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pdfNational Mental Health Study Field Test,
Supporting Statement
Attachment B – Lead Letter
UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES
ROCKVILLE, MD 20857
[NAME County/Parish/District] Resident at:
1234 Main Street
Anywhere, XX 12345
Dear [NAME County/Parish/District] Resident:
The U.S. Department of Health and Human Services (DHHS) is conducting a study called the
National Mental Health Study. This study asks questions about mental health and other healthrelated topics. Knowledge gained from this study will improve our ability to describe and
understand mental health issues in the United States.
Your address was randomly chosen along with almost 3,600 others across the country. RTI
International, a nonprofit organization, was selected to conduct this study. Soon, an RTI
interviewer will be in your neighborhood to give you more information. When the interviewer
arrives, please ask to see his or her personal identification card. An example of the ID card is
shown below.
First, the interviewer will ask a few general questions. In appreciation for the time taken to
answer these screening questions, the household member will receive [FILL $5/$10] in
cash. Then the interviewer may ask one or two members of your household to complete an
interview. It is possible that no one from your household will be chosen to be interviewed.
Every person who is chosen and completes the full interview will receive $40 in cash.
By Federal law*, the answers you give will be kept confidential and will be used only for
statistical purposes.
This letter is addressed to “Resident” because your address was selected, and we do not know
your name. Feel free to ask the interviewer any questions you have about the study. More
information is also available on the study website at: https://www.nmhsweb.org, or you may
contact us at [PHONE NUMBER FILL].
We may also ask you to consider participating in future studies. When we contact you in the
future, you can decide whether you want to participate.
Your help is very important to this study’s success. Thank you for your cooperation.
Sincerely,
Lisa J. Colpe, PhD, MPH
National Study Director, DHHS
Grace Medley
National Field Director, DHHS
Amy Kowalski
National Field Director, RTI
You will be contacted by: ___________________________________________
Interviewer Name
*Confidentiality protected by the Confidential Information Protection and Statistical Efficiency Act of 2002 (PL 107-347)
Authorized by the U.S. Congress as part of Section 505 of the Public Health Service Act (42 USC 290aa4)
Approved by Office of Management and Budget (OMB Approval No. UPDATE)
National Mental Health Study Field Test,
Supporting Statement
Attachment C – Unable-to-Contact Letters and
Call-Me Letters
Unable to Contact Letters
No contact
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIP]
Dear Resident:
Recently, a Field Interviewer from RTI International attempted to contact your household about participating in
the National Mental Health Study*. So far, we have been unable to speak with anyone in your household. Your
participation in this study is important—this is why we continue to try and reach you.
Some people are cautious about speaking to a stranger at the door, and that is understandable. Please know that
we are not soliciting or selling anything—we have just a few general questions to ask that will take about five
minutes.
It is not necessary for you to let the interviewer into your home—you can answer the questions right at your door.
In appreciation for the time taken to complete the screening, the household member will receive [FILL:
$5/$10] in cash.
After these initial questions, someone in your household may or may not be randomly selected to participate in
the full interview. If anyone is selected for the full interview, that person will receive $40 in cash at the end
of the interview as a token of appreciation.
A limited number of households were randomly selected to represent the population of the U.S. Your household
cannot be replaced. If you choose not to participate, your experiences and views—as well as the thousands of
people you represent—will not have a chance to be heard.
Thank you for your time. I hope you’ll choose to participate in this extremely important and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, telephone me toll-free at [TOLL
FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
1
Unable to Contact Letters
Unable to contact selected respondent
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIP]
Attention: [age] year old [gender] resident
Dear Resident:
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in the
National Mental Health Study*. You were not available to complete the interview at that time and have been
away or unavailable each time the interviewer has returned since then. Your participation in this study is
important—this is why we continue to try and reach you.
A limited number of people were randomly selected to represent the population of the U.S. You cannot be
replaced. If you choose not to participate, your experiences and views—as well as the thousands of people you
represent—will not be heard.
Your answers to the study questions are combined with the answers of over a thousand other people and reported
only as overall numbers. To further protect your privacy, the study is set up so that you record most of your own
answers—the interviewer never sees or hears them. Also, the option to refuse to answer any question is always
available.
The results of this study will provide health agencies and researchers with extremely valuable information about
mental health and treatment in the United States. By participating in this study, you will make a direct impact on
important health-related discoveries and decisions.
Your participation is critical to the success of this study, and we are happy to make a special effort to work around
your schedule so that you can be included. Please feel free to call me to set up an appointment time—the
interview can also be conducted at a neutral location such as a public library.
We appreciate that your time is a precious commodity. As a token of our appreciation, you will receive $40 in
cash at the end of the interview.
Thank you for your time. I hope you’ll choose to participate in this extremely important and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, telephone me toll-free at [TOLL
FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org]. [http://www.rti.org]
2
Controlled Access Flyer
ATTENTION RESIDENTS!
The U.S. Department of Health and Human Services is conducting a
national study on health-related issues in order to provide better future
services to all segments of the population. RTI International has been
contracted to complete the work.
Some residences in this building were randomly selected for
participation in this study. A field representative, [FIELD
INTERVIEWER], will be at your complex:
[DATE]
[TIMES]
[LOCATION]
The initial questions will only take a few minutes and then one or two
persons from your household may be asked to participate in a voluntary
interview. It is also possible that no one will be selected to participate.
All data collected will be kept completely confidential. This study is
covered by the Confidential Information Protection and Statistical
Efficiency section of the E-Government Act of 2002 (Public Law 107347) which ensures that any information provided will only be used for
statistical purposes and cannot be used for any other purpose.
You may contact Field Supervisor [FS NAME] at [FS PHONE NUMBER]
or visit https://www.nmhsweb.org on the internet to verify the legitimacy
of the study.
Your participation is extremely important to the success of this
study and we thank you in advance for your cooperation.
3
Controlled Access Letters
Controlled Access Letter to College/University
[DATE]
[NAME], [TITLE]
[COLLEGE/UNIVERSITY NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [DR./MR./MS.] [NAME]:
Recently one of our interviewers, [FIRST & LAST NAMES], attempted to contact specific [ROOMS/
RESIDENCES] on the [COLLEGE/UNIVERSITY NAME] campus that were randomly selected to
participate in the National Mental Health Study (NMHS) conducted by RTI International for the U.S.
Department of Health and Human Services. So far, [MR./MS.] [LAST NAME] has been unable to [GAIN
ACCESS/GAIN FULL ACCESS] to [NAME OF RESIDENCE HALL/STUDENT APTS], and we are
asking for your help.
We understand your responsibility to protect the students on campus and want to provide you with
additional information about the study:
We are not selling anything. This is not a marketing survey.
The NMHS will improve our ability to describe and understand mental health issues in the
United States. It will also examine the frequency of a variety of mental illnesses as well as
investigate connections between mental health problems and treatment.
A limited number of [ROOMS/HOUSEHOLDS] were randomly chosen to take part. We do not
have any information about the residents other than an address.
The RTI International interviewer only needs a few minutes of the residents’ time to see if
someone in the [ROOM/HOUSEHOLD] will be asked to participate in an interview. If selected,
those completing the interview receive a cash incentive.
All information provided is kept completely confidential and used for statistical purposes only in
compliance with the Confidential Information Protection and Statistical Efficiency Act of 2002
(PL 107-347).
For more details about the study, please visit https://www.nmhsweb.org/
By helping us access the selected [ROOMS/HOUSEHOLDS] at [COLLEGE/UNIVERSITY NAME],
you will make a direct contribution to this important research effort. [FIRST & LAST NAMES], our
supervisor in your area, will contact you soon to address any questions, or you may call [HIM/HER] toll
free at [TOLL FREE NUMBER].
Your assistance is extremely important, and I thank you in advance for your help.
Sincerely,
Amy Kowalski
National Field Director
4
Controlled Access Letters
Controlled Access to Group Quarters
[DATE]
[NAME], [TITLE]
[GQU NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [MR./MS.] [LAST NAME]:
Recently one of our field interviewers, [FIRST & LAST NAME], attempted to contact specific
[RESIDENCES/UNITS] within your [TYPE OF GQU] that were randomly selected to participate in the
National Mental Health Study (NMHS) conducted by RTI International for the U.S. Department of
Health and Human Services. So far, [MR./MS.] [LAST NAME] has been unable to [GAIN
ACCESS/GAIN FULL ACCESS] to [GQU NAME OR ADDRESS], and we are asking for your help.
We understand your responsibility to protect your residents and want to provide you with additional
information about the study:
We are not selling anything. This is not a marketing survey.
The NMHS will improve our ability to describe and understand mental health issues in the
United States. It will also examine the frequency of a variety of mental illnesses as well as
investigate connections between mental health problems and treatment.
A limited number of addresses were randomly chosen to take part. We do not have any
information about the residents other than an address.
The RTI International interviewer only needs a few minutes of the residents’ time to see if
someone in the [HOUSEHOLD/UNIT] will be asked to participate in an interview. If selected,
those completing the interview receive a cash incentive.
All information provided is kept completely confidential.
For more details about the study, please visit https://www.nmhsweb.org.
By helping our interviewer access the selected [RESIDENCES/UNITS] in [NAME OF GQU], you will
make a direct contribution to this important research effort. [FIRST & LAST NAMES], our supervisor
in your area, will contact you soon to address any questions, or you may call [HIM/HER] toll free at
[TOLL FREE NUMBER].
Your assistance is extremely important to the success of this study, and I thank you in advance for your
help.
Sincerely,
Amy Kowalski
National Field Director
5
Controlled Access Letters
Law Enforcement Legitimacy Letter
[DATE]
[FIRST NAME] [LAST NAME]
[POSITION], [LAW ENFORCEMENT AGENCY]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [TITLE/MR./MS.] [LAST NAME]:
RTI International will be in your area conducting the National Mental Health Study (NMHS) for the
U.S. Department of Health and Human Services during the months of [FILL IN MONTHS].
We understand your responsibility to protect the residents of [CITY/COUNTY NAME]. Since the public
may ask your department about the legitimacy of this national study, we seek your cooperation in providing
information about the study to staff members who may receive such inquiries.
We are not selling anything. This is not a marketing survey.
The NMHS will improve our ability to describe and understand mental health issues in the
United States. It will also examine the frequency of a variety of mental illnesses as well as
investigate connections between mental health problems and treatment.
A limited number of household addresses are randomly selected to represent the population of
the U.S. Once a household has been chosen, it cannot be replaced.
An RTI International interviewer will only visit the selected households and needs a few minutes
of the residents’ time to see if someone in the household will be asked to participate in an
interview. If selected, those completing the interview will receive a cash incentive.
All information provided is kept completely confidential as required by federal law*.
For more details about the study, please visit https://www.nmhsweb.org.
Thank you in advance for sharing this information with all pertinent staff in your department. Your
efforts are important to the success of this study, and I thank you in advance for your help. If you have
any questions, please contact our supervisor for your area, [FIRST & LAST NAME] toll free at [TOLL
FREE NUMBER].
Sincerely,
Amy Kowalski
National Field Director
_______________________
* The Confidential Information Protection and Statistical Efficiency section of the E-Government Act of 2002 (Public Law 107-347)
ensures that any information residents provide will only be used for statistical purposes and cannot be used for any other purpose. Any
unlawful use of these data may result in a jail term of up to 5 years, a fine of $250,000, or both.
6
Controlled Access Letters
List of Enclosures
National Mental Health Study
A. Lead Letter
Prior to the interviewer’s arrival at a household, a “lead letter” will be mailed to the selected address briefly
explaining the study and requesting the residents’ assistance. The interviewer will visit the household a few days later, refer
the resident to this letter, and answer questions if necessary. If the resident has no knowledge of the lead letter, the
interviewer will provide another copy. All NMHS interviewers prominently display their ID badge, which is referenced on
this letter.
B. Authorization Letter
Each NMHS field interviewer will carry a personal identification letter which is provided by the U.S. Department of
Health and Human Services (DHHS). This letter serves as documentation that DHHS formally authorizes the interviewer to
work on the NMHS for RTI International
C. Study Description
When an in-person contact is made with an adult member of a selected household and an introductory exchange is
completed, the interviewer will follow consent procedures that include presenting a “Study Description” and answering any
questions the respondent might have. Upon respondent permission, the interviewer will proceed to create a list of all
members of the household using a tablet computer. This list includes information such as the member’s age, gender, and
race, but does not include names or any other personally identifying information. The tablet will process this roster of the
household members and apply a statistical algorithm to randomly select zero, one, or two persons’ age 13 and older to be
interviewed. The selected respondent(s) will be asked to complete an interview using a laptop computer.
D. Question and Answer Brochure
Entitled “Answers to your questions,” the NMHS Question and Answer Brochure provides a ready reference to the
study, including answers to commonly asked questions. This brochure is given to each adult interview respondent or parent
or guardian of youth respondents.
7
Controlled Access Letters
Controlled Access Letter - Base
[DATE]
[RANK] [FULL NAME], [TITLE]
[NAME OF BASE]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [RANK/MR./MS.] [LAST NAME]:
Please be advised that [MR./MS.] [FIRST & LAST NAMES], an authorized representative of RTI
International, is collecting data for the National Mental Health Study (NMHS). This important research
study is sponsored by the U.S. Department of Health and Human Services (OMB No. XXXX-XXXX).
We understand and respect your responsibility to protect individuals living on [NAME OF BASE] and
want to provide you with additional information about the study:
We are not selling anything. This is not a marketing survey.
The NMHS will improve our ability to describe and understand mental health issues in the
United States. It will also examine the frequency of a variety of mental illnesses as well as
investigate connections between mental health problems and treatment.
The RTI International interviewer only needs a few minutes of the residents’ time to see if any
civilian members of the household will be asked to participate in an interview (active-duty
members of the military are not eligible for this study). If selected, those completing the
interview receive a cash incentive at the end of the interview.
All information provided is kept completely confidential and used for statistical purposes only
in compliance with the Confidential Information Protection and Statistical Efficiency Act of
2002 (PL 107-347).
For more details about the study, please visit https://www.nmhsweb.org.
By helping us access the selected households on [NAME OF BASE], you will make a direct
contribution to this important research effort. [FIRST & LAST NAMES], our supervisor in your area,
will contact you soon to address any questions, or you may call [HIM/HER] toll free at [TOLL FREE
NUMBER].
Your assistance is extremely important to the success of this study, and I thank you in advance for your
help.
Sincerely,
Amy Kowalski
National Field Director
Enclosures
8
Controlled Access Letters
Controlled Access Initial Letter – Complex/Gated Community
[DATE]
[NAME], [TITLE]
[COMPLEX/COMMUNITY NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [MR./MS.] [NAME]:
One of our field interviewers, [FIRST & LAST NAMES], needs to contact specific residences within
[COMPLEX/COMMUNITY NAME] that were randomly selected to participate in the National Mental
Health Study (NMHS) conducted by RTI International for the U.S. Department of Health and Human
Services.
We understand your responsibility to protect your residents and want to provide you with additional
information about the study:
We are not selling anything. This is not a marketing survey.
The NMHS will improve our ability to describe and understand mental health issues in the
United States. It will also examine the frequency of a variety of mental illnesses as well as
investigate connections between mental health problems and treatment.
A limited number of household addresses were randomly chosen to take part. We do not have
any information about the residents other than an address.
The RTI International interviewer only needs a few minutes of the residents’ time to see if
someone in the household will be asked to participate in an interview. If selected, those
completing the interview receive a cash incentive.
All information provided is kept completely confidential.
For more details about the study, please visit https://www.nmhsweb.org.
By helping our interviewer access the selected households in [NAME OF COMPLEX/COMMUNITY],
you will make a direct contribution to this important research effort. [FIRST & LAST NAMES], our
supervisor in your area, will contact you soon to address any questions, or you may call [HIM/HER] toll
free at [TOLL FREE NUMBER].
Your assistance is extremely important to the success of this study, and I thank you in advance for your
help.
Sincerely,
Amy Kowalski
National Field Director
Enclosures
9
Controlled Access Letters
Controlled Access Follow-Up Letter – Complex/Gated Community
[DATE]
[NAME], [TITLE]
[COMPLEX/COMMUNITY NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [MR./MS.] [NAME]:
Recently one of our field interviewers, [FIRST & LAST NAMES], attempted to contact specific
residences within [COMPLEX/COMMUNITY NAME] that were randomly selected to participate in the
National Mental Health Study (NMHS) conducted by RTI International for the U.S. Department of
Health and Human Services. So far, [MR./MS.] [LAST NAME] has been unable to [GAIN
ACCESS/GAIN FULL ACCESS] to [NAME OF COMPLEX/COMMUNITY], and we are asking for
your help.
We understand your responsibility to protect your residents and want to provide you with additional
information about the study:
We are not selling anything. This is not a marketing survey.
The NMHS will improve our ability to describe and understand mental health issues in the
United States. It will also examine the frequency of a variety of mental illnesses as well as
investigate connections between mental health problems and treatment.
A limited number of household addresses were randomly chosen to take part. We do not have
any information about the residents other than an address.
The RTI International interviewer only needs a few minutes of the residents’ time to see if
someone in the household will be asked to participate in an interview. If selected, those
completing the interview receive a cash incentive.
All information provided is kept completely confidential.
For more details about the study, please visit https://www.nmhsweb.org.
By helping our interviewer access the selected households in [NAME OF COMPLEX/COMMUNITY],
you will make a direct contribution to this important research effort. [FIRST & LAST NAMES], our
supervisor in your area, will contact you soon to address any questions, or you may call [HIM/HER] toll
free at [TOLL FREE NUMBER].
Your assistance is extremely important to the success of this study, and I thank you in advance for your
help.
Sincerely,
Amy Kowalski
National Field Director
Enclosures
10
Public Health Authorization Letter
Authorization Letter – Complex/Gated Community
[DATE]
[NAME], [TITLE]
[COMPLEX/COMMUNITY NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [MR./MS.] [NAME]:
This letter is to confirm that RTI International is authorized to conduct data collection for the National
Mental Health Study (NMHS) for the U.S. Department of Health and Human Services.
The NMHS has a rigorous commitment to respondent confidentiality and will increase public awareness
of mental health. The data from this study will provide information for tracking mental health in the
general population.
I want to assure you that this agency and RTI International are committed to full compliance with all
policies regarding security on your property. RTI International's representative will work with you to
develop a mutually agreeable procedure for contacting selected units for voluntary participation in our
study.
