DefinitionWeighted mean number of days reported by adults 18 years of age and older on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?"
NumeratorWeighted number of days reported by adults (18+) on the BRFSS to the question: "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?"
DenominatorWeighted number of adults (18+) with complete and valid responses to the BRFSS question on mentally unhealthy days, excluding those with missing, "Don't know/Not sure", or "Refused" responses.
Data Interpretation IssuesThe Behavioral Risk Factor Surveillance System (BRFSS) is a source for estimating the mean number of mentally unhealthy days for Alaska. The median of states, District of Columbia, and territories provides a comparison for the United States (U.S.). The BRFSS is a telephone survey of adults 18 and over. Information on background and methodology of the BRFSS managed by the Centers for Disease Control and Prevention (CDC) can be found at: [http://www.cdc.gov/brfss/]. The website for the Alaska BRFSS is: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx].
Alaska data were obtained from the Standard AK BRFSS from 1993-2003, and from the Standard and Supplemental AK BRFSS surveys combined from 2004 onward. The Supplemental BRFSS survey is conducted using identical methodology as the Standard BRFSS and allows a doubling of the BRFSS sample size for those measures included in both surveys.
The question of "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" has been asked since 1993.
Post-stratification weights were used for Alaska prior to 2006; raking weights were used from 2007 onward. For more on this methodological change see: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/method.aspx].
Why Is This Important?Mental health is 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. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society. Mental health was recognized in the U.S. Surgeon General's 1999 report as being fundamental to overall health.^1^ Poor mental health can occur across the lifespan, affecting persons of all racial and ethnic groups, both sexes, and all educational and socioeconomic groups. Evidence has shown that mental disorders are strongly related to the occurrence, treatment, and course of many chronic diseases including diabetes, cancer, cardiovascular disease, asthma, and obesity, as well as many risk behaviors for chronic disease, including physical inactivity, smoking, excessive drinking, and insufficient sleep.^2^ In teens, sadness or depression can lead to poor grades at school, alcohol or drug use, unsafe sex, and other problems.^3-4^ National studies have found that mental health issues have been the most commonly identified precipitating circumstance in suicide deaths.^5-7^[[br]] [[br]]
1. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. [http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS]. Published 1999. Accessed September 15, 2016.
2. Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. [http://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm]. Published 2005. Accessed September 15, 2016.
3. Frjd SA, Nissinen ES, Pelkonen MU, Marttunen MJ, Koivisto AM, Kaltiala-Heino R. Depression and School Performance in Middle Adolescent Boys and Girls. J Adolesc 200831(4):485-98.
4. Diego MA, Field TM, Sanders CE. Academic Performance, Popularity, and Depression Predict Adolescent Substance Use. Adolescence 2003;38(149):35-42.
5. Ortega LA, Karch D. Precipitating Circumstances of Suicide Among Women of Reproductive Age in 16 U.S. States, 2003-2007. Journal Women's Health 2010;19(1):5-7.
6. Karch DL, Logan J, McDaniel DD, Floyd CF, Vagi KJ. Precipitating Circumstances of Suicide Among Youth Aged 10-17 Years by Sex: Data from the National Violent Death Reporting System, 16 States, 2005-2008. J Adolesc Health 2013;53(1 Suppl):S51-3.
7. Trigylidas TE, Reynolds EM, Teshome G, Dykstra HK, Lichenstein R. Paediatric Suicide in the USA: Analysis of the National Child Death Case Reporting System. Inj Prev 2016;22:268-273.
Other ObjectivesHealthy Alaskans 2020 Indicator 9: Reduce the mean number of days in the past 30 days that adults (age 18 and older) report being mentally unhealthy to 2.9 days by 2020.
How Are We Doing?The mean number of mentally unhealthy days was 3.9 for all Alaskans and 4.3 for Alaska Native people in 2017. Females reported a significantly higher number of mentally unhealthy days (4.4) than males (3.3) in 2017. Individuals 65 years of age and older reported fewer mentally unhealthy days than most younger age groups.
The 4.9 mentally unhealthy days reported by those with less than a high school education was twice the level and significantly higher than the 2.3 days reported by those with a college education. Those unable to work had a significantly higher mean number of unhealthy days (9.0) compared to those who are employed (3.0) or not in the workforce (3.2). The mean number of mentally unhealthy days declined with increasing income.
