Research Paper on "Domestic Violence and Hispanic Women"

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Evidence-Based Practice Protocol: Domestic Violence and Hispanic Women

Evidence-based Practice

Domestic violence (DV) accounts for about 30% of all acute injuries to women treated in emergency departments, as it currently constitutes a critical public health concern, not only in the United States (U.S.), but worldwide. Some studies indicate that Hispanic women are more likely to be injured during intimate partner violence incidents than non-Hispanic women, with scholars agreeing that DV among Latinos must be addressed as it constitutes a serious problem among the Latino growing population.

Research reveals that utilizing emergency room protocols to identify and treat victims of domestic violence increases the identification of victims by medical practitioners. Although a high percentage of female victims of domestic violence visit emergency rooms for treatment, low and underreported incidents, however, complicate current concerns that counter domestic violence detection assessed in clinical environments.

Nevertheless, researchers recognize the value of domestic violence screening in general practice and primary care as an effective method of identifying and responding to domestic violence cases presenting to emergency departments. In light of the need to better assess domestic violence, this Capstone presents considerations for the development and implementation of an evidence-based practice protocol (EBPP) to help fill this critical contemporary need.

TABLE OF CONTENTS

ABSTRACT

ii iv

LIST OF ABBRIEVIATONS

v

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INTRODUCTION

1

Intimate Partner Violence

1

Clinical Practice Problem

2

Assessing DV Concerns

3

Study Aim and Objectives

4

RELATED LITERATURE

9

Increasing Concerns

9

Myths and Facts Regarding DV

12

Studies Reveal

13

Inadequate Reporting

14

Need to Educate DV Victims

16

Domestic Violence and Hispanic Women

17 DOMESTIC ABUSE SCREENING TESTS

22

EBP PROCESS for EBPP

24

ANALYSIS AND CONCLUSION

27

Evidence-Based Support

27

REFERENCES

32

APPENDICES

38

APPENDIX A

39

Table 1 Demographic Characteristics of adults with a serious mental illness

Table 2 Disparities for Focus Area 18

Table 3 Demographic Characteristics of adults with a serious mental illness

Tables 5-9 Female deaths by age and race in the U.S., preliminary 2006

Table 10 Deaths and death rates for selected mental health causes in the U.S. 2006

APPENDIX B

43

Figure I: Domestic Violence Wheel

5

Figure 2: Common Factors in Mental Illness and Domestic Violence

29

Figure 3: Australian Law Concept of DV

30

LIST OF ABBRIEVIATONS

APN -- Advance Practice Nurse

EBPP - Evidence-Based Practice Protocol

SAMHSA - Substance Abuse and Mental Health Service Administration

EVIDENCE-BASED PRACTICE PROTOCOL:

DOMESTIC VIOLENCE AND HISPANIC WOMEN

"Intimate partner violence is considered a major public health concern in the United States and worldwide"

- Jerry Tello (2008, p. 61).

INTRODUCTION

Intimate Partner Violence

Intimate partner violence (IPV), a component of domestic violence (DV) currently constitutes a critical public health concern, not only in the United States (U.S.), but worldwide, Jerry Tello (2008) stresses in his book, Family Violence and Men of Color: Healing the Wounded Male Spirit. Tello notes that some studies indicate that Hispanic women are more likely to be injured during intimate partner violence incidents than non-Hispanic women. Some studies, however, reflect that no significant difference exists between Latinos and non-Hispanic women. Despite that contradiction, scholars agree that IPV among Latinos must be addressed as it constitutes a serious problem among the Latino growing population. In regard to the current urgency for effective interventions to counter IPV, this Capstone project integrates knowledge from previous coursework in the development and implementation of an evidence-based practice protocol (EBPP) in the researcher's clinical specialty area.