Thank you for your assistance. If you have any questions, you may call me at [FILL] (9:00 a.m. to 5:00
p.m., ET, Monday through Friday).
Sincerely,
Lisa J. Colpe, PhD, MPH
National Study Director, DHHS
11
Meet Me Letter
Meet Me Letter – to household or room at Complex/University
[DATE]
Resident
[NAME OF COMPLEX/UNIVERSITY]
[STREET ADDRESS]
[CITY], [STATE] [ZIP]
Dear Resident:
We need your help with the National Mental Health Study (NMHS) conducted by RTI International for
the U.S. Department of Health and Human Services.
A limited number of addresses—including yours—were randomly chosen to take part in this important
study. No other household or person can take your place.
Typically, a professional RTI International interviewer visits each selected residence in person. We
respect the policies of [NAME OF COMPLEX/UNIVERSITY] so we are asking you to speak with our
interviewer, who only needs a few minutes of your time to see if someone in your
[HOUSEHOLD/ROOM] will be chosen for an interview. In appreciation for the time taken to complete
the screening, the household member will receive [FILL: $5/$10 in cash]. Every person who is chosen
and completes the full interview will receive $40 in cash at the end of the interview as a token of
appreciation.
Please meet with our interviewer [FI FIRST/LAST NAME] in [MEETING PLACE]:
Please meet in [MEETING PLACE]:
[DAY OF WEEK], [MONTH] [DATE] [TIME]
OR
[DAY OF WEEK], [MONTH] [DATE] [TIME]
If you are unable to speak with [MR/MS] [LAST NAME], call [FS FIRST/LAST NAME], our
supervisor for your area, at [TOLL FREE NUMBER] (toll free) to request another meeting time.
Any information you provide is kept completely confidential and used only for statistical purposes.
Information gathered from this study will be used by researchers and federal agencies in developing
various medical and health-related policies and programs.
For more details about the study, please visit https://www.nmhsweb.org.
Your visit with [MR/MS] [FI LAST NAME] or call to [MR/MS] [FS LAST NAME] is extremely
important to the success of this study, and I thank you in advance for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
12
Thank You Letter
Thank you letter for help at Complex/Community
[DATE]
[NAME], [TITLE]
[NAME OF COMPLEX/COMMUNITY]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear [MR./MS.] [LAST NAME]:
On behalf of our client, the U.S. Department of Health and Human Services, I would like to express our
most sincere appreciation for the assistance you recently provided our [FI/FS] [CIRCUMSTANCES] at
[NAME OF COMPLEX/COMMUNITY]. It was your cooperation that made it possible for us to meet
our response rate goals in this important national study. Every completed interview helps ensure that the
data collected for the National Mental Health Study (NMHS) are statistically sound. The information
generated from the NMHS will provide the nation’s policymakers with accurate data on a number of
important health issues.
If you have any questions, please do not hesitate to call me during 9:00 am and 5:00 pm (Eastern Time),
Monday through Friday, at [FILL]. Once again, thank you for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
13
Call-Me Letters
No contact and no response to sent letter
[DATE]
Resident
[COMPLEX/COMMUNITY NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear Resident:
Recently we sent a letter requesting your help with the National Mental Health Study conducted by RTI
International for the U.S. Department of Health and Human Services.
A limited number of household addresses—including yours—were randomly chosen to take part in this
important study. No other household or person can take your place. Information gathered from this
study will provide health agencies and researchers with extremely valuable information about mental
health and treatment in the United States. By participating in this study, you will make a direct impact
on important health-related discoveries and decisions.
Typically, a professional RTI International interviewer visits each selected residence in person. We
respect the policies of [COMPLEX/COMMUNITY NAME] and appreciate your desire for privacy, so
we are contacting you by mail instead. Your participation in this study is very important or we would
not continue to try to reach you.
Since we cannot contact you in person, we ask you to please call our supervisor for your area, [FIRST &
LAST NAMES] to set an appointment for an RTI International interviewer to visit your household.
Please call:
[FIRST & LAST NAME]
[PHONE NUMBER] (toll free)
The interviewer only needs a few minutes of your time to see if someone in your household will be
chosen for an interview. In appreciation for the time taken to complete the screening, the household
member will receive [FILL: $5/$10] in cash. Every person who is chosen and completes the full
interview will receive $40 in cash at the end of the interview as a token of appreciation. Any
information you provide is kept completely confidential and will be used only for statistical purposes.
For more details about the study, please visit https://www.nmhsweb.org.
Your call to [MR./MS. LAST NAME] is extremely important to the success of this study, and I thank
you in advance for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
Call Me Letters
No contact with selected R, Call Me letter
[DATE]
Resident
[NAME OF COMPLEX/COLLEGE/UNIVERSITY]
[ADDRESS]
[CITY], [STATE] [ZIP]
Attention: [age and gender of respondent]
Dear Resident:
Recently, an interviewer from RTI International came to your [HOME /RESIDENCE HALL] and asked
you to participate in the National Mental Health Study*. Your participation in this study is
important—which is why we continue to try to reach you.
We want to provide you with additional information about the study:
A limited number of individuals—including you—were randomly chosen to take part. No other
person can take your place in this study.
As a token of our appreciation, you will receive $40 in cash at the end of the interview.
Any information you provide is kept completely confidential and will be used only for statistical
purposes.
For more details about the study, please visit https://www.nmhsweb.org.
We are happy to work around your schedule so that you can be included. Please contact our supervisor
for your area, [FIRST & LAST NAME], to set up an appointment.
Please call:
[FIRST & LAST NAME]
[PHONE NUMBER] (toll free)
If [MR./MS. LAST NAME] is not available when you call, please leave your phone number, address
and the time you wish to be interviewed. [HE/SHE] will call you to confirm your appointment.
Thank you for your time. Your call to [MR./MS. LAST NAME] is very important to the success of this
study, and I thank you in advance for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
_______________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and
Human Services.
Call Me Letters
Call Me Letter to Parent about Adolescent R
[DATE]
Resident
[NAME OF COMPLEX]
[ADDRESS]
[CITY], [STATE] [ZIP]
Attention: Parent of [age and gender of respondent]
Dear Resident:
Recently, an interviewer from RTI International came to your home and asked your
[SON/DAUGHTER] to participate in the National Mental Health Study*. [HIS/HER] participation in
this study is important—which is why we continue to try to reach you.
We want to provide you with additional information about the study:
A limited number of individuals—including your [SON/DAUGHTER]—were randomly chosen
to take part. No other person can take [HIS/HER] place in this study.
As a token of our appreciation, [HE/SHE] will receive $40 in cash at the end of the interview.
All information provided is kept completely confidential and will be used only for statistical
purposes.
For more details about the study, please visit https://www.nmhsweb.org.
We are happy to work around your family’s schedule so that your [SON/DAUGHTER] can be included.
Please contact our supervisor for your area, [FIRST & LAST NAME], to set up an appointment.
Please call:
[FIRST & LAST NAME]
[PHONE NUMBER] (toll free)
If [MR./MS. LAST NAME] is not available when you call, please leave your phone number, address
and the time you wish to be visited for your [SON’S/DAUGHTER’S] interview. [HE/SHE] will call
you to confirm the appointment.
Thank you for your time. Your call to [MR./MS. LAST NAME] is very important to the success of this
study, and I thank you in advance for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
_____________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and
Human Services.
Call Me Letters
Call Me Letter follow-up from previous letter. R not yet selected
[DATE]
Resident
[COMPLEX/COMMUNITY NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear Resident:
Recently we sent a letter requesting your help with the National Mental Health Study conducted by RTI
International for the U.S. Department of Health and Human Services.
A limited number of household addresses—including yours—were randomly chosen to take part in this
important study. No other household or person can take your place. Knowledge gained from this study
will improve our ability to describe and understand mental health issues in the United States.
Typically, a professional RTI International interviewer visits each selected residence in person. We
appreciate your desire for privacy, so we are contacting you by mail instead. Your participation in this
study is very important or we would not continue to try to reach you.
Since we cannot contact you in person, we ask you to please call our supervisor for your area, [FIRST &
LAST NAMES] to set an appointment for an RTI International interviewer to visit your household.
Please call:
[FIRST & LAST NAME]
[PHONE NUMBER] (toll free)
The interviewer only needs a few minutes of your time to see if someone in your household will be
chosen for an interview. In appreciation for the time taken to complete the screening, the household
member will receive [FILL: $5/$10] in cash. Every person who is chosen and completes the full
interview will receive $40 in cash at the end of the interview as a token of appreciation. Any
information you provide is kept completely confidential and will be used only for statistical purposes.
For more details about the study, please visit https://www.nmhsweb.org.
Your call to [MR./MS.] [LAST NAME] is extremely important to the success of this study, and I thank
you in advance for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
Call Me Letters
Call Me Letter to dorm/residence hall; no R selected yet
[DATE]
Resident
[NAME OF RESIDENCE HALL/STUDENT APTS]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear Resident:
We need your assistance with the National Mental Health Study conducted by RTI International for the
U.S. Department of Health and Human Services.
A limited number of addresses—including yours—were randomly chosen to take part in this study. No
other household or person can take your place. Knowledge gained from this study will improve our
ability to describe and understand mental health issues in the United States.
Typically, a professional RTI International interviewer visits each selected residence in person. We
respect the policies of [DORMITORY/RESIDENCE HALL NAME OR COLLEGE/UNIVERSITY
NAME] and appreciate your desire for privacy, so we are contacting you by mail instead. Your
participation in this study is very important or we would not continue to try to reach you.
Since we cannot contact you in person, we ask you to please call our supervisor for your area, [FIRST &
LAST NAMES] to set an appointment for an RTI International interviewer to visit your residence.
Please call:
[FIRST & LAST NAME]
[PHONE NUMBER] (toll free)
The interviewer only needs a few minutes of your time to see if someone living at your residence will be
chosen for an interview. In appreciation for the time taken to complete the screening, the household
member will receive [FILL: $5/$10] in cash. Every person who is chosen and completes the full
interview will receive $40 in cash at the end of the interview as a token of appreciation. Any
information you provide is kept completely confidential and will be used only for statistical purposes.
For more details about the study, please visit https://www.nmhsweb.org.
Your call to [MR./MS.] [LAST NAME] is extremely important to the success of this study, and I thank
you in advance for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
Call Me Letters
Call me letter result of no contact – complex or gated community
[DATE]
Resident
[COMPLEX/COMMUNITY NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Dear Resident:
Recently we sent a letter requesting your help with the National Mental Health Study conducted by RTI
International for the U.S. Department of Health and Human Services.
A limited number of household addresses—including yours—were randomly chosen to take part in this
important study. No other household or person can take your place. Knowledge gained from this study
will improve our ability to describe and understand mental health issues in the United States.
Typically, a professional RTI International interviewer visits each selected residence in person. We
have been unable to contact you in this manner, so we are contacting you by mail instead. Your
participation in this study is very important or we would not continue to try to reach you.
Since we cannot contact you in person, we ask you to please call our supervisor for your area, [FIRST &
LAST NAMES] to set an appointment for an RTI International interviewer to visit your household.
Please call:
[FIRST & LAST NAME]
[PHONE NUMBER] (toll free)
The interviewer only needs a few minutes of your time to see if someone in your household will be
chosen for an interview. In appreciation for the time taken to complete the screening, the household
member will receive [FILL: $5/$10] in cash. Every person who is chosen and completes the full
interview will receive $40 in cash at the end of the interview as a token of appreciation. Any
information you provide is kept completely confidential and will be used only for statistical purposes.
For more details about the study, please visit https://www.nmhsweb.org.
Your call to [MR./MS.] [LAST NAME] is extremely important to the success of this study, and I thank
you in advance for your cooperation.
Sincerely,
Amy Kowalski
National Field Director
National Mental Health Study Field Test,
Supporting Statement
Attachment D – Refusal Letters
Interview [Adult]—Too Busy/No Time (I1)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident:
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study*. At the time, you expressed some reluctance about spending the time
necessary to do the interview.
A limited number of people were randomly selected to represent the population of the U.S. You cannot
be replaced. If you choose not to participate, your experiences and views—as well as the thousands of
people you represent—will not be heard.
As you know, this nation is made up of all kinds of people, and so we are interviewing all kinds of
people—including busy people like you. If we only interviewed people who have a lot of free time, then
active people like yourself would not be fairly represented. Your participation is critical to the success of
this study, and we are happy to make a special effort to work around your schedule so that you can be
included.
We appreciate that your time is precious. As a token of our appreciation, you will receive $40 in cash
at the end of the interview.
We combine your answers with the answers of over a thousand other people and report them only as
overall numbers. The study is set up so that you record most of your own answers—the interviewer never
sees or hears them. Also, the option to refuse to answer any question is always available.
The results of this study will provide health agencies and researchers with extremely valuable information
about mental health and treatment in the United States. By participating in this study, you will have a
direct impact on important health-related discoveries and decisions.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely beneficial
study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
I1
Interview [Adult]—Studies/Government Too Invasive (I2)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study *. At the time, you expressed some concerns about participating in the
study.
We understand that your privacy is important—RTI International does not provide individual answers to
anyone. Your answers are combined with the answers of over a thousand other people and reported only
as overall numbers.
To further protect your privacy, the study is set up so that you record most of your own answers—the
interviewer never sees or hears them. Also, the option to refuse to answer any question is always
available.
A limited number of people were randomly selected to represent the population of the U.S. You cannot
be replaced. If you choose not to participate, your experiences and views—as well as the thousands of
people you represent—will not be heard.
We also appreciate that your time is a precious commodity. As a token of our appreciation, you will
receive $40 in cash at the end of the interview.
The results of this study will provide health agencies and researchers with extremely valuable information
about mental health and treatment in the United States. By participating in this study, you will have a
direct impact on important health-related discoveries and decisions.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions, contact me toll-free at [TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
I2
Interview [Adult]—Needs Clarification (I3)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study*. At the time, you expressed some concerns about the study.
A limited number of people were randomly selected to represent the population of the U.S. You cannot
be replaced. If you choose not to participate, your experiences and views—as well as the thousands of
people you represent—will not be heard.
Your answers to the study questions are combined with the answers of over a thousand other people and
reported only as overall numbers. To further protect your privacy, the study is set up so that you record
most of your own answers—the interviewer never sees or hears them. Also, the option to refuse to answer
any question is always available.
The results of this study will provide health agencies and researchers with extremely valuable information
about mental health and treatment in the United States. By participating in this study, you will make a
direct impact on important health-related discoveries and decisions.
Your participation is critical to the success of this study, and we are happy to make a special effort to
work around your schedule so that you can be included.
We appreciate that your time is a precious commodity. As a token of our appreciation, you will receive
$40 in cash at the end of the interview.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
I3
Interview [Adult]—"Nothing in it for me"/Uncooperative (I4)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study*. At the time, you were not interested in participating. We are writing
this letter to ask you to reconsider.
The results of this study will provide health agencies and researchers with extremely valuable information
about mental health and treatment in the United States. By participating in this study, you will make a
direct impact on important health-related discoveries and decisions.
Without adequate levels of participation, these health-related decisions might not be sufficiently
informed.
A limited number of people were randomly selected to represent the population of the U.S.—and you
were one of them! You cannot be replaced. If you choose not to participate, your experiences and
views—as well as the thousands of people you represent—will not be heard.
We appreciate that your time is a precious commodity. As a token of our appreciation, you will receive
$40 in cash at the end of the interview.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions, contact me toll-free at [TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
I4
Interview [Adult]—Spouse/HH Member will not allow Participation (I5)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study*. At the time, you expressed some concerns about participating in the
study.
We understand that your privacy is important—RTI International does not provide individual answers to
anyone. Your answers are combined with the answers of over a thousand other people and reported only
as overall numbers.
To further protect your privacy, the study is set up so that you record most of your own answers—the
interviewer never sees or hears them. Also, the option to refuse to answer any question is always
available.
A limited number of people were randomly selected to represent the population of the U.S. You cannot
be replaced. If you choose not to participate, your experiences and views—as well as the thousands of
people you represent—will not be heard.
Your participation is critical to the success of this study, and we are happy to make a special effort to
work around your schedule so that you can be included. Please feel free to call me to set up an
appointment at a time that would be convenient for you.
We also appreciate that your time is a precious commodity. As a token of our appreciation, you will
receive $40 in cash at the end of the interview.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions, contact me toll-free at [TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
I5
Interview [Adolescent]—Too Busy/No Time (M1)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study*. At the time, you expressed some reluctance about spending the time
necessary to do the interview.
A limited number of adolescents were randomly selected to represent the adolescent population of the
U.S. You cannot be replaced. If you choose not to participate, your experiences and views—as well as
thousands of other adolescents you represent—will not be heard.
We understand that you have many demands on your time. However, if we only interviewed adolescents
who had lots of free time, then active adolescents like yourself would not be fairly represented. Your
participation is critical to the success of this study, and we are happy to make a special effort to work
around your schedule so that you can be included.
We appreciate that your time is precious to you. As a token of our appreciation, you will receive $40
in cash at the end of the interview.
Please know that your privacy will be protected. Your answers cannot be viewed by anyone—including
your parents. We combine your answers with the answers of hundreds of other adolescents and report
them only as overall numbers. Also, the study is set up so that you record most of your own answers—
the interviewer never sees or hears them. The option to refuse to answer any question is always available.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
M1
Interview [Parent]— Adolescent Exposure (M2)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: Parent/Guardian of [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International asked permission for a young person in your home
to participate in the National Mental Health Study*. At the time, you expressed some reluctance about
exposing your adolescent to questions related to mental health issues.
We understand your concern. Please know that if you allow your adolescent to participate, the option is
always available for him or her to answer “I don’t know” to any question.
A limited number of adolescents were randomly selected to represent the adolescent population of the
U.S. Your adolescent cannot be replaced. We need responses from everyone selected to get an accurate
picture of adolescent health issues. It is not necessary that he or she know anything about mental health
issues to participate in the study.
We also appreciate that your adolescent’s time is a precious commodity. As a token of our
appreciation, your adolescent will receive $40 in cash at the end of the interview. Also, the
interviewer can give your adolescent a Certificate of Participation—some participants have been able to
go to their schools with this certificate and get class or community service credit for participating in the
study.
Thank you for your time. I hope you’ll reconsider and choose to let your adolescent participate in this
extremely important and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
Interview [Adolescent]—Needs Clarification (M3)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study*. At the time, you expressed some concerns about the study.
