rate for females. Between 2007 and 2010, the rates of hospital visits for any mental health issue were fairly consistent across age groups. Patterns indicate slight increases within age groups from year to year, and also indicate that older individuals were more likely to visit a hospital. Inpatient services for any mental health issue among children under 15 and adolescents did not exceed a rate of 933.5 per 100,000 for any year between 2007 and 2010, while visits among young adults and older individuals surpassed 2,000 per 100,000 in all years. The rate of hospital inpatient services was greatest among White, non-hispanic individuals across all years, followed by the rate for Black or African American patients. Asian or Pacific Islanders sought inpatient services at the lowest rate across all years, and the number seeking services for any mental health issue decreased for the period 2007 to 2008 and decreased again from 2009 to 2010. Rates for all other races/ethnicities slightly increased across the time period. Table 1.1: Number (N) and Rate of Hospital Discharges with Any Mental Disorder per 100,000 Population by Year and Demographics Category Gender Female 85,261 2,657.0 91,066 2,791.7 94,213 2,860.0 97,937 3,045.1 Male 76,733 2,380.7 78,222 2,390.0 81,686 2,474.2 85,860 2,703.6 Unknown 0 * 4 * 5 * 8 * Age Group Children <15 2,472 175.0 2,717 190.1 3,096 215.8 3,413 251.1 Adolescents 15-19 3,923 881.9 4,091 905.3 4,104 899.8 4,309 933.5 Young Adults 20-44 48,228 2,135.7 48,305 2,100.2 50,496 2,167.6 52,516 2,475.1 Middle-Aged Adults 45-64 58,708 3,965.4 61,446 4,085.9 64,114 4,224.0 66,699 4,251.7 Elderly 65+ 48,660 5,822.2 52,733 6,206.2 54,094 6,310.0 56,686 6,428.2 Unknown 3 * 0 * 0 * 0 * Race/Ethnicity White non-hispanic 122,751 3,169.6 129,541 3,288.7 133,708 3,359.4 138,773 3,755.0 Hispanic or Latino 21,500 1,195.6 22,331 1,224.5 23,876 1,300.9 25,136 1,374.9 Black or African American 7,383 2912.7 7,678 2,982.9 8,243 3,165.1 9,139 3,528.5 American Indian or Alaskan Native 5,819 1,722.8 5,915 1,727.7 6,336 1,830.8 7,015 2,365.7 Asian or Pacific Islander 1,598 941.2 1,373 796.0 1,684 968.3 1,560 832.7 Other 1,529 * 15 * 0 * 22 * Refused 1,414 * 2,439 * 2,057 * 1,980 * State (Total) 161,994 2,518.6 169,292 2,590.6 175,904 2,666.9 183,625 2,872.7 Source: Arizona Department of Health Services; tables 1, 2 and 3 (2007-2010), http://www.azdhs.gov/plan/hip/for/mental/index.htm 11
Inpatient Hospital Discharges for Any Mental Health Issue by County Table 1.2 presents mental health inpatient hospital discharges for any mental health issue by county for 2007 2010. While Maricopa County had the highest number of discharges each year, in 2007, 2008 and 2009, Mohave County had the greatest rate of inpatient services for mental health issues. In 2010, Gila County had the greatest rate of inpatient services for mental health issues. The lowest rate of inpatient services was observed in Apache County all four years. For some counties, rates decreased between 2007 and 2010 (see, for example, La Paz and Pinal counties), but the predominant trend was toward slight increases in inpatient hospital visits related to any mental health issue over time. Table 1.2: Number (N) and Rate of Hospital Discharges with Any Mental Disorder per 100,000 Population by Year and County County Apache 842 1113.8 919 1206.7 959 1250.8 1,055 1475.2 Cochise 2,991 2172.0 3,280 2352.4 3,597 2536.5 3,887 2959.4 Coconino 2,094 1550.3 2,293 1690.8 2,136 1542.1 2,412 1794.4 Gila 1,860 3335.2 1,950 3399.5 2,189 3687.5 2,182 4071.1 Graham 1,003 2765.3 1,209 3129.4 1,263 3174.0 1,265 3398.7 Greenlee 152 1840.4 202 2257.0 172 1979.7 180 2133.5 La Paz 626 2874.3 528 2450.8 530 2435.0 550 2684.4 Maricopa 89,584 2309.4 96,168 2450.2 101,636 2563.9 107,282 2810.6 Mohave 7,222 3580.7 7,532 3675.6 8,042 3933.1 7,834 3913.4 Navajo 2,222 1926.6 2,152 1874.9 2,097 1816.7 2,228 2073.5 Pima 32,309 3218.3 33,147 3270.3 32,932 3234.9 33,864 3454.6 Pinal 9,172 3127.0 9,052 2805.7 9,395 2867.0 10,296 2740.0 Santa Cruz 720 1546.9 747 1579.6 817 1720.4 772 1628.0 Yavapai 6,226 2827.8 6,425 2852.1 6,150 2702.7 6,043 2863.5 Yuma 3,405 1690.4 3,657 1794.6 3,935 1924.5 3,751 1916.2 Unknown 1,566 * 31 * 54 * 24 * State (Total) 161,994 2518.6 169,292 2590.6 175,904 2666.9 183,625 2784.0 Source: Arizona Department of Health Services; table 4 (2007-2010), http://www.azdhs.gov/plan/hip/for/mental/index.htm 12
