MDPS Findings Report-Final 6-22-23 Pubs

!
Mental and Substance Use

(MDPS)
Mental and Substance Use

Disorders Prevalence Study:
Findings Report
Citation
Ringeisen, H., Edlund, M., Guyer, H., Geiger, P., Stambaugh, L., Dever, J., Liao, D., Carr, C., Peytchev,
A., Reed, W., McDaniel, K., & Smith, T. (2023). Mental and Substance Use Disorders Prevalence Study
(MDPS): Findings Report. RTI International.
Acknowledgments
The research was conducted by RTI International in collaboration with Columbia University and the New
York State Psychiatric Institute, Duke Health, the University of Washington, Harvard University, the
University of Chicago, and the Treatment Advocacy Center. Co-investigators and team members at
collaborating sites include:
Columbia University/New York State Psychiatric Institute: Lisa Dixon, Mark Olfson, Scott Stroup,
Thomas Smith, and Natalie Bareis
Duke Health: Marvin Swartz, Jeffrey Swanson, and Allison Robertson
University of Washington: Lydia Chwastiak, Maria Monroe-DeVita, Mackenzie Tennison, and
Katherine Winans
Harvard University: Ronald Kessler
University of Chicago: Robert Gibbons
Treatment Advocacy Center: Elizabeth Sinclair-Hancq
TeleSage and Adaptive Testing Technologies collaborated on the data collection systems. Dr. Evelyn
Bromet, Dr. Ronald Manderscheid, Dr. Alaina Boyer, and Dr. Rhonda Karg collaborated on the data
collection methods.
We also acknowledge the time and effort of the many interviewers, supervisors, and respondents
participating in the MDPS, as well as the many RTI team members and support staff.
Funding
This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA)
under a cooperative agreement grant, Federal Award Identification Number (FAIN) H79FG000030, with
SAMHSA, U.S. Department of Health and Human Services (HHS). The Mental and Substance Use
Disorders Prevalence Study (MDPS) is a cooperative agreement between RTI International and
SAMHSA. SAMHSA provided funding for the project (H79FG000030).
Disclaimer
The views, opinions, and content of this publication are those of the authors and do not necessarily reflect
the views, opinions, or policies of SAMHSA. Nothing in this document constitutes a direct or indirect
endorsement by SAMHSA of any nonfederal entity’s products, services, or policies, and any reference to
a nonfederal entity’s products, services, or policies should not be construed as such.
Table of Contents
Executive Summary 1
1. Introduction 3
1.A Background ............................................................................................................... 3
1.B Study Objectives and Research Questions ................................................................ 4
1.C Study Team ............................................................................................................... 4
1.D Study Timeline .......................................................................................................... 5
1.E Current Report .......................................................................................................... 5
2. Methods 5
2.A Design Overview ...................................................................................................... 5
Multiple Populations of Interest................................................................................ 5
Multistage Design ..................................................................................................... 6
Multimode Design .................................................................................................... 7
Addressing the Nature of the MDPS Pilot Program ................................................. 7
2.B Sample ..................................................................................................................... 8
Household Sample .................................................................................................... 8
Non-Household Sample ............................................................................................ 9
Sample Power, Sample Sizes, and Weighted Response Rates................................ 10
2.C Instruments.............................................................................................................. 11
The Household Roster............................................................................................. 11
The Household Screening Interview ....................................................................... 11
The Semi-Structured Clinical Interview ................................................................. 12
2.D Data Collection and Quality Control ...................................................................... 13
Human Subjects Approval and Informed Consent.................................................. 13
Data Collection Staffing and Timeline ................................................................... 14
Clinical Interviewers and Supervisors .................................................................... 15
Data Collection Outcomes ...................................................................................... 15
Quality Control ....................................................................................................... 16
2.E Methods—Weighting and Estimation ..................................................................... 16
Survey Analysis Weights ........................................................................................ 17
Estimation ............................................................................................................... 18
Restricted-Use Data ................................................................................................ 19
3. Findings 19
3.A Sample Characteristics ............................................................................................ 19
3.B Research Question 1: What is the past-year prevalence rate of mental and
substance use disorders among adults aged 18 to 65 in the United States? ............ 21
Prevalence Rates of Mental Disorders .................................................................... 21
Prevalence Rates of Substance Use Disorders ........................................................ 25
3.C Research Question 2: What proportion of adults in the United States with
mental and substance use disorders received treatment in the past year? ............... 28
Mental Health Treatment Receipt ........................................................................... 29
Substance Use Disorder Treatment Receipt............................................................ 34
3.D Feasibility Study Preliminary Results ..................................................................... 36
4. MDPS Lessons Learned 37
Mental and Substance Use Disorders Prevalence Study: Findings Report i

5. Conclusions 40
5.A Summary of Findings .............................................................................................. 40
5.B Methodological Differences Between the MDPS and Prior Studies....................... 41
5.C Considering MDPS Findings in the Context of Prior Research .............................. 42
5.D Implications of Findings ......................................................................................... 43
5.E Study Limitations .................................................................................................... 44
5.F Recommendations for Future Research .................................................................. 44
References 46
Appendix
A. Tables of MDPS Disorder Prevalence Rates and Treatment Estimates 51
Mental and Substance Use Disorders Prevalence Study: Findings Report ii

Figures
Number Page
2.A.1 MDPS Household Three-Stage Design ........................................................................ 7