The results of this study will provide health agencies and researchers with extremely valuable information
about mental health and treatment in the United States. By participating in this study, you will have a
direct impact on important health-related discoveries and decisions.
A limited number of adolescents were randomly selected to represent the adolescent population of the
U.S. You cannot be replaced. If you choose not to participate, your experiences and views—as well as
thousands of other adolescents you represent—will not be heard.
Please know that your privacy will be protected. Your answers cannot be viewed by anyone—including
your parents. We combine your answers with the answers of hundreds of other adolescents and report
them only as overall numbers. Also, the study is set up so that you record most of your own answers—
the interviewer never sees or hears them. The option to refuse to answer any question is always available.
Your participation is critical to the success of this study, and we are happy to make a special effort to
work around your schedule so that you can be included.
We appreciate that your time is a precious commodity. As a token of our appreciation, you will receive
$40 in cash at the end of the interview.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
M3
Interview [Adolescent]—"Nothing in it for me"/Uncooperative (M4)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International came to your home and asked you to participate in
the National Mental Health Study*. At the time, you were not interested in participating. We are writing
this letter to ask you to reconsider.
A limited number of adolescents were randomly selected to represent the adolescent population of the
U.S.—and you were one of them! You cannot be replaced. If you choose not to participate, your
experiences and views—as well as thousands of other adolescents you represent—will not be heard.
The results of this study will provide health agencies and researchers with extremely valuable information
about mental health and treatment in the United States. By participating in this study, you will have a
direct impact on important health-related discoveries and decisions.
We appreciate that your time is a precious commodity. As a token of our appreciation, you will receive
$40 in cash at the end of the interview. Also, your interviewer can give you a Certificate of
Participation—some participants have been able to go to their schools with this certificate and get class or
community service credit for participating in the study.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions, contact me toll-free at [TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
M4
Interview [Parent]—Parent /HH Member will not allow Participation (M5)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Attention: Parent/Guardian of [age] year old [gender] resident
Dear Resident,
Recently, a Field Interviewer from RTI International asked permission for a young person in your home
to participate in the National Mental Health Study*. At the time, you expressed some reluctance about
allowing your adolescent to participate in the study. We are writing this letter to ask you to reconsider.
A limited number of adolescents were randomly selected to represent the adolescent population of the
U.S. Your adolescent cannot be replaced. It is not necessary that he or she know anything about mental
health issues to participate in the study.
If you allow your adolescent to participate, the option is always available for him or her to answer “I
don’t know” or to refuse any question.
We understand that the privacy of your family is important—RTI International does not provide
individual answers to anyone. Your adolescent’s answers would be combined with the answers of
hundreds of other adolescents and reported only as overall totals.
We also appreciate that your adolescent’s time is a precious commodity. As a token of our
appreciation, your adolescent will receive $40 in cash at the end of the interview. Also, the
interviewer can give your adolescent a Certificate of Participation—some participants have been able to
go to their schools with this certificate and get class or community service credit for participating in the
study.
Thank you for your time. I hope you’ll reconsider and choose to let your adolescent participate in this
extremely important and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
M5
Screening—Too Busy/No Time (S1)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Dear Resident,
Recently, a Field Interviewer from RTI International contacted someone in your household about
participating in the National Mental Health Study*. We are sorry we called on your household at an
inconvenient time.
The initial questions for the study only take about five minutes and ask for very general information. In
appreciation for the time taken to complete the screening, the household member will
receive [FILL: $5/$10] in cash. After these initial questions, someone in your household may or may
not be randomly selected to participate in the full interview.
If anyone is selected for the full interview, that person will receive $40 in cash at the end of the
interview as a token of appreciation.
A limited number of households were randomly selected to represent the population of the U.S. Your
household cannot be replaced. If you choose not to participate, your experiences and views—as well as
the thousands of people you represent—will not have a chance to be heard.
As you know, this nation is made up of all kinds of people, and therefore we are talking to all kinds of
people—including busy people like you. If we only interviewed people who have a lot of free time, then
active people like yourself would not be fairly represented. Your participation is critical to the success of
this study, and we are happy to make a special effort to work around your schedule so that you can be
included.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
S1
Screening—Studies /Government Too Invasive (S2)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Dear Resident,
Recently, a Field Interviewer from RTI International contacted someone in your household about
participating in the National Mental Health Study*. We understand that some concerns were expressed
about participating in the study.
Your privacy is important—RTI International does not provide individual answers to anyone. Your
answers are combined with the answers of over a thousand other people and reported only as overall
numbers. To further protect your privacy, the interview is set up so that you record most of your own
answers—the interviewer never sees or hears them.
A limited number of households were randomly selected to represent the population of the U.S. Your
household cannot be replaced. If you choose not to participate, your experiences and views—as well as
the thousands of people you represent—will not have a chance to be heard.
If you agree to participate, the option to refuse to answer any question is always available. The initial
questions for the study only take about five minutes and ask for very general information. In
appreciation for the time taken to complete the screening, the household member will
receive [FILL: $5/$10] in cash. After these initial questions, someone in your household may or may
not be randomly selected to participate in the full interview.
If anyone is selected for the full interview, that person will receive $40 in cash at the end of the
interview as a token of appreciation.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions, contact me toll-free at [TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
S2
Screening—Needs Clarification (S3)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Dear Resident,
Recently, a Field Interviewer from RTI International contacted someone in your household about
participating in the National Mental Health Study*. We understand that some concerns were expressed
about participating in the study.
A limited number of households were randomly selected to represent the population of the U.S. Your
household cannot be replaced. If you choose not to participate, your experiences and views—as well as
the thousands of people you represent—will not have a chance to be heard.
If you agree to participate, the option to refuse to answer any question is always available. The initial
questions for the study only take about five minutes and ask for very general information. In
appreciation for the time taken to complete the screening, the household member will
receive [FILL: $5/$10] in cash. After these initial questions, someone in your household may or may
not be randomly selected to participate in the full interview.
If anyone is selected for the full interview, that person will receive $40 in cash at the end of the
interview as a token of appreciation.
Your answers are combined with the answers of over a thousand other people and reported only as overall
numbers. To further protect privacy, the interview is set up so that the participant records most
answers—the interviewer never sees or hears them.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions or would like to set up an appointment, contact me toll-free at
[TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
Screening—"Nothing in it for me"/Uncooperative (S4)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Dear Resident,
Recently, a Field Interviewer from RTI International contacted someone in your household about
participating in the National Mental Health Study*. We understand that at the time, there was no interest
in participating. We are writing to ask you to reconsider.
The initial questions for the study only take about five minutes and ask for very general information. In
appreciation for the time taken to complete the screening, the household member will
receive [FILL: $5/$10] in cash. After these initial questions, someone in your household may or may
not be randomly selected to participate in the full interview.
If anyone is selected for the full interview, that person will receive $40 in cash at the end of the
interview as a token of appreciation.
A limited number of households were randomly selected to represent the population of the U.S. Your
household cannot be replaced. If you choose not to participate, your experiences and views—as well as
the thousands of people you represent—will not have a chance to be heard.
The results of this study will provide health agencies and researchers with extremely valuable information
about mental health and treatment in the United States. By participating in this study, you can make a
direct impact on important health-related discoveries and decisions.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions, contact me toll-free at [TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
S4
Screening—Spouse/HH Member will not allow Participation (S5)
[DATE]
Resident
[STREET ADDRESS]
[CITY], [STATE] [ZIPCODE]
Dear Resident,
Recently, a Field Interviewer from RTI International contacted someone in your household about
participating in the National Mental Health Study*. We understand that some concerns were expressed
about participating in the study.
Your privacy is important—RTI International does not provide individual answers to anyone. Your
answers are combined with the answers of over a thousand other people and reported only as overall
numbers. To further protect privacy, the interview is set up so that the participant records most
answers—the interviewer never sees or hears them.
If you agree to participate, the option to refuse to answer any question is always available. The initial
questions for the study only take about five minutes and ask for very general information. In
appreciation for the time taken to complete the screening, the household member will
receive [FILL: $5/$10] in cash. After these initial questions, someone in your household may or may
not be randomly selected to participate in the full interview.
If anyone is selected for the full interview, that person will receive $40 in cash at the end of the
interview as a token of appreciation.
A limited number of households were randomly selected to represent the population of the U.S. Your
household cannot be replaced. If you choose not to participate, your experiences and views—as well as
the thousands of people you represent—will not have a chance to be heard.
Your participation is critical to the success of this study, and we are happy to make a special effort to
work around your schedule so that you can be included. Please feel free to call me to set up an
appointment at a time that would be convenient for you.
Thank you for your time. I hope you’ll reconsider and choose to participate in this extremely important
and beneficial study.
Sincerely,
[FS NAME], Field Supervisor
P.S. Please, if you have any questions, contact me toll-free at [TOLL FREE NUMBER].
________________________
*The National Mental Health Study is conducted by RTI International for the U.S. Department of Health and Human Services.
[https://www.nmhsweb.org] [http://www.rti.org]
S5
National Mental Health Study Field Test,
Supporting Statement
Attachment E – Incentive Receipt
Incentive Receipt
U.S. Department of Health and Human Services and RTI International
thank you for participating in the National Mental Health Study.
In appreciation of your participation in this important study, you are eligible to receive $____ in cash.
Since maintaining the confidentiality of your information is important to us, your name will not be entered on this
form. However, the interviewer must sign and date this form to certify you received (or declined) the cash incentive.
__________________________
Interviewer
□
______________
Date
Accepted Cash Incentive
□S □
MI
□
□
FI
__ __ __ __ __ __ __ __ __ __ - __
Case ID
Declined Cash Incentive
□
PI
□
PFI
If you ever feel that you need to talk to someone about mental health issues, you can call the National Lifeline
Network or the Boy’s Town National Helpline. Counselors are available to talk at any time of the day or night
and they can give you information about services in your area.
National Lifeline Network: 1-800-273-TALK or 1-800-273-8255
http://suicidepreventionlifeline.org/
Boy’s Town National Helpline (adolescent): 1-800-448-3000
If you ever feel that you need to talk to someone about drug use issues, you can call the Substance Abuse and Mental
Health Services Administration’s Treatment Referral Helpline. This is a 24-hour service that will help you locate
treatment options near you.
1-800-662-HELP or 1-800-662-4357
1-800-487-4889 (TDD)
http://findtreatment.samhsa.gov
Disposition: Top copy to Respondent, yellow to Field Supervisor, pink to Field Interviewer.
National Mental Health Study Field Test,
Supporting Statement
Attachment G – Study Description
U.S. Department of Health and
Human Services
NMHS Study
Description
The National Mental Health Study (NMHS) is a nationally representative study that will:
•
•
Examine the frequency of a variety of mental health conditions;
Investigate connections between mental health problems and treatment.
Knowledge gained from this study will improve our ability to describe and understand mental
health issues in the United States.
This study is sponsored by the Substance Abuse and Mental Health Services Administration
(SAMHSA) and the National Institute of Mental Health (NIMH), both part of the U.S.
Department of Health and Human Services.
Your address is one of several in this area randomly chosen for the NMHS. Your name and
address will never be connected to your answers. Also, federal law requires us to keep all of
your answers confidential. Any data that you provide will only be used by authorized
personnel for statistical purposes according to the Confidential Information Protection and
Statistical Efficiency Act of 2002.
The screening questions take just a few minutes. We will give you [FILL: $5/$10] when you
finish the screening. If anyone is chosen, the interview will take about an hour. You can
refuse to answer any questions, and you can quit at any time. Each person who is chosen
and completes the interview will receive $40 in cash.
If you have questions about the study, call the Project Representative at 1-800-XXX-XXXX. If
you have questions about your rights as a study participant, call RTI’s Office of Research
Protection at 1-866-214-2043 (a toll-free number). You can also visit our project website:
https://www.nmhsweb.org for more information. Thank you for your cooperation and time.
Lisa J. Colpe, Ph.D., MPH
National Study Director, DHHS
Grace Medley
National Field Director, DHHS
Your confidentiality is protected by the Confidential Information Protection and Statistical Efficiency Act of 2002
(CIPSEA, PL 107-347). Any project staff or authorized data user who violates CIPSEA may be subject to a jail term of up to 5
years, a fine of up to $250,000, or both.
NOTICE: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (XXXX-XXXX); Room 15E57B; 5600 Fishers
Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is XXXX-XXXX, expiration date XX/XX/XX.
National Mental Health Study Field Test,
Supporting Statement
Attachment J – Question & Answer Brochure
Answers
to your questions
If you have more questions
about the NMHS, please call
[FILL]
or visit our website at
https://www.nmhsweb.org
National Mental
Health Study
For more information on SAMHSA,
NIMH, or RTI International, contact:
The National Mental Health Study (NMHS)
will provide up-to-date information on
a variety of mental health conditions in
the United States. This important study
will explore connections between mental
health issues and services. The NMHS is
sponsored by the Substance Abuse and
Mental Health Services Administration
(SAMHSA) and the National Institute
of Mental Health (NIMH), both part
of the U.S. Department of Health and
Human Services (DHHS). This study is
being conducted by RTI International, a
nonprofit research organization.
The NMHS asks questions about mental
health and other health-related topics.
This year almost 1,200 people from across
the United States will be interviewed for
this study.
The NMHS National Field Director
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709
www.rti.org
RTI International is a registered trademark
and a trade name of Research Triangle Institute.
What Is the
National
Mental Health
Study?
Sponsored by SAMHSA, NIMH, and the
U.S. Department of Health and Human Services (DHHS).
Conducted by RTI International.
Information from the NMHS will be used
to evaluate mental health trends, examine
treatment programs, and assist with the
creation of government policy.
Answers to Your Important Questions about the National Mental Health Study
Why Should I Participate?
How Was I Chosen?
You are important! Your household was one of
only a few in this area selected for this study,
and no other household or person can take
your place.
Household addresses, not specific people,
are randomly selected through scientific
methods. Once a household has been
selected, it cannot be replaced for any reason.
This ensures that the NMHS accurately
represents the many different types of people
in the United States.
Every person who is chosen and completes
the full interview will receive $40 in cash at
the end of the interview in appreciation for
their help.
Your participation will also provide vital
information to researchers and federal
agencies about mental health conditions and
treatment.
What if I Do Not Have Mental
Health Problems?
The responses of people who do not
experience mental health problems are
just as important as the responses of people
who do.
While some questions ask about mental
health problems, other questions ask about a
number of health-related topics relevant for
all people. You do not need to know anything
about mental illness to answer the questions.
A professional RTI International interviewer
will visit your household to ask several general
questions that take only a few minutes to
answer. Afterward, one or possibly two
members of your household may be asked to
complete the full interview. It is possible that
no one in your household will be chosen for
the interview.
What Will Happen During
the Interview?
An interviewer will conduct the interview
with each selected person using a laptop
computer. No prior computer skills are
necessary.
Participants will answer most of the
interview questions in private, entering their
responses directly into the computer. For
other questions, the interviewer will read the
Your household has been chosen at random, but no one
else can take your place. Your participation matters!
What Is the Substance Abuse
and Mental Health Services
Administration (SAMHSA)?
SAMHSA was created to improve the lives
of people with or at risk for mental and
substance use disorders. SAMHSA’s mission is
to reduce the impact of substance abuse and
mental illness on America’s communities.
SAMHSA selected RTI to conduct the NMHS.
What Is the National Institute
of Mental Health (NIMH)?
questions aloud and enter the participant’s
responses into the computer.
The interview takes about one hour to
complete. People who complete the full
interview will receive $40 at the end of the
interview as a token of our appreciation.
All information collected for this study will be
kept confidential and used only for statistical
purposes, as required by federal law—the
Confidential Information Protection and
Statistical Efficiency Act of 2002 (CIPSEA).
NIMH is the lead federal agency for research
on mental disorders. The mission of the
NIMH is to transform the understanding and
treatment of mental illnesses through basic
and clinical research, paving the way for
prevention, recovery, and cure.
What Is the U.S. Department
of Health and Human Services
(DHHS)?
DHHS is the nation’s principal agency for
protecting the health of all Americans and
providing essential human services. The
mission of DHHS is to enhance and protect
the health and well-being of all Americans.
SAMHSA and NIMH are both part of DHHS.
National Mental Health Study Field Test,
Supporting Statement
Attachment O – Confidentiality and Data
Collection Agreements
CIPSEA Confidentiality Agreement, SAMHSA/CBHSQ
Administered by RTI International
This agreement is intended for review and signature by employees of RTI International and all its subcontractors who have
access to information designated as confidential on a research study sponsored by SAMHSA/CBHSQ covered under CIPSEA.
This agreement must be renewed each year as part of mandated CIPSEA training to maintain access to confidential project
information.
Assurances of Confidentiality under CIPSEA
For any research study sponsored by the Substance Abuse and Mental Health Services Administration’s (SAMHSA)
Center for Behavioral Health Statistics and Quality (CBHSQ) that is covered under the Confidential Information
Protection and Statistical Efficiency Act (CIPSEA) of 2002* and Section 501(n) of the Public Health Service Act, all
data and associated materials collected and/or utilized on that study are subject to protection by CIPSEA. CIPSEA
ensures the confidentiality of all information provided is protected by Federal Law and stipulates that all
information collected shall be used exclusively for statistical purposes. All research subjects contacted on
SAMHSA/CBHSQ’s behalf by RTI International are notified of these protections prior to study participation.
You have been identified as a person who has access to confidential information on a SAMHSA/CBHSQ-sponsored
study covered under CIPSEA (NSDUH, DAWN, and/or NMHS**) and therefore have been designated as an Agent
under CIPSEA. This confidential information includes (but is not limited to) all electronic and hard copy documents
containing respondent information and data, as well as non-data related records containing information that could
identify a location or respondent associated with a particular study.
Protection Agreement under CIPSEA
Per CIPSEA regulations, you agree that any materials that would permit the identification of research subjects are
to be treated as confidential, and that you will never share or use that confidential information with anyone else or
in a manner other than those authorized by CBHSQ. This includes never disclosing confidential information with
law enforcement officials, officers of the court or your supervisor (if not also authorized as an Agent).
