a longitudinal study of the mental health of adults living in private households in Great Britain

190 Pages·2003·1.32 MB·English

Editors Report based on
Nicola Singleton surveys carried out by
Glyn Lewis the Office for
National Statistics in
2000 and 2001 for
the Department of
Health and the
Scottish Executive
Health Department
Better or worse:
a longitudinal study of
the mental health of
adults living in private
households in Great
Britain
London: TSO
© Crown copyright 2003 This report has been produced by the Social Survey Division of
Published with the permission of the Controller of Her Majesty’s the Office for National Statistics in accordance with the National
Stationery Office (HMSO). Statistics Code of Practice.
ISBN 0 11 621658 1
Applications for reproduction should be submitted to HMSO
under HMSO’s Class Licence:
www.clickanduse.hmso.gov.uk
Alternatively applications can be made in writing to:
HMSO
Licensing Division
St. Clement’s House
2–16 Colegate
Norwich
NR3 1BQ
Contact points
For enquiries about this publication, contact
Nicola Singleton
Tel: [phone]
E-mail:
Contents
Page
List of tables v
List of figures vii
Editors’ acknowledgements viii
Notes to tables ix
Summary of key findings xi
1. Introduction and overview of methods used 1
Nicola Singleton, Alison Lee, Howard Meltzer and Glyn Lewis
1.1 Background, aims and coverage of the study 1
1.2 Sampling and interviewing procedures for the face-to-face interviews 4
1.3 Sampling and interviewing procedures for the telephone interview study
of met and unmet needs for care 6
1.4 Assessment of disorder and other key variables 8
1.5 Response to the survey 11
1.6 Approach to the analysis 12
2. Onset of episodes of the common mental disorders 17
Scott Weich
2.1 Introduction 17
2.2 Factors associated with episode onset 18
2.3 Discussion 20
3. Recovery from common mental disorders 31
Glyn Lewis
3.1 Introduction 31
3.2 Factors associated with recovery 32
3.3 Discusion 34
4. Suicidal thoughts 45
David Gunnell and Roger Harbord
4.1 Introduction 45
4.2 Factors associated with the onset of suicidal thoughts 46
4.3 Factors associated with recovery from suicidal thoughts 48
4.4 Discussion 49
5. Tobacco, alcohol and drug use and cessation of use at follow-up 66
Michael Farrell
5.1 Introduction 66
5.2 Onset of smoking at follow-up 67
5.3 Cessation of tobacco smoking 69
5.4 Onset of hazardous and dependent drinking 71
5.5 Recovery from hazardous and dependent drinking 74
5.6 Onset of drug use 77
5.7 Recovery from or cessation of drug use 78
5.8 Discussion 79
iii
Page
6. Treatment 122
Michael King, Paul Bebbington and Ula Nur
6.1 Introduction 122
6.2 Definitions and methods 123
6.3 Extent of treatment and service provision 124
6.4 Factors associated with reporting treatment or service contacts 125
6.5 Associations between treatment and service contacts and outcome
of common mental disorder 126
6.6 Results of the sub-study of met and unmet needs 127
6.7 Conclusions 129
7. Quality of life, social support and physical health 146
Traolach Brugha and Sherrill Evans
7.1 Introduction 146
7.2 The Lancashire Quality of Life Profile 146
7.3 Health status 148
7.4 Economic Quality of Life indicators 149
7.5 Social support 149
7.6 Activities of Daily Living 150
7.7 Conclusion 151
Appendices
A The assessment of common mental disorder and alcohol problems 157
B Statistical terms and their interpretation 162
C Glossary of survey definitions and terms 166
iv
List of tables
Page Page
Chapter 1 Introduction and overview of 4.5 Odds Ratios associated with the onset of
methods used suicidal thoughts from T1 to T2: Substance
use variables 60
1.1 The sample size in different sample groups 15 4.6 Odds Ratios associated with the recovery from
1.2 Response to the initial interview stage 15 suicidal thoughts from T1 to T2 61
