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The State of Health in New Mexico 2018

11. Mental Health and Mental Disorders

Mental Disorders are Common, Serious, and Treatable

Mental illness is common in the United States and around the world. Mental disorders are generally characterized by "a combination of abnormal thoughts, perceptions, emotions, behavior and relationships with others." They include depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

Burden of Mental Illness

Mental illness is one of the main causes of years of healthy life lost to disability (YLD). But the estimate of the burden of mental illness may be underestimated by more than a third. Mental illness affects not only the mental and physical health and well-being of the individual but also has a tremendous impact on families and communities.

In the U.S. in 2015, excluding developmental and substance use disorders, there were an estimated 43.4 million adults aged 18 or older with any mental illness (AMI) within the past year. This represents nearly one in five of all U.S. adults. AMI can range in impact from no or mild impairment to significantly disabling impairment, such as individuals with serious mental illness (SMI).

The burden of mental illness is particularly concentrated among those who experience disability due to SMI. In the U.S. in 2015, there were an estimated 9.8 million adults aged 18 years or older with SMI within the past year, or 4% of all U.S. adults. Individuals with SMI have higher mortality rates and die earlier than the general population.

Mental disorders are also common in childhood and adolescence. Approximately one in five children either currently or at some point during their life have had a seriously debilitating mental disorder. Adult mental illness is commonly preceded by psychiatric conditions that begin during childhood.

Treatment of mental illness can reduce the level of disability and improve quality of life. However, in 2014, only about 45% of U.S. adults who experienced a mental illness in the past year received mental health care. Barriers to receiving treatment include cost and insurance coverage issues, not feeling a need for treatment or thinking that the problem can be handled without treatment, and stigma associated with mental illness. Those who haven't received mental health care on an outpatient basis as well as those who are experiencing a particularly severe episode of mental illness may require hospitalization. Hospitalizations in the U.S. due to mental disorders and substance use accounted for nearly 6 percent of all inpatient stays in 2014, up 20.1 percent from 2005.

Depression

Depression is a common mental disorder characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness and poor concentration. Depressive symptoms can be chronic, lasting over a long period of time, or episodic and recurring, impairing individuals' ability to function at work or school and to cope with daily life. In 2015, the World Health Organization (WHO) ranked depression as the single largest contributor to global disability (7.5% of all years lived with disability) and anxiety as sixth (3.4%). When depression is severe, it can lead to suicide.

The New Mexico Behavioral Risk Factor Surveillance System (BRFSS) estimated 9.8% of New Mexico adults were suffering from depression in 2016. According to results from the 2014-2015 National Survey of Drug Use and Health, 11.5% of New Mexico youth 12-17 years had a major depressive episode in the last 12 months.

Prevention programs have been shown to reduce depressive symptoms, both in children and adults, and there are also effective treatments. Mild to moderate depression can be effectively treated with talk therapies, e.g., cognitive behavior therapy, while antidepressant medications can be an effective form of treatment for moderate to severe depression. However, antidepressant medications should not be used for treating depression in children and should be used with caution in adolescents.

Though depression is a very treatable disorder on an outpatient basis, it can be a chronic and debilitating disorder. Severely depressed individuals, people with treatment-resistant depression and those who are at risk of hurting themselves or others may also require short hospital stays so they can recover in a safe and stable environment. In New Mexico, from 2013-2016, hospitalizations of residents with depression as a first-listed diagnosis increased 241%, from an age-adjusted rate of 10.8/10,000 population in 2013 to 26.0/10,000 in 2016 (Figure 1).

Contributing Factors

Risk and Resiliency Factors

In managing depression, it is important to address contributing psychosocial factors. These include the identification of factors leading to stress, e.g., financial problems, difficulties at work, physical or mental abuse, as well as sources of support available to the depressed individual, i.e., family members and friends. Maintaining or reactivating social networks and activities plays an important role in depression management.

Results from the BRFSS also show that depression is strongly related to education, employment and income (Figure 2). College graduates suffered from depression the least (6.4%) compared to those who did not complete high school (13.8%). People who were retired or employed had much lower rates of depression (5.8% and 6.7%, respectively) than those who were unemployed (15.4%) or unable to work (37.8%). Depression was much less common among adults with household incomes of $75,000 or more (5.0%) than among those with household incomes of less than $15,000 (19.5%).