To ensure the protection of all confidential information in both physical and electronic form, as an Agent, you also
agree to:
1) keep all confidential information in a space where access is limited only to authorized personnel,
whether on a computer or in hard copy form;
2) keep all confidential information within computer memory controlled by password protection;
3) maintain a secure location (such as file cabinet or locked drawer) for printed materials, diskettes, and
data on hard disks of personal computers when not in use;
4) never remove confidential information from your approved worksite without prior approval from
CBHSQ and/or RTI International;
5) never permit any unauthorized removal of any confidential project information from the limited access
space protected under the provisions of this agreement without first notifying and obtaining written
approval from RTI;
6) notify RTI when you no longer have access to electronic or hard copy files or printed materials
containing confidential project information;
* Public Law 107-347, Title V; for more info: http://www.whitehouse.gov/omb/fedreg/2007/061507_cipsea_guidance.pdf
**National Survey on Drug Use and Health (NSDUH); Drug Abuse Warning Network (DAWN); National Mental Health Study (NMHS)
v. 7.15
CIPSEA Confidentiality Agreement, SAMHSA/CBHSQ
Administered by RTI International
7) when appropriate, return all confidential project information to RTI;
8) complete annual training on restrictions associated with the use of confidential information;
9) agree that representatives of CBHSQ have the right to make unannounced and unscheduled
inspections of the facilities where you work to evaluate compliance with this agreement;
10) notify RTI International immediately upon receipt of any legal, investigatory, or other demand for
disclosure of confidential project information;
11) notify RTI International immediately upon discovering any breach or suspected breach of security or
any disclosure of confidential project information to unauthorized parties or agencies.
12) and agree that obligations under this agreement will survive the termination of any assignment with
SAMHSA/CBHSQ and/or RTI International.
Penalties under CIPSEA
Any violation of the terms and conditions of this agreement may subject you, the Agent, to immediate termination
of access to confidential information by RTI International or CBHSQ, and will require the immediate return of all
electronic and hard copy files and materials in your possession.
Any violation of this agreement may also be a violation of Federal criminal law under Title V, subtitle A of the EGovernment Act of 2002 (P.L. 107-347); and/or Section 501(n) of the Public Health Services Act. Alleged violations
under the Title V, subtitle A of the E-Government Act of 2002 are subject to prosecution by the United States
Attorney. The penalty for violation of subtitle A of the E-Government Act of 2002 is a fine of not more than
$250,000 and imprisonment for a period of not more than 5 years. In addition to the above, all relevant statutory
and regulatory penalties apply.
Your signature (whether in electronic or written form) below affirms your understanding and acknowledgement of
all the regulations, requirements and penalties associated with CIPSEA as part of your work on this
SAMHSA/CBHSQ project for RTI International.
Name
ID Number (if applicable, RTI employees only)
Signature
Company Name
Date
Job Title
v. 7.15
DATA COLLECTION AGREEMENT
Project Name:
.
Project No.:
National Mental Health Study
0213985
.
I, __________________________________________, an employee of Headway, agree to provide field data collection
services for the benefit of RTI in connection with the RTI Project shown above (“the Project”). Further, I
1)
am aware that the research being conducted by RTI is being performed under contractual arrangement with the
Substance Abuse and Mental Health Services Administration (SAMHSA);
2)
hereby accept all duties and responsibilities of performing specified data collection tasks and will do so
personally, in accordance with the training and guidelines provided to me. At no time will I engage the services
of another person to perform any data collection tasks for me without the prior written approval of both my
employer (Headway) and RTI;
3)
agree to treat as confidential all information secured during interviews or obtained in any Project-related way
during the period I am working on the Project, as required by the Confidential Information Protection and
Statistical Efficiency Act of 2002 (CIPSEA), and understand, under Section 513 of this Act, I am subject to
criminal felony penalties of imprisonment for not more than five years, or fines of not more than $250,000, or
both, for voluntary disclosure of confidential information. Any breach of confidentiality must be reported
immediately to the National Field Director. This information will be shared with the National Field Director, the
SAMHSA Project Officer and Headway. I have also completed and fully understand the CIPSEA training
provided to me;
4) agree to treat as confidential and proprietary to RTI/SAMHSA any and all information provided by the
public, whether collected or accessed in electronic or printed form during the course of my service on this
Project, including but not limited to all data collection computer software and respondent data, and will protect
such items from unauthorized use or disclosure;
5) am aware that the survey instruments completed form the basis from which all analyses will be drawn, and
therefore, agree that all work for which I submit invoices will be legitimate, of high quality and performed in
compliance with all Project specifications to ensure the scientific integrity of the data;
6) understand that I am fully and legally responsible for taking all reasonable and appropriate steps to ensure that
any computer equipment issued to me for use on this Project is safeguarded against damage, loss, or theft. I also
understand that I have a legal obligation to immediately return all equipment at the conclusion of my
assignment or at the request of my supervisor;
7) fully agree to conduct myself at all times in a manner that will obtain the respect and confidence of all
individuals that I encounter as a representative of the Project and I will not betray this confidence by divulging
information obtained to anyone other than authorized Project representatives of RTI;
8) understand that evidence of falsification, fabrication or distortion of any data collected for this Project will
be reported to RTI's Scientific Integrity Committee, and such acts are grounds for immediately removing me
from the Project and can result in my suspension from any government-funded research. Also, if falsification of
data is substantiated, I understand a formal fraud complaint will be submitted to the U.S. Department of
Health and Human Services’ Office of Inspector General (OIG) and I could be subject to criminal and/or
civil prosecution and thereby face imprisonment, financial penalties or both;
9)
understand my obligations under this agreement supersede any prior or existing agreements on the same subject
matter and will survive the termination of any assignment with RTI and/or my employment by Headway.
10) understand any involvement in the study is for research purposes only. I cannot and will not utilize clinical
knowledge or skills to provide medical or psychiatric advice, diagnosis or treatment to respondents.
_________________________________________________________
__________________________
Employee Signature
Date
Disposition: Original to Headway, Yellow retained by employee.
7/15
National Mental Health Study Field Test,
Supporting Statement
Attachment P – Federalwide Assurance
http://ohrp.cit.nih.gov/search/IOrgDtl.aspx
National Mental Health Study Field Test,
Supporting Statement
Attachment Q – NMHS Fact Sheet
National Mental Health Study
NMHS
SAMHSA,
NIMH, and RTI
Fact Sheet
Substance Abuse and Mental Health Services
Administration (SAMHSA)
National Institute of Mental Health
(NIMH)
The Substance Abuse and Mental Health Services Administration
(SAMHSA) is the agency within the U.S. Department of Health and
Human Services that leads public health efforts to improve the
behavioral health of the nation. SAMHSA’s mission is to reduce the
impact of substance abuse and mental illness in the United States.
The National Institute of Mental Health (NIMH) is the
lead federal agency for research on mental disorders.
NIMH is one of 27 Institutes and Centers that make
up the National Institutes of Health (NIH), the nation’s
medical research agency. NIH is part of the U.S.
Department of Health and Human Services.
SAMHSA provides leadership and dedicates its resources, including
programs, policies, information and data, and contracts and grants,
to help the United States act on the knowledge that:
• Behavioral health is essential for overall well-being.
• Prevention works.
• Treatment is effective.
• People recover from mental and substance use disorders.
Fundamental to the NIMH mission is the idea that mental
illnesses are brain disorders expressed as complex
cognitive, emotional, and behavioral syndromes.
The Center for Behavioral Health Statistics and Quality (CBHSQ),
one of SAMHSA’s four centers, is the main point for the collection,
analysis, and distribution of national data on practices and issues
related to substance abuse and mental disorders. This center is
responsible for the National Mental Health Study (NMHS) and the
Behavioral Health Services Information System (BHSIS), among
other studies.
As such, NIMH fosters innovative thinking and
encourages a full array of novel scientific perspectives
to further discovery in the evolving science of brain,
behavior, and experience.
To fulfill its vital public health charge, NIMH scientific
research is guided by the following high-level objectives:
CBHSQ is responsible for supervising the National Survey on Drug
Use and Health (NSDUH). This is an annual nationwide survey
involving interviews with approximately 70,000 randomly selected
individuals aged 12 or older. Data from the NSDUH provide national
and state-level estimates on the use of tobacco products, alcohol,
illicit drugs (including nonmedical use of prescription drugs), and
mental health in the United States.
For more information about SAMHSA, contact:
SAMHSA, Center for Behavior Health
Statistics and Quality
5600 Fishers Lane
Rockville, MD 20857
Email: CBHSQRequest@samhsa.hhs.gov
www.samhsa.gov
RTI International
RTI International was created in 1958 as the Research Triangle
Institute (RTI) through a partnership with Duke University in
Durham, the University of North Carolina at Chapel Hill, and
North Carolina State University in Raleigh and has become an
independently operating, nonprofit organization dedicated to
doing research that improves the human condition.
RTI offers innovative research and technical solutions
to governments and businesses worldwide in the areas
of surveys and statistics, health and pharmaceuticals,
advanced technology, education and training, economic
RTI International is a registered trademark and a trade name of Research
Triangle Institute.
The mission of NIMH is to transform the understanding
and treatment of mental illnesses through basic and
clinical research, paving the way for prevention,
recovery, and cure.
• Define the mechanisms of complex behaviors.
• Chart mental illness trajectories to determine when,
where, and how to intervene.
• Strive for prevention and cures.
• Strengthen the public health impact of NIMHsupported research.
• For
Strengthen
the publicabout
healthNIMH,
impact
of NIMHmore information
contact:
National Institute of Mental Health
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard, Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 1-866-615-6464 (toll-free)
Email: nimhinfo@nih.gov
www.nimh.nih.gov
and social policy, international development, energy, and the
environment.
SAMHSA selected RTI to conduct the NMHS.
For more information about RTI, contact:
NMHS National Field Director
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709
Phone: 1-800-848-4079
https://www.nmhsweb.org
http://www.rti.org
National Mental Health Study Field Test,
Supporting Statement
Attachment R – NIMH Articles and Information
Sheets
Year
Past
the
in
Services
Health
Mental
Received
Illness
Mental
Any
with
Adults
Young
of
One-Third
National Survey on Drug Use and Health
Spotlight
July 14, 2016
ONE-THIRD OF YOUNG ADULTS WITH ANY MENTAL ILLNESS
RECEIVED MENTAL HEALTH SERVICES IN THE PAST YEAR
According to data from the 2014 National Survey on Drug Use and Health,
among adults with any mental illness (AMI),1 young adults aged 18 to 25 are less
likely to receive mental health services than adults aged 26 to 49 or adults aged
50 or older (33.6 vs. 44.2 or 49.9 percent, respectively).2
Mental health service use among young adults
aged 18 to 25 with any mental illness: 2014
In 2014, about 2.4 million, or 33.6 percent, of young adults with AMI received
mental health services such as inpatient services, outpatient services, or
prescription medication in the past year. This means that about two-thirds (66.4
percent) of young adults with AMI are not receiving potentially needed mental
health services. Of young adults with AMI, about 1 in 4 received prescription
medication (25.5 percent) and 1 in 5 received outpatient services (21.3 percent).
In the past year, 3.7 percent of young adults with AMI received inpatient
services.
Because young adults with AMI are less likely to receive services than adults in
other age groups, young adults may benefit from developmentally appropriate
services to facilitate the transition to adulthood.3 Young adults with AMI may
want to talk to a mental health care professional to find out what type of
services would best meet their needs. The Substance Abuse and Mental Health
Services Administration provides resources for those seeking mental health care
services. For information on accessing treatment, please visit
https://findtreatment.samhsa.gov.
Source: National Survey on Drug Use and Health
1. Any mental illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder.
2. Center for Behavioral Health Statistics and Quality. (2015). Tables 1.22A and 1.22B. In 2014 National Survey on Drug Use and Health: Detailed tables. Retrieved from
http://www.samhsa.gov/data/
3. Miller, S., Ringeisen, H., Munoz, B., Hedden, S. L., Colpe, L. J., Rohloff, H., & Embry, V. (2016). Correlates of mental health service use among young adults with mental illness:
Results from the National Survey on Drug Use and Health. Psychiatric Services. Advance online publication. doi:10.1176/appi.ps.201400486
Source: National Surveys on Drug Use and Health (NSDUH), 2014. The NSDUH is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey
collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their places of residence.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the
behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. The Data Spotlight may be copied without permission.
Citation of the source is appreciated. Find this report and those on similar topics online at http://www.samhsa.gov/data/.
Settings
Medical
General
and
Educational,
Specialty,
in
Services
Using
for
Reasons
and
Use
Service
Health
Mental
Adolescent
National Survey on Drug Use and Health
Short Report
May 05, 2016*
ADOLESCENT MENTAL HEALTH SERVICE USE AND
REASONS FOR USING SERVICES IN SPECIALTY,
EDUCATIONAL, AND GENERAL MEDICAL SETTINGS
AUTHORS
Rachel N. Lipari, Ph.D., Sarra Hedden, Ph.D., Gary Blau, Ph.D., and Lisa Rubenstein, MHA
In Brief
INTRODUCTION
Substance use and mental health issues (i.e., behavioral health issues) affect millions of
adolescents in the United States. Half of all lifetime cases of mental disorders begin by age
14,1 and about 1 in 4 adolescents experience mental disorders that result in severe
impairment.2 Although many disorders can be treated, almost half of adolescents with
mental health issues do not receive any mental health services.3,4 Ensuring that the mental
health needs of adolescents are met has long-term implications. Research indicates that
older adolescents with mental health issues are less likely than their peers without mental
health issues to have the foundation needed to succeed as young adults.5 For example,
adolescents who had experienced a major depressive episode (MDE) were more likely than
those who had not had MDE to do poorly in school and to engage in delinquent behaviors.5
When adolescents do receive mental health services, care may occur across a variety of
settings, such as educational or primary care settings. Understanding whether and where
adolescents receive mental health services is important to understand where there may be
gaps in care, and may help policymakers, mental health providers, and parents expand and
improve access to care.
The National Survey on Drug Use and Health (NSDUH) includes questions on adolescent
mental health service utilization that ask all respondents aged 12 to 17 whether they
received any treatment or counseling within the 12 months before the interview for
problems with emotions or behavior. Respondents are asked whether they received these
mental health services in several settings: (1) specialty mental health settings (inpatient or
outpatient care), (2) educational settings (talked with a school social worker, psychologist, or
counselor about an emotional or behavioral problem; participated in a program for students
with emotional or behavioral problems while attending a regular school; or attended a school
for students with emotional or behavioral problems), or (3) general medical settings (care
from a pediatrician or family physician for emotional or behavioral problems). Adolescents
aged 12 to 17 were also asked the reasons they received mental health care from
each reported mental health service (i.e., specialty setting, educational setting, and
●
●
●
●
●
●
Adolescents receive mental health services in a
variety of settings. Of the 24.9 million adolescents
aged 12 to 17 in the United States in 2014, 3.4
million received mental health services in a
specialty setting (i.e., inpatient or outpatient
mental health setting), 3.2 million received
services in an educational setting, and 700,000
received services in a general medical setting.
Among adolescents, females were more likely than
males to receive mental health services regardless
of the mental health services sertting.
Older adolescents (aged 16 or 17) were less likely
than younger adolescents to receive mental health
services in an educational setting.
Adolescents living in rural areas were less likely
than those living in urban areas to receive mental
health services in a general medical setting.
Asian adolescents were less likely than
adolescents of most other races/ethnicities to
receive mental health services regardless of the
mental health services setting.
Although adolescents accessed mental health
services in a variety of settings, their reasons for
obtaining help were similar. For example,
regardless of the setting, approximately half of
adolescents reported that they received mental
health services because they felt depressed.
general medical setting). Respondents could indicate multiple reasons for the last time they received mental health care; thus, the response
categories are not mutually exclusive.6 Note that NSDUH does not collect data on the presence of one or more mental disorders among
adolescents. Therefore, this report focuses on the use of mental health services among all adolescents.
This issue of The CBHSQ Report uses 2014 NSDUH data from approximately 17,000 adolescents aged 12 to 17 to examine the prevalence of
mental health service use among adolescents and the reasons these adolescents receive mental health services. Results are presented for
adolescents aged 12 to 17 overall, and by age subgroups (i.e., 12 or 13, 14 or 15, and 16 or 17), gender, race/ethnicity, and rural residence
status.7,8 Only comparisons that are statistically significant at the .05 level are discussed in this report.
ADOLESCENT RECEIPT OF MENTAL HEALTH SERVICES IN A SPECIALTY SETTING
In 2014, an estimated 13.7 percent of adolescents aged 12 to 17 received mental health services in a specialty mental health setting (inpatient
or outpatient care) for problems with emotions or behaviors in the past 12 months. This represents an estimated 3.4 million adolescents out of
the 24.9 million in the United States who are receiving mental health services in a specialty mental health setting. The adolescents who received
mental health services in a specialty mental health setting could receive these services as part of inpatient and/or outpatient care. In 2014,
approximately 606,000 adolescents received inpatient or residential specialty mental health services, and 3.1 million received outpatient
specialty mental health services in the past year.9
To present a more complete picture of adolescent mental health service use, this report examines the demographic characteristics of
adolescents aged 12 to 17 who received mental health services in a specialty mental health setting in the past 12 months. There were no
statistically significant differences in receipt of mental health services by age group; however, adolescent females were more likely to have
received mental health services in a specialty setting than adolescent males (17.0 vs. 10.6 percent; Figure 1). Asian adolescents were less likely
to have received mental health services in a specialty setting than adolescents of other races/ethnicities (Figure 2). There were no statistically
significant differences in adolescent receipt of mental health services in a specialty setting by rural residence status (13.8 percent among those
living in urban areas and 11.3 percent among those living in rural areas).
Figure 1. Receipt of mental health services in a specialty setting in the past
year among adolescents aged 12 to 17, by age group and gender: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Figure 2. Receipt of mental health services in a specialty setting in the past
year among adolescents aged 12 to 17, by race/ethnicity and rural residence
status: 2014
Note: Data for Native Hawaiians or Other Pacific Islanders are suppressed because of
low precision.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
ADOLESCENT RECEIPT OF MENTAL HEALTH SERVICES IN AN EDUCATIONAL SETTING
Adolescents were also asked whether they had received mental health services in an educational setting in the past 12 months for an emotional
or behavioral problem. Because most adolescents are in school and mental health concerns may affect performance or behavior in school, an
educational setting is an opportunity to identify and provide services to adolescents who may need mental health services. Receipt of mental
health services in an educational setting is defined in NSDUH as a nonspecialty mental health setting. In 2014, 13.2 percent of adolescents aged
12 to 17 received mental health services in an educational setting in the past year. This translates to approximately 3 million adolescents
receiving services in an educational setting.10
Adolescents aged 16 or 17 were less likely to receive mental health services in an educational setting than those aged 12 or 13 and 14 or 15
(11.3 vs. 15.1 and 13.5 percent, respectively; Figure 3). Adolescent females were more likely to have received mental health services in an
educational setting than adolescent males (15.2 vs. 11.4 percent). Black adolescents were more likely to receive mental health services in an
educational setting than white, Hispanic, American Indian or Alaska Native, or Asian adolescents (16.7 vs. 13.1, 12.6, 10.1, and 8.0 percent,
respectively; Figure 4). There were no statistically significant differences in adolescent receipt of mental health services in an educational setting
by rural or urban residence status (13.3 percent among those living in urban areas and 12.3 percent among those living in rural areas).
