Behavioral Health Equity Report 2021

Behavioral Health Equity

Report 2021

Substance Use and Mental Health Indicators Measured from the

National Survey on Drug Use and Health (NSDUH), 2015¨C2019

Acknowledgments

Behavioral Health Equity Report 2021: Substance Use and Mental Health Indicators Measured from the

National Survey on Drug Use and Health (NSDUH), 2015¨C2019 was prepared for the Substance Abuse

and Mental Health Services Administration (SAMHSA) under Contract No. HHSS283201700002C with

SAMHSA, U.S. Department of Health and Human Services (HHS).

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without

permission from SAMHSA. Citation of the source is appreciated. However, this publication may

not be reproduced or distributed for a fee without the specific, written authorization of the Office of

Communications, SAMHSA, HHS.

Electronic Access and Printed Copies

This publication may be downloaded or ordered at . Or call SAMHSA at

1-877-SAMHSA-7 (1-877-726-4727) (English and Espa?ol).

Recommended Citation

Center for Behavioral Health Statistics and Quality. (2021). Behavioral health equity report 2021:

Substance use and mental health indicators measured from the National Survey on Drug Use and Health

(NSDUH), 2015¨C2019 (Publication No. PEP21-07-01-004). Rockville, MD: Substance Abuse and Mental

Health Services Administration. Retrieved from

Originating Office

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services

Administration, 5600 Fishers Lane, Rockville, MD 20857.

Nondiscrimination Notice/Aviso de no discriminaci¨®n

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of

race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos

civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Publication No. PEP21-07-01-004

Published 2021

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CONTENTS

FOREWORD .............................................................................................................................. iv

INTRODUCTION ........................................................................................................................v

HIGHLIGHTS ..............................................................................................................................1

YOUTH SUBSTANCE USE.........................................................................................................3

Illicit Drug Use .........................................................................................................................3

Marijuana Use .........................................................................................................................5

Binge Alcohol Use ..................................................................................................................7

Initiation of Substance Use ......................................................................................................9

YOUTH MENTAL HEALTH AND TREATMENT ........................................................................ 13

Depression ........................................................................................................................... 13

Treatment for Depression ...................................................................................................... 15

ADULT MENTAL HEALTH AND TREATMENT ......................................................................... 17

Thoughts of Suicide .............................................................................................................. 17

Serious Mental Illness ........................................................................................................... 19

Treatment for Serious Mental Illness ......................................................................................21

SUBSTANCE USE ....................................................................................................................23

Alcohol Dependence or Abuse..............................................................................................23

SUBSTANCE USE TREATMENT .............................................................................................25

Alcohol .................................................................................................................................25

Illicit Drugs ............................................................................................................................27

FIGURE NOTES .......................................................................................................................29

DEFINITIONS ...........................................................................................................................30

REFERENCES AND SOURCES ...............................................................................................32

APPENDIX A: SUPPORTING TABLES OF ESTIMATES FOR SELECTED FIGURES............ A-1

iii

FOREWORD

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within

the U.S. Department of Health and Human Services (HHS), is charged with reducing the impact of

substance abuse and mental illness on America¡¯s communities. As these communities undergo rapid

changes in their ethnic and racial composition, it becomes imperative to monitor variations in mental

and substance use disorders among these diverse populations. Differences in prevalence of disorders,

perceptions of risk, and access to treatment contribute to the variations in burden of care. In addition,

other factors such as income level, geographic location, and health insurance status are key determinants

of disparities in behavioral health across populations. Examining these data is critical to providing the

most appropriate and highest-quality behavioral health care.

SAMHSA¡¯s National Survey on Drug Use and Health (NSDUH), conducted annually, provides

nationally representative data on use of tobacco, alcohol, and illicit drugs; substance use disorders

(SUDs); receipt of substance use treatment; mental health issues; and use of mental health services

among the civilian, noninstitutionalized population aged 12 or older in the United States. NSDUH

estimates allow researchers, clinicians, policymakers, and the general public to better understand and

improve the nation¡¯s behavioral health. To ask any questions regarding how to use or interpret the data

included in this report, please contact CBHSQRequest@samhsa..

This report, Behavioral Health Equity Report 2021: Substance Use and Mental Health Indicators

Measured from the National Survey on Drug Use and Health (NSDUH), 2015¨C2019, disaggregates

the behavioral health indicators by selected determinants of health: race and ethnicity (White, Black or

African American, Native Hawaiian or Other Pacific Islander, American Indian/Alaska Native, Asian,

Two or More Races, and Hispanic or Latino), income level, county type, and health insurance status.

For some of the indicators, the lack of sufficient sample size precluded reporting for smaller racial/ethnic

groups. In these cases, the low precision estimates are not reported.

In this report, the array of indicators presented across racial/ethnic groups and other selected

determinants of health provides a unique overview of population-based variations in behavioral health at

a point in time. This effort¡ªalthough a beginning step in addressing the complexity of behavioral health

issues and social determinants of health¡ªprovides a mechanism for systematically tracking changes,

trends, and disparities over time.

Ahmed Khago, PhD

Branch Chief

Populations Survey Branch (PSB)

Statistical tests (t tests) have been conducted for all statements appearing in the text on this page of the report that compare estimates between years or subgroups of

the population. Unless explicitly stated that a difference is not statistically significant, all statements that describe differences are significant at the .05 level.

iv

INTRODUCTION

Purpose of This Report

Behavioral Health Equity Report 2021: Substance Use and Mental Health Indicators Measured from the

National Survey on Drug Use and Health (NSDUH), 2015¨C2019 provides an update on a series of topics

that focus on substance use and mental health (collectively referred to as behavioral health) in the United

States. The Substance Abuse and Mental Health Services Administration (SAMHSA) selected specific

topics and indicators in this report to represent a cross-section of the key behavioral health indicators

that are assessed in SAMHSA data collections, including NSDUH. This report is intended to provide a

concise, reader-friendly summary of key behavioral health measures for lay and professional audiences.

Organization of This Report

This report is divided into sections based on content areas and age groups. It begins with sections on

substance use, mental health, and treatment among adolescents aged 12¨C17, followed by a section on

mental health and treatment among adults aged 18 or older. Next are sections on substance use and

treatment among people aged 12 or older. Figure titles are included above all graphics, including callouts

for figure notes that are presented on page 29. These figure notes include additional information about

the measures, populations, and analyses presented in the graphics and text. Definitions of key measures

and terms included in the report are presented on pages 30¨C31. Appendix A contains supporting

estimates found in the figures and starts on page A-1.

Methodological Information

Statistical tests (t tests) have been conducted for all statements appearing in the text of the report based

on NSDUH data that compare estimates between years or population subgroups. In cases where more

than two levels of a population subgroup were being tested, an overall chi-square test was conducted first

to control for Type I error due to multiple comparisons, then pairwise t tests followed if the chi-square

test was significant or unable to be calculated. Unless explicitly stated that a difference is not statistically

significant, all statements based on NSDUH data that describe differences are significant at the .05 level.

Not all statistically significant findings are presented in the body of this report, but results of all tests

can be found in the ¡°P¡± versions of the Appendix A tables. Standard NSDUH suppression rules have

been applied for all estimates in this report. Tables that display all data points included in this report,

including tests of statistical significance and standard errors, are available upon request. To request these

tables or to ask any questions regarding how to use or interpret the data included in this report, please

contact CBHSQRequest@samhsa..

Statistical tests (t tests) have been conducted for all statements appearing in the text on this page of the report that compare estimates between years or subgroups of

the population. Unless explicitly stated that a difference is not statistically significant, all statements that describe differences are significant at the .05 level.

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