Satvinder S. Dhingra

Change in Level of Positive Mental Health as a Predictor of Future Risk of Mental Illness

OBJECTIVES We sought to describe the prevalence of mental health and illness, the stability of both diagnoses over time, and whether changes in mental health level predicted mental illness in a cohort group. METHODS In 2009, we analyzed data from the 1995 and 2005 Midlife in the United States cross-sectional surveys (n = 1723), which measured positive mental health and 12-month mental disorders of major depressive episode, panic, and generalized anxiety disorders. RESULTS Population prevalence of any of 3 mental disorders and levels of mental health appeared stable but were dynamic at the individual level. Fifty-two percent of the 17.5% of respondents with any mental illness in 2005 were new cases; one half of those languishing in 1995 improved in 2005, and one half of those flourishing in 1995 declined in 2005. Change in mental health was strongly predictive of prevalence and incidence (operationalized as a new, not necessarily a first, episode) of mental illness in 2005. CONCLUSIONS Gains in mental health predicted declines in mental illness, supporting the call for public mental health promotion; losses of mental health predicted increases in mental illness, supporting the call for public mental health protection.

The Relationship of Level of Positive Mental Health With Current Mental Disorders in Predicting Suicidal Behavior and Academic Impairment in College Students

Abstract Objective: To investigate whether level of positive mental health complements mental illness in predicting students at risk for suicidal behavior and impaired academic performance. Participants: A sample of 5,689 college students participated in the 2007 Healthy Minds Study and completed an Internet survey that included the Mental Health Continuum–Short Form and the Patient Health Questionnaire screening scales for depression and anxiety disorders, questions about suicide ideation, plans, and attempts, and academic impairment. Results: Just under half (49.3%) of students were flourishing and did not screen positive for a mental disorder. Among students who did, and those who did not, screen for a mental disorder, suicidal behavior and impaired academic performance were lowest in those with flourishing, higher among those with moderate, and highest in those with languishing mental health. Conclusions: Positive mental health complements mental disorder screening in mental health surveillance and prediction of suicidal behavior and impairment of academic performance.

A New Source of Data for Public Health Surveillance: Facebook Likes

Background Investigation into personal health has become focused on conditions at an increasingly local level, while response rates have declined and complicated the process of collecting data at an individual level. Simultaneously, social media data have exploded in availability and have been shown to correlate with the prevalence of certain health conditions. Objective Facebook likes may be a source of digital data that can complement traditional public health surveillance systems and provide data at a local level. We explored the use of Facebook likes as potential predictors of health outcomes and their behavioral determinants. Methods We performed principal components and regression analyses to examine the predictive qualities of Facebook likes with regard to mortality, diseases, and lifestyle behaviors in 214 counties across the United States and 61 of 67 counties in Florida. These results were compared with those obtainable from a demographic model. Health data were obtained from both the 2010 and 2011 Behavioral Risk Factor Surveillance System (BRFSS) and mortality data were obtained from the National Vital Statistics System. Results Facebook likes added significant value in predicting most examined health outcomes and behaviors even when controlling for age, race, and socioeconomic status, with model fit improvements (adjusted R 2) of an average of 58% across models for 13 different health-related metrics over basic sociodemographic models. Small area data were not available in sufficient abundance to test the accuracy of the model in estimating health conditions in less populated markets, but initial analysis using data from Florida showed a strong model fit for obesity data (adjusted R 2=.77). Conclusions Facebook likes provide estimates for examined health outcomes and health behaviors that are comparable to those obtained from the BRFSS. Online sources may provide more reliable, timely, and cost-effective county-level data than that obtainable from traditional public health surveillance systems as well as serve as an adjunct to those systems.

Addressing Mental Health Promotion in Chronic Disease Prevention and Health Promotion

The authors discuss mental health promotion and its underlying importance to prevention of chronic diseases and overall health promotion. The authors compare World Health Organization (WHO) definitions of mental health and mental illness, while noting WHOs definition of health, in total. The authors also discuss a so-called two-continuum model of mental health and mental illness.

Associations between Overall and Abdominal Obesity and Suicidal Ideation among US Adult Women

Obesity is associated with increased risks for mental disorders. This study examined associations of obesity indicators including body mass index (BMI), waist circumference, and waist-height ratio with suicidal ideation among U.S. women. We analyzed data from 3,732 nonpregnant women aged ≥20 years who participated in the 2005–2008 National Health and Nutrition Examination Survey. We used anthropometric measures of weight, height, and waist circumference to calculate BMI and waist-height ratio. Suicidal ideation was assessed using the Item 9 of the Patient Health Questionnaire-9. Odds ratios with 95% conference intervals were estimated using logistic regression analyses after controlling for potential confounders. The age-adjusted prevalence of suicidal ideation was 3.0%; the prevalence increased linearly across quartiles of BMI, waist circumference, and waist-height ratio (P for linear trend <0.01 for all). The positive associations of waist circumference and waist-height ratio with suicidal ideation remained significant (P < 0.05) after adjustment for sociodemographics, lifestyle-related behavioral factors, and having either chronic conditions or current depression. However, these associations were attenuated after both chronic conditions and depression were entered into the models. Thus, the previously reported association between obesity and suicidal ideation appears to be confounded by coexistence of chronic conditions and current depression among women of the United States.