Figure 3. Receipt of mental health services in an educational setting in the
past year among adolescents aged 12 to 17, by age group and gender: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Figure 4. Receipt of mental health services in an educational setting in the
past year among adolescents aged 12 to 17, by race/ethnicity and rural
residence status: 2014
Note: Data for Native Hawaiian or Other Pacific Islanders are suppressed because of
low precision.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
ADOLESCENT RECEIPT OF MENTAL HEALTH SERVICES IN A GENERAL MEDICAL SETTING
Some adolescents receive mental health care in another nonspecialty location, referred to as a general medical setting. In 2014, 2.9 percent of
adolescents aged 12 to 17 received mental health services in a general medical setting in the past year. This translates to approximately
700,000 adolescents receiving mental health services in a general medical setting.10
The percentage of adolescents who received mental health services in a general medical setting did not differ statistically by age group
(Figure 5). Adolescent females were more likely to have received mental health services in a specialty setting than adolescent males (3.4 vs.
2.3 percent). Receipt of mental health services in a general medical setting differed by race/ethnicity. For example, although the percentage of
white adolescents (3.4 percent) receiving mental health services in a general medical setting did not differ statistically from the percentage of
American Indian and Alaska Native adolescents receiving services (6.3 percent), white adolescents were more likely to receive mental health
services in a general medical setting than black, Hispanic, or Asian adolescents (3.4 vs. 1.9, 2.1, and 1.5 percent, respectively; Figure 6).
Adolescents living in a rural area were less likely than adolescents living in an urban area to receive mental health services in a general medical
setting (1.0 vs. 2.9 percent).
Figure 5. Receipt of mental health services in a general medical setting in
the past year among adolescents aged 12 to 17, by age group and gender:
2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Figure 6. Receipt of mental health services in a general medical setting in
the past year among adolescents aged 12 to 17, by race/ethnicity and rural
residence status: 2014
Note: Data for Native Hawaiians or Other Pacific Islanders are suppressed because of
low precision.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
REASONS FOR RECEIVING MENTAL HEALTH SERVICES IN A SPECIALTY SETTING
The 3.4 million adolescents who received mental health services in a specialty setting were asked to identify one or more reasons why they
received mental health treatment.6 Reasons that adolescents received mental health services were based on respondent self-reports and
therefore do not necessarily indicate clinical diagnoses for specific mental disorders.
Of the 3.4 million adolescents aged 12 to 17 in 2014 who received specialty mental health services, about half (56.5 percent) reported receiving
services because they felt depressed (Figure 7). Other commonly reported reasons for receiving services in a specialty setting included thinking
about or attempting suicide (29.1 percent), feeling very afraid or tense (29.0 percent), having problems with home or family situations (26.6
percent), having broken rules or "acted out" (20.8 percent), having problems at school (18.1 percent), having trouble controlling anger (16.7
percent), having problems with friends (13.0 percent), and having eating problems (12.0 percent). Other less frequently reported reasons for
receiving mental health services in a specialty setting are shown in Figure 7.
Figure 7. Reasons for receiving mental health services in the past year
among adolescents aged 12 to 17 who received mental health services in a
specialty setting in the past year: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
REASONS FOR RECEIVING MENTAL HEALTH SERVICES IN AN EDUCATIONAL SETTING
Adolescents who received mental health services in an educational setting were asked to identify one or more reasons why they received mental
health treatment.6 Similar to adolescents who received mental health services in a specialty setting, nearly half (44.3 percent) of adolescents
who received mental health services in an educational setting reported receiving services because they felt depressed (Figure 8). Other
commonly mentioned reasons adolescents received mental health services in an educational setting were having problems at school (22.9
percent), feeling very afraid or tense (21.2 percent), having broken rules or "acted out" (18.6 percent), having problems with friends (17.9
percent), thinking about or attempting suicide (15.8 percent), having problems with home or family situations (14.6 percent), and having trouble
controlling anger (10.0 percent). Other less frequently reported reasons for receiving mental health services in an educational setting are shown
in Figure 8.
Figure 8. Reasons for receiving mental health services in the past year
among adolescents aged 12 to 17 who received mental health services in an
educational setting in the past year: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
REASONS FOR RECEIVING MENTAL HEALTH SERVICES IN A GENERAL MEDICAL SETTING
Consistent with adolescents who received services in a specialty setting or in an educational setting, about half (52.1 percent) of adolescents
receiving services in a general medical setting in 2014 reported that they received services because they felt depressed (Figure 9).6 Nearly 1 in 5
adolescents reported that they received mental health services in a general medical setting because they were thinking about or attempting
suicide (23.4 percent), and about 1 in 4 adolescents were receiving services because they felt very afraid or tense (21.7 percent). Other
commonly mentioned reasons for receiving mental health services in a general medical setting were having eating problems (12.3 percent) or
having broken rules or "acted out" (12.3 percent). Other less frequently reported reasons for receiving mental health services in a general
medical setting are shown in Figure 9.
Figure 9. Reasons for receiving mental health services in the past year
among adolescents aged 12 to 17 who received mental health services in a
general medical setting in the past year: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
DISCUSSION
Receiving services for behavioral health needs can improve health and social outcomes for adolescents as they transition into adulthood.11 About
1 in 4 adolescents experience mental disorders that result in severe impairment, which highlights the need for early intervention.2 This report
shows that of the 24.9 million adolescents in the United States, approximately 3.4 million received services in a specialty setting, 3.2 million
received services in an educational setting, and 700,000 received services in a general medical setting.9 Across all three types of settings,
female adolescents were more likely than males to have received mental health services. Adolescents aged 16 or 17 were less likely to receive
services in an educational setting than younger adolescents. The use of mental health services among adolescents by race/ethnicity varied
across the three settings. Although white adolescents were more likely to receive mental health services in a specialty setting or in a general
medical setting, black adolescents were more likely to receive services in an educational setting. Compared with their counterparts, Asian
adolescents were least likely to receive mental health services across any of the three settings. Adolescents living in rural areas were less likely
than adolescents living in more urban areas to receive services in a specialty setting or in a general medical setting.
This report also examined the variety of reasons that adolescents receive mental health services. Across all three settings, approximately half
reported that they received services because they felt depressed. Another common reason for receiving mental health services across all three
settings was feeling afraid or tense. The percentage of adolescents reporting that they were receiving services because they were thinking about
or attempting suicide ranged from 15.8 percent in an educational setting to 29.1 percent in a specialty setting. Although adolescents were
accessing mental health services in a variety of settings, their reasons for obtaining help were similar.
The Substance Abuse and Mental Health Services Administration provides information about where to find mental health treatment at
https://findtreatment.samhsa.gov. When adolescents feel that they are in an immediate crisis, they can call the National Suicide Prevention
Lifeline at 1-800-273-TALK (8255). Resources to help parents, teachers, and caregivers locate mental health services are available from
www.samhsa.gov.
ENDNOTES
1. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005, June). Prevalence, severity, and comorbidity of 12-month DSM-IV
disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.
2. Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents:
Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry,
49(10), 980–989.
3. Center for Behavioral Health Statistics and Quality. (2013). Results from the 2012 National Survey on Drug Use and Health: Mental health findings (HHS
Publication No. SMA 13-4805, NSDUH Series H-47). Rockville, MD: Substance Abuse and Mental Health Services Administration.
4. Merikangas, K. R., He, J.-P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in U.S.
adolescents: Results of the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent
Psychiatry, 50(1), 32–45.
5. Center for Behavioral Health Statistics and Quality. (2014). The CBHSQ Report: Serious mental health challenges among older adolescents and young
adults. Rockville, MD: Substance Abuse and Mental Health Services Administration.
6. Respondents who did not indicate receiving mental health care from a particular mental health service category for any of the reasons listed were
excluded.
7. NSDUH collects information on race following guidance from the U.S. Office of Management and Budget's 1997 Revisions to the Standards for the
Classification of Federal Data on Race and Ethnicity. NSDUH first asks respondents if they are of Hispanic or Latino origin; respondents are then asked to
identify which racial groups describe them: white, black or African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander,
Asian, or other. Respondents could choose more than one racial group.
8. Rural residence status is based on the characteristics of the county in which an adolescent resides. Counties were grouped based on the Rural-Urban
Continuum Codes developed by the U.S. Department of Agriculture. Large metropolitan (large metro) areas have a population of 1 million or more. Rural
residence status was defined as living in counties with a population of fewer than 2,500 in urbanized areas. Adolescents living in rural areas were
compared with their counterparts not living in rural areas.
9. Adolescents can receive mental health services in more than one setting, including specialty mental health services, mental health services in an
educational setting, and mental health services in a general medical setting. For example, adolescents could have received both outpatient specialty
mental health services and inpatient or residential specialty mental health services. As a result, the number of adolescents receiving either outpatient or
inpatient or residential services may exceed the total number (3.4 million) of adolescents receiving any mental health services in a specialty mental
health setting.
10. Respondents with unknown receipt of mental health services information were excluded.
11. Government Accountability Office. (2008). Young adults with serious mental illness: Some states and federal agencies are taking steps to address their
transition challenges (GAO-08-678). Washington, DC: Author.
SUGGESTED CITATION
Lipari, R.N., Hedden, S., Blau, G. and Rubenstein, L. Adolescent mental health service use and reasons for using services in specialty,
educational, and general medical settings. The CBHSQ Report: May 5, 2016. Center for Behavioral Health Statistics and Quality, Substance Abuse
and Mental Health Services Administration, Rockville, MD.
SUPPORTING TABLES
Table S1. Receipt of mental health services in a specialty setting in the past
year among adolescents aged 12 to 17, by demographic characteristics: 2014
a
Difference between males and females is statistically significant at the .05 level.
Differences between the following racial/ethnic groups are statistically significant at
the .05 level: whites versus blacks, whites versus Asians, whites versus Hispanics,
blacks versus Asians, Native Americans/Alaska Natives versus Asians, Asians versus
people of two or more races, and Asians versus Hispanics.
b
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Table S2. Receipt of mental health services in an educational setting in the
past year among adolescents aged 12 to 17, by demographic characteristics:
2014
Differences between the following age groups are statistically significant at the .05
level: adolescents aged 12 or 13 versus those aged 16 or 17, and adolescents aged 14
or 15 versus those aged 16 or 17.
a
Difference between males and females is statistically significant at the .05 level.
b
Differences between the following racial/ethnic groups are statistically significant at
the .05 level: whites versus blacks, whites versus Asians, blacks versus Native
Americans/Alaska Natives, blacks versus Asians, blacks versus Hispanics, Asians versus
people of two or more races, and Asians versus Hispanics.
c
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Table S3. Receipt of mental health services in a medical setting in the past
year among adolescents aged 12 to 17, by demographic characteristics: 2014
a
Difference between males and females is statistically significant at the .05 level.
Differences between the following racial/ethnic groups are statistically significant at
the .05 level: whites versus blacks, whites versus Asians, whites versus Hispanics,
blacks versus people of two or more races, Native Americans/Alaska Natives versus
Asians, Asians versus people of two or more races, and people of two or more races
versus Hispanics.
b
Difference between adolescents living in urban areas and those living in rural areas is
statistically significant at the .05 level.
c
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Table S4. Reasons for receiving mental health services in the past year
among adolescents aged 12 to 17 who received mental health services in a
specialty setting in the past year: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Table S5. Reasons for receiving mental health services in the past year
among adolescents aged 12 to 17 who received mental health services in an
educational setting in the past year: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
Table S6. Reasons for receiving mental health services in the past year
among adolescents aged 12 to 17 who received mental health services in a
medical setting in the past year: 2014
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey
on Drug Use and Health (NSDUH), 2014.
SUMMARY
Background: Substance use and mental health issues (i.e., behavioral health issues) affect millions of adolescents in the United States;
however, estimates show that only half of those who have mental health issues receive mental health services. Although there are a variety of
settings in which adolescents can get treatment, it is important to understand where they access mental health services and their reason for
accessing services. Method: The 2014 National Surveys on Drug Use and Health (NSDUHs) data provide estimates of prevalence of mental
health service use among adolescents aged 12 to 17, the setting for the services received, and the reasons these adolescents received mental
health services. Additionally, the 2014 estimates were analyzed by age subgroups among adolescents, gender, race/ethnicity, and rural
residence status. Results: Findings in this report indicate that of the 24.9 million adolescents in the United States, approximately 3.4 million
received services in a specialty setting, 3.2 million received services in an educational setting, and 700,000 received services in a general
medical setting. Across all three settings, approximately half reported that they received services because they felt depressed. Conclusion:
Although adolescents were accessing mental health services from a variety of settings, their reasons for obtaining help were similar. Highlighting
where and why adolescents receive mental health services may inform efforts to expand and improve access to mental health service use
among adolescents.
Understanding whether and where adolescents receive mental health services is important to understand where there may be gaps in care, and
may help policymakers, mental health providers, and parents expand and improve access to care.
Keywords: adolescents, mental health, treatment, National Survey on Drug Use and Health, NSDUH
AUTHOR INFORMATION
cbhsqrequest@samhsa.hhs.gov
KEYWORDS
Short Report, Population Data, 2009, 2010, 2011, 2012, 2013, Adolescents as Audience, Mental Illness, Adolescents as Population Group, People with Mental
Health Problems as Population Group, Systems of Care, Suicide Prevention, Treatment, All US States Only
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance
the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.
The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by SAMHSA. The data used in this report are based on information obtained from 17,000 adolescents
aged 12 to 17 in 2014. NSDUH collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.
The CBHSQ Report is prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI
International is a registered trademark and a trade name of Research Triangle Institute.)
Information on the most recent NSDUH is available in the following publication:
Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No.
SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/.
Also available online: http://www.samhsa.gov/data/population-data-nsduh.
Attention-Deficit/
Hyperactivity Disorder
(ADHD):
THE BASICS
Overview
Do you find it hard to pay attention? Do you feel the need to
move constantly during times when you shouldn’t? Do you find
yourself constantly interrupting others? If these issues are
ongoing and you feel that they are negatively impacting your
daily life, it could be a sign of attention-deficit/hyperactivity
disorder (ADHD).
ADHD is a disorder that makes it difficult for a person to pay
attention and control impulsive behaviors. He or she may also
be restless and almost constantly active.
ADHD is not just a childhood disorder. Although the
symptoms of ADHD begin in childhood, ADHD can continue
through adolescence and adulthood. Even though hyperactivity
tends to improve as a child becomes a teen, problems with
inattention, disorganization, and poor impulse control often
continue through the teen years and into adulthood.
What causes ADHD?
Researchers at the National Institute of Mental Health (NIMH),
National Institutes of Health (NIH), and across the country are
studying the causes of ADHD. Current research suggests ADHD
may be caused by interactions between genes and environmental
or non-genetic factors. Like many other illnesses, a number of
factors may contribute to ADHD such as:
Ê Genes
Ê Cigarette smoking, alcohol use, or drug use during pregnancy
Ê Exposure to environmental toxins, such as high levels of
lead, at a young age
Ê Low birth weight
Ê Brain injuries
Warning Signs
People with ADHD show an ongoing pattern of three different
types of symptoms:
Ê Difficulty paying attention (inattention)
Ê Being overactive (hyperactivity)
Ê Acting without thinking (impulsivity)
These symptoms get in the way of functioning or development.
People who have ADHD have combinations of these symptoms:
Ê Overlook or miss details, make careless mistakes in
schoolwork, at work, or during other activities
Ê Have problems sustaining attention in tasks or play,
including conversations, lectures, or lengthy reading
Ê Seem to not listen when spoken to directly
Ê Fail to not follow through on instructions, fail to finish
schoolwork, chores, or duties in the workplace, or start
tasks but quickly lose focus and get easily sidetracked
Ê Have problems organizing tasks and activities, such as
doing tasks in sequence, keeping materials and belongings
in order, keeping work organized, managing time, and
meeting deadlines
Ê Avoid or dislike tasks that require sustained mental effort,
such as schoolwork or homework, or for teens and older
adults, preparing reports, completing forms, or reviewing
lengthy papers
Ê Lose things necessary for tasks or activities, such as school
supplies, pencils, books, tools, wallets, keys, paperwork,
eyeglasses, and cell phones
Ê Become easily distracted by unrelated thoughts or stimuli
Ê Forgetful in daily activities, such as chores, errands,
returning calls, and keeping appointments
Signs of hyperactivity and impulsivity may include:
Ê Fidgeting and squirming while seated
Ê Getting up and moving around in situations when staying
seated is expected, such as in the classroom or in the office
Ê Running or dashing around or climbing in situations where it
is inappropriate, or, in teens and adults, often feeling restless
Ê Being unable to play or engage in hobbies quietly
Ê Being constantly in motion or “on the go,” or acting as if
“driven by a motor”
Ê Talking nonstop
Ê Blurting out an answer before a question has been
completed, finishing other people’s sentences, or speaking
without waiting for a turn in conversation
Ê Having trouble waiting his or her turn
Ê Interrupting or intruding on others, for example in
conversations, games, or activities
Showing these signs and symptoms does not necessarily mean
a person has ADHD. Many other problems, like anxiety,
depression, and certain types of learning disabilities, can
have similar symptoms. If you are concerned about whether
you or your child might have ADHD, the first step is to talk
with a health care professional to find out if the symptoms fit
the diagnosis. The diagnosis can be made by a mental health
professional, like a psychiatrist or clinical psychologist,
primary care provider, or pediatrician.
Treating ADHD
Although there is no cure for ADHD, currently available
treatments may help reduce symptoms and improve
functioning. ADHD is commonly treated with medication,
education or training, therapy, or a combination of treatments.