3.B.1 Estimated Prevalence Rates of Past-Year MDPS Mental Disorders .......................... 22
3.B.2 Estimated Prevalence Rates of Past-Year MDPS Mental Disorders, by Age
Group .......................................................................................................................... 22
3.B.3 Estimated Prevalence Rates of Past-Year MDPS Mental Disorders, by Gender
Identity ........................................................................................................................ 23
3.B.4 Estimated Prevalence Rates of Any Past-Year MDPS Mental Disorder, by
Race/Ethnicity............................................................................................................. 23
3.B.5 Estimated Prevalence Rates of Any Past-Year MDPS Mental Disorder, by
Urbanicity ................................................................................................................... 24
3.B.6 Estimated Prevalence Rates of Any Past-Year MDPS Substance Use Disorder, by
Race/Ethnicity............................................................................................................. 27
3.B.7 Estimated Prevalence Rates of Any Past-Year MDPS Substance Use Disorder, by
Urbanicity ................................................................................................................... 27
3.C.1 Receipt of Outpatient Treatment, Inpatient Treatment, or Medication for a Past-
Year MDPS Mental Disorder...................................................................................... 30
Year MDPS Mental Disorder, by Age Group ............................................................. 31
Year MDPS Mental Disorder, by Gender Identity ..................................................... 32
Year MDPS Mental Disorder, by Race/Ethnicity ....................................................... 33
Year MDPS Mental Disorder, by Urbanicity ............................................................. 33
Year MDPS Substance Use Disorder ......................................................................... 35
Year MDPS Substance Use Disorder, by Age Group................................................. 36
Year MDPS Substance Use Disorder, by Gender Identity ......................................... 36
Mental and Substance Use Disorders Prevalence Study: Findings Report iii
Tables
Number Page
2.B.1 MDPS Sample Sizes and Weighted Response Rates, by Household and Non-
Household Sample Components ................................................................................. 10
2.C.1 Mental and Substance Use Disorders Measured by the SCID-5® Within the
MDPS ......................................................................................................................... 13
3.A.1 Demographic Characteristics of MDPS Participants .................................................. 20
3.B.1 Estimated Prevalence Rates of Past-Year MDPS Mental Disorders Among
Adults Aged 18 to 65 .................................................................................................. 21
3.B.2 Estimated Prevalence Rates of MDPS Substance Use Disorders Among Adults
Aged 18 to 65.............................................................................................................. 25
3.B.3 Estimated Prevalence Rates of Past-Year MDPS Substance Use Disorders
Among Adults Aged 18 to 65, by Age Group and Gender Identity ........................... 26
Year MDPS Mental Disorder...................................................................................... 30
Year MDPS Substance Use Disorder ......................................................................... 35
Mental and Substance Use Disorders Prevalence Study: Findings Report iv

Executive Summary
The Mental and Substance Use Disorders Prevalence Study (MDPS) is a pilot program
designed to determine the lifetime prevalence rates and past-year prevalence rates of
schizophrenia spectrum disorders (defined as including schizophrenia, schizoaffective
disorder, and schizophreniform disorder); past-year bipolar I disorder, major depressive
disorder, generalized anxiety disorder, posttraumatic stress disorder, obsessive-compulsive
disorder, and anorexia nervosa; and past-year alcohol, opioid, cannabis, stimulant, and
sedative/hypnotic/anxiolytic use disorders. Schizophrenia spectrum disorders were of
particular importance because they are especially disabling and costly to society (Hjorthøj et
al., 2017; Lin et al., 2023; Weber et al., 2022; Wu et al., 2006). The MDPS was also designed
to determine treatment rates among those with these mental and substance use disorders. The
study sample included adults aged 18 to 65 residing in households, prisons, homeless shelters,
and state psychiatric hospitals in the United States. The MDPS addresses two gaps in prior
research: (1) the exclusion of institutionalized populations at high risk for disorders, and (2)
the reliance on self-report measures or nonclinical interviews to assess mental and substance
use disorders. Clinical interviews were conducted with 5,679 participants, virtually or in
person, between October 2020 and October 2022. Prevalence rates and treatment estimates
were combined for the household and non-household samples and weighted accordingly.
The MDPS provides the most up-to-date prevalence rates of specific mental disorders in the
U.S. adult population. Substance use disorders are included within the MDPS design to
provide a more comprehensive understanding of the co-occurrence of mental and substance
use disorders. Importantly, the MDPS is the first study to estimate the national prevalence of
schizophrenia spectrum disorders.
Key findings from the MDPS are highlighted as follows:
Schizophrenia Spectrum Disorders

 Approximately 3.7 million adults aged 18 to 65 (1.8 percent) had a lifetime history of
schizophrenia spectrum disorders.
 A total of 1.2 percent of adults aged 18 to 65 (approximately 2.5 million adults) met
diagnostic criteria for a schizophrenia spectrum disorder in the past year.
Other Mental Disorders in the Past Year

 The two most common mental disorders among adults aged 18 to 65 were major
depressive disorder (15.5 percent, or approximately 31.4 million adults) and generalized
anxiety disorder (10.0 percent, or approximately 20.2 million adults).
 A total of 4.1 percent of adults aged 18 to 65 had past-year posttraumatic stress disorder
(approximately 8.2 million adults), 2.5 percent had obsessive-compulsive disorder
Mental and Substance Use Disorders Prevalence Study: Findings Report 1

(approximately 5.0 million adults), and 1.5 percent had bipolar I disorder (approximately
3.1 million adults).
Substance Use Disorders in the Past Year

 The most common substance use disorder among adults aged 18 to 65 was alcohol use
disorder. Approximately 13.4 million adults (6.7 percent) met criteria for alcohol use
disorder in the past year.
 A total of 3.8 percent of adults aged 18 to 65 had cannabis use disorder (approximately
7.7 million adults), 1.6 percent had stimulant use disorder (approximately 3.2 million
adults), and 0.5 percent had opioid use disorder (approximately 1.0 million adults).
Any Mental or Substance Use Disorder in the Past Year

 One in 4 adults aged 18 to 65 (25.1 percent) had one or more MDPS mental disorders.
One in 12 (8.0 percent) had two or more MDPS mental disorders.
 One in 10 adults aged 18 to 65 (10.6 percent) had one or more MDPS substance use
disorders, and 1.8 percent had two or more MDPS substance use disorders.
 One in 20 adults aged 18 to 65 (5.5 percent) had at least one MDPS mental disorder and at
least one MDPS substance use disorder. This percentage represents approximately
11.0 million adults aged 18 to 65 with co-occurring mental and substance use disorders in
the past year.
Treatment Receipt Among Those with Mental or Substance Use Disorders

 Past-year treatment receipt included any outpatient or inpatient treatment or medication
for a mental or substance use disorder in the past year. “Any treatment” was defined as at
least one visit with a specialty (e.g., psychiatrist) or non-specialty (e.g., primary care
doctor) provider. Any treatment could also include the use of one or more medications.
 Among adults aged 18 to 65 with any MDPS mental disorder, 60.8 percent received any
treatment in the past year.
 Among adults aged 18 to 65 with any MDPS substance use disorder, 12.2 percent received
any treatment in the past year.
The MDPS supports the Substance Abuse and Mental Health Services Administration’s
commitment to collecting, analyzing, and sharing data to help ensure that people with, affected
by, or at risk for mental and substance use disorders receive treatment, thrive, and achieve
well-being. The MDPS supports this commitment by providing prevalence rate estimates of
specific mental and substance use disorders among U.S. adults and treatment rates among
adults with these disorders. The MDPS dataset will be made available for restricted use upon
approval through the Inter-university Consortium for Political and Social Research
(https://www.icpsr.umich.edu/web/pages/ ). Release is anticipated in fall 2023.

