SAMHSA 2025 National Household Survey on Behavioral Health (NHSBH) -- comments invited to OMB (by 9/16)

Question

Aug 15 -- The Substance Abuse and Mental Health Services Administration (SAMHSA) invites comments to OMB by September 16, 2024 regarding the proposed 2025 National Household Survey on Behavioral Health (NHSBH), formerly known as the National Survey on Drug Use and Health (NSDUH).

The National Survey on Drug Use and Health (NSDUH) is a survey of the U.S. civilian, non-institutionalized population aged 12 years old or older. The data are used to provide estimates of substance use and mental illness at the national, state, and substate levels. Information collected through NSDUH has multiple applications, including 1) advancing the study of the epidemiology of substance use and mental health; 2) monitoring substance use and mental health trends and patterns; 3) identifying licit and illicit substances being used and abused (including those causing/contributing to medical, psychological, or social problems requiring emergency medical care or rehabilitation); 4) advancing the study of the use of health care resources for treatment of substance use and mental health problems; and 5) assisting federal, state and local agencies in the allocation of resources, and the proper design and implementation of substance use prevention, treatment, and rehabilitation programs.

For the 2025 NSDUH, SAMHSA is proposing to change the name of the study to the National Household Survey on Behavioral Health (NHSBH) to emphasize the inclusion of the long-standing mental health-related survey elements and to clarify for key stakeholders the full content of the survey's questions and data. The proposed name change will facilitate participant, researcher, and public understanding that the NSDUH is focused on both drug use but also mental health. The current name of the survey does not specifically capture questionnaire items across substance use and mental health, both separately and as co-occurring conditions. In addition, the name change will better align the survey with SAMHSA's mission.

The survey's name is currently well recognized by those in the community, states, and academia, and this recognition comes from the quality of the established information provided. The continuing excellence of the information provided is anticipated to re-establish the recognition of the survey with the new name. It is anticipated that changing the name of the survey will highlight, in addition to substance, mental health components.

SAMHSA is committed to addressing any concerns with a name change that may lead to confusion and/or misperception among some stakeholders and the general public, which could affect participation in the survey, misinterpretation of changes with the survey's content or purpose, or difficulty locating the pertinent information about the study's results. Nonetheless, these potential stakeholder responses and challenges will be addressed by emphasizing the significance of a name that reflects the complete content of the survey. A new name may also facilitate discussions on substance use and co-occurring mental health disorders.

Efforts will be made to promote, market, and educate about the well-established quality and applicability of the survey results. These efforts may spark enhanced interest in the survey and the uptake of the results in publications and reports.

As with all NSDUH/NHSDA surveys conducted since 1999, the sample size of the NSDUH main study for 2025 will be sufficient to permit prevalence estimates for each of the fifty states and the District of Columbia. The NSDUH will continue to use a sample design which provides data at both the national level and the state level. The survey’s sample design includes targets to yield 4,560 completed interviews in California; 3,300 completed interviews each in Texas, New York, and Florida; 2,400 completed interviews each in Illinois, Pennsylvania, Ohio, and Michigan; 1,500 completed interviews each in Georgia, North Carolina, New Jersey, and Virginia; 967 completed interviews in Hawaii; and 960 completed interviews in each of the remaining 37 states and the District of Columbia. This approach will ensure a sufficient sample in every state to support either small area estimation (SAE) or direct estimation methods, while at the same time maintaining efficiency for national estimates.The sample design will also include the same age group allocation implemented since the 2014 survey. To accurately estimate drug use and related mental health measures among the aging drug use population, the NSDUH sample will be allocated to age groups as follows: 25 percent 12 to 17, 25 percent 18 to 25, 15 percent 26 to 34, 20 percent 35 to 49, and 15 percent 50 or older.

For the 2025 NHSBH the following changes from 2024 are planned:

-- updating the Hallucinogens Module to include follow-up questions for each hallucinogen;
-- adding three questions to the Health Module to measure sleep disorders (SLPFALL, SLPSTAY, and SLPMED) for adult respondents;
-- adding an introduction screen and two questions to the Health Module to measure chronic pain (PAININT, PAINPM and PAINLIM) for adult respondents;
-- adding two questions to the Youth Experiences Module to measure non-suicidal self-harm (SFHRMPY and SFHRMNUM);
-- removing the Prior Substance Use Module to lower respondent burden; and
-- removing 87 questions across nine modules for questionnaire clean-up reasons.

Overall, these changes are anticipated to reduce respondent burden and produce more up-to-date data. The revisions to the Hallucinogens module will allow the 2025 NHSBH to collect more detailed information about a wider range of hallucinogens to better meet data users' needs. The new questions measuring sleep disorders, chronic pain, and non-suicidal self-harm were added because the NHSBH did not previously include these items and they are of growing interest to data users. All removed questions, including the entire Prior Substance Use Module, were determined to be of low or no analytic value to CBHSQ. Removing these questions will allow room to add questions that are more useful to CBHSQ and relevant to data users in the future.

NSDUH: https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
SAMHSA submission to OMB: https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202408-0930-003 Click on IC List for questionnaire, View Supporting Statement for technical documentation. Submit comments through this site.
FR notice inviting public comment: https://www.federalregister.gov/d/2024-18250
 
For AEA members wishing to submit comments, "A Primer on How to Respond to Calls for Comment on Federal Data Collections" is available at https://www.aeaweb.org/content/file?id=5806

Comments

The proposed change in the name of the NSDUH and the additional questions are well suited to today's biggest issues in behavioral health, which combine concerns about increases in mental health disorders and substance abuse (particularly but not only related to drug overdose deaths), particularly among the young. Reported pain, for example, is often associated positively with increases in drug use (both legal and elicit) and subsequent addiction, while suicidal ideation is on the rise among the young as well.

One important thing that should be included, however, is a question on positive well-being, with life satisfaction and/or hope for the future being the most commonly used and useful ones. It is important to benchmark markers of ill-being, such as reported depression or anxiety, with respondents' baseline levels of positive well-being. Increases in reported depression or anxiety, for example, are much more worrisome in individuals who have low levels of baseline wellbeing than among those with positive levels but who are reacting to immediate challenges with increased levels of anxiety or feelings of depression. At the aggregate level, meanwhile, it is important to have both sets of measures in order to identify and reach the most vulnerable population cohorts. Reported wellbeing questions usually take no more than 30 seconds to answer, so do not add much time to survey response burdens and are validated by responses correlating with psychological measures of well-being, such as genuine "Duchenne" smiles and/or frontal cortex patterns. Many other wealthy countries, such as the UK, New Zealand, and Canada, include them in their regular official statistics collection, allowing for robust tracking of trends in ill-being and well-being over time. The U.S. is woefully behind on this effort, and the proposed changes in the NUSDUH provide an opportunity to change this.