In the study, "Cross-Lagged Relationships between substance use and intimate partner violence among a sample of young adult women," Steven C. Martino, Rebecca L. Collins, and Phyllis L. Ellickson (2005) report that approximately 1.5 million women in the United States are victims of intimate partner violence each year, additionally confirming that related research and interventions to this concern are critical. Donna Scott Tilley, Assistant Professor, Texas Tech University (Nursing) and Margaret Brackley (2004), Professor and Director of the Center for Violence Prevention, University of Texas, note in their study, "Violent lives of women: critical points for intervention-phase I focus groups," that several women/participants equated their abuser to "Dr. Jekyll and Mr. Hyde." Tilley and Brackley point out that partner violence, frequently accompanied by emotional and verbal abuse, and controlling behavior, also includes physical and sexual violent acts. They confirm domestic violence to be significant health problem in the U.S. And point out that domestic violence infiltrates all socioeconomic and ethnic groups and occurs not only in heterosexual, but also in homosexual relationships. "Advanced practice nurses [APNs] are in a position to identify battered women in varied settings," Tilley and Brackley note. Consequently, this affords APNs, who observe the symptoms of abuse and post-traumatic stress disorder in the primary care setting, the opportunity to routinely screen and intervene on the behalf of the abused women.

Clinical Practice Problem

The rates of domestic violence detection in clinical settings, however, remain low and underreported despite the fact a high percentage of female victims of domestic violence visit emergency rooms for treatment, which provide opportunities for detection and intervention. Garcia (2004) states that health professionals seldom check for signs of violence or ask women about experiences of abuse. Although certain argument questions the value of domestic violence screening in general practice and primary care, an increasing recognition of the importance of domestic violence screening as an effective method of identifying and responding to domestic violence cases presenting to emergency departments confirms the practice to be valuable. Research reveals that utilizing emergency room protocols to identify and treat victims of domestic violence increases the identification of victims by medical practitioners from 5.6% to 30% (Garcia, 2004, p. 536).

Domestic violence accounts for about 30% of all acute injuries to women treated in emergency departments. Medical expenses each year from domestic violence, one of the leading causes of serious injury to women 15 to 54 years-old (Surgeon General, 1999), total at least $3 to $5 billion. In addition, businesses lose approximately $100 million in lost wages, sick leave, absenteeism and non-productivity. As a number of DV victims do not report the crimes to authorities or healthcare professionals, the severe underreporting of violence against women leads to the belief the problem is less widespread than it actually is. This false representation regarding this critical problem's severity may hinder healthcare providers from more diligently assessing women for domestic violence.

Assessing DV Concerns

The People's Law Dictionary defines domestic violence as:

the continuing crime and problem of the physical beating of a wife, girlfriend or children, usually by the woman's male partner (although it can also be female violence against a male). It is now recognized as an antisocial mental illness. (Hill & Hill, 2006, p.1).

Police and prosecutors frequently feel frustrated as they encounter the problem or a battered woman refusing to press charges or testify against her abuser due to fear, intimidation and/or misplaced "love." At times, this may evolve from a woman's fear of leaving, her dependence on her abuser, or her low self-esteem, causing her to endure abusive conduct and/or fail to protect a child. Increasingly domestic violence, however, still attracts the sympathetic attention of law enforcement and the courts, In addition, community services, which include shelters, offer protection for those women in danger, if/when they take advantage of the offer.

The Domestic Violence Handbook. (N.d.), created through the efforts of the Oakland County Coordinating Council Against Domestic Violence, defines domestic violence and emotional abuse as behaviors one person uses in a relationship to control the other person. "Partners may be married or not married; heterosexual, gay, or lesbian; living together, separated or dating" (The Domestic Violence, ¶1).

Examples of abuse include:

name-calling or putdowns keeping a partner from contacting their family or friends withholding money stopping a partner from getting or keeping a job actual or threatened physical harm sexual assault stalking intimidation (The Domestic Violence…, N.d., ¶1).

Domestic violence may be criminal; particularly when it involves one person physically assaulting the other (hitting, pushing, shoving, etc. The DM act may also be sexual abuse, including undesired or forced sexual activity, as well as stalking. Emotional, psychological and financial abuse do not constitute criminal behaviors, nevertheless these acts depict forms of abuse and may lead to criminal violence (The Domestic Violence…, N.d.).

Figure 1 depicts the "Violence Wheel," a tool those who assess DV may utilize to help the one experiencing DV better communicate the abusive behavior(s).

Figure I: Domestic Violence Wheel (The Domestic Violence…, N.d.).

Domestic Violence appears in a myriad of forms and may occur all the time or occasionally. A vital step those who assess DV, as well as victims/survivors, is to understand that preventing or stopping violence involves first recognizing the warning signs listed on the "Violence Wheel" (The Domestic Violence…, N.d.).

Anyone may be a victim of DV, as they may be any age, sex, race, culture, religion, education, employment or marital status. Even though both men and women may be abused, however, women make up the majority of DV victims. Children in homes where domestic violence occurs will more… READ MORE

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Quoted Instructions for "Domestic Violence and Hispanic Women" Assignment:

“

I am providing the instructions that were given to us for the capstone project:

EVIDENCE BASED PRACTICE PROTOCOL (EBPP)

Purpose: The purpose of this project is to provide the student with the opportunity to apply and integrate knowledge from previous coursework in the development and implementation of an evidence based practice protocol (guidelines) in the student's clinical specialty area.

Evidence Based Practice Protocol Criteria:

1. Identify and describe a clinical practice problem. (5 pts.)

2. Review and analyze the current research and clinical literature pertinent to the key issues of the clinical practice problem, including any published standards. Integration of this content should also be evident throughout the paper. (15 pts.)

3. Identify the need for development of an Evidence Based Practice Protocol or implementation of an existing EBPP to address the clinical practice problem identified in your setting. (5 pts.)

4. Provide a theoretical base for the proposed EBPP: physiological/psychological/pathophysiological, behavioral, developmental theories, etc. (5 pts.)

5. Describe/Develop the EBPP, and describe the process for its implementation in your practice setting (attach EBPP document as appendix). (30 pts.)

6. Identify ways in which the effectiveness of the EBPP will be evaluated and documented; identify outcomes. (10 pts.)

7. Describe the cost implications of the new EBPP. How will the implementation of this EBPP be financed? (5 pts.)

8. Summarize the significance of this case to the APN role, e.g., identify relevant specialty competencies. (10 pts.)

9. Use proper grammar (syntax and structure), current APA format, correct spelling, logical progression of ideas. (10 pts.)

10. Submit letter of inquiry to relevant journal to determine possibility for publication of project paper

(5 pts.)

I need to structure the evidence based practice protocol. I want to use a structure such as the WAST (womens assessment screening tool and/or HITS). I will translate it to Spanish since I need it in both languages. My plan is to use my EBPP in an emergency department. I will email you an article that compared the 2 screening tools (WATS & HITS) in Hispanic women.

This is what I have so far, so you can get an idea:

Running head: EVIDENCE BASED PRACTICE

Alexandra Burkowsky

Evidence Based Practice Protocol: Domestic Violence and Hispanic Women

Rush University

Clinical Practice Problem

According to A Report of the Surgeon General (1999), domestic violence is considered one of the leading causes of serious injury to women ages fifteen to forty-four, accounting for about thirty percent of all acute injuries to women seen in emergency departments. Many victims of domestic violence do not report the crimes to authorities or healthcare professionals. The severe underreporting of violence against women leads to the belief that the problem is less widespread than it is; and this false sense can hinder healthcare providers from becoming more diligent at assessing women for domestic violence.

The rates of domestic violence detection in clinical settings are still low despite the fact that a high percentage of female victims of domestic violence visit emergency rooms for treatment. Garcia (2004) states that health professionals very seldom check for signs of violence or ask women about experiences of abuse. Although there is still certain argument about the value of domestic violence screening in general practice and primary care, there is an increasing recognition of the importance of domestic violence screening as an effective method of identifying and responding to domestic violence cases presenting to emergency departments. As research has shown, the use of emergency room protocols for identifying and treating victims of domestic violence has been found to increase the identification of victims by medical practitioners from 5.6 percent to 30 percent (Garcia, 2004, p. 536).

Domestic Violence and Hispanic Women

The prevalence of domestic violence among Hispanic women in the United States is increasing every year which poses a high threat for the development of mental illness among this population. According to Rodriguez, Heilemann, Fielder, Ang, Nevarez, & Mangione (2008), Hispanic women who experience physical violence are at increased risk for mental and physical problems including depression, anxiety and substance abuse. It is crucial to understand the cultural beliefs and practices of Hispanic women in order to increase reports of domestic violence. This knowledge and awareness will facilitate healthcare providers to specifically assess Hispanic women who present with signs and symptoms of physical abuse.

Many Hispanic women still believe that their role in the family and community is inferior in comparison to males. Some of these women are brought up in homes with male role models who are very controlling and manipulative. Some of these women also suffer sexual abuse as a child. It is common for Hispanic women to think that domestic violence acceptable since many are raised in abusive homes. Young females who get involved in abusive relationships during early adulthood often come from a family with history of intimate partner violence (Pailler, Kassam-Adams, Datner, & Fein, 2007).

The family is of utmost importance for Latin women; and therefore neglecting their own health needs is not unusual. According to Maternidad Latina (2008), pressure to *****keep the family together***** may come from family or church members, even if it means suffering more abuse. Religious and societal beliefs may make a woman feel guilty if she leaves her abusive partner or acts against his will. Hispanic women, particularly immigrants, may not be familiar with U.S. laws that protect women and children against violence; and these laws may differ considerably from those in other countries. They may also fear involving the law because of their immigration status. Another factor which restrains Hispanic women from seeking help is the language barrier and lack of financial means.

One of the most important elements for developing an evidenced based protocol for Hispanic women suffering from domestic violence and mental illness involves providing cultural sensitive interventions. According to National Alliance of Mental Illness, the first component is the education of Hispanic women about domestic violence and its negative effects on mental and physical health; available community resources for victims of domestic violence, treatment options and current research.

Domestic Violence and Mental Health Disorders

One of the major risk factors for the development of mental illness in women is physical violence. In 2006, the percentages of females with mental health disorders were higher than in males. Furthermore, Hispanics have the highest percentage for mental illness, which was 86.9 percent in 2006 according to the Substance Abuse and Mental Health Service. The percentage of women treated for psychiatric disorders has increased each year. A large amount of quantitative data on this population is found in the Substance Abuse and Mental Health Service Administration (SAMHSA) reports. SAMHSA reports include demographic data such as gender, age distribution, race/ethnic distribution, employment status, and living situation (Table 1, 3 & 4).

Many studies have proven that physical violence is often the number one risk factor for mental illness among women especially anxiety disorders such as post traumatic stress disorder. According to Baca-Garcia, Perez-Rodriguez, Mann & Oquendo (2008), women who experience higher rates of domestic violence or sexual abuse are linked to increased risk for mental health disorders, suicidal ideation and attempts. Pailler et al. (2007) state that individuals who suffer repeated physical violence report more symptoms of posttraumatic stress disorder and depression. Therefore, it is also important to identify the risk factors which increase the probability of women becoming victims of recurring violent acts.

Research studies indicate that mental health disorders are more prevalent in females than in males. A large volume of this evidence suggests that the reason relates to the higher rate of sexual and physical abuse in females. According to Dixon, Howie, & Starling (2005), abuse is an overwhelming risk factor for depression and posttraumatic stress disorder in females. Seventy percent of the females in this study who suffer from posttraumatic stress are victims of domestic violence and sexual assault. Many adolescent females also have dual diagnosis of depression, panic disorder, and/or substance abuse due to the physical abuse. There are several interventions that will impact and improve the health and quality of life of this population: prompt and accurate assessment of physical abuse through a domestic violence assessment tool; and proper use of mental health resources and referrals.