1. Introduction
1.A Background
Mental and substance use disorders are significant public health concerns that affect the lives
of millions of Americans. In 2021, the National Survey on Drug Use and Health (NSDUH)
estimated that, in the past year, 57.8 million adults aged 18 or older in U.S. households
experienced mental illness, and 44.0 million adults had a substance use disorder (Substance
Abuse and Mental Health Services Administration [SAMHSA], 2022). The Mental and
Substance Use Disorders Prevalence Study (MDPS) is a pilot program designed to estimate
the prevalence rates of specific mental and substance use disorders among U.S. adults aged 18
to 65. The MDPS is also designed to estimate the percentage of adults with these specific
mental and substance use disorders who receive treatment. The study is funded by SAMHSA.
The MDPS expands upon prior studies that estimate the prevalence rates of specific mental
and substance use disorders. NSDUH is an ongoing, annual population survey in the United
States focused on mental illness and substance use. Although NSDUH does provide estimates
of specific substance use disorders, it is not designed to provide estimates of most specific
mental disorders such as schizophrenia spectrum disorders, bipolar I disorder, obsessive-
compulsive disorder, and posttraumatic stress disorder. Other studies including the National
Comorbidity Survey Replication (e.g., Kessler, Chiu, et al., 2005) and the National
Epidemiologic Survey on Alcohol and Related Conditions-III (e.g., Hasin et al., 2018) provide
national prevalence rates of specific mental and substance use disorders. However, these
studies are more than a decade old and do not provide a prevalence rate of schizophrenia.
Consequently, the MDPS provides the most up-to-date prevalence rates of specific mental
disorders in the U.S. adult population. Substance use disorders are included within the MDPS
design to provide a more comprehensive understanding of the co-occurrence of mental and
substance use disorders. Importantly, the MDPS is the first study to estimate the national
prevalence of schizophrenia spectrum disorders (defined as including schizophrenia,
schizoaffective disorder, and schizophreniform disorder).
To estimate the prevalence rates of specific mental and substance use disorders, the MDPS
design addresses two gaps in prior general population survey efforts: (1) the exclusion of
institutionalized populations at high risk for disorders, and (2) the reliance on self-report
measures or nonclinical interviews to estimate mental and substance use disorders. The
specific disorders of interest measured in the MDPS are past-year and lifetime schizophrenia
spectrum disorders; past-year bipolar I disorder, major depressive disorder (MDD),
generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), obsessive-
compulsive disorder (OCD), and anorexia nervosa; and past-year alcohol, opioid, cannabis,
stimulant, and sedative/hypnotic/anxiolytic use disorders. The MDPS assessed past-year and
lifetime schizophrenia spectrum disorders because these disorders are especially disabling and
costly to society (Hjorthøj et al., 2017; Lin et al., 2023; Weber et al., 2022; Wu et al., 2006). In

addition, past-year estimates alone would not include those adults who met criteria for a
lifetime disorder but did not meet criteria for a past-year disorder because their symptoms
were in remission from treatment.
The MDPS sample includes adults from both household and non-household settings, including
those in state psychiatric hospitals, prisons, and homeless shelters. The MDPS also utilizes the
Structured Clinical Interview for the Fifth Edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) (SCID-5®; First et al., 2015), which is delivered by trained mental
health clinicians and is the gold standard for mental and substance use disorder diagnostic
assessment. SAMHSA is committed to collecting, analyzing, and sharing data to help ensure
that people with, affected by, or at risk for mental and substance use disorders receive
treatment, thrive, and achieve well-being. The MDPS supports this commitment by providing
prevalence rate estimates of specific mental and substance use disorders among U.S. adults
and treatment rates among adults with these disorders. MDPS results will help researchers,
clinicians, and the public to understand factors associated with mental and substance use
disorders, and patterns of comorbidity, which are vital for improving prevention and treatment.
MDPS findings will also provide guidance to SAMHSA on how to improve future mental and
substance use disorder survey efforts.
1.B Study Objectives and Research Questions
The key objectives of the MDPS pilot program are as follows:
 Provide national prevalence rate estimates of mental and substance use disorders among
U.S. adults aged 18 to 65.
 Determine what proportion of adults with these disorders received any treatment in the
past year.
 Investigate research methods for conducting future studies like the MDPS.
The MDPS is designed to answer two research questions:
 What are the prevalence rates among U.S. adults aged 18 to 65 of past-year and lifetime
schizophrenia spectrum disorders (defined as including schizophrenia, schizoaffective
disorder, and schizophreniform disorder); past-year bipolar I disorder, MDD, GAD,
PTSD, OCD, and anorexia nervosa; and past-year alcohol, opioid, cannabis, stimulant, and
sedative/hypnotic/anxiolytic use disorders?
 What proportion of adults in the United States with these mental and substance use
disorders received any treatment in the past year?
1.C Study Team
The MDPS is funded by SAMHSA through a cooperative agreement with RTI International.
RTI leads this study, in partnership with Columbia University and the New York State

Psychiatric Institute, the University of Washington, Duke University, the University of
Chicago, the Treatment Advocacy Center, TeleSage, and Adaptive Testing Technologies.
1.D Study Timeline
The MDPS is a 4-year project. In the first year (starting in October 2019), the study team
designed the study and planned for its implementation. The next 2 years focused on data
collection. The final year (ending in September 2023) focuses on data analysis, report
preparation, and the creation of datasets for public use.
Data collection for the MDPS occurred from October 2020 to October 2022. This data
collection effort occurred during the severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19) pandemic. To reduce the impact of
the COVID-19 pandemic on data collection, much of the MDPS data collection occurred
virtually.
1.E Current Report
This report provides results for the MDPS’s two research questions outlined earlier. Study
outcomes are presented by sex assigned at birth, current gender identity, race/ethnicity, age
group, geographic region, and urbanicity. The report summarizes the MDPS design and
preliminary results of several feasibility studies that inform methods for future studies. Finally,
the report summarizes lessons learned and recommendations for future research.
2. Methods
2.A Design Overview
The MDPS employed a complex design with multiple populations, stages of data collection,
and interview modes. This design helped to support the generation of unbiased estimates for
disorders and treatment receipt. The MDPS also included feasibility studies to investigate
optimal research methods for future population surveys.
Multiple Populations of Interest
The goal of the MDPS was to estimate disorder prevalence rates for the U.S. adult population.
Approximately 98 percent of the U.S. population lives in households (Koerber & Wilson,
2021). Thus, the primary population of interest was adults aged 18 to 65 1 living in households.
1 Adults older than 65 were excluded from the MDPS sample because of the difficulty of differentiating mental disorders
(like schizophrenia or MDD) from symptoms of dementia. The need for an efficient MDPS assessment protocol did not
support this type of differential diagnosis.