Uninsurance Among Nonelderly Adults With and Without Frequent Mental and Physical Distress in the United States

OBJECTIVES This research describes uninsurance rates over time among nonelderly adults in the United States with or without frequent physical and mental distress and provides estimates of uninsurance by frequent mental distress status and sociodemographic characteristics nationally and by state. METHODS Data from the 1993 through 2009 Behavioral Risk Factor Surveillance System, a telephone survey that uses random-digit dialing, were used to examine the prevalence of uninsurance among nearly 3 million respondents by self-report of frequent physical and frequent mental distress and sociodemographic characteristics, response year, and state of residence. RESULTS After adjustment for sociodemographic characteristics, uninsurance among adults aged 18 to 64 years was markedly higher among those with frequent mental distress only (22.6%) and those with both frequent mental and frequent physical distress (21.8%) than among those with frequent physical distress only (17.7%). The prevalence of uninsurance did not differ markedly between those with only frequent mental distress and those with both frequent mental distress and frequent physical distress. The prevalence of uninsurance among those with frequent mental distress only and those with neither frequent mental distress nor frequent physical distress increased significantly over time. CONCLUSIONS Uninsurance rates among nonelderly adults with frequent mental distress were disproportionately high. The results of this analysis can be used as baseline data to assess whether implementation of the Affordable Care Act is accompanied by changes in health care access, utilization, and self-reported measures of health, particularly among those with mental illness.

Change in Health Insurance Coverage in Massachusetts and Other New England States by Perceived Health Status: Potential Impact of Health Reform

OBJECTIVES We examined the impact of Massachusetts health reform and its public health component (enacted in 2006) on change in health insurance coverage by perceived health. METHODS We used 2003-2009 Behavioral Risk Factor Surveillance System data. We used a difference-in-differences framework to examine the experience in Massachusetts to predict the outcomes of national health care reform. RESULTS The proportion of adults aged 18 to 64 years with health insurance coverage increased more in Massachusetts than in other New England states (4.5%; 95% confidence interval [CI] = 3.5%, 5.6%). For those with higher perceived health care need (more recent mentally and physically unhealthy days and activity limitation days [ALDs]), the postreform proportion significantly exceeded prereform (P < .001). Groups with higher perceived health care need represented a disproportionate increase in health insurance coverage in Massachusetts compared with other New England states--from 4.3% (95% CI = 3.3%, 5.4%) for fewer than 14 ALDs to 9.0% (95% CI = 4.5%, 13.5%) for 14 or more ALDs. CONCLUSIONS On the basis of the Massachusetts experience, full implementation of the Affordable Care Act may increase health insurance coverage especially among populations with higher perceived health care need.

Mental Health Promotion in a Reformed Health Care System

The article introduces this special issue on mental health promotion, with reference to the importance of mental health in overall well-being and funding of wellness programs authorized by the March 2010 U.S. health care legislation.

Lack of Health Insurance Among Adults Aged 18 to 64 Years: Findings From the 2013 Behavioral Risk Factor Surveillance System

Introduction The objective of this study was to estimate the prevalence of lack of health insurance among adults aged 18 to 64 years for each state and the United States and to describe populations without insurance. Methods We used 2013 Behavioral Risk Factor Surveillance System data to categorize states into 3 groups on the basis of the prevalence of lack of health insurance in each state compared with the national average (21.5%; 95% confidence interval, 21.1%–21.8%): high-insured states (states with an estimated prevalence of lack of health insurance below the national average), average-insured states (states with an estimated prevalence of lack of health insurance equivalent to the national average), and low-insured states (states with an estimated prevalence of lack of health insurance higher than the national average). We used bivariate analyses to compare the sociodemographic characteristics of these 3 groups after age adjustment to the 2000 US standard population. We examined the distribution of Medicaid expansion among the 3 groups. Results Compared with the national age-adjusted prevalence of lack of health insurance, 24 states had lower rates of uninsured residents, 12 states had equivalent rates of uninsured, and 15 states had higher rates of uninsured. Compared with adults in the high-insured and average-insured state groups, adults in the low-insured state group were more likely to be non-Hispanic black or Hispanic, to have less than a high school education, to be previously married (divorced, widowed, or separated), and to have an annual household income at or below

A Triple Play: Psychological Distress, Physical Comorbidities, and Access and Use of Health Services among U.S. Adults with Disabilities

35,000. Seventy-one percent of high-insured states were expanding Medicaid eligibility compared with 67% of average-insured states and 40% of low-insured states. Conclusion Large variations exist among states in the estimated prevalence of health insurance. Many uninsured Americans reside in states that have opted out of Medicaid expansion.