Of 2,043 women aged 18 to 59 who participated in the 1998 Centers for Disease Control and Prevention: Behavioral Risk Factor Surveillance System, women experiencing intimate partner violence were more than 3 times more likely than other women to have been depressed for over half of the past month and approximately twice as likely to have been anxious or suffered insomnia for over half of the past month compared to women without a history of violence. A study of 84 women diagnosed with depression who disclosed intimate partner violence revealed that 18.6 percent of abused women reported post traumatic stress disorder, compared to 6.7 percent of non-abused women (Dienemann, Boyle, Baker, Resnick, Wiederhorn & Campbell, 2000). According to the same study, 53.5 percent of abused women reported sleeping problems and nightmares, compared to 23.3 percent of non-abused women.

A cross-sectional survey by Coker, Smith, Thompson, LcKeown, Bethea & Davis (2002) of 1,152 women aged 18 to 65 conducted between 1997 and 1999 found that 36.8 percent of women who ever experienced domestic violence reported having considered suicide, compared to 25.9 percent for all the women in the sample. Similarly, 18.6 percent of those who ever experienced violence reported having attempted suicide, compared to 11.8 percent for all the women in the sample.

Psychosocial stressors, negative environmental influences and traumatic experiences are unfortunately inevitable in the lives of some women. The way that women deal with these experiences sets up coping mechanisms for future stressful events. All these risk factors in women pose an enormous threat not only to the development of mental illness but also to the progression and deterioration of mental health. Healthcare providers should be meticulous in the initial physical, mental, and psychosocial assessment of women to exclude any suspicion of domestic violence and mental illness.

Evidence Based Support

Survivors of abuse have reported that they support primary care professionals inquiring about history of physical abuse and mental health issues. According to Nakell (2007), asking patients about their trauma history can be useful to patients in several ways. First, when patients acknowledge their history of trauma, the healthcare provider can provide psycho-education to help patients understand their trauma and its effects, and then can recommend useful treatment. Second, clinicians who understand patient*****s histories of trauma and mental illness can appreciate the patient*****s symptoms and therefore treat patients with appropriate care.

The American College of Obstetricians and Gynecologists (ACOG) guidelines on domestic violence recommend that clinicians routinely ask women direct and specific questions about abuse. The American Medical Association also recommends routine screening of intimate partner violence and referrals to community-based services. The American Academy of Family Physicians (AAFP) states that family healthcare providers can offer early intervention by routine screening and identification of abuse and mental health issues. The AAFP recommends that family clinicians be aware for the presence of family violence in every patient encounter.

Recommendations are also made for working with families to prevent abuse by teaching conflict resolution skills that promote respectful and peaceful relationships. The mental health consequences of domestic violence are detrimental. Increased rates of depression, posttraumatic stress disorder, other anxiety disorders, somatization, drug and alcohol abuse, chronic mental illness, and suicide attempts have all been documented in survivors of domestic violence (Falsetti, 2007).

References

American Academy of Family Physicians (AAFP) (2009). Retrieved August 10, 2008

from http://www.aafp.org/online/en/home/clinical/publichealth.html

Carrasco, M. (2004). Latino Outreach Resource Manual: National Alliance on Mental

Illness. Retrieved July 31, 2008 from

http://www.nami.org/Content/ContentGroups/Multicultural_Support1/Fact_Sheets1/Outreach_Manuals/Latino_Manual.pdf

Centers for Disease Control and Prevention: Behavioral Risk Factor Surveillance System

(1998). Retrieved August 10, 2008 from http://www.cdc.gov/brfss/

Centers for Disease Control and Prevention: National Center for Health Statistics (2008). Deaths: Preliminary Data for 2006. National Vital Statistics report. Retrieved July 11, 2008 from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf

Centers for Disease Control and Prevention: National Center for Health Statistics (2008). Cause of Death: Preliminary Data for 2006. National Vital Statistics report. Retrieved July 11, 2008 from http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf

Coker A. L., Smith P. H., Thompson M. P., LcKeown R. E., Bethea L., & Davis K. E.

(2002). Social Support Protects against the Negative Effects of Partner Violence on Mental Health. Journal of Women*****s Health and Gender-based Medicine, 11 (5), 465-476.