1.3 Response to the telephone interviews 15 4.7 Odds Ratios associated with the recovery from
1.4 Response to the telephone interviews suicidal thoughts from T1 to T2: Demographic
according to selection group 15 variables 62
1.5 Socio-economic characteristics of responders 4.8 Odds Ratios associated with the recovery
and non-responders 16 from suicidal thoughts from T1 to T2:
1.6 Mental health and substance use Economic variables 63
characteristics of responders and 4.9 Odds Ratios associated with the recovery
non-responders 16 from suicidal thoughts from T1 to T2:
Social context variables 64
Chapter 2 Onset of episodes of the common 4.10 Odds Ratios associated with the recovery
mental disorders from suicidal thoughts from T1 to T2:
Substance use variables 65
2.1 Odds Ratios associated with the onset of
common mental disorder at T2 22 Chapter 5 Tobacco, alcohol and drug use and
2.2 Odds Ratios associated with the onset of cessation of use at follow-up
common mental disorder at T2:
Demographic variables 23 5.1 Odds Ratios associated with onset of
2.3 Odds Ratios associated with the onset of smoking at T2 82
common mental disorder at T2: Economic 5.2 Odds Ratios associated with onset of
variables 26 smoking at T2: Demographic variables 83
2.4 Odds Ratios associated with the onset of 5.3 Odds Ratios associated with onset of
common mental disorder at T2: Social smoking at T2: Economic variables 84
context variables 29 5.4 Odds Ratios associated with onset of
smoking at T2: Social context variables 85
Chapter 3 Recovery from common mental disorders 5.5 Odds Ratios associated with onset of
smoking at T2: Mental health and substance
3.1 Odds Ratios associated with recovery from use variables 86
common mental disorder by T2 36 5.6 Odds Ratios associated with recovery from
3.2 Odds Ratios associated with recovery from smoking at T2 87
common mental disorder by T2: 5.7 Odds Ratios associated with recovery from
Demographic variables 37 smoking at T2: Demographic variables 88
3.3 Odds Ratios associated with recovery from 5.8 Odds Ratios associated with recovery from
common mental disorder by T2: smoking at T2: Economic variables 89
Economic variables 40 5.9 Odds Ratios associated with recovery from
3.4 Odds Ratios associated with recovery from smoking at T2: Social context variables 90
common mental disorder by T2: Social 5.10 Odds Ratios associated with recovery from
context variables 43 smoking at T2: Mental health and other
substance use variables 91
Chapter 4 Suicidal thoughts 5.11 Odds Ratios associated with onset of
hazardous or dependent drinking at T2 92
4.1 Odds Ratios associated with the onset of 5.12 Odds Ratios associated with onset of
suicidal thoughts from T1 to T2 51 hazardous or dependent drinking at T2:
4.2 Odds Ratios associated with the onset of Demographic variables 93
suicidal thoughts from T1 to T2: 5.13 Odds Ratios associated with onset of
Demographic variables 52 hazardous or dependent drinking at T2:
4.3 Odds Ratios associated with the onset of Economic variables 96
suicidal thoughts from T1 to T2: Economic 5.14 Odds Ratios associated with onset of
variables 56 hazardous or dependent drinking at T2:
4.4 Odds Ratios associated with the onset of Social context variables 99
suicidal thoughts from T1 to T2: Social 5.15 Odds Ratios associated with onset of
context variables 58 hazardous or dependent drinking at T2:
Mental health and substance use variables 101
v
Page Page
5.16 Odds Ratios associated with recovery from 6.8 Association between recovery from common
hazardous or dependent drinking at T2 103 mental disorder and treatment 142
5.17 Odds Ratios associated with recovery from 6.9 Relationship between level of functioning
hazardous or dependent drinking at T2 : assessed on the Needs for Care Assessment