Medication
For many people, ADHD medications reduce hyperactivity
and impulsivity and improve their ability to focus, work, and
learn. The first line of treatment for ADHD is stimulants.
Stimulants: Although it may seem unusual to treat ADHD
with a medication that is considered a stimulant, it is effective.
Many researchers think that stimulants are effective because
the medication increases the brain chemical dopamine, which
plays essential roles in thinking and attention.
Non-Stimulants: These medications take longer to start working
than stimulants, but can also improve focus, attention, and
impulsivity in a person with ADHD. Doctors may prescribe a
non-stimulant if a person had bothersome side effects from
stimulants, if a stimulant was not effective, or in combination
with a stimulant to increase effectiveness. Two examples of
non-stimulant medications include atomoxetine and guanfacine.
Antidepressants: Although antidepressants are not approved
by the U.S. Food and Drug Administration (FDA) specifically
for the treatment of ADHD, antidepressants are sometimes
used to treat adults with ADHD. Older antidepressants, called
tricyclics, sometimes are used because they, like stimulants,
affect the brain chemicals norepinephrine and dopamine.
There are many different types and brands of these
medications—all with potential benefits and side effects.
Sometimes several different medications or dosages must
be tried before finding the one that works for a particular
person. Anyone taking medications must be monitored
closely and carefully by their prescribing doctor.
Call your doctor right away if you have any problems with
your medicine or if you are worried that it might be doing
more harm than good. Your doctor may be able to adjust
the dose or change your prescription to a different one
that may work better for you.
Therapy
There are different kinds of therapy that have been tried
for ADHD, but research shows that therapy may not be
effective in treating ADHD symptoms. However, adding
therapy to an ADHD treatment plan may help patients and
families better cope with daily challenges.
For Children and Teens: Parents and teachers can help
children and teens with ADHD stay organized and follow
directions with tools such as keeping a routine and a schedule,
organizing everyday items, using homework and notebook
organizers, and giving praise or rewards when rules are followed.
For Adults: A licensed mental health provider or therapist
can help an adult with ADHD learn how to organize his or
her life with tools such as keeping routines and breaking
down large tasks into more manageable, smaller tasks.
Education and Training
Children and adults with ADHD need guidance and
understanding from their parents, families, and teachers to
reach their full potential and to succeed. Mental health
professionals can educate the parents of a child with ADHD
about the condition and how it affects a family. They can
also help the child and his or her parents develop new skills,
attitudes, and ways of relating to each other. Examples include:
Ê Parenting skills training teaches parents the skills
they need to encourage and reward positive behaviors
in their children.
Ê Stress management techniques can benefit parents
of children with ADHD by increasing their ability to
deal with frustration so that they can respond calmly
to their child’s behavior.
Ê Support groups can help parents and families connect
with others who have similar problems and concerns.
Adding behavioral therapy, counseling, and practical
support can help people with ADHD and their families to
better cope with everyday problems.
School-based Programs
Some schools offer special education services to children
with ADHD who qualify. Educational specialists help the
child, parents, and teachers make changes to classroom and
homework assignments to help the child succeed. Public
schools are required to offer these services for qualified
children, which may be free for families living within the
school district. Learn more about the Individuals with
Disabilities Education Act (IDEA), visit http://idea.ed.gov/.
Finding Help
The National Resource Center on ADHD, a program
of Children and Adults with Attention Deficit/Hyperactivity
Disorder (CHADD®) supported by the Centers for Disease
Control and Prevention (CDC), has information and
many resources. You can reach this center online at
www.help4adhd.org or by phone at 1-800-233-4050.
You can also visit the NIMH’s Help for Mental Illness page
at www.nimh.nih.gov/findhelp.
Participate in a Clinical Trial
It’s your involvement that helps researchers to ultimately
uncover better ways to treat, prevent, diagnose, and understand
human disease. You can get involved by participating in a
clinical research trial. The goal of clinical trials is to determine
if a new test or treatment works and is safe. Clinical trials
can also look at other aspects of care, such as improving
the quality of life for people with chronic illnesses.
Researchers at the NIMH and other NIH institutes, such as
the National Human Genome Research Institute, conduct
research in many areas including cognition, genetics,
epidemiology, brain imaging, and treatment development.
The studies take place at the NIH Clinical Center in
Bethesda, Maryland. If you think you might be interested
in participating in a clinical trial, you should talk to your
doctor about whether to apply and identify which ones are
right for you. To learn about studies on ADHD that are currently
recruiting at NIMH, visit http://www.nimh.nih.gov/joinastudy.
To find a clinical trial near you, visit ClinicalTrials.gov. This
is a searchable registry and results database of federally and
privately supported clinical trials conducted in the United
States and around the world. ClinicalTrials.gov gives you
information about a trial’s purpose, who may participate,
locations, and phone numbers for more details. This information
should be used in conjunction with advice from your health
care provider.
Learn more about ADHD
To learn more about ADHD, visit:
National Institute of Mental Health
www.nimh.nih.gov
Centers for Disease Control and Prevention
https://www.cdc.gov/ncbddd/adhd/
MedlinePlus (National Library of Medicine)
https://www.nlm.nih.gov/medlineplus/attentiondeficit
hyperactivitydisorder.html
Reprints
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or copied without permission from NIMH. Citation of NIMH
as a source is appreciated. We encourage you to reproduce it
and use it in your efforts to improve public health. However,
using government materials inappropriately can raise legal or
ethical concerns, so we ask you to use these guidelines:
Ê NIMH does not endorse or recommend any commercial
products, processes, or services, and our publications
may not be used for advertising or endorsement
purposes.
Ê NIMH does not provide specific medical advice or
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may not be used in a manner that has the appearance of
providing such information.
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our publications in ways that will jeopardize the integrity
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Ê The addition of non-Federal Government logos and website
links may not have the appearance of NIMH endorsement
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If you have questions regarding these guidelines and use
of NIMH publications, please contact the NIMH Information
Resource Center at 1-866-615-6464 or e-mail
nimhinfo@nih.gov.
For More Information
For more information on conditions that affect mental
health, resources, and research, go to MentalHealth.gov
at http://www.mentalhealth.gov, or the NIMH
website at http://www.nimh.nih.gov. In addition,
the National Library of Medicine’s MedlinePlus
service has information on a wide variety of health
topics, including conditions that affect mental health.
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
FAX: 301-443-4279
E-mail: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov
U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. QF-16-3572
Revised 2016
Could I
Have
Attention-Deficit/
Hyperactivity
Disorder (ADHD)?
Finding an Answer to
ADHD as an Adult
Do you feel that you
have struggled throughout your
life with poor concentration,
inattention, impulsivity, or getting
organized? Have you wondered
whether you might have attentiondeficit/hyperactivity disorder (ADHD)?
Our society has become more aware
of ADHD as a condition that affects
adults as well as children, and there
are many adults who struggle with
this disorder. At the same time, other
life stressors or mental health
conditions can cause similar
symptoms. Consider getting an
evaluation from a psychiatrist or
psychologist who has experience in
diagnosing ADHD. Getting an
evaluation can help you find the right
answer to your struggles and identify
the treatment you need to feel better.
What is ADHD?
ADHD is defined as a persistent pattern of inattention and/
or hyperactivity-impulsivity that interferes with functioning
or development.
n Inattention means a person wanders off task, lacks
persistence, has difficulty sustaining focus, and is
disorganized; these problems are not due to defiance or
lack of comprehension.
n Hyperactivity means a person moves about excessively
when it is not appropriate, and/or excessively fidgets,
taps, or talks. In adults, it may appear as extreme
restlessness or wearing others out with their activity.
n Impulsivity means hasty actions that occur in the
moment without a person thinking first; or a desire for
immediate rewards or inability to delay gratification.
Impulsive actions may have high potential for harm. An
impulsive person may be socially intrusive and interrupt
others excessively or make important decisions without
considering the long-term consequences.
ADHD begins in childhood and is considered a
developmental disorder, but a person may not receive a
diagnosis until adolescence or adulthood.
To receive a diagnosis of ADHD as an adult:
n Several symptoms must have been present before the
age of 12.
n A person must have at least five symptoms of either
inattention and/or hyperactivity-impulsivity.
n The symptoms must be present in two or more settings,
such as at home and at work.
n There must be evidence that the symptoms interfere
with the person’s functioning in these settings.
Several other mental health conditions commonly occur
with ADHD, including conduct disorder, learning disorders,
anxiety disorders, and depression.
How does ADHD affect adults?
Some children with ADHD continue to have the condition
as adults.
Many adults who have ADHD don’t know it. These adults
may feel that it is impossible to get organized, stick to a
job, or remember to keep appointments. Daily tasks such
as getting up in the morning, preparing to leave the house
for work, arriving at work on time, and being productive
on the job can be especially challenging for adults with
undiagnosed ADHD. These adults may have a history of
academic problems, problems at work, or difficult or
failed relationships. Many have had multiple traffic
accidents. Like teens, adults with ADHD may seem
restless and may try to do several things at once, most of
them unsuccessfully. They also tend to prefer “quick
fixes,” rather than taking the steps needed to achieve
greater rewards.
A person may not be diagnosed with ADHD until
adulthood because the condition was not recognized by
teachers or family at a younger age, the person has a
mild form of ADHD, or he or she managed fairly without
the demands of adulthood. However, it is common for
young adults with undiagnosed ADHD to encounter
academic problems in college because of the intense
concentration required by higher education.
Untreated ADHD in an adult can lead to significant
problems with education, social and family situations and
relationships, employment, self-esteem, and emotional
health. It is never too late to recognize, diagnose, and
treat ADHD and any other mental health condition that
can commonly occur with it. Effective treatment can
improve the lives of many adults and their families.
What are the symptoms of ADHD?
A person with inattention often:
n Fails to give close attention to details or makes
careless mistakes at work or during other activities
n Has difficulty sustaining attention in tasks, such as
during lectures or lengthy reading
n Does not seem to listen when spoken to directly
n Does not follow through on instructions and fails to
finish chores or duties in the workplace
n Has difficulty organizing tasks and activities—for
example, is messy and has poor time management
n Avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort
n Loses things necessary for tasks or activities, such as
keys, wallets, and mobile phones
n Is easily distracted by unrelated thoughts or stimuli
n Is forgetful in daily activities, such as paying bills,
keeping appointments, or returning calls
A person with hyperactivity-impulsivity often:
n Fidgets with or taps hands or feet or
squirms in seat
n Leaves seat in situations when remaining
seated is expected
n Feels restless or is unable to be still for extended
periods of time
n Is unable to engage in leisure activities quietly
n Talks excessively
n Blurts out an answer before a question has been
completed
n Has difficulty waiting his or her turn, such as when
waiting in line
n Interrupts or intrudes on others
Some people with ADHD primarily have symptoms of
inattention, while others have primarily symptoms of
hyperactivity-impulsivity. Some people have symptoms
in both categories.
Problems with concentration and staying organized
can be common for many busy adults; however, an
adult who is impaired both at work and at home, or in
social situations, is more likely to have ADHD.
What causes ADHD?
Scientists are not sure what causes ADHD, although
many studies suggest that genes play a large role. Like
many other illnesses, ADHD probably results from a
combination of factors. In addition to genetics,
researchers are looking at possible environmental
factors and are studying how brain injuries, nutrition,
and the social environment might contribute to ADHD.
How is ADHD in adults diagnosed?
Adults who suspect they have ADHD should see a
licensed mental health professional or doctor, such as
a psychologist or psychiatrist who has experience
diagnosing ADHD, for an evaluation.
Stress, other mental health conditions, and physical
conditions or illnesses can cause similar symptoms to
those of ADHD. Some of these include:
n Stress at work or home
n Lack of sleep
n Sleep apnea, a health condition in which a person
has one or more pauses in breathing or shallow
breaths while sleeping, causing poor sleep quality
and daytime sleepiness
n Lack of exercise
n Lack of proper nutrition
n Anxiety
n Depression
n Problems with the thyroid gland, a gland in the
neck that makes the thyroid hormone, which
controls the body’s metabolism
Therefore, a thorough evaluation will help the doctor
find out what is causing the symptoms and
recommend effective treatment.
There is no one test that can diagnose ADHD. Mental
health professionals use certain rating scales to
determine if an adult meets the diagnostic criteria
for ADHD.
A thorough evaluation also includes looking at the
person’s history of childhood behavior and school
experiences. To obtain this information, the doctor
may interview spouses or partners, parents, close
friends, and other associates.
The person may also undergo a physical exam and
various psychological tests that evaluate working
memory, executive functioning (abilities like planning
and decision-making), and visual and spatial skills or
reasoning. The evaluation will also look at the person’s
mood and whether he or she struggles with other
issues, such as anxiety, depression, or substance abuse.
A person’s medical history is also important, as
previous health problems, trauma, or injury can also be
the cause of symptoms.
What are the treatments for ADHD
in adults?
Adults with ADHD can be treated with behavioral
interventions, medication, or a combination of the two.
Medications
Stimulants such as methylphenidate and amphetamines
are the most common type of medication used for
treating ADHD. In addition, a few nonstimulant
medications are also available. Although not approved by
the U.S. Food and Drug Administration (FDA) specifically
for the treatment of ADHD, antidepressants are
sometimes used to treat adults with ADHD. An adult
who is offered a prescription for a stimulant for ADHD
should tell his or her doctor about all other medications
that he or she takes. Medications for common adult
health problems, such as diabetes, high blood pressure,
anxiety, and depression may interact badly with
stimulants. In this case, a doctor can offer other
medication options.
For general information about stimulants and other
medications used for treating mental disorders, see the
NIMH Mental Health Medications webpage (http://www.
nimh.nih.gov/health/topics/mental-health-medications/
index.shtml). The FDA website (http://www.fda.gov) has
the latest information on medication approvals,
warnings, and patient information guides.
Psychotherapy
Psychotherapy, including cognitive behavioral therapy,
can help an adult with ADHD to become more aware of
the deficit in attention and concentration and can
provide the skills for improving organization and
efficiency in daily tasks. It can also address feelings of
low self-esteem and help adults with ADHD gain
confidence, as well as control impulsive and risky
behaviors. A professional counselor or therapist can also
help an adult with ADHD learn how to organize his or
her life and break large tasks down into smaller, more
manageable steps.
Where can I turn if I feel alone in my
diagnosis of ADHD?
In addition to the benefits of psychotherapy, adults with
ADHD can gain social support and better coping skills by
talking with family, friends, and colleagues about their
diagnosis. If the people in their lives are aware of their
diagnosis, they will better understand their behavior.
Psychotherapy for families and couples can help any
relationship problems and teach everyone involved about
ADHD. There are also support groups just for adults with
ADHD.
Some adults also find it helpful to obtain support from a
professional life coach or ADHD coach who can help with a
variety of skills to improve daily functioning.
For More Information
National Institute of Mental Health (NIMH)
http://www.nimh.nih.gov
Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/ncbddd/adhd/
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. QF 16-3572
N AT I O N A L I N S T I T U T E O F M E N TA L H E A LT H
Eating Disorders:
About More Than Food
Has your urge to eat less or more food
spiraled out of control?
Are you overly concerned about your
outward appearance?
If so, you may have an eating disorder.
What are eating disorders?
The eating disorders anorexia nervosa, bulimia nervosa, and binge-eating
disorder, and their variants, all feature serious disturbances in eating behavior
and weight regulation. They are associated with a wide range of adverse
psychological, physical, and social consequences. A person with an eating
disorder may start out just eating smaller or larger amounts of food, but at
some point, their urge to eat less or more spirals out of control. Severe distress
or concern about body weight or shape, or extreme efforts to manage weight or
food intake, also may characterize an eating disorder.
Eating disorders are real, treatable medical illnesses. They frequently coexist
with other illnesses such as depression, substance abuse, or anxiety disorders.
Other symptoms can become life-threatening if a person does not receive
treatment, which is reflected by anorexia being associated with the highest
mortality rate of any psychiatric disorder.
Eating disorders affect both genders, although rates among women and girls
are 2½ times greater than among men and boys. Eating disorders frequently
appear during the teen years or young adulthood but also may develop during
childhood or later in life.
What are the different
types of eating disorders?
Anorexia nervosa
Many people with anorexia nervosa see themselves as overweight, even
when they are clearly underweight. Eating, food, and weight control become
obsessions. People with anorexia nervosa typically weigh themselves
repeatedly, portion food carefully, and eat very small quantities of only certain
foods. Some people with anorexia nervosa also may engage in binge eating
followed by extreme dieting, excessive exercise, self-induced vomiting, or misuse
of laxatives, diuretics, or enemas.
Symptoms of anorexia nervosa include:
◗ Extremely low body weight
◗ Severe food restriction
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◗◗
Some who have anorexia nervosa recover with treatment after only one episode. Others
get well but have relapses. Still others have a more chronic, or long-lasting, form of
anorexia nervosa, in which their health declines as they battle the illness.
Other symptoms and medical complications may develop over time, including:
◗◗
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◗◗
◗◗
◗◗
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◗◗
◗◗
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◗◗
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◗◗
Bulimia nervosa
People with bulimia nervosa have recurrent and frequent episodes of eating unusually
large amounts of food and feel a lack of control over these episodes. This binge eating
is followed by behavior that compensates for the overeating such as forced vomiting,
excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of
these behaviors.
Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered
a healthy or normal weight, while some are slightly overweight. But like people with
anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and
are intensely unhappy with their body size and shape. Usually, bulimic behavior is done
secretly because it is often accompanied by feelings of disgust or shame. The binge eating
and purging cycle can happen anywhere from several times a week to many times a day.
Other symptoms include:
◗◗
◗◗
◗◗
◗◗
◗◗
◗◗
◗◗
Binge-eating disorder
People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa,
periods of binge eating are not followed by compensatory behaviors like purging,
excessive exercise, or fasting. As a result, people with binge-eating disorder often are
overweight or obese. People with binge-eating disorder who are obese are at higher risk
for developing cardiovascular disease and high blood pressure. They also experience guilt,
shame, and distress about their binge eating, which can lead to more binge eating.
How are eating disorders treated?
Typical treatment goals include restoring adequate nutrition, bringing weight
to a healthy level, reducing excessive exercise, and stopping binge eating
and purging behaviors. Specific forms of psychotherapy, or talk therapy—
including a family-based therapy called the Maudsley approach and cognitive
behavioral approaches—have been shown to be useful for treating specific
eating disorders. Evidence also suggests that antidepressant medications
approved by the U.S. Food and Drug Administration may help for bulimia
nervosa and also may be effective for treating co-occurring anxiety or
depression for other eating disorders.
