Distress More Likely In New York, Study Finds

Distress More Likely In New York, Study Finds
By SEWELL CHAN
10 April 2006
The New York Times

Nearly 1 in 7 adults in New York City described their mental health last year as being frequently ''not good,'' compared with 1 in 10 adults in a comparable national survey, according to data being released today by the City Department of Health and Mental Hygiene.

The findings, from the city's community health survey, a telephone poll of 10,000 randomly selected adults conducted each year since 2002, confirm what many New Yorkers suspect -- that life in the nation's most populous city can be difficult and lonely.

Thirteen percent of adults who answered the city's survey last year reported that their mental health was ''not good'' on 14 or more days of the month, compared with 10 percent in a similar national survey that measured ''frequent mental distress,'' like stress, depression or other emotional problems. The data will be presented today in a conference at Hunter College organized by Dr. Neal L. Cohen, a former city health commissioner.

Dr. Lloyd I. Sederer, the executive deputy commissioner for mental hygiene at the health department, said he believed that the higher rate of ''frequent mental distress'' reported by city residents was statistically significant, although the precise reasons were not clear. ''I wish we knew, in a way that we could say with confidence, why that difference is,'' he said.

The survey also contains a separate set of questions, which asked adults whether in the past month they had felt hopeless, nervous, worthless or restless; whether they had felt so sad that nothing could cheer them up; and whether they had felt that ''everything was an effort.'' Those questions, developed by Ronald C. Kessler, a Harvard Medical School professor, measure ''nonspecific psychological distress.''

The department, in a paper that is also being presented today at Hunter College, found that rates of such psychological distress were higher in 2003 among women; Hispanics; people who were divorced, widowed or separated; and people who were poor, ill or chronically unemployed. Only 40 percent of people who reported such distress in 2003 had received counseling or medication for mental illness within the past year.

Cited as the most common barriers to mental health treatment were cost (41 percent); not wanting or needing help (11 percent); shame, fear and other beliefs about mental illness (10 percent); procrastination and logistical barriers (each 8 percent); and lack of access to care and negative perceptions of treatment (each 6 percent). The remaining 10 percent cited other reasons.

''You put that all together and it adds up to a major public health problem,'' Dr. Sederer said. ''These are common disorders, they're highly prevalent, they are disabling, they cause great human suffering, and they interfere with functioning.'' Mental illness increases the risk of dying from untreated medical conditions, like diabetes or high blood pressure, and from suicide, he said.

In 2004, the city began urging doctors to use a simple questionnaire to screen for depression. This month, the city will bolster that effort with an advertising campaign urging New Yorkers to see a primary-care doctor if they experience signs of depression.

The study of the 2003 data will be published in the May issue of The Journal of Urban Health. The lead author is Katharine H. McVeigh, a psychiatric epidemiologist for the city.

Bonnie D. Kerker, the city's assistant health commissioner for epidemiology services, said the two measures of distress in the survey were only an approximation of the true prevalence of mental disorders. ''There are limitations to self-reported data, although we think it's a fairly good estimate of what's going on in New York, especially over time,'' she said.

The Centers for Disease Control and Prevention, in their Behavioral Risk Factor Surveillance System, an annual national survey, uses the same questions the city uses to measure ''frequent mental distress,'' but does not use the Kessler questions.

The city's Department of Health and its Department of Mental Health, Mental Retardation and Alcoholism Services were merged in July 2002, and a key theme of today's conference will be how to better integrate mental health into the regular health care system.