Behavioral Health Outcomes Among Adults: Associations With Individual and Community-Level Economic Conditions.
OBJECTIVE
This study examined the relationship between state and local economic conditions and serious psychological distress, substance use disorders, and mental health service utilization among adults in the United States.


METHODS
Using data from 21,100 adults who responded to the 2008-2010 National Survey on Drug Use and Health, a nationally representative survey of the U.S. civilian noninstitutionalized population living in households, the study used multivariate methods to examine associations between selected macroeconomic conditions and behavioral health outcomes.


RESULTS
Living in states in the top three quartiles for serious mortgage delinquency rate and in counties in the top three quartiles for unemployment rate was associated with a lower likelihood of using mental health services among individuals experiencing serious psychological distress (adjusted relative risk [ARR]=.54, .52, and .73, and ARR=.58, .62, and .71, respectively, versus quartile 1). Individual-level characteristics were the primary predictors associated with higher odds of having substance use disorders or experiencing serious psychological distress, but macroeconomic variables were not statistically significant predictors of these outcomes.


CONCLUSIONS
Both individual-level socioeconomic characteristics and population-level macroeconomic conditions were associated with behavioral health outcomes. Prevalence of serious psychological distress and substance use disorders and use of mental health services varied by economic measure. The findings suggest that access to and availability of mental health services for individuals experiencing serious psychological distress may be more challenging for those who do not have health insurance or who reside in regions with higher rates of mortgage foreclosures or higher rates of unemployment.
Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ljd@rti.org ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland.
Laura J
LJ
Dunlap
Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ljd@rti.org ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland.
Beth
B
Han
Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ljd@rti.org ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland.
William N
WN
Dowd
Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ljd@rti.org ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland.
Alexander J
AJ
Cowell
Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ljd@rti.org ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland.
Valerie L
VL
Forman-Hoffman
Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ljd@rti.org ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland.
M Christine
MC
Davies
Dr. Dunlap, Mr. Dowd, Dr. Cowell, and Dr. Forman-Hoffman are with RTI International, Research Triangle Park, North Carolina (e-mail: ljd@rti.org ). Dr. Han is with the Center for Behavioral Health Quality and Statistics, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Ms. Davies was with RTI International at the time of the study, but she is now with Quintiles, Inc., Durham, North Carolina. Dr. Colpe is with the Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland.
Lisa J
LJ
Colpe
D000293:Adolescent; D000328:Adult; D000368:Aged; D004467:Economics; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014478:Unemployment / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult