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UNHAPPY
Often unhappy, depressed, or tearful, past 6 months

Codes and Frequencies



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Description

For sample children age 4 to 17, UNHAPPY reports parents' responses to a question about whether, during the past 6 months, the child was often unhappy, depressed, or tearful.

The interviewer began this part of the survey by stating, "I am going to read a list of items that describe children. For each item, please tell me if it has been not true, somewhat true, [or] certainly true for [sample child] during the past 6 months," and handed the respondent a flashcard listing the three acceptable responses.

Instructions to Interviewers on Asking this Question 

The Field Representative's Manuals for 2001 and 2003 forward directed interviewers that, when an item included two or more behaviors linked by an "or":

For those questions, emphasize the OR. Be sure that the respondent understands that the question should be answered positively if the child does ANY part of the question.

These Manuals also provided directions on how interviewers should respond if parents indicated that the child was taking medication:

If the [parent/respondent] indicates that the child is taking medication, [the parent/he/she] should answer the questions as best possible describing [their/the] child's behavior when the child is NOT on the medication. However, do not ask if the child is on medication. Only if the [parent/respondent] states that the child takes medication and they do not know how to respond to the question, inform the [parent/respondent] to answer as best as they can, describing the child when the child is NOT on the medication.

As discussed in more detail below, UNHAPPY was intended to be a measure of the child's "emotional symptoms." This question was part of the Strengths and Difficulties Questionnaire Extended (SDQ-EX), which, according to the 2001 and 2003 forward Field Representative's Manuals, was included "to monitor emotional and behavioral problems in children and the impact that these problems have on children's lives."

In 2002 and 2005 forward, a brief version of the Strengths and Difficulties Questionnaire, consisting of just six items, including UNHAPPY, was included in the sample child section of the NHIS. The elements of, and the interpretation of results from, the abbreviated version of the SDQ-EX in 2002 and 2005 forward are discussed toward the bottom of this variable description.

Strengths and Difficulties Questionnaire Extended

UNHAPPY is part of a set of 33 questions from the Strengths and Difficulties Questionnaire Extended (SDQ-EX) developed by Dr. Robert Goodman, Institute of Psychiatry, London, England.

 

As the Appendix on SDQ in the 2001 and 2003-2004 Codebook of the NHIS public use files explains:

The parent respondent version of the SDQ was added as a mental health supplement for children ages 4-17 as part of a collaborative agreement between NCHS and the National Institute of Mental Health (NIMH). The first part of the SDQ consists of 25 scale items . . . These items can be divided into five subscales measuring the following psychological attributes or dimensions:
  • emotional symptoms;
  • conduct problems;
  • hyperactive behavior;
  • peer relationships;
  • prosocial behavior.

The survey forms for 2001 and 2003-2005 acknowledged the debt to Dr. Goodman, as follows:

The SDQ questions are copyrighted by Robert Goodman, Ph.D., FRCPsych, MRCP. State and local agencies may use these questions without charge and without seeking separate permission provided the wording is not modified, all the questions are retained, and Dr. Goodman's copyright is acknowledged.

This information was included for legal reasons and was not shared with survey respondents. More information on the SDQ is available at www.sdqinfo.org.

Scoring Responses to SDQ-EX: Emotional Symptoms

As noted in the Appendix on SDQ in the 2001 and 2003-2004 Codebooks, UNHAPPY is an element of the 5-item subscale dealing with emotional symptoms.

 

The other elements of this subscale on emotional symptoms are:

  • Complains of headaches/stomach-aches or sickness, past 6 months (STOMACHE)
  • Often seems worried, past 6 months (WORRIED)
  • Nervous or clingy in new situations, past 6 months (CLINGY)
  • Many fears or easily scared, past 6 months (FEARFUL)

Valid responses for these questions were "not true," "somewhat true," and "certainly true." A response of "not true" for these variables (code 0 in IPUMS NHIS) implies the lowest level of emotional symptoms; a response of "certainly true" for these variables (code 2 in IPUMS NHIS) implies the highest level of emotional symptoms; and a response of "somewhat true" for these variables (code 1 in IPUMS NHIS) implies an intermediate level of emotional symptoms. Researchers may choose to use a single variable from this set, but they can also sum the scores across the 5 variables. Summing these elements yields a total score for emotional symptoms ranging from 0 (the lowest level) to 10 (the highest level).

Summing the values for these variables yields valid totals only if the analyst excludes not in universe cases (persons other than sample children age 4-17, code 6 in IPUMS NHIS) and cases with missing information (codes 7, 8, and 9 in IPUMS NHIS).

The SDQ Scoring Guide provides guidelines for interpreting subscale scores (with Not in Universe and unknown cases excluded) for the SDQ-EX. For "Parent Completed" results (as in the NHIS), the guide suggests a three-band or four-band approach for interpreting the summed score for "Emotional Problems." Under the original three-band categorization, the summed Emotional Problems score can be identified as normal, borderline, or abnormal: a score of 0-3 is normal; a score of 4 is borderline; and a score of 5-10 is abnormal. Under the newer four-band categorization, the summed score can be identified as close to average, slightly raised, high, or very high: a score of 0-3 is close to average; a score of 4 is slightly raised; a score of 5-6 is high; and a score of 7-10 is very high.

Scoring Responses to SDQ-EX: Combining 4 Subscales

The SDQ-EX includes 5 subscales for measuring different aspects of child mental health. The five subscales (i.e., emotional symptoms, conduct problems, hyperactivity behavior, peer relationships, and prosocial behavior) can be scored separately to look at specific psychological characteristics (as described above, for the "emotional symptoms" subscale). Alternatively, items in four of the five subscales (emotional symptoms, conduct problems, hyperactivity behavior, and peer relationships) can be added for an overall score from 0 to 40.

 

Variables from the SDQ-EX receive codes in IPUMS NHIS that facilitate this scoring process. More specifically, the response that corresponds to the lowest likelihood of a psychological problem is coded as 0 in IPUMS NHIS; the response that corresponds to the highest likelihood of a psychological problem is coded 2 in IPUMS NHIS; and the response that corresponds to an intermediate level likelihood of a psychological problem is coded 1 in IPUMS NHIS.

This coding strategy to facilitate scoring means that a given parental response of "not true" or "certainly true" may be sometimes coded as 0 and sometimes coded as 2. (Responses of "somewhat true" are always coded 1.) For example, the question, "During the past 6 months, has [child] often complained of headaches, stomach aches, or sickness?" presupposes that "not true" (coded 0 in IPUMS NHIS) implies less emotional symptomology than a response of "certainly true" (coded 2 in IPUMS NHIS). However, with the question, "During the past 6 months, has [child had] at least one good friend?," a response of "not true" implies poorer peer relationships than a response of "certainly true." In the latter case (for the variable HASFRIEND), responses of "not true" are coded 2 in IPUMS NHIS, and responses of "certainly true" are coded 0 in IPUMS NHIS.

Once analysts exclude not in universe cases (persons who are not sample children age 4-17, IPUMS NHIS code 6) and cases with missing information (IPUMS NHIS codes 7, 8, and 9), they may sum the values for the following SDQ-EX variables for an overall score of 0 (least likely to have psychological problems) to 40 (most likely to have psychological problems). In addition to the 5 variables (including UNHAPPY) used to measure "Emotional Symptoms," as described in the previous section, the variables whose values may summed are:

For measuring "Conduct Problems"
  • Often loses temper, past 6 months (BADTEMPER)
  • Often fights or bullies kids, past 6 months (BULLIES)
  • Often lies or cheats, past 6 months (LIECHEAT)
  • Steals from home, school, or elsewhere, past 6 months (STEALS)
For measuring "Hyperactivity Behavior"
  • Restless or overactive, past 6 months (OVERACTIVE)
  • Constantly fidgeting, past 6 months (FIDGETY)
  • Good attention span and finishes tasks, past 6 months (GOODATTEN)
For measuring "Peer Relationships"
  • Prefers to be alone, past 6 months (SOLITARY)
  • Had at least 1 good friend, past 6 months (HASFRIEND)
  • Liked by other kids, past 6 months (KIDSLIKE)
  • Was picked on or bullied, past 6 months (PICKEDON)
  • Gets along better with adults than kids, past 6 months (GETALONGAD)

Brief Strengths and Difficulties Questionnaire

In 2002, 2005-2007, and 2010-2018, six items from the SDQ-EX were included in the sample child section of the NHIS, again with the permission of Dr. Robert Goodman. According to Appendix V of the NHIS Survey Description Document for 2002 and 2005 forward, the abbreviated SDQ, "constructed to save time and space in the questionnaire, was added for children of ages 4-17 as a part of a collaborative agreement between NCHS and the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH)."