Although only a small proportion of U.S. adults reside in non-household settings, they have a
higher prevalence rate of mental and substance use disorders than adults living in households.
For this reason, the MDPS sample also included adults living in prisons, state psychiatric
hospitals, and homeless shelters.
The two largest MDPS populations of focus—adults living in households and prisons—were
sampled using probability-based methods at all stages of the MDPS design. Probability-based
methods mean that each eligible person has a known, nonzero probability of being selected for
study participation. This method allows for the calculation of population estimates.
The two smallest MDPS populations of focus—adults living in state psychiatric hospitals and
homeless shelters—were sampled differently from adults living in households and prisons.
Non-household facilities were selected with nonprobability-based methods. In other words,
these facilities were not randomly selected from a national list of facilities but were selected as
convenience samples. Next, adults living within selected facilities were selected with
probability-based methods. The extent to which the sheltered homeless and state psychiatric
hospital samples are representative was enhanced by including a diverse set of facilities that
cover different types of geography (e.g., urban, suburban, rural) and different populations
served (e.g., male- and female-only homeless shelters) (U.S. Census Bureau, 2021).
The MDPS sampling design for each population is described in Section 2.B, the study
instruments are described in Section 2.C, the data collection is described in Section 2.D, and
the statistical weighting used to combine the data is noted in Section 2.E.
Multistage Design
The MDPS used a three-stage design for the household survey to increase the study’s
efficiency and to oversample those who might meet criteria for a mental or substance use
disorder, especially schizophrenia spectrum disorders (see Figure 2.A.1). 2 This study design
consisted of a roster to establish eligibility and select adults for participation, a mental health
screening survey that was used to disproportionately select those with a higher likelihood of
disorders, and a clinical interview that included the SCID-5® and questions about treatment
receipt. The SCID-5® was used to determine the presence or absence of each mental or
substance use disorder based on DSM-5 criteria.
2 These stages in data collection should not be confused with the stages in the sampling design, which are described in the
following section.

Figure 2.A.1 MDPS Household Three-Stage Design
Because adults living in non-household settings were expected to have higher rates of
disorders, a single-stage data collection design was used for these populations. Those living in
prisons, state psychiatric hospitals, and homeless shelters received only a clinical interview.
Multimode Design
The MDPS design allowed adults to complete the household roster and screener in multiple
modes. To reduce the impact of the COVID-19 pandemic on data collection, a high priority
was placed on conducting virtual, as opposed to in-person, data collection. The study
maximized the percentage of rostered households and screenings completed online and by
phone, by starting with mailed invitations and sequentially adding options to complete the
household rostering and screening on paper and in person. To aid participation rates,
incentives were used at each stage: a $2 prepaid and $10 promised household roster incentive,
a $20 promised household screening incentive, and a $30 clinical interview incentive. 3 The
clinical interviews used a combination of video, phone, and in-person modes depending on the
population (see Section 2.D).
Addressing the Nature of the MDPS Pilot Program
Because of its design complexity, populations, and topic of focus, the MDPS required features
that, in combination, have not been used in previous studies. This resulting methodological
uncertainty was addressed by embedding three feasibility studies within the study design:
3 Participants from the non-household sample were also offered an incentive for their completion of the clinical interview.
However, the incentive varied across settings. Participants within prisons received a small snack, participants in state
psychiatric hospitals received $30 in their hospital account to be used in the store or cafeteria, and participants in homeless
shelters received a $30 gift card.

 Household screening. We assessed the feasibility of using either one of two screeners
within the household arm of the MDPS: (1) the Computerized Adaptive Test for Mental
Health (CAT-MH®), or (2) a non-adaptive survey instrument that included items selected
from the Composite International Diagnostic Interview (CIDI®) (Kessler & Ustün, 2004).
 Use of proxy participants. We assessed the degree to which proxy participants would be
necessary when the selected household or state psychiatric hospital participant was unable
to provide reliable information. We also assessed the feasibility of interviewing these
proxy participants.
 Use of administrative health records. We investigated the feasibility of gathering primary
diagnostic codes from administrative health records among participants in state psychiatric
hospitals.
2.B Sample
The core of the MDPS was a national probability-based household sample of sufficient size to
generate national prevalence rate estimates with acceptable precision. Another key feature of
the MDPS was the combination of the household sample with sample members living in
prisons, state psychiatric hospitals, and homeless shelters. Although the number of adults
living in such facilities is a relatively small proportion of the overall population, the inclusion
of these non-household populations can provide more complete coverage of the full U.S. adult
population.
Household Sample
The household sample was drawn via a multistage, clustered, and stratified area sampling
scheme to form a nationally representative sample of adults. At the first stage, the household
sample consisted of 100 primary sampling units (PSUs) defined as individual counties or
groups of counties (for counties with small populations). The PSUs were randomly selected
with probabilities proportional to the population estimate of adults aged 18 to 64 based on the
2018 American Community Survey 5-year population estimates. 4 This sampling process is
known as probability-proportional-to-size (PPS) sampling and was used to ensure that every
eligible adult in the household population had approximately equal probability of being
included in the study. Within each PSU, at the second stage, 16 secondary sampling units
(SSUs) defined by census block group were selected with PPS sampling. At the third stage,
address-based sampling was used to implement a random sample of addresses within the
sampled SSUs from residential addresses in the U.S. Postal Service Computerized Delivery
Sequence file. Because of the large sample size and long data collection period, the selected
addresses were released in replicates (or batches) within each SSU to control the data
collection workloads over time by providing interviewers with a manageable number of cases.
4 The American Community Survey provides population estimates for the 18 to 64 age group but not for the 18 to 65 age
group. The population estimates of adults aged 18 to 64 are assumed to be distributed in a way similar to that used for the
population estimates of adults aged 18 to 65 across all the counties in the United States, and thus can be considered as an
appropriate size measure for the sample design.