Demographic variables 104 and the diagnostic categories obtained from
5.18 Odds Ratios associated with recovery from the baseline interviews 142
hazardous or dependent drinking at T2: 6.10 Level of functioning and primary need
Economic variables 107 status with respect to common mental
5.19 Odds Ratios associated with recovery from disorders (depression, anxiety/obsession or
hazardous or dependent drinking at T2: adjustment disorder) assessed in the
Social context variables 110 telephone interviews by CIS-R score at T1 142
5.20 Odds Ratios associated with recovery from 6.11 Level of functioning and assessed need with
hazardous or dependent drinking at T2: respect to alcohol problems by level of
Mental health and other substance use alcohol problem at T1 143
variables 112 6.12 GP consultations for mental or emotional
5.21 Odds Ratios associated with onset of drug problems in the 2 weeks prior to T1 or
use between T1 and T2 113 between T1 and T2 by level of functioning
5.22 Odds Ratios associated with onset of drug and assessed need for treatment for common
use between T1 and T2: Demographic mental disorders 143
variables 114 6.13 GP consultations for mental or emotional
5.23 Odds Ratios associated with onset of drug problems in the 2 weeks prior to T1 or
use between T1 and T2: Economic between T1 and T2 by level of functioning
variables 115 and assessed need for treatment for alcohol
5.24 Odds Ratios associated with onset of drug problems 144
use between T1 and T2: Social context 6.14 Assessment of levels of delivery of different
variables 116 types of care for those assessed as having
5.25 Odds Ratios associated with onset of drug current, past or likely depressive symptoms 145
use: Mental health and substance use 6.15 Assessment of levels of delivery of different
variables 117 types of care for those assessed as having current,
5.26 Odds Ratios associated with recovery from past or likely alcohol problems 145
drug use 117 6.16 Assessment of levels of delivery of different
5.27 Odds Ratios associated with recovery from types of care for those assessed as having
drug use: Demographic variables 118 current, past or likely anxiety symptoms 146
5.28 Odds Ratios associated with recovery from
drug use: Economic variables 119 Chapter 7 Quality of life, social support and physical
5.29 Odds Ratios associated with recovery from health
drug use: Social context variables 120
5.30 Odds Ratios associated with recovery from 7.1 Distribution of Lancashire Quality of Life
drug use: Mental health and other substance subscale scores by change in CIS-R caseness
misuse variables 121 from T1 to T2 153
7.2 Longstanding physical complaints at T1 by
Chapter 6 Treatment change in CIS-R caseness from T1 to T2 154
7.3 Economic Quality of Life indicators by change
6.1 Treatment or health care services received in CIS-R caseness from T1 to T2 154
at either T1 or T2 by CIS-R score at T1 131 7.4 Social support by change in CIS-R caseness
6.2 Treatment or health care services received from T1 to T2 155
at either T1 or T2 by change in CIS-R 7.5 Change in the extent of difficulties with
caseness 132 activities of daily living by change in CIS-R
6.3 Treatment or health care services received caseness from T1 to T2 156
at either T1 or T2 by alcohol problems at T1 133
6.4 Treatment or health care services received
at either T1 or T2 by illicit drug use in the
previous year at T1 134
6.5 Odds Ratios associated with receiving any
treatment or service at T1 or T2 135
6.6 Odds Ratios associated with receiving any
treatment or service at T1 or T2:
Demographic variables 136
6.7 Odds Ratios associated with receiving any
treatment or service at T1 or T2: Economic
variables 139
vi
List of figures
Page Page
Table No.