Dienemann J., Boyle E., Baker D, Resnick W., Wiederhorn N., & Campbell J. (2000).

Intimate Partner Abuse Among Women Diagnosed with Depression. Issues in Mental Health Nursing, 21(5), 499-513.

Falsetti, S. A. (2007). Screening and Responding to Family and Intimate Partner Violence

in the Primary Care Setting. Primary Care: Clinics in Office Practice 34 (3). Retrieved August 18, 2008 from http://www.mdconsult.com/das/article/body/102896730-8/jorg=journal&source=MI&sp=19972184&sid=739184307/N/608462/1.html

Family Violence and Prevention Fund (1999). Preventing Domestic Violence: Clinical

Guideline on Routine Screening. Retrived August 10, 2008 from http://endabuse.org/programs/healthcare/files/screpol.pdf

Manderscheid, R. W., Atay, J. E., Hernandez-Cartagana, M. R., Edmond, P. Y., Male, E., & Parker, A. C. E. (2001). Highlights of organized mental health services in 1998 and major national and state trends. Mental Health, United States, 2000 (135*****“ 171). Washington, DC: U.S. Government Printing Office.

Maternidad Latina (2007). Promoting Child and Maternal Health. Retrieved August 1,

2008 from http://www.nchealthystart.org/aboutus/maternidad/vol1no3.htm

McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, Implementing, &

Evaluating Health Promotion Programs. San Francisco: Pearson Benjamin Cummings.

Mental Health: A Report of the Surgeon General (1999). Retrieved July 11, 2008 from http://www.surgeongeneral.gov/library/mentalhealth/home.html

Nakell, L. (2007). Adult Post traumatic Stress Disorder: Screening and Treating in

Primary Care. Primary Care: Clinics in Office Practice, 34 (3). Retrieved August 18, 2008 from http://www.mdconsult.com/das/article/body/102896730-8/jorg=journal&source=MI&sp=19972190&sid=739184307/N/608468/1.html

Pailler, M. E., Kassam-Adams, N., Datner, E. M., & Fein J. A. (2007). Depression, Acute Stress and Behavioral Risk Factors in Violently Injured Adolescents. General Hospital Psychiatry, 29 (4). April 20, 2008, from http://www.mdconsult.com/das/article/body/93332740- 8/jorg=journal&source=MI&sp=19665266&sid=699894081/N/594331/1.html

Rodriguez, M. A., Heilemann, M. V., Fielder, E., Ang, A., Nevarez, F., & Mangione, C.

M. (2008). Intimate Partner Violence, Depression, and PTSD Among Pregnant Latina Women. Annals of Family Medicine, 6 (1). Retrieved August 1, 2008 from http://www.mdconsult.com/das/article/body/101140726-5/jorg=journal&source=MI&sp=20349779&sid=731739019/N/626290/1.html

Substance Abuse and Mental Health Service Administration (2006). Florida Mental

Health National Outcome Measures (NOMS): CMHS Uniform reporting System. Retrieved July 10, 2008 from

http://mentalhealth.samhsa.gov/publications/allpubs/SMA06-4195/Chapter15.asp

Substance Abuse and Mental Health Service Administration (2005). United States Mental Health National Outcome Measures (NOMS): CMHS Uniform reporting System. Retrieved July 10, 2008 from

http://download.ncadi.samhsa.gov/ken/pdf/URS_Data05/FL.pdf

Substance Abuse and Mental Health Service Administration (2004). United States Mental Health National Outcome Measures (NOMS): CMHS Uniform reporting System. Retrieved July 10, 2008 from

http://download.ncadi.samhsa.gov/ken/pdf/URS_Data04/FL04.pdf

The American College of Obstetricians and Gynecologists (ACOG) guidelines (2009).