Releasing the sample in replicates also provides additional opportunities to optimize the study
design by trying new approaches in later releases to facilitate or increase participation.
Each sampled household was sent a letter explaining the study and offering the option to
complete the household roster online, by phone, or by mail. In the roster, participants were
asked to list all individuals living in their household. Some nonresponding households were
selected and followed up via in-person interviewing to complete the roster (i.e., nonresponse
follow-up). Among those households that completed the roster, up to two adults aged 18 to 65
in the household were randomly selected to complete a screening interview. Adults who
completed the screening interview were randomly selected to complete the clinical interview.
Participants who completed the screening interview were divided into one of three groups
based on their responses:
 Group 1. Those who reported experiencing psychotic symptoms or receiving disability

payments because of schizophrenia
 Group 2. Those who reported experiencing symptoms of other MDPS mental or substance
use disorders (e.g., MDD, GAD, alcohol use disorder)
 Group 3. Those who reported no mental or substance use disorder symptoms
The proportion of cases selected within each group was set to 100 percent for Group 1 (i.e., all
invited to complete a clinical interview), 80 percent for Group 2, and 20 percent for Group 3.
This strategy helped increase the number of adults completing clinical interviews who might
meet criteria for a mental or substance use disorder, especially schizophrenia spectrum
disorders. This stratified sample selection procedure based on the screening results provided
an enriched MDPS sample designed to reduce the variance and increase the precision of
prevalence rate estimates.
Non-Household Sample
The MDPS prison sample consisted of a nationally representative sample of prisons. The
Bureau of Justice Statistics provided a national list of prisons, and the MDPS team selected
50 prisons via random PPS sampling. Twenty-two of the 50 sampled prisons chose to
participate in the study. Unlike prisons, the MDPS state psychiatric hospitals and homeless
shelters were not selected from national lists. Instead, these facilities were recruited with the
help of MDPS collaborative partners and co-investigators. For this reason, the hospital and
homeless shelter samples are considered convenience samples, which are not selected using
random sampling methods, but rather, based on accessibility and availability. Four state
psychiatric hospitals and 23 homeless shelters were successfully recruited.
Each participating facility (prison, hospital, or shelter) submitted a roster of current individuals
meeting the study eligibility criteria (e.g., aged 18 to 65). Then, the roster was sorted by key
characteristics of the individuals, such as age and time since admission, and a random
probability sample was then selected from the sorted roster via a systematic sampling scheme.

This sampling process is known as implicit stratified sampling, which can ensure that the
selected sample is balanced by the characteristics used in the sorting.
Sample Power, Sample Sizes, and Weighted Response Rates
The target sample size for the MDPS was determined by power calculations that established
the approximate number of completed clinical interviews necessary to produce a precise
population prevalence rate for schizophrenia spectrum disorders. Power calculations focused
on schizophrenia spectrum disorders because they are understudied in prior population
surveys, have an expected low prevalence rate, and cause significant functional impairment.
Because most of the sample included household participants, the target number of completed
clinical interviews determined the needed number of households to be sampled.
Table 2.B.1 presents an overview of the final sample sizes. It also shows weighted response
rates for the household and prison samples. In total, the MDPS completed 5,679 clinical
interviews, 4,764 from the household sample and 915 from the non-household sample.
Table 2.B.1 MDPS Sample Sizes and Weighted Response Rates, by Household
and Non-Household Sample Components
Weighted Conditional
Household and Non-Household Sample Components Unweighted Count Response Rate (%)
Household Population
Sampled households for rosters 234,270 -
Completed household rosters1 25,752 17.4
Sampled adults for screeners 41,868 -
Completed screeners—adults rostered2 29,084 67.4
Selected adults for clinical interviewing 12,906 -
Completed clinical interviews—adults screened2 4,764 31.2
Non-Household Populations
Prisons
Sampled institutions 50 -
Responding institutions2 22 43.5
Sampled adults (from responding institutions) 606 -
Completed clinical interviews—adults3 321 49.6
State Psychiatric Hospitals
Responding institutions 4 -
Completed clinical interviews—adults 171 Not applicable
Homeless Shelters
Sampled adults (from responding institutions) 1,233 -
(continued)

Table 2.B.1 MDPS Sample Sizes and Weighted Response Rates, by Household
and Non-Household Sample Components (continued)
Weighted Conditional
Household and Non-Household Sample Components Unweighted Count Response Rate (%)
Combined Household and Non-Household
Populations
Completed clinical interviews—adults 5,679 -
1
The American Association for Public Opinion Research (AAPOR) (2016) RR3 formula and base weights were
used for the weighted response rate calculation.
2
The AAPOR (2016) RR1 formula and person-level base weights adjusted for nonresponse follow-up were used
for the weighted response rate calculation.
3
The AAPOR (2016) RR1 formula and person-level base weights were used for the weighted response rate
calculation.
Note: Weighted conditional response rates are included for only the household and prison samples because those
two samples were selected using probability-based sampling methods.
2.C Instruments
The MDPS utilized three separate instruments: (1) the household roster, (2) the household
screening interview (which used one of two screening protocols), and (3) the semi-structured
clinical interview.
The Household Roster
The household roster identified eligible adults residing in sampled households. The roster
collected only information needed to identify members of the household aged 18 to 65. Up to
two adults aged 18 to 65 per household were randomly selected to participate in the
subsequent screening interview.
The Household Screening Interview
The screening interview helped the research team oversample adults at increased risk for
mental and substance use disorders. Large population surveys often do not screen for a variety
of specific mental disorders. As a result, the MDPS tested the feasibility of using two
screening interviews. Adults were randomly selected to receive one of these two screening
interviews.
The first screening interview used items from the CIDI® (Kessler & Ustün, 2004), developed
by the World Health Organization (Direk & Tiemeier, 2010) and used in the National
Comorbidity Survey Replication (NCS-R) study (Kessler et al., 2004). It included items
assessing depression, GAD, mania, PTSD, psychosis, and substance use disorders.
The second screening interview, the CAT-MH®, is a brief adaptive test of mental disorders.
The CAT-MH® modules used in the MDPS are quantitative measures of the severity of

depression (Gibbons et al., 2012), anxiety (Gibbons et al., 2014), mania/hypomania (Achtyes
et al., 2015), PTSD (Brenner et al., 2021), psychosis (Guinart et al., 2021), and substance use
disorders (Gibbons et al., 2020). These quantitative severity measures are predictive of
underlying disorders such as MDD, GAD, bipolar I disorder, PTSD, schizophrenia, and
substance use disorders and have all been validated. The adaptive approach of the CAT-MH®
uses the participant’s answers to initial items to determine which items are subsequently
administered. Maximally informative follow-up items are selected from a large (1,461
symptom items) “bank” of items to efficiently complete the assessment with as little response
burden as possible.
The Semi-Structured Clinical Interview
Many population surveys use self-administered surveys or fully structured interviews