Emergency Department Visits for Any Mental Health Issue by Demographics Data regarding emergency department visits, seen in Table 1.3, indicate that females were slightly more likely than males to present at an emergency department with a mental health issue. From 2007 to 2010, the rate of emergency department visits for any mental health issue increased at a slightly greater rate for females. The rates of ED visits for any mental health issue increased across all age groups between 2007 and 2010. Young adults 20 44 years of age had the highest rate of emergency department visits for any mental disorder of any age group. Emergency department visits for any mental health issue among children under 15 did not exceed a rate of 562.1 per 100,000 for any year between 2007 and 2010, although the rate increased every year. The rate of emergency department visits for any mental disorder for middle-aged adults increased by 50 percent from 2007 to 2010. Table 1.3: Number (N) and Rate of Emergency Department Visits for Any Mental Disorder per 100,000 Population by Year and Demographics Category Gender Female 118,875 3,704.6 138,759 4,253.8 158,810 4,820.9 178,787 5,559.0 Male 109,499 3,397.3 123,417 3,770.9 141,341 4,281.0 159,069 5,008.7 Unknown 4 * 4 * 5 * 20 * Age Group Children <15 5,872 415.7 6,222 435.3 7,082 493.5 7,633 562.1 Adolescents 15-19 15,983 3,593.1 17,584 3,891.0 19,775 4,335.9 20,505 4,442.3 Young Adults 20-44 125,301 5,548.8 142,321 6,187.8 162,490 6,975.0 180,609 8,512.2 Middle-Aged Adults 45-64 61,053 4,123.8 72,998 4,854.1 84,687 5,579.5 97,646 6,224.4 Elderly 65+ 20,162 2,412.4 23,047 2,712.4 26,113 3,046.1 31,475 3,569.3 Unknown 7 * 8 * 9 * 8 * State (Total) 228,378 3,550.6 262,180 4,012.0 300,156 4,550.7 337,876 5,285.9 Source: Arizona Department of Health Services; tables 6 and 7 (2007-2010), http://www.azdhs.gov/plan/hip/for/mental/index.htm 13
Emergency Department Visits for Any Mental Health Issue by County Data regarding emergency department visits by county (see Table 1.4) indicate that Mohave County had the greatest rates of emergency department visits from 2008 to 2010. The lowest emergency department visit rate for any mental disorder across all years was noted in Apache County. For some counties, rates decreased slightly from 2007 to 2009 (see, for example, Greenlee County), but rates for emergency department visits for any mental disorder increased from 2009 to 2010 in all counties with the exception of Santa Cruz County. Table 1.4: Number (N) and Rate of Emergency Department Visits for Any Mental Disorder per 100,000 Population by Year and County County Apache 904 1,195.8 990 1,300.0 986 1,286.1 1,290 1,682.6 Cochise 5,712 4,147.9 6,534 4,686.1 7,962 5,614.6 8,079 5,697.1 Coconino 5,883 4,355.5 5,810 4,284.3 6,596 4,762.1 8,590 6,201.7 Gila 2,741 4,914.9 2,902 5,059.2 3,713 6,254.8 3,900 6,569.9 Graham 1,235 3,404.9 1,248 3,230.4 1,464 3,679.1 1,569 3,943.0 Greenlee 133 1,610.4 138 1,541.9 115 1,323.7 157 1,807.1 La Paz 383 1,758.6 408 1,893.8 428 1,966.4 452 2,076.6 Maricopa 113,561 2,927.5 139,687 3,558.9 158,643 4,002.0 180,729 4,559.2 Mohave 8,743 4,334.8 12,789 6,241.0 15,548 7,604.1 18,553 9,073.7 Navajo 2,800 2,427.8 2,706 2,357.6 2,803 2,428.4 3,220 2,789.7 Pima 61,737 6,149.6 61,649 6,082.3 70,294 6,905.0 74,633 7,331.2 Pinal 7,066 2,409.0 8,463 2,623.1 9,693 2,957.9 13,570 4,141.0 Santa Cruz 944 2,028.1 1,009 2,133.6 1,109 2,335.2 1,087 2,288.9 Yavapai 8,153 3,703.0 10,568 4,691.2 12,850 5,647.0 13,673 6,008.7 Yuma 5,338 2,650.0 7,177 3,522.0 7,853 3,840.7 8,274 4,046.6 Unknown 3,045 * 102 * 99 * 100 * State (Total) 228,378 3,550.6 262,180 4,012.0 300,156 4,550.7 337,876 5,122.6 Source: Arizona Department of Health Services; table 4 (2007-2010), http://www.azdhs.gov/plan/hip/for/mental/index.htm 14