Treatment plans often are tailored to individual needs and may include one or
more of the following:
◗◗
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◗◗
Some patients also may need to be hospitalized to treat problems caused
by malnutrition or to ensure they eat enough if they are very underweight.
Complete recovery is possible
What is being done to better understand
and treat eating disorders?
Researchers are finding that eating disorders are caused by a complex
interaction of genetic, biological, psychological, and social factors. But many
questions still need answers. Researchers are studying questions about
behavior, genetics, and brain function to better understand risk factors,
identify biological markers, and develop specific psychotherapies and
medications that can target areas in the brain that control eating behavior.
Brain imaging and genetic studies may provide clues for how each person
may respond to specific treatments for these medical illnesses. Ongoing
efforts also are aimed at developing and refining strategies for preventing and
treating eating disorders among adolescents and adults.
Where can I find more information?
To learn more about eating disorders, visit:
MedlinePlus (National Library of Medicine):
http://medlineplus.gov
(En Español: http://medlineplus.gov/spanish)
For information on clinical trials, visit:
ClinicalTrials.gov: http://www.clinicaltrials.gov
For more information on conditions that affect mental health, resources, and research, go to
MentalHealth.gov at http://www.mentalhealth.gov, the NIMH website at
http://www.nimh.nih.gov, or contact us at:
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or
1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or
1-866-415-8051 toll-free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov
NIH Publication No.TR 14-4901
Revised 2014
WHAT IS GAD?
Occasional anxiety is a normal part
of life. You might worry about things
like health, money, or family
problems. But people with
generalized anxiety disorder (GAD)
feel extremely worried or feel
nervous about these and other
things—even when there is little or
no reason to worry about them.
People with GAD find it difficult to
control their anxiety and stay
focused on daily tasks.
The good news is that GAD is
treatable. Call your doctor to talk
about your symptoms so that you
can feel better.
What are the signs and
symptoms of GAD?
GAD develops slowly. It often starts during the
teen years or young adulthood. People with
GAD may:
n Worry very much about everyday things
n Have trouble controlling their worries or
feelings of nervousness
n Know that they worry much more than
they should
n Feel restless and have trouble relaxing
n Have a hard time concentrating
n Be easily startled
n Have trouble falling asleep or staying asleep
n Feel easily tired or tired all the time
n Have headaches, muscle aches, stomach aches,
or unexplained pains
n Have a hard time swallowing
n Tremble or twitch
n Be irritable or feel “on edge”
n Sweat a lot, feel light-headed or out of breath
n Have to go to the bathroom a lot
Children and teens with GAD often worry
excessively about:
n Their performance, such as in school or in
sports
n Catastrophes, such as earthquakes or war
Adults with GAD are often highly nervous about
everyday circumstances, such as:
n Job security or performance
n Health
n Finances
n The health and well-being of their children
n Being late
n Completing household chores and other
responsibilities
Both children and adults with GAD may
experience physical symptoms that make it hard
to function and that interfere with daily life.
Symptoms may get better or
worse at different times, and
they are often worse during
times of stress, such as with a
physical illness, during exams
at school, or during a family or
relationship conflict.
What causes GAD?
GAD sometimes runs in families, but no one
knows for sure why some family members
have it while others don’t. Researchers have
found that several parts of the brain, as well as
biological processes, play a key role in fear and
anxiety. By learning more about how the brain
and body function in people with anxiety
disorders, researchers may be able to create
better treatments. Researchers are also
looking for ways in which stress and
environmental factors play a role.
How is GAD treated?
First, talk to your doctor about your symptoms.
Your doctor should do an exam and ask you
about your health history to make sure that an
unrelated physical problem is not causing your
symptoms. Your doctor may refer to you a
mental health specialist, such as a psychiatrist
or psychologist.
GAD is generally treated with psychotherapy,
medication, or both. Talk with your doctor
about the best treatment for you.
Psychotherapy
A type of psychotherapy called cognitive
behavioral therapy (CBT) is especially useful for
treating GAD. CBT teaches a person different
ways of thinking, behaving, and reacting to
situations that help him or her feel less anxious
and worried. For more information on
psychotherapy, visit http://www.nimh.nih.gov/
health/topics/psychotherapies.
Medication
Doctors may also prescribe medication to help
treat GAD. Your doctor will work with you to
find the best medication and dose for you.
Different types of medication can be effective
in GAD:
n Selective serotonin reuptake inhibitors
(SSRIs)
n Serotonin-norepinephrine reuptake
inhibitors (SNRIs)
n Other serotonergic medication
n Benzodiazepines
Doctors commonly use SSRIs and SNRIs to
treat depression, but they are also helpful for
the symptoms of GAD. They may take several
weeks to start working. These medications
may also cause side effects, such as
headaches, nausea, or difficulty sleeping.
These side effects are usually not severe for
most people, especially if the dose starts off
low and is increased slowly over time. Talk
to your doctor about any side effects
that you have.
Buspirone is another serotonergic medication
that can be helpful in GAD. Buspirone needs to
be taken continuously for several weeks for it
to be fully effective.
Benzodiazepines, which are sedative
medications, can also be used to manage
severe forms of GAD. These medications are
powerfully effective in rapidly decreasing
anxiety, but they can cause tolerance and
dependence if you use them continuously.
Therefore, your doctor will only prescribe them
for brief periods of time if you need them.
Don’t give up on treatment too quickly. Both
psychotherapy and medication can take some
time to work. A healthy lifestyle can also help
combat anxiety. Make sure to get enough sleep
and exercise, eat a healthy diet, and turn to
family and friends who you trust for support.
For basic information about these and other
mental health medications, visit http://www.
nimh.nih.gov/health/topics/mental-healthmedications. Visit the Food and Drug
Administration’s website (http://www.fda.gov/)
for the latest information on warnings, patient
medication guides, or newly approved
medications.
What is it like to have GAD?
“I was worried all the time and felt
nervous. My family told me that there
were no signs of problems, but I still
felt upset. I dreaded going to work
because I couldn’t keep my mind
focused. I was having trouble falling
asleep at night and was irritated at my
family all the time.
I saw my doctor and explained my
constant worries. My doctor sent me to
someone who knows about GAD. Now
I am working with a counselor to cope
better with my anxiety. I had to work
hard, but I feel better. I’m glad I made
that first call to my doctor.”
Where can I find more information?
To learn more about generalized anxiety
disorder, visit:
MedlinePlus (National Library of Medicine)
http://medlineplus.gov
(En Español: http://medlineplus.gov/spanish)
For information on clinical trials, visit:
ClinicalTrials.gov
http://www.clinicaltrials.gov
(En Español: http://salud.nih.gov/investigacionclinica/)
For more information on conditions that affect
mental health, resources, and research, visit the
NIMH website (http://www.nimh.nih.gov).
National Institute of Mental Health (NIMH)
Office of Science Policy, Planning,
and Communications
Science Writing, Press,
and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or
1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or
1-866-415-8051 toll free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov
U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. QF 16-4677
Revised 2016
Post-Traumatic
Stress Disorder
(PTSD)
National Institute
of Mental Health
Contents
What is post-traumatic
stress disorder, or PTSD? .......................................................... 1
Who develops PTSD? ..................................................................... 2
What are the symptoms of PTSD? ........................................... 3
Do children react differently than adults? .................... 6
Why do some people develop PTSD
and other people do not? ..........................................................8
How is PTSD treated? ................................................................... 9
How can I help a friend or
relative who has PTSD? ............................................................ 10
How can I help myself? .............................................................. 11
Where can I go for help? ...........................................................13
What if I or someone I know is in crisis? ............................. 14
Next Steps for PTSD Research ................................................ 15
What is post-traumatic stress
disorder, or PTSD?
PTSD is a disorder that some people develop after experiencing a shocking,
scary, or dangerous event.
It is natural to feel afraid during and after a traumatic situation. This fear
triggers many split-second changes in the body to respond to danger and
help a person avoid danger in the future. This “fight-or-flight” response is a
typical reaction meant to protect a person from harm. Nearly everyone will
experience a range of reactions after trauma, yet most people will recover
from those symptoms naturally. Those who continue to experience problems
may be diagnosed with PTSD. People who have PTSD may feel stressed or
frightened even when they are no longer in danger.
National Institute of Mental Health
1
Who develops PTSD?
Anyone can develop PTSD at any age. This includes war veterans as well as
survivors of physical and sexual assault, abuse, car accidents, disasters, terror
attacks, or other serious events. Not everyone with PTSD has been through a
dangerous event. Some experiences, like the sudden or unexpected death of
a loved one, can also cause PTSD.
According to the National Center for PTSD, about seven or eight of every 100
people will experience PTSD at some point in their lives. Women are more
likely to develop PTSD than men. Some traumas may put an individual at a
higher risk and biological factors like genes may make some people more
likely to develop PTSD than others.
2
Post-Traumatic Stress Disorder (PTSD)
What are the
symptoms of PTSD?
Symptoms usually begin within 3 months of the traumatic incident, but
sometimes they begin later. For symptoms to be considered PTSD, they
must last more than a month and be severe enough to interfere with
functioning in relationships or work. The course of the illness varies from
person to person. Some people recover within 6 months, while others have
symptoms that last much longer. In some people, the condition becomes
chronic (ongoing).
A doctor who has experience helping people with mental illnesses, such as a
psychiatrist or psychologist, can diagnose PTSD.
To be diagnosed with PTSD, an adult must have all of the following for
at least 1 month:
Ì At least one re-experiencing symptom
Ì At least one avoidance symptom
Ì At least two arousal and reactivity symptoms
Ì At least two cognition and mood symptoms
National Institute of Mental Health
3
Re-experiencing symptoms:
Ì Flashbacks—reliving the trauma over and over, including physical
symptoms like a racing heart or sweating
Ì Bad dreams
Ì Frightening thoughts
Re-experiencing symptoms may cause problems in a person’s everyday
routine. They can start from the person’s own thoughts and feelings. Words,
objects, or situations that are reminders of the event can also trigger reexperiencing symptoms.
Avoidance symptoms:
Ì Staying away from places, events, or objects that are reminders
of the experience
Ì Avoiding thoughts or feelings related to the traumatic event
Things or situations that remind a person of the traumatic event can trigger
avoidance symptoms. These symptoms may cause a person to change his or
her personal routine. For example, after a bad car accident, a person who
usually drives may avoid driving or riding in a car.
4
Post-Traumatic Stress Disorder (PTSD)
Arousal and reactivity symptoms:
Ì Being easily startled
Ì Feeling tense or “on edge”
Ì Having difficulty sleeping, and/or having angry outbursts
Arousal symptoms are usually constant, instead of being triggered by
something that brings back memories of the traumatic event. They can make
the person feel stressed and angry. These symptoms may make it hard to do
daily tasks, such as sleeping, eating, or concentrating.
Cognition and mood symptoms:
Ì Trouble remembering key features of the traumatic event
Ì Negative thoughts about oneself or the world
Ì Distorted feelings like guilt or blame
Ì Loss of interest in enjoyable activities
Cognition and mood symptoms can begin or worsen after the traumatic
event. These symptoms can make the person feel alienated or detached from
friends or family members.
National Institute of Mental Health
5
After a dangerous event, it’s natural to have some of the symptoms mentioned
on previous pages. Sometimes people have very serious symptoms that go away
after a few weeks. This is called acute stress disorder, or ASD. When the
symptoms last more than a month, seriously affect a person’s ability to function
and are not due to substance use, medical illness, or anything except the event
itself, the person might be experiencing PTSD. Some people with PTSD don’t
show any symptoms for weeks or months. PTSD is often accompanied by
depression, substance abuse, or one or more anxiety disorders.
Do children react differently
than adults?
Children and teens can have extreme reactions to trauma, but their
symptoms may not be the same as adults. In very young children (less than 6
years of age), these symptoms can include:
Ì Wetting the bed after having learned to use the toilet
Ì Forgetting how or being unable to talk
Ì Acting out the scary event during playtime
Ì Being unusually clingy with a parent or other adult
Older children and teens usually show symptoms more like those seen in
adults. They may also develop disruptive, disrespectful, or destructive behaviors.
Older children and teens may feel guilty for not preventing injury or deaths.
They may also have thoughts of revenge. For more information, see the NIMH
booklet series, “Helping Children and Adolescents Cope with Violence and
Disasters.” These are available on the NIMH website, www.nimh.nih.gov.
6
Post-Traumatic Stress Disorder (PTSD)
Why do some people develop
PTSD and other people do not?
It is important to remember that not everyone who lives through a dangerous
event develops PTSD. In fact, most will recover quickly without intervention.
Many factors play a part in whether a person will develop PTSD. Some of these
are risk factors that make a person more likely to develop PTSD. Other factors,
called resilience factors, can help reduce the risk of developing the disorder.
Some of these risk and resilience factors are present before the trauma and
others become important during and after a traumatic event.
RISK FACTORS for PTSD include:
Ì Living through dangerous events and traumas
Ì Getting hurt
Ì Seeing people hurt or killed
Ì Childhood trauma
Ì Feeling horror, helplessness, or extreme fear
Ì Having little or no social support after the event
Ì Dealing with extra stress after the event, such as loss of
a loved one, pain and injury, or loss of a job or home
Ì Having a history of mental illness or substance abuse
RESILIENCE FACTORS that may reduce the risk of PTSD include:
Ì Seeking out support from other people, such as friends
and family
Ì Finding a support group after a traumatic event
Ì Learning to feel good about one’s own actions in the face of danger
Ì Having a coping strategy, or a way of getting through the bad event
and learning from it
Ì Being able to act and respond effectively despite feeling fear
8
Post-Traumatic Stress Disorder (PTSD)
Researchers are studying the importance of various risk and resilience factors
including genetics and neurobiology. With more research, someday it may be
possible to predict who is likely to develop PTSD and to prevent it.
How is PTSD treated?
It is important for anyone with PTSD to be treated by a mental health
professional who is experienced with PTSD. The main treatments are
psychotherapy (“talk” therapy), medications, or both. Everyone is different,
and PTSD affects people differently, so a treatment that works for one
person may not work for another. People with PTSD need to work with a
mental health professional to find the best treatment for their symptoms.
If someone with PTSD is living through an ongoing trauma, such as being in
an abusive relationship, both of the problems need to be addressed. Other
ongoing problems can include panic disorder, depression, substance abuse,
and feeling suicidal. Research shows that support from family and friends can
be an important part of recovery.
Psychotherapy
Psychotherapy is “talk” therapy. There are many types of psychotherapy but
all of them involve talking with a mental health professional to treat a mental
illness. Psychotherapy can occur one-on-one or in a group and usually lasts 6
to 12 weeks, but can take more time.
Many types of psychotherapy can help people with PTSD. Some types target
PTSD symptoms while others focus on social, family, or job-related problems.
The doctor or therapist may combine different therapies depending on each
person’s needs.
Effective psychotherapies tend to emphasize a few key components,
including education about symptoms, teaching skills to help identify the
triggers of symptoms, and skills to manage the symptoms. One type of
psychotherapy is called cognitive behavioral therapy, or CBT. CBT can include:
Exposure therapy. This therapy helps people face and control their fear.
It gradually exposes them to the trauma they experienced in a safe way.
It uses mental imagery, writing, or visits to the place where the event
happened. The therapist uses these tools to help people with PTSD cope
with their feelings.
National Institute of Mental Health
9
Cognitive restructuring. This therapy helps people make sense of the
bad memories. Sometimes people remember the event differently than
how it happened. They may feel guilt or shame about what is not their
fault. The therapist helps people with PTSD look at what happened in a
realistic way.
Other talk therapies teach people helpful ways to react to frightening events
that trigger their PTSD symptoms. Based on this general goal, different types
of therapy may:
Ì Teach about trauma and its effects
Ì Use relaxation and anger control skills
Ì Provide tips for better sleep, diet, and exercise habits
Ì Help people identify and deal with guilt, shame, and other feelings
about the event
Ì Focus on changing how people react to their PTSD symptoms.
Medications
The most studied medications for treating PTSD include antidepressants,
which may help control PTSD symptoms such as sadness, worry, anger, and
feeling numb inside. Antidepressants and other medications may be prescribed
along with psychotherapy. Other medications may be helpful for specific
PTSD symptoms. For example, although it is not currently FDA-approved,
research has shown that Prazosin may be helpful with sleep problems,
particularly nightmares, commonly experienced by people with PTSD.
Doctors and patients can work together to find the best medication or
medication combination, as well as the right dose. Check the U.S. Food and
Drug Administration website (http://www.fda.gov/) for the latest information
on patient medication guides, warnings, or newly approved medications.
How can I help a friend or
relative who has PTSD?
If you know someone who may be experiencing PTSD, the first and most
important thing you can do is to help him or her get the right diagnosis and
treatment. You may need to help the person make an appointment and then
visit the doctor together. Encourage the person to stay in treatment, or to
seek different treatment if symptoms don’t get better after 6 to 8 weeks.
10
Post-Traumatic Stress Disorder (PTSD)
TO HELP A FRIEND OR RELATIVE, YOU CAN:
Ì Offer emotional support, understanding, patience, and encouragement.
Ì Learn about PTSD so you can understand what your friend
is experiencing.
Ì Listen carefully. Pay attention to your relative’s feelings
and the situations that may trigger PTSD symptoms.
Ì Share positive distractions such as walks, outings, and
other activities.
Ì Remind your friend or relative that, with time and treatment,
he or she can get better.
Never ignore comments about death or wanting to die. Contact your
friend’s or relative’s therapist or doctor for help or call the National Suicide
Prevention Lifeline (1–800–273–8255) or 911 in an emergency.
There are other types of treatment that can help as well. People with PTSD
should talk about all treatment options with their mental health professional.
Treatment should provide people with the skills to manage their symptoms and
help them participate in activities that they enjoyed before developing PTSD.
How can I help myself?
It may be very hard to take that first step to help yourself. It is important to
realize that although it may take some time, with treatment, you can get better.
TO HELP YOURSELF:
Ì Talk with your doctor about treatment options.
Ì Engage in mild physical activity or exercise to help reduce stress.
Ì Set realistic goals for yourself.
Ì Break up large tasks into small ones, set some priorities, and do
what you can as you can.