delivered by lay interviewers to assess symptoms of mental and substance use disorders. These
fully structured interviews are not well suited to assess schizophrenia, schizoaffective disorder,
and schizophreniform disorder (collectively referred to as schizophrenia spectrum disorders;
these were high priorities for the MDPS). Consequently, the MDPS used the SCID-5® (First et
al., 2015). The SCID-5® is a semi-structured clinical interview for psychiatric diagnosis. It is
designed to be delivered by trained clinicians (e.g., social workers, psychologists, and
psychiatrists) who are familiar with diagnostic interviewing and the DSM-5. A version of the
SCID-5® specifically tailored to assess MDPS disorders of interest (SCID-5-NSMH [National
Study of Mental Health]) was administered by the clinical interviewers.
Other modifications were made to simplify the SCID-5® instrument and shorten its
administration time. For example, the MDPS focused on primary psychotic disorders,
irrespective of accompanying mood disturbances. Thus, the SCID-5-NSMH did not
differentiate schizophrenia from schizoaffective disorder or schizoaffective disorder from
schizophreniform disorder. Instead, the MDPS SCID-5-NSMH assessed the past-year and
lifetime prevalence rates of schizophrenia spectrum disorders with symptom duration of
6 months or longer (i.e., schizophrenia and schizoaffective disorder) and schizophrenia
spectrum disorders with symptom duration of fewer than 6 months (i.e., schizophreniform
disorder). Mood disorders (i.e., depression, bipolar I) were differentiated from schizoaffective
disorder.
The SCID-5® and its previous versions have very good to excellent reliability and validity for
assessing mental and substance use disorders (Gerdner et al., 2015; Lobbestael et al., 2011;
Osório et al., 2019; Shankman et al., 2018; Zanarini et al., 2000; Zanarini & Frankenburg,
2001). The MDPS used a computerized version of the SCID-5-NSMH, the NetSCID (Brodey
et al., 2016). In a validation study of the NetSCID, researchers found that the NetSCID
reduced data entry and branching errors when compared with the paper version of the
SCID-5® (Brodey et al., 2016; First et al., 2015).
The clinical interview assessed the past-year prevalence rates of all mental and substance use
disorders in Table 2.C.1. Lifetime prevalence rate was also assessed for schizophrenia

spectrum disorders. Stimulant use disorder included substances such as cocaine, prescription
stimulants, and methamphetamine. In the opioid use disorder module, adults were initially
asked if they had used drugs like heroin, methadone, or prescription pain relievers such as
morphine, codeine, Percocet®, Percodan®, OxyContin®, Tylox® or oxycodone, Vicodin®,
Lortab®, Lorcet® or hydrocodone, or Suboxone® or buprenorphine. In the
sedative/hypnotic/anxiolytic use disorder module, adults were asked about past-year use of
“any pills to calm you down, help you relax, or help you sleep” such as Valium®, Xanax®,
Ativan®, Klonopin®, Ambien®, Sonata®, or Lunesta®.
Table 2.C.1 Mental and Substance Use Disorders Measured by the SCID-5®
Within the MDPS
MDPS Mental Disorders MDPS Substance Use Disorders

Schizophrenia Spectrum Disorders (past year) Alcohol Use Disorder
Schizophrenia Spectrum Disorders (lifetime) Opioid Use Disorder
Major Depressive Disorder Stimulant Use Disorder
Generalized Anxiety Disorder Sedative/Hypnotic/Anxiolytic Use Disorder
Bipolar I Disorder Cannabis Use Disorder
Posttraumatic Stress Disorder
Obsessive-Compulsive Disorder
Anorexia Nervosa
The clinical interview was conducted among household and non-household participants. The
version of the clinical interview used with the prison sample omitted the module on substance
use. This omission avoided the possibility of an inmate disclosing information that could lead
to their being charged with an infraction of prison rules.
The clinical interview also included items assessing demographic characteristics, cigarette and
e-cigarette use, suicidal ideation and behavior, treatment (inpatient, outpatient, and
medication) for mental and substance use disorders, and disability status (e.g., receipt of
Supplemental Security Income or Social Security Disability Insurance). Because the MDPS
data collection occurred during the COVID-19 pandemic, the study included items to assess
impacts of the pandemic on access to mental and substance use disorder treatment and medical
care.
All instruments were available in English and Spanish.
2.D Data Collection and Quality Control

Human Subjects Approval and Informed Consent
MDPS protocols, instruments, and consent forms were reviewed and approved by the Advarra
Institutional Review Board. RTI and all partner sites entered into reliance agreements with
Advarra. Informed consent was obtained before each phase of interviewing. A key information

statement that summarized the purpose, risks, and benefits of the MDPS was read to each
participant at the start of the interview when obtaining informed consent. Each participant was
provided the opportunity to read the consent form in full and ask any questions or have the
consent form read to them. A knowledge check was administered before conducting the
clinical interview to ensure that participants were informed and understood the purpose of the
study and had the opportunity to ask questions. The knowledge check included questions like
“True or False: You can refuse to answer any questions.” If the participant was unable to
correctly answer the knowledge check questions after several attempts, it was determined that
the participant lacked the ability to consent, and the interview ended. Additionally, the Short
Blessed Test was administered by the clinical interviewer if it appeared that the participant did
not understand the questions, provided conflicting information, or did not appear to be able to
complete the interview on their own (Davis et al., 1990; Katzman et al., 1983).
If the participant did not pass the Short Blessed Test or failed the knowledge test, the interview
ended. In total, 181 (26 household, 155 non-household) such interviews were terminated, and
results from these interviews were not used for prevalence rate calculations.
Data Collection Staffing and Timeline
MDPS data collection began in October 2020. Five experienced clinical interviewers were
trained on the study protocols and instruments, and a small sample of households was released
to test study protocols. Household rostering and screening interviews were completed online,
by phone, or by mail, and clinical interviews were completed by video.
Following this preliminary test of study protocols, the training content and instruments were
updated to include expanded study protocols and additional practice interview scenarios. A
second training and certification session was held with a larger group of 63 clinical
interviewers and 11 clinical supervisors on the MDPS systems, protocols, and instruments in
November 2020. Because the data collection period was extended as a result of the COVID-19
pandemic, a third cohort of 26 clinical interviewers was recruited and completed training in
October 2021. In total, 94 clinical interviewers and 11 clinical supervisors received training on
MDPS data collection protocols, systems, and instruments. Forty clinical interviewers also
received training on conducting clinical interviews with non-household participants from each
of the sample types (i.e., prisons, homeless shelters, and state psychiatric hospitals).
All household rostering and screening activities were completed online, by phone, or by mail
through June 2021, because of restrictions on in-person interviewing as a result of the
COVID-19 pandemic. In-person rostering and screening were conducted between June 2021
and June 2022. Household clinical interviews began in full in January 2021 and continued
through July 2022. Engagement with non-household facility administrators began in April
2020 and continued for the duration of data collection. Clinical interviews within the non-
household facilities were conducted between April 2021 and October 2022.
MDPS data collectors included the following:

 Eight telephone interviewers were hired and trained to conduct household rostering and
screening by phone. Trainings occurred in October 2020, January 2021, and January 2022.
 A total of 157 field interviewers were hired and trained to conduct in-person household
rostering and screening. Five trainings occurred between May 2021 and January 2022.
 Ninety-four clinical interviewers were hired and trained to conduct the MDPS structured
clinical interview by video with the household population and by video, by phone, or in
person with the non-household populations. Training consisted of review of study
protocols and systems, review of the SCID-5-NSMH, and multiple practice interviews. A
standardized certification interview was conducted with all clinical interviewers upon
completion of training. Certification was done by the clinical supervisors. Of those who
received training, 60 became certified, and all the certified clinical interviewers
administered at least one clinical interview.
 Eleven clinical supervisors were hired and trained to provide oversight to the clinical
interviewers, conduct certification interviews with the clinical interviewers, conduct
quality reviews of completed interviews, hold regular meetings with their clinical
interviewer teams, attend supervisor quality circle meetings, and conduct retraining on
components of the clinical interview as needed.
Clinical Interviewers and Supervisors
Interviews were conducted by a team of highly trained clinical interviewers who were required
to have at least a master’s degree in clinical or counseling psychology, social work, or a
similar field, or a medical degree with a specialty in psychiatry. In addition, all clinical
interviewers had to have experience conducting clinical assessments. Initially, 63 clinical
interviewers were hired and then trained on the NetSCID over a 2-week period. After 1 year of
data collection, additional clinical interviewers were hired to replenish the workforce,
accounting for expected attrition. These clinical interviewers were supervised by 11 clinical
supervisors who all had PhDs in one of the aforementioned fields, experience with the
SCID-5®, and experience supervising others in conducting clinical interviews. Clinical
interviewers were required to commit between 6 and 12 hours per week to the project. Clinical
supervisors met with their clinical interviewers regularly to review case content and ensure
ongoing agreement on clinical ratings throughout the project.
Data Collection Outcomes
Household rostering interviews were completed with 25,752 participants, and household
screening interviews were completed with 29,084 participants between October 2020 and June
2022. The average screening interview length was 16.1 minutes. Of the screening interviews,
71.0 percent were completed online, 20.0 percent in person, 8.0 percent by phone, and
0.4 percent by mail.
In total, 5,679 clinical interviews were completed in households, prisons, homeless shelters,
and state psychiatric hospitals during the 2-year data collection period.

Household clinical interviews were completed with 4,764 participants. The average interview
length was 77 minutes. Two-thirds of household clinical interviews were completed by video,
and the remaining third were conducted by phone.
Non-household clinical interviews were completed among 915 participants. This total included
171 participants in 4 state psychiatric hospitals, 423 participants in 23 homeless shelters, and
321 participants in 22 prisons. The average clinical interview length varied by population, and
some sites had restrictions on interview duration or content (e.g., prison facilities restricting
the use of questions on substance use). The duration of the average clinical interview was
70.9 minutes in state psychiatric hospitals, 72.4 minutes in homeless shelters, and
59.2 minutes in prisons. Data collection was conducted in person in half of the facility sites
and by video or phone in the other half.
Table 2.B.1 in Section 2.B provides the number of eligible and interviewed participants at
each stage and for each sample type and the weighted response rates.
Quality Control
Quality control was conducted at each step of the data collection process. The roster data were
evaluated for completeness and duplicate entries. Screening interviews were reviewed for
completeness, duplicate entries within households, correct randomization of the screening
instrument (CIDI® or CAT-MH®), expected versus actual screening group outcomes, and
selection rate by group. The GPS coordinates of the location of completion were compared
with the sample address for the selected roster and screening interviews completed in person
to verify the legitimacy of the interview location. Verification calls were made to confirm key
information. Clinical interviews were reviewed for completeness and consistency. Recordings
were reviewed to ensure accurate delivery of the interview script, input of data, and clinical
assessment of mental and substance use diagnostic variables. Clinical supervisors provided
feedback as needed to clinical interviewers to maintain high quality. Quarterly calibration
exercises were also conducted with the clinical interviewers to ensure consistency in coding
the clinical interview. Agreement at the disorder level (i.e., presence or absence of a disorder)
remained at or above 90 percent for all SCID-5® disorders, across all calibration exercises.
2.E Methods—Weighting and Estimation
The MDPS estimates presented in this report were calculated using survey analysis weights.
Survey analysis weights are needed to produce MDPS estimates that represent the U.S. adult
population aged 18 to 65, along with the estimates’ measure of precision (e.g., confidence
intervals [CIs]). Unweighted data represent only the MDPS sample; unweighted data do not
align with the U.S. adult population.
Survey analysis weights were calculated independently for each of the four MDPS population
samples: residential households, prisons, state psychiatric hospitals, and homeless shelters.
Each weight reflects the design used to identify and recruit each population sample type and

the relative size of that population within the entire U.S. adult population. For example, almost
all U.S. adults live in residential households. Consequently, adults living in residential
households make up 99.2 percent of the MDPS target population. The remaining 0.8 percent
of the combined MDPS target population includes the federal/state prison population
(0.6 percent), the state psychiatric hospital population (0.02 percent), and the sheltered
homeless population (0.2 percent). Designing methods for non-household population data
collection was an MDPS pilot program goal. For this reason, the MDPS sample size for each
non-household population was deliberately designed to be larger than what would have been
necessary to reflect each sample’s representation within the entire U.S. adult population. For
final MDPS estimates to accurately represent all U.S. adults, the household and non-household
population data were weighted to reflect the relative size of each population within the United
States. Weights also accounted for the different probabilities of being selected for and
participating in the survey. As a result, the weighted MDPS estimates calculated with the
combined household and non-household survey data reflect all U.S. adults aged 18 to 65.
Additional highlights of the weighting and estimation methodology are provided as follows.
Survey Analysis Weights
Multistage probability sampling was employed for the household population. The person-level
household analysis weights used to analyze the clinical interview data incorporated
adjustments for (1) the selection probability at each design stage—geography, household,
within-household, and clinical interview post-screening; (2) subsampling for an in-person
nonresponse follow-up; (3) nonresponse to the household rostering, screening, and clinical
interviews; and (4) adjustments to align estimates for select characteristics with those from the
2019 American Community Survey 1-year Public Use Microdata Sample file, the most recent
information available at the time for the population of interest. See, for example, Valliant,
Dever, and Kreuter (2018) and Valliant and Dever (2018) for additional information on
calculation of survey analysis weights. Consequently, the weighted estimates from the person-
level residential household data cover U.S. adults aged 18 to 65 and comprise 99.2 percent of
the MDPS total sample estimates.
Participants from the non-household populations were identified through a mix of protocols.
Weights for the federal/state prison sample selected from a probability-based design include
factors for (1) the two-stage selection probability of prison facilities and participants within
each prison, (2) nonresponse at both levels, and (3) calibration to information obtained from
the statistical tables for prisoners in 2020 by the Bureau of Justice Statistics. 5 Consequently,
the weighted federal/state prison data comprise 0.6 percent of the MDPS total sample
population estimates.
5 The tables are published at https://bjs.ojp.gov/library/publications/prisoners-2020-statistical-tables. The total numbers for

sentenced prisoners under the jurisdiction of state or federal correctional authorities by demographic characteristics were
used as control totals in the calibration procedure.

