IPUMS NHIS: descr: FTODMHI

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NATIONAL HEALTH INTERVIEW SURVEY

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FTODMHI

Female toddler mental health indicator (MHI) scale score

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Description

FTODMHI reports Mental Health Indicator (MHI) scores for female sample children age 2 to 3 based on parents' responses to a set of four questions about behavioral/emotional problems. The questions used to calculate MHI scores were taken from the Child Behavior Checklist (CBCL) developed by Dr. Thomas Achenbach and were selected separately according to specific gender and age groups (males and females; ages 2-3, 4-11, 12-17).

FTODMHI, which covers female children age 2-3, is one of six summary recodes for CBCL questions.

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The other variables in this series are the following:

MTODMHI (male children 2-3) (available 1997 forward)

MKIDMHI (male children 4-11) (available 1997-2000)

FKIDMHI (female children 4-11) (available 1997-2000)

MTEENMHI (male children 12-17) (available 1997-2000)

FTEENMHI (female children 12-17) (available 1997-2000)

Before asking the appropriate set of questions for female sample children age 2-3, the interviewer stated, "I am going to read a list of items that describe children. For each one, tell me if it has been NOT TRUE, SOMETIMES TRUE, or OFTEN TRUE, of [sample child] during the past 2 months."

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The Field Representative's Manuals for 1997-2000 instructed interviewers, "[i]f the respondent gives an answer which does not match the categories read in the question, reread the question emphasizing the wording of the answer categories."

The statements parents were asked to rate for female sample children age 2 to 3 included:

SHE:

(During the past 2 months)

Has temper tantrums or a hot temper?

Has speech problems?

Has been nervous or high-strung?

Has been unhappy, sad, or depressed?

Responses for these four items were coded by NHIS as 0 (Not True), 1 (Sometimes True), and 2 (Often True). Individual item scores were then summed to calculate an overall MHI score ranging from 0 (lowest need for mental health services) to 8 (highest need for mental health services), which is reported in FTODMHI.

Child Behavior Checklist and MHI Item Selection

The 1997-2000 NHIS Survey Descriptions provide the following explanation for how items were chosen from the Child Behavior Checklist for use in the NHIS:

The questions pertaining to child behavior were designed to serve as a global mental health indicator. The items were taken from the Child Behavior Checklist for Ages 2-3, and the Child Behavior Checklist for Ages 4-18; these are standardized instruments for obtaining parents' reports of their children's problems. The items were chosen for their ability to discriminate between children who have not received mental health services in the preceding 12 months and those who have, by using demographically-matched normative and clinical samples for each sex and age group.

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The items selected from the CBCL for parents to rate for the other gender/age groups (other than females age 2-3) included:

Males 2-3 (1997 forward)

(During the past 2 months)

Has been uncooperative?

Has trouble getting to sleep?

Has speech problems?

Has been unhappy, sad, or depressed?

Males 4-11 (1997-2000)

(During the past 6 months)

Doesn't get along with other kids?

Can't concentrate or pay attention long?

Feels worthless or inferior?

Has been unhappy, sad, or depressed?

Females 4-11 (1997-2000)

(During the past 6 months)

Can't concentrate or pay attention long?

Has been nervous, high strung or tense?

Acts too young for her age?

Has been unhappy, sad, or depressed?

Males 12-17 (1997-2000)

(During the past 6 months)

Can't concentrate or pay attention long?

Lies or cheats?

Doesn't get along with other kids?

Has been unhappy, sad, or depressed?

Females 12-17 (1997-2000)

(During the past 6 months)

Lies or cheats?

Does poorly at school work?

Has trouble sleeping?

Has been unhappy, sad, or depressed?

Scores for the individual subscale items were only made publicly available for "Has been unhappy, sad, or depressed?" (Males and Females 2-3, TODDEPRES; Males and Females 4-11, KIDDEPRES; Males and Females 12-17, TEENDEPRES).

Interpreting MHI Scores

Data analyses specified and reviewed by Dr. Achenbach were conducted at the National Center for Health Statistics (NCHS) using data from the 1997 NHIS. According to the Codebooks of the NHIS public use files for 1997-forward, these analyses included "tabulations of specific responses to each behavior/emotional problem item" as well as "tabulations of relations between total problem scores and classification of children as deviant versus nondeviant on the basis of external criteria."

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Examples of such "external criteria" included the parent's affirmative response to the following questions:

Has a doctor or health professional ever told you that [sample child] had:

Attention Deficit Disorder? (ADDEV)

Mental Retardation? (RETEV)

Any other developmental delay?(ODDEV)

Has a doctor or other health professional ever told you that [sample child] had:

Down's syndrome? (DOWNSYNEV)

Autism? (AUTISMEV)

Has a representative from a school or a health professional ever told you that [sample child] had a learning disability? (LEARNDEV)

During the past 12 months, was there any time when [sample child] needed any of the following, but didn't get it because you couldn't afford it:

Mental health care or counseling? (YBARMENTAL)

During the past 12 months, has anyone in the family seen or talked to any of the following about [sample child's] health?

A mental health professional such as a psychologist, psychiatric nurse, or clinical social worker? (SAWMENT)

Relative Operating Characteristic (ROC) analyses were then performed on the overall MHI scores to ascertain the sensitivity and specificity of different cutpoints in predicting the likelihood of a "deviant" classification.

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According to the Codebooks for 1997-forward, Dr. Achenbach made the following recommendation for sample children age 2-3 based on the analyses conducted at NCHS:

[MHI scores for sample children age 2-3] are useful for quantitative analyses in relation to other variables. However, categorical mental health indicators should not be derived from specific cutpoints on the total scores for the 4 behavioral/emotional problem items on the basis of 1997 NHIS data for ages 2-3 for the following reasons:

The total number of children . . . classified as deviant according to external criteria . . . was too small to provide a sound basis for establishing cutpoints;

Many disorders relevant to defining criterion groups (e.g., ADHD) are not identified as early as age 2-3;

The rates of referral for mental health services and other possible indicators of deviance are much lower at ages 2-3 than at older ages.

The Codebooks for 1997-forward also include the following cautionary note regarding the interpretation of MHI scores:

It is essential to note that such a small set of items cannot be used to evaluate individual children for clinical or other purposes. Even for use as mental health indicators in large surveys such as the NHIS, very small sets of items can serve only as approximate indicators of needs for mental health services. Multiple items tapping each of several specific areas of functioning would be needed to identify specific disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), Depression, Conduct Disorder, and Somatization Disorder.

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