Retrieved August 10, 2008 from http://www.acog.org/

United States Department of Health and Human Services. Healthy People 2010. Retrieved July 10, 2008 from http://www.healthypeople.gov/Search/objectives.htm

Table 1

Demographic Characteristics of adults with a serious mental illness served by a Statewide Mental Health Agency (SMHA) in the US 2006

Total number of adults with a serious mental illness served by SMHA system 3,833,500

Gender Male: 47.3%

Female: 52.7%

Age Distribution 18 *****“ 20: 3.8%

21- 64: 64%

Race/Ethnic Distribution American Indian/Alaskan Native: 1.0%

Asian/Island Pacific: 1.6%

Black or African American: 21.7%

Hispanic or Latino: 86.9%

Native Hawaiian/Pacific Islander: 0.2%

White Caucasian: 61.9%

Multi-racial: 1.6%

Employment Percent Employed: 18%

Percent not in Labor Force: 56%

Percent Unemployed: 26%

Living Situation Private residence: 66.1%

Foster home: 1.8%

Residential care: 3.7%

Crisis residence: 1.0%

Institutional setting: 2.7%

Jail/Correctional facility: 2.0%

Homeless or shelter: 2.4%

Other living situation: 3.1%

Medicaid Funding Status of the Consumers Medicaid only: 46%

SMHA funds only (Non-Medicaid): 38%

Both Medicaid and other funds: 16%

Table 2

Disparities for Focus Area 18: Mental Health and Mental Disorders, 2002

Health People 2010

Hispanic/Latino Black Non-Hispanic White Non Hispanic

Treatment for

serious mental illness:

18+ years 50 to 99% 50 to 99% The group with the

best rate

Treatment for

recognized depression:

18+ years 50 to 99% 50 to 99% The group with the

best rate

Treatment for

generalized

anxiety disorder: 18+ years Data not

available 10 to 49% The group with the

best rate

Employment: 18+ years

With a serious mental

illness 10 to 49% 10 to 49% The group with the

best rate

Table 3

Demographic Characteristics of adults with a serious mental illness served by a Statewide Mental Health Agency (SMHA) in the US 2005

Total number of adults with a serious mental illness served by SMHA system 3,556,280

Gender Male: 48.4%

Female: 50.4%

Age Distribution 18 *****“ 20: 4.4%

21- 64: 62.3%

Table 4

Demographic Characteristics of adults with a serious mental illness served by a Statewide Mental Health Agency (SMHA) in the US 2004

Total number of adults with a serious mental illness served by SMHA system 3,174,121

Gender Male: 48.4%

Female: 50.0%

Age Distribution 18 *****“ 20: 3.6%

21- 64: 61.4%

Tables 5-9

Female deaths by age and race in the US, preliminary 2006

Centers for Disease Control and Prevention

[Age specific rates are 100,000 population in specified group]

All Races Number Rate

Age Distribution

15 *****“ 24:

25- 34:

35-44:

45-54:

8,814

12,726

30,881

69,775

42.8

64.1

141.5

317.3

White females Number Rate

Age Distribution

15 *****“ 24:

25- 34:

35-44:

45-54:

6,698

9,020

22,296

52,255

41.8

58.7

129.0

291.5

Non-Hispanic White females Number Rate

Age Distribution

15 *****“ 24:

25- 34:

35-44:

45-54:

5,530

7,507

19,649

47,610

43.1

62.7

136.7

300.2

Black females Number Rate

Age Distribution

15 *****“ 24:

25- 34:

35-44:

45-54:

1,684

3,117

7,386

15,265

51.1

106.3

244.2

546.6

Hispanic females Number Rate

Age Distribution

15 *****“ 24:

25- 34:

35-44:

45-54:

1,196

1,533

2,679

4,701

34.5

42.2

85.5

210.8

Table 10

Deaths and death rates for selected mental health causes in the US 2006

[Rates are per 100,000 population]

Number Rate

Alzheimer*****s Disease 72,914 24.4

Total suicide 32,185 10.7

Suicide by firearm 16,650 5.6

Suicide by other unspecified means 15,535 5.2

Drug induced deaths 34,678 11.6

Alcohol induced deaths 21,513 7.2

*****

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