Ì Try to spend time with other people and confide in a trusted
friend or relative.
Ì Tell others about things that may trigger symptoms.
Ì Expect your symptoms to improve gradually, not immediately.
Ì Identify and seek out comforting situations, places, and people.
12
Post-Traumatic Stress Disorder (PTSD)
Where can I go for help?
If you are unsure of where to go for help, ask your family doctor, visit NIMH’s
Help for Mental Illnesses page (www.nimh.nih.gov/findhelp), or contact
someone from one of the groups listed below:
Ì Mental health specialists, such as psychiatrists, psychologists, social
workers, or mental health counselors
Ì Health maintenance organizations
Ì Community mental health centers
Ì Hospital psychiatry departments and outpatient clinics
Ì Mental health programs at universities or medical schools
Ì State hospital outpatient clinics
Ì Family services, social agencies, or clergy
Ì Peer support groups
Ì Private clinics and facilities
Ì Employee assistance programs
Ì Local medical and/or psychiatric societies
National Institute of Mental Health
13
What if I or someone
I know is in crisis?
If you are thinking about harming yourself, or know someone who is, get
help immediately:
Ì In a crisis, an emergency room doctor can provide temporary help and
can tell you where and how to get further support.
Ì Call 911 or go to a hospital emergency room or ask a friend or family
member to help you do these things.
Ì Call the toll-free, 24-hour National Suicide Prevention Lifeline at
1–800–273–TALK (1-800-273-8255); TTY: 1–800–799–4TTY (4889)
to talk to a trained counselor.
Ì Call your doctor.
Ì Do not leave the suicidal person alone.
14
Post-Traumatic Stress Disorder (PTSD)
Next Steps for PTSD Research
In the last decade, researchers have focused on understanding the mental and
biological foundations of PTSD. They have also been looking at why people
experience a range of reactions to trauma. NIMH-funded researchers are working:
Ì With data from trauma patients in urgent care settings to better
understand the changes that occur in individuals who do not recover
compared to those whose symptoms improve naturally
Ì To understand how fear memories are affected by learning, changes in
the body, or even sleep
Ì On preventing the development of PTSD soon after trauma exposure
Ì To identify what factors determine whether someone with PTSD will
respond well to one type of intervention or another, aiming to develop
more personalized, effective, and efficient treatments
As gene research and brain imaging technologies continue to improve,
reseachers are more likely to be able to pinpoint when and where in the
brain PTSD begins. This understanding may then lead to better targeted
treatments to suit each person’s own needs or even prevent the disorder
before it causes harm.
For more information on PTSD research, please see the PTSD Clinical Trials
website (http://www.nimh.nih.gov/health/trials/post-traumatic-stressdisorder-ptsd.shtml).
For more information on PTSD
Ì Visit the National Library of Medicine’s: MedlinePlus
https://www.nlm.nih.gov/medlineplus/
Ì Learn about joining a research study at
www.nimh.nih.gov/health/trials/index.shtml
Ì Search for information on clinical trials for PTSD at https://clinicaltrials.gov
(search PTSD)
Ì Find additional information from NIMH online or receive paper
brochures through the mail. You can order free NIMH publications
online at www.nimh.nih.gov
Ì For the most up-to-date information on this topic, please check the
NIMH website, www.nimh.nih.gov
If you do not have Internet access and would like more information on PTSD,
please contact the NIMH Information Center at 1–866–615–6464
National Institute of Mental Health
15
Reprints:
This publication is in the public domain and may be reproduced or copied
without permission from NIMH. Citation of the National Institute of Mental
Health as a source is appreciated. We encourage you to reproduce it and use
it in your efforts to improve public health. However, using government
materials inappropriately can raise legal or ethical concerns, so we ask you to
use these guidelines:
Ì NIMH does not endorse or recommend any commercial products,
processes, or services, and our publications may not be used for
advertising or endorsement purposes.
Ì NIMH does not provide specific medical advice or treatment
recommendations or referrals; our materials may not be used in a
manner that has the appearance of providing such information.
16
Post-Traumatic Stress Disorder (PTSD)
Ì NIMH requests that organizations not alter our publications in ways that
will jeopardize the integrity and “brand” when using the publication.
ÌThe addition of logos and website links may not have the appearance
of NIMH endorsement of any specific commercial products or services or
medical treatments or services.
Ì The photos in this publication are of models and are used for illustrative
purposes only.
If you have questions regarding these guidelines and use of NIMH
publications, please contact the NIMH Information Center at 1–866–615–6464
or e-mail nimhinfo@nih.gov.
National Institute of Mental Health
17
For More Information
For more information on conditions that affect mental
health, resources, and research, go to MentalHealth.gov at
www.mentalhealth.gov, or the NIMH website at www.nimh.nih.gov.
In addition, the National Library of Medicine’s MedlinePlus service
(www.nlm.nih.gov/medlineplus/) has information on a wide variety
of health topics, including conditions that affect mental health.
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892–9663
Phone: 301–443–4513 or
1–866–615–NIMH (6464) toll-free
TTY: 301–443–8431
TTY: 866–415–8051 toll-free
FAX: 301–443–4279
E-mail: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. QF 16-6388
SOCIAL ANXIETY DISORDER:
More Than Just Shyness
Are you extremely afraid of being judged by others?
Are you very self-conscious in everyday social situations?
Do you avoid meeting new people?
If you have been feeling this way for at least six months and
these feelings make it hard for you to do everyday tasks—
such as talking to people at work or school—you may have a
social anxiety disorder.
Social anxiety disorder (also called social phobia) is a
mental health condition. It is an intense, persistent fear
of being watched and judged by others. This fear can
affect work, school, and your other day-to-day activities.
It can even make it hard to make and keep friends.
But social anxiety disorder doesn’t have to stop you
from reaching your potential. Treatment can help you
overcome your symptoms.
What is it like having social anxiety disorder?
What is social anxiety disorder?
Social anxiety disorder is a common type of anxiety disorder. A person with
social anxiety disorder feels symptoms of anxiety or fear in certain or all
social situations, such as meeting new people, dating, being on a job
interview, answering a question in class, or having to talk to a cashier in a
store. Doing everyday things in front of people—such as eating or drinking
in front of others or using a public restroom—also causes anxiety or fear.
The person is afraid that he or she will be humiliated, judged, and rejected.
The fear that people with social anxiety disorder have in social situations is
so strong that they feel it is beyond their ability to control. As a result, it gets
in the way of going to work, attending school, or doing everyday things.
People with social anxiety disorder may worry about these and other things
for weeks before they happen. Sometimes, they end up staying away from
places or events where they think they might have to do something that will
embarrass them.
Some people with the disorder do not have anxiety in social situations but
have performance anxiety instead. They feel physical symptoms of anxiety
in situations such as giving a speech, playing a sports game, or dancing or
playing a musical instrument on stage.
Social anxiety disorder usually starts during youth in people who are
extremely shy. Social anxiety disorder is not uncommon; research suggests
that about 7 percent of Americans are affected. Without treatment, social
anxiety disorder can last for many years or a lifetime and prevent a person
from reaching his or her full potential.
What are the signs and symptoms of social anxiety
disorder?
When having to perform in front of or be around others, people with social
anxiety disorder tend to:
Ê Blush, sweat, tremble, feel a rapid heart rate, or feel their “mind
going blank”
Ê Feel nauseous or sick to their stomach
Ê Show a rigid body posture, make little eye contact, or speak with an
overly soft voice
Ê Find it scary and difficult to be with other people, especially those they
don’t already know, and have a hard time talking to them even though
they wish they could
Ê Be very self-conscious in front of other people and feel embarrassed
and awkward
Ê Be very afraid that other people will judge them
Ê Stay away from places where there are other people
What causes social anxiety disorder?
Social anxiety disorder sometimes runs in families, but no one knows for
sure why some family members have it while others don’t. Researchers have
found that several parts of the brain are involved in fear and anxiety. Some
researchers think that misreading of others’ behavior may play a role in
causing or worsening social anxiety. For example, you may think that people
are staring or frowning at you when they truly are not. Underdeveloped
social skills are another possible contributor to social anxiety. For example, if
you have underdeveloped social skills, you may feel discouraged after
talking with people and may worry about doing it in the future. By learning
more about fear and anxiety in the brain, scientists may be able to create
better treatments. Researchers are also looking for ways in which stress and
environmental factors may play a role.
How is social anxiety disorder treated?
First, talk to your doctor or health care professional about your symptoms.
Your doctor should do an exam and ask you about your health history to
make sure that an unrelated physical problem is not causing your symptoms.
Your doctor may refer you to a mental health specialist, such as a
psychiatrist, psychologist, clinical social worker, or counselor. The first step
to effective treatment is to have a diagnosis made, usually by a mental
health specialist.
Social anxiety disorder is generally treated with psychotherapy (sometimes
called “talk” therapy), medication, or both. Speak with your doctor or health
care provider about the best treatment for you. If your health care provider
cannot provide a referral, visit the NIMH Help for Mental Illnesses web page
at www.nimh.nih.gov/findhelp for resources you may find helpful.
Psychotherapy
A type of psychotherapy called cognitive behavioral therapy (CBT) is
especially useful for treating social anxiety disorder. CBT teaches you
different ways of thinking, behaving, and reacting to situations that help you
feel less anxious and fearful. It can also help you learn and practice social
skills. CBT delivered in a group format can be especially helpful. For more
information on psychotherapy, please visit www.nimh.nih.gov/health/
topics/psychotherapies.
Support Groups
Many people with social anxiety also find support groups helpful. In a group
of people who all have social anxiety disorder, you can receive unbiased,
honest feedback about how others in the group see you. This way, you can
learn that your thoughts about judgment and rejection are not true or are
distorted. You can also learn how others with social anxiety disorder
approach and overcome the fear of social situations.
Medication
There are three types of medications used to help treat social
anxiety disorder:
Ê Anti-anxiety medications
Ê Antidepressants
Ê Beta-blockers
Anti-anxiety medications are powerful and begin working right away to
reduce anxious feelings; however, these medications are usually not taken
for long periods of time. People can build up a tolerance if they are taken
over a long period of time and may need higher and higher doses to get the
same effect. Some people may even become dependent on them. To avoid
these problems, doctors usually prescribe anti-anxiety medications for short
periods, a practice that is especially helpful for older adults.
Antidepressants are mainly used to treat depression, but are also helpful for
the symptoms of social anxiety disorder. In contrast to anti-anxiety
medications, they may take several weeks to start working. Antidepressants
may also cause side effects, such as headaches, nausea, or difficulty
sleeping. These side effects are usually not severe for most people,
especially if the dose starts off low and is increased slowly over time.
Talk to your doctor about any side effects that you have.
Beta-blockers are medicines that can help block some of the physical
symptoms of anxiety on the body, such as an increased heart rate, sweating,
or tremors. Beta-blockers are commonly the medications of choice for the
“performance anxiety” type of social anxiety.
Your doctor will work with you to find the best medication, dose, and duration
of treatment. Many people with social anxiety disorder obtain the best
results with a combination of medication and CBT or other psychotherapies.
Don’t give up on treatment too quickly. Both psychotherapy and medication
can take some time to work. A healthy lifestyle can also help combat
anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and
turn to family and friends who you trust for support.
For basic information about these and other mental health medications, visit
www.nimh.nih.gov/health/topics/mental-health-medications.
Visit the Food and Drug Administration’s website (www.fda.gov/) for the
latest information on warnings, patient medication guides, or newly
approved medications.
For More Information
To learn more about social anxiety disorder, visit:
MedlinePlus (National Library of Medicine)
http://medlineplus.gov
(En Español: http://medlineplus.gov/spanish)
For information on clinical trials, visit:
ClinicalTrials.gov: http://www.clinicaltrials.gov
(En Español: http://salud.nih.gov/investigacion-clinica/)
For more information on conditions that affect mental health, resources, and
research, visit the NIMH website http://www.nimh.nih.gov
Finding Help
Mental Health Treatment Program Locator
The Substance Abuse and Mental Health Services Administration (SAMHSA)
provides this online resource for locating mental health treatment facilities and
programs. The Mental Health Treatment Locator section of the Behavioral Health
Treatment Services Locator lists facilities providing mental health services to persons
with mental illness. Find a facility in your state at www.findtreatment.samhsa.gov/.
For additional resources, visit www.nimh.nih.gov/findhelp.
Reprints
This publication is in the public domain and may be reproduced or copied without
permission from NIMH. Citation of NIMH as a source is appreciated. We encourage
you to reproduce it and use it in your efforts to improve public health. However,
using government materials inappropriately can raise legal or ethical concerns, so
we ask you to use these guidelines:
Ê NIMH does not endorse or recommend any commercial products, processes, or
services, and our publications may not be used for advertising or endorsement
purposes.
Ê NIMH does not provide specific medical advice or treatment recommendations or
referrals; our materials may not be used in a manner that has the appearance of
providing such information.
Ê NIMH requests that non-Federal organizations not alter our publications in ways
that will jeopardize the integrity and “brand” when using the publication.
Ê The addition of non-Federal Government logos and website links may not have
the appearance of NIMH endorsement of any specific commercial products or
services, or medical treatments or services.
Ê Images used in publications are of models and are used for illustrative purposes
only. Use of some images is restricted.
If you have questions regarding these guidelines and use of NIMH publications,
please contact the NIMH Information Resource Center at 1-866-615-6464 or e-mail
nimhinfo@nih.gov.
National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: www.nimh.nih.gov
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. QF 16-4678
Revised 2016
National Mental Health Study Field Test,
Supporting Statement
Attachment S – SAMHSA Authorization Letter
DEPARTM ENT OF HEAL TH & HUM AN SERVI CES
Substance Abuse and Mental
Health Services Administration
Rockville, MD 20857
[FILL DATE]
To Whom It May Concern:
This letter certifies that «Fname» «Lname» is a representative for the National Mental
Health Study, sponsored by the Substance Abuse and Mental Health Services
Administration (SAMHSA) and the National Institute of Mental Health (NIMH). RTI
International, a nationally recognized research organization with headquarters in
Research Triangle Park, North Carolina, is under contract to the Federal Government to
perform all data collection activities associated with the study (DHHS Contract
Number: HHSS283201300001C).
If you need additional assurance that «Fname» «Lname» is a legitimate RTI
representative assigned to this government sponsored study, please contact Amy
Kowalski, National Field Director, at [FILL 800 NUMBER], or the National Study
Director at [FILL], between 9:00 AM and 5:00 PM ET, Monday through Friday.
Thank you for your cooperation.
Sincerely,
Peter Tice, Ph.D.
Project Officer
Center for Behavioral Health Statistics and Quality
Substance Abuse and Mental Health Services
Administration, DHHS
Lisa J. Colpe, Ph.D., MPH
National Study Director
National Institute of Mental Health
National Institutes of Health, DHHS
National Mental Health Study Field Test,
Supporting Statement
Attachment U – Parental Introductory Script
Parental Introductory Script
Document Format:
• Screen/question/instructional text designated by black and non-italicized text in
parenthesis. In the program, upper-lower black text to be read and red text is instructions to FI.
• Fills designated by parentheses and italics
• Logic designated by brackets
• Text of instructional message boxes provided in bracketed logic
• Response categories underlined
English:
INTRODUCE YOURSELF/STUDY AS NECESSARY:
Hello, I’m ________with RTI International. We are conducting a nationwide study sponsored by
the U.S. Department of Health and Human Services. You should have received a letter about this
study. (SHOW LEAD LETTER, IF NECESSARY.)
ONE YOUTH IS SELECTED:
Your (AGE) year-old adolescent has been selected for an interview. I would like to talk with
him/her to see if he/she is interested in participating in this study which asks about various
common mental health issues that adolescents face, such as depression or sadness, anxiety and
fears, attention and concentration difficulties, and other health related issues.
If your adolescent is interested, I will give both of you more information and ask for permission
to complete the interview. (Is [he/she] available?)
TWO YOUTHS ARE SELECTED:
Your (AGE) year-old and (AGE) year-old adolescents have been selected for an interview. I
would like to talk with them to see if they are interested in participating in this study which
asks about various common mental health issues that adolescents face, such as depression or
sadness, anxiety and fears, attention and concentration difficulties, and other health related
issues.
If they are interested, I will give all of you more information and ask for permission to complete
the interview. (Are they available?)
National Mental Health Study Field Test,
Supporting Statement
Attachment Y – Sorry I Missed You Card
Sorry I
Missed You…
RTI International
Research Triangle Park, NC 27709-2194
Sorry I
Missed You…
RTI International
Research Triangle Park, NC 27709-2194
Dear Resident:
Dear Resident:
I stopped by today to talk to you about an
important research study being conducted by RTI
International.
I stopped by today to talk to you about an
important research study being conducted by RTI
International.
I am sorry that I did not find you at home. I will
return to talk with you in the next few days.
I am sorry that I did not find you at home. I will
return to talk with you in the next few days.
Thank you in advance for your participation.
Thank you in advance for your participation.
Sincerely,__________________________________
Sincerely,__________________________________
Date: ________________ Time: ______________
Date: ________________ Time: ______________
National Mental Health Study Field Test,
Supporting Statement
Attachment Z – Other Language Card
Arabic
Hello – I’m sorry, but I don’t speak Arabic. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Chinese
Hello – I’m sorry, but I don’t speak Chinese. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
French
Hello – I’m sorry, but I don’t speak French. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
German
Hello – I’m sorry, but I don’t speak German. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Italian
Hello – I’m sorry, but I don’t speak Italian. I’m here because I’m working on a nationwide health study
sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Korean
Hello – I’m sorry, but I don’t speak Korean. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Polish
Hello – I’m sorry, but I don’t speak Polish. I’m here because I’m working on a nationwide health study
sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Russian
Hello – I’m sorry, but I don’t speak Russian. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Spanish
Hello – I’m sorry, but I don’t speak Spanish. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Tagalog
Hello – I’m sorry, but I don’t speak Tagalog. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
Vietnamese
Hello – I’m sorry, but I don’t speak Vietnamese. I’m here because I’m working on a nationwide health
study sponsored by the U.S. Department of Health and Human Services. This study is completely
confidential.
Is there someone here that speaks English? If yes, can you please ask him or her to come to the
door? Thank you.
| File Type | application/pdf |
| File Title | Microsoft Word - NMHS_Electronic Attachment Dividers_PDF 8.doc |
| Author | allewis |
| File Modified | 2017-04-13 |
| File Created | 2017-04-13 |