Depression is often associated with other mental disorders, such as anxiety and substance use disorders. In 2016, more than one third of those respondents with current depression reported having been told at some point in their life by a doctor or other healthcare provider that they had an anxiety disorder. Depression is also a risk factor for suicide. Among those New Mexico adults with current depression, nearly 60% reported thinking about suicide in the past year and more than one-third reported making a suicide attempt at some point in their lives. Notably, of those currently depressed individuals reporting at least one past suicide attempt, nearly two-thirds reported an attempt in the past year.

Depression has also been associated with an increased prevalence of chronic medical conditions such as heart disease, stroke, asthma, diabetes and obesity. In New Mexico in 2016, the prevalence of current depression was strongly and inversely related to self-reported general health (Figure 2). More than 40% of those reporting poor overall health had been told by a health professional at some point in their life that they had a depressive disorder compared to less than 2% of those reporting excellent health.

New Mexican adults with one or more chronic medical conditions were much more likely to suffer from depression than adults without these conditions (Figure 3). Rates of health care provider diagnoses of asthma (27.8%), diabetes (17.2%), coronary heart disease (6.8%), and stroke (7.8%) were much higher in those suffering from depression. In addition, adults with current depression had lower rates of exercise in the past month and were more likely to get insufficient, i.e., less than 7 hours per night, sleep.

Health Disparities

Depression Among Adults
2016 results from the New Mexico BRFSS indicate that the prevalence of current depression in New Mexico residents is 9.8%. Depression is significantly greater for men ages 18-24 years compared to those 65 years and older. Among women, the prevalence of current depression is significantly greater for those aged 25-64 years compared to those 65 years and older. Respondents who identified as lesbian or gay or bisexual were 2 1/2 to 3 times more likely to be currently depressed compared to those who identified as straight. There were no statistically significant differences in current depression by racial/ethnic group.
Depression Among Youth
Persistent feelings of sadness and hopelessness are markers for depression in youth. Results from the 2015 New Mexico Youth Risk and Resiliency Survey indicated that 32.5% of high school students reported feeling sad or hopeless almost every day for two weeks or more in a row in the previous year, essentially the same as the national rate of 29.9%. New Mexico female students (42.3%) were more likely to report persistent feelings of sadness or hopelessness than male students (23%). The prevalence of feeling sad or hopeless was significantly higher in those students who described themselves as gay or lesbian (53.8%) or bisexual (62.6%) compared to straight students (28.4%). Students who reported housing instability were significantly more likely to report feelings of sadness or hopelessness (49.3%) than those with stable housing (31.6%).

Assets and Resources

Psychotherapy paired with medication and social support can promote recovery from mental illness. Not all therapies work for everyone. Choosing the right mix of treatments and supports is important, as is a person's empowerment and involvement in choosing his or her path to recovery.

Hotlines

  • New Mexico Crisis Line: 1-855-NMCRISIS (662-7474)
  • National Suicide Prevention Lifeline (http://www.suicidepreventionlifeline.org/): 1-800-273-TALK (8255). En Español: 1-888-628-9495
  • Teen to Teen Peer Counseling Hotline: 1-877-YOUTHLINE (1-877-968-8454)
  • Native Youth Crisis Hotline: 1-877-209-1266
  • Veterans Peer Support Line: 1-877-Vet2Vet (1-877-838-2838)
  • University of New Mexico Agora Crisis Line (http://www.unm.edu/~agora/): 505-277-3013 or 1-866-HELP-1-NM
  • New Mexico State University Crisis Assistance Listening Line or The CALL: 1-575-646-CALL (2255) or 1-866-314-6841
  • Graduate Student Hotline: 1-800-GRADHLP (1-800-472-3457)
  • Postpartum Depression Hotline: 1-800-PPD-MOMS (1-800-773-6667)
  • Trans Lifeline: 1/877-565-8860