 

In the brief version of the questionnaire used in the 2002, 2005-2007, and 2010-2018 NHIS, one or two items were chosen from each of the 4 subscales making up the Strengths and Difficulties Questionnaire Extended (SDQ-EX). UNHAPPY was selected from the "emotional symptoms" subscale and, according to Appendix V, "correlates 0.64" with the full "SDQ emotion score." WORRIED (Has many worries or often seems worried) was also selected from the "emotional symptoms" subscale and, according to Appendix V, "correlates 0.71" with the full "SDQ emotion score." WELLBEHAVED (Generally well behaved, past 6 months) was selected from the "conduct problems" subscale and, according to Appendix V, "correlates 0.69" with the full "SDQ conduct score." GETALONGAD (Gets along better with adults than kids, past 6 months) was selected from the "peer relationships" subscale and, according to Appendix V, "correlates 0.69" with the full "SDQ peer problems score." GOODATTEN (Good attention span and finishes tasks, past 6 months) was selected from the "hyperactivity behavior" subscale and, according to Appendix V, "correlates 0.72" with the full "SDQ hyperactivity-inattention score."

As with the SDQ-EX, variables from the brief version of the SDQ receive codes in IPUMS NHIS that allow researchers to add codes across items for a meaningful overall score. More specifically, the response that corresponds to the lowest likelihood of a psychological problem is coded as 0 in IPUMS NHIS; the response that corresponds to the highest likelihood of a psychological problem is coded 2 in IPUMS NHIS; and the response that corresponds to an intermediate level likelihood of a psychological problem is coded 1 in IPUMS NHIS.

Once analysts exclude not in universe cases (persons who are not sample children age 4-17, IPUMS NHIS code 6) and cases with missing information (IPUMS NHIS codes 7, 8, and 9), they may sum the values for the aforementioned six SDQ variables for an overall score of 0 (least likely to have psychological problems) to 10 (most likely to have psychological problems). According to Appendix V in both 2002 and 2005 forward, "all values are summed to produce a total score. A total score from 1 to 5 correlates 0.84 with the full [long] SDQ total difficulties score."

Comparability

With the exception of the NHIS questionnaire redesign introduced in 2019, UNHAPPY is completely comparable over time. As mentioned above, this variable is an element of both the extended version of the SDQ, which was fielded for sample children in the NHIS in 2001, 2003, 2004, and 2019 forward, and an element of the short version of SDQ, which was fielded for sample children in 2002, 2005-2007, and 2010-2018.

Other Variables on Child Mental Health 

From 1997-2000, the NHIS used questions from the Child Behavioral Checklist (CBCL) developed by Dr. Thomas Achenbach to measure children's emotional and behavioral problems. For 2001 forward, the NHIS retained the CBCL questions for children age 2-3, but replaced the CBCL survey with the Strengths and Difficulties Questionnaire (SDQ) for older children.

For the most part, the public use files of the NHIS data include only summary recodes for the CBCL questions, calculated separately for male and female children age 2-3 (MTODMHI, FTODMHI), for male and female children age 4-11 (MKIDMHI, FKIDMHI), and for male and female children age 12 to 17 (MTEENMHI, FTEENMHI). The one exception to this generalization is that variables from the CBCL relating to whether the child had been unhappy or depressed in recent months (TODDEPRES, KIDDEPRES, TEENDEPRES) appear in the NHIS public files.

The NHIS questionnaire was substantially redesigned in 2019 to introduce a different data collection structure and new content. For more information on changes in terminology, universes, and data collection methods beginning in 2019, please see the user note.

Universe

  • 2001-2007: Sample children age 4 to 17.
  • 2010-2018: Sample children age 4 to 17.
  • 2019: Sample children age 4 to 17.

Availability

  • 2001-2007, 2010-2019

Weights