Mean number of mentally unhealthy days from the BRFSS are initially presented for all Alaskans, Alaska Native people, and the median from states, District of Columbia, and territories for all available years. Subsequent analyses by demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status) are limited to 2010 and later to allow for ease of assessing recent trends.
Crosstabulations were also conducted for three-year averages by body mass index, current smoking, sexual orientation, disability, and number of Adverse Childhood Experiences. Significant differences occurred within each comparison.
Mean number of mentally unhealthy days by regions of Alaska are presented for the most recent time period allowing reporting for all Alaskans and Alaska Native people: 1) single-year for the 7 Alaska Public Health Regions, 2) three-year averages by the 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) single-year for the 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) three-year averages for 29 boroughs and census areas, and 5) five-year averages for the 12 tribal health organization regions. These time intervals match those for the InstantAtlas health profiles for each of the geographic regionalizations of Alaska for those desiring longer time series.
How Do We Compare With the U.S.?In Alaska, as in the US, there has been an increasing trend over time in the mean number of unhealthy days among adults. The median national value for the mean number of mentally unhealthy days in 2016 was 3.4, similar to the 3.5 days for all Alaskans and 4.2 days for Alaska Native people.
What Is Being Done?Reducing poor mental health in adults was identified as one of the 25 leading health indicators to be addressed by [http://hss.state.ak.us/ha2020/assets/Actions-Partners_9_MentalHealth_Adults.pdf Healthy Alaskans 2020].
The Alaska strategies being followed are:
1. Identify adults who rate their mental health as not good and connect them to screening, treatment, and social support services without delay.
2. Identify environmental and individual strengths of Alaskans who are mentally healthy to inform health promotion strategies.
3. Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities.
Evidence-based PracticesAs part of the Healthy Alaskans 2020 health improvement process, groups of Alaskan subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Below are the strategies identified for enhancing adult support systems.
[[br]]Identify adults who are experiencing or at-risk of experiencing mentally unhealthy days and connect them to screening, treatment, and social support services immediately (indicated prevention).
[[br]]Individuals who receive treatment and/or behavioral interventions earlier are less likely to develop serious mental health disorders. Screening for both depression and substance abuse is indicated, as the impact of misuse and dependence on alcohol and drugs in overall mental health is substantial. The U.S. Preventive Services Task Force recommends depression screening for adults at higher risk, including those experiencing substance misuse, chronic medical diseases, unemployment, and poverty.
[[br]]Depression Guide to Clinical Preventive Services. [http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2a.html].
Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare. [http://beta.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf]
[[br]]Identify the environmental and individual strengths of Alaskans reporting 0-3 mentally unhealthy days per month to inform mental health improvement strategies.
[[br]]Individuals have both biological and psychological characteristics that affect their vulnerability and resiliency to potential behavioral health problems. Protective factors might include positive self-image, self-control, or social competence. Understanding the specific characteristics of mentally healthy Alaskans will inform prevention and health promotion activities tailored to improve mentally healthy days.
[[br]]Bonanno, GA. Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events? American Psychologist. 2004;59(1):20-28.
'''Strategy 3:''' [[br]]
Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities (universal prevention).
The World Health Organization holds that "a supportive environment is of paramount importance for health. The two are interdependent and inseparable" (Sundsvall Statement on Supportive Environments for Health, 1991). Supportive environments can help protect people from risk factors for poor health, encourage participation in health care and health promotion, expand individuals' health competencies and self-reliance, and support person-centered health care. Stigma and attitudes about help-seeking (specifically seeking treatment or services for mental health conditions) are key barriers to promoting mental and emotional health and preventing mental illness. Creating communities that de-stigmatize depression and mental illness and encourage people to seek mental health services when needed can increase the number of people accessing services.
[[br]]Segal DL et al. Beliefs about Mental Illness and Willingness to Seek Help: A Cross-Sectional Study. Aging Ment Health. 2005;9(4):363-367.
Reynders A, Kerkhof AJFM, Molenberghs G, Van Audenhove C. Attitudes and Stigma in Relation to Help-Seeking Intentions for Psychological Problems in Low and High Suicide Rate Regions. Social Psychiatry and Psychiatric Epidemiology. 2014;49(2):231-239.
A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_9_MentalHealth_Adults.pdf].