Chapter 1 Introduction and overview of methods used Chapter 6 Treatment
1.1 Timing of fieldwork for baseline and 6.1 Receipt of treatment at T1 or between T1
follow-up interviews 5 and T2 by level of CIS-R score and sex 124
1.2 Calculation of symptom score for Anxiety
from the CIS-R 9 Chapter 7 Quality of life, social support and physical
1.3 Topics covered by the AUDIT questionnaire 9 health
Chapter 2 Onset of Episodes of the Common 7.1 Proportion indicating poor quality of life
Mental Disorders (score 1–3) on the LQOLP work and finances
subscales by change in CIS-R caseness 148
2.1 Proportion of men and women with onset 7.2 Extent of difficulty with household activities
of common mental disorder by baseline by change in common mental disorder
CIS-R score 19 between T1 and T2 151
2.2 Proportion of men and women with onset
of common mental disorder by number of
stressful life events experienced since
baseline 20
Chapter 3 Recovery
3.1 Proportion of men and women with
recovery from common mental disorder by
experience of stressful life events between
baseline and follow-up 33
Chapter 4 Suicidal Thoughts
4.1 Proportion of men and women reporting
onset of suicidal thoughts by CIS-R score at
T1 46
4.2 Proportion of men and women reporting
onset of suicidal thoughts by number of
stressful life events experienced between
baseline and follow-up 47
4.3 Odds of recovery from suicidal thoughts by
level of CIS-R score at T1 (adjusted for age
and sex) 48
Chapter 5 Tobacco, alcohol and drug use and
cessation of use to follow up
5.1 Proportion of people with onset of smoking
by mental health and substance use factors 69
5.2 Proportion of people reporting smoking
cessation by daily cigarette consumption
at T1 70
5.3 Proportion of men and women with onset of
hazardous or dependent drinking patterns
by age 72
5.4 Proportion of people reporting cessation of
hazardous or dependent drinking by baseline
AUDIT score and sex 75
5.5 Odds of onset of drug use associated with
number of stressful life events experienced
between interviews (adjusted for age and sex) 78
vii
Editors’ acknowledgements
We would like to thank everybody who contributed
to the survey and the production of this report.
Most importantly, we would like to thank all the
participants in the survey for their time and co-
operation over all stages of the study.
We are also very grateful for the support of our
specialist colleagues in ONS who undertook the
sampling, fieldwork and computing elements for
the survey. In addition great thanks are due to all
the ONS interviewers who worked on the survey.
Thanks are also due to Professor Paul Bebbington,
and the team at University College London who
were responsible for carrying out the telephone
interviews for the survey.
The authors of the individual chapters all
contributed a considerable amount of time and
effort to the production of the report. In addition
we would like to acknowledge the assistance we
have received from the following people who
provided valuable advice and suggestions on the
analysis and reporting:
Ricardo Araya, University of Bristol
Professor Peter Huxley, University College, London
Petros Skapinakis, University of Bristol
Dr Nick Taub, University of Leicester
Colin Taylor, National Addiction Centre, Institute
of Psychiatry
We also received support and advice throughout
the project from many people within the
Department of Health, in particular:
Prof Cathy Borowy
Dr Alan Glanz
Dr Anna Higgitt
Mr David Daniel
Ms Anne Richardson
viii
Notes to tables
1 Tables 2 Statistical significance
The majority of tables have a similar format and Unless otherwise stated, differences mentioned in
show the association between a number of variables the text have been found to be statistically
of a similar type (eg socio-economic characteristics) significant at the 95% confidence level. Standard
and a dichotomous dependent variable, such as errors that reflect the complex sampling design and
onset of common mental disorder present or not. weighting procedures used in the survey have been
The content of the tables is as follows, using the calculated and used in tests of statistical
tables for onset of common mental disorder significance.
(chapter 2) as an example. The tables show firstly
the percentage of cases with onset of disorder in 3 Small bases
each category of the variable under consideration.
They then show the results from an unadjusted Very small bases have been avoided wherever
regression analysis using the dependent variable and possible because of the relatively high sampling
the variable of interest only, followed by an adjusted errors that attach to small numbers. In general,
regression analysis controlling for age, sex (in percentage distributions are shown if the base is 30
analyses of all adults) and level of disorder at T1. or more. Where the base is lower, actual numbers
For each of these regression analyses, the overall are shown in square brackets.
significance of the variable under consideration and
the odds ratios with level of significance and 95%
confidence intervals are shown. Guidance on
interpreting odds ratios and other output from
logistic regression analyses is given in Appendix B.
In other types of tables (for example those in
chapter 7) the varying positions of the percentage
signs and bases in the tables denote the presentation
of different types of information. Where there is a
percentage sign at the head of a column and the
base at the foot (as in table 7.1), the whole
distribution is presented and the individual
percentages add to between 99% and 101% (due to
rounding). Where there is no percentage sign in the
table and a note above the figures (as in table 7.2),
the figures refer to the proportion of people who
had the attribute being discussed, and the
complementary proportion, to add to 100%, is not
shown in the table.
The following conventions have been used within
tables:
- no cases
0 values less than 0.5%
.. data not available
ix
x