To Seek Treatment

  • SAMHSA Treatment Referral Helpline: 1-800-662-HELP (4357), also online at https://findtreatment.samhsa.gov/
  • The SKY Center (http://nmsip.org/services/sky-center/): 1-505-473-6191
  • Search Providers in Bernalillo County: http://cepr.unm.edu/tools/ABQ-Providers.html
  • New Mexico Social Service Resource Directory (https://www.nmresourcedirectory.org/SitePages/Home.aspx): 1-800-432-2080
  • SHARE New Mexico Resource Directory: http://www.sharenm.org/communityplatform/newmexico/directory/landing
  • United Way Central New Mexico Referral Service (http://www.referweb.net/uwcnm/): 505-245-1735

Summary

Depression is a common mental disorder and a significant - perhaps the largest - contributor to years lived with disability. Depression is strongly related to social determinants such as education, employment and income, and is often associated with other chronic disorders, both mental (such as anxiety and substance use disorders) and physical (such as heart disease, stroke, asthma, diabetes and obesity). Depression is also an important risk factor for suicide. Treatment can reduce the level of disability and improve quality of life, but many New Mexicans do not receive such needed care on an outpatient basis and, along with those who are experiencing a particularly severe episode of illness, may require hospitalization. Expansion of the continuum of the behavioral health workforce, to include telemental health, the provision of incentives for providers to work in rural, frontier and tribal areas, and increased emphasis on early identification of those with mental illness, e.g., screening of adolescents and adults for depression, is needed to impact the overall burden of mental disorders in the state. References

Figure 1. Hospitalizations for Depression by Year, New Mexico, 2007-2016 Example Line Chart, NM and U.S. by Year Non-federal hospitals only. ICD-9 codes 296.2, 296.3 and 311; ICD-10 codes F32 and F33. Data have been directly age-adjusted to the U.S. 2000 standard population.
Sources: NMDOH HIDD, UNM GPS Program
Figure 2. Prevalence of Depression by Selected Sociodemographic Characteristics, Adults 18+ Years, New Mexico, 2016 Prevalence of Depression by Selected Sociodemographic Characteristics, Adults 18+ Years, New Mexico, 2016 Sources: NM BRFSS Figure 3. Prevalence of Chronic Health Conditions by Depression Diagnosis, Adults 18+ Years, New Mexico, 2016 Prevalence of Chronic Health Conditions by Depression Diagnosis, Adults 18+ Years, New Mexico, 2016 Sources: NMDOH BVRHS, UNM GPS Program

What is Being Done?

  • Behavioral health services are included in essential benefits packages provided through health insurance exchanges.
  • Behavioral health services for middle and high school students are offered at 70 school-based health centers throughout New Mexico.
  • Core service agencies in local collaborative areas coordinate the continuum of mental health and substance abuse treatment for people with serious mental health needs.
  • The Behavioral Health Services Division (BHSD) of the NM Human Services Department has instituted a social-emotional learning program, the PAX Good Behavior Game, in schools throughout the state to teach children coping and problem-solving skills.
  • BHSD has worked to promote safer care through systems change by implementing effective clinical and professional practices for assessing and treating at-risk individuals.
  • The Epidemiology and Response Division of the NM Department of Health has initiated county-based data presentations based on mental health indicators to identified at-risk communities in the state, providing them with capacity-building training and technical assistance.

What Needs to be Done?

  • Support continued coverage of mental health conditions in insurance policies through mental health parity laws.
  • Continue to improve youth and adult access to services through braided funding strategies.
  • Expand the implementation of collaborative care for the management of depressive disorders as recommended by the U.S. Preventive Services Task Force.
  • Increase the capacity to provide mental health and substance abuse assessment, crisis intervention and early intervention services at school-based health centers.
  • Expand early recognition and intervention programs for young people with signs of serious mental illness.
  • Expand the continuum of the behavioral health workforce, to include telemental health, and provide incentives for providers to work in rural, frontier and tribal areas.
The information provided above is from the New Mexico Department of Health's NM-IBIS web site (http://ibis.health.state.nm.us). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Thu, 20 June 2019 from New Mexico Department of Health, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.nm.us".

Content updated: Tue, 20 Mar 2018 15:16:58 MDT