Weights for the state psychiatric hospital and sheltered homeless samples (with facilities
chosen from select areas of the United States without a probability-based sampling
mechanism) were created to enhance generalizability of the data to the intended populations.
This goal was addressed by creating adjustments to approximate a probability-based sampling
design, to account for differential probabilities of selection and participation by the facility
residents, and to address differences between the sample characteristics and available
population information. 6 Specifically, the weights included components for (1) the within-
facility selection probability, (2) nonresponse within each facility, and (3) adjustments to align
weighted estimates to the most recent available population distributions across MDPS facility
state locations from the 2018 National Mental Health Services Survey estimates for
psychiatric hospital residents (Lutterman, 2022) 7 and the 2020 U.S. Department of Housing
and Urban Development Point-in-Time estimates 8 for homeless shelter residents.
Consequently, the weighted state psychiatric hospital data and the weighted sheltered
homeless data comprise 0.02 percent and 0.2 percent, respectively, of the MDPS total sample
population estimates.
Estimation
The findings described within Chapter 3 of this report include U.S. adult population estimates
that have been calculated from the weighted MDPS clinical interview data. These estimates
include data generated from all four independent MDPS samples (households, prisons, state
psychiatric hospitals, and homeless shelters). The analysis tables in the report and in
Appendix A contain weighted prevalence rate estimates overall and, where relevant, by certain
key characteristics. Unweighted participant counts are shown to describe the sample
characteristics. Weighted counts of adults (in millions) are provided for all study estimates.
These weighted counts illustrate the number of adults in the United States affected by a
disorder of focus. Weighted 95 percent CIs are provided to quantify the measure of precision
for each estimate. Estimates and CIs are suppressed from the report (i.e., not presented) due to
low precision if the scaled relative standard error—defined as the standard error divided by the
prevalence rate estimate—exceeds 30 percent, or if the number of adults used in the numerator
of the disorder by characteristic prevalence estimate is fewer than 20. 9 Select estimates with
adequate precision are shown in graphical form for ease of interpretation.
All analyses were conducted in SUDAAN® (Research Triangle Institute, 2012), software
developed by RTI that accounts for complex sampling designs such as the MDPS.
6 See for example, Valliant, Dever, and Kreuter (2018) and Valliant and Dever (2018) for additional information on
nonprobability survey weights.
7 The total number of adult hospital residents was used as a control total in the calibration procedure.
8 The total numbers of sheltered adults in 2020 were used as control totals in the calibration procedure and are found at
https://www.hudexchange.info/resource/3031/pit-and-hic-data-since-2007/ .
9 The scaled relative standard error is calculated as [(SE / P) / –log(P)], where SE is the standard error of the prevalence
estimate; and P equals the prevalence estimate for values less than or equal to 0.5, or 1 minus the prevalence estimate for
values greater than 0.5 (Center for Behavioral Health Statistics and Quality, 2020, Section 3.2.2). A scaled relative
standard error is used to account for the presence of P in the numerator and denominator.

Restricted-Use Data
The MDPS dataset will be made available for restricted use upon approval through the Inter-
university Consortium for Political and Social Research
(https://www.icpsr.umich.edu/web/pages/ ). Release is anticipated in fall 2023. Additional
details on MDPS weighting and estimation are found in the restricted-use data file
documentation.
3. Findings
Chapter 3 presents the prevalence rates of MDPS mental and substance use disorders. In this
chapter, unweighted counts refer to the raw numbers of participants in the MDPS sample who
fall into a given category such as aged 18 to 25, male gender identity, or having a past-year
disorder. In contrast, weighted counts and percentages refer to numbers that represent the total
U.S. population based on census demographics. Tables in Chapter 3 show the percentage of
adults and the estimated total number of adults aged 18 to 65 in the U.S. population meeting
criteria for each disorder. Following these estimates, Chapter 3 also presents the percentage
and number of U.S. adults with mental and substance use disorders who received treatment in
the year before the interview. These percentages are represented by the bars in the bar graphs
and are broken down by disorder and by demographic characteristics.
The graphs in Chapter 3 are scaled to represent 100 percent of the sample with the exception
of categories where no subgroup reached 50 percent (e.g., certain race/ethnicity categories). In
the latter case, y-axes are set to less than 100 percent for clarity of presentation. The sample
for graphs illustrating treatment receipt corresponds to those participants with a past-year
MDPS disorder. In other words, treatment receipt is reported for only adults meeting criteria
for a mental or substance use disorder in the past year.
All estimates presented in the graphs are provided in detailed tables found in Appendix A.
These detailed tables illustrate the prevalence rate of each mental and substance use disorder
by age group, sex assigned at birth, current gender identity, race/ethnicity, geographic region,
and urbanicity. Detailed tables in Appendix A also illustrate rates of treatment receipt by each
MDPS disorder. Chi-square statistics were run for demographic group comparisons, and
p-values are shown in the Appendix A tables. Significant differences should be interpreted at
the overall group level (e.g., across all racial categories, across all age categories).
3.A Sample Characteristics

The demographic characteristics of the total sample are shown in Table 3.A.1. More than
80.0 percent of the sample participants were aged 26 to 65. Gender identity was split almost
evenly between male and female, with about 1.0 percent of the sample identifying as
transgender or gender diverse. Adults reporting their race as non-Hispanic Black or African
American are subsequently referred to as non-Hispanic Black in the text. Adults reporting
their ethnicity as Hispanic or Latino are subsequently referred to as Hispanic in the text. The

majority of the participants self-identified as non-Hispanic White (59.5 percent), 12.6 percent
self-identified as non-Hispanic Black, and 18.4 percent self-identified as Hispanic. Among
geographic regions, the South was most heavily represented (38.0 percent), and the majority of
participants lived in urban areas (82.0 percent).
Table 3.A.1 Demographic Characteristics of MDPS Participants
Total Sample
Weighted 95% Confidence
Demographic Characteristics Count1 Percent2 Interval2
Overall 5,679 - -
Age Group
18–25 691 16.8 (14.1, 19.9)
26–44 2,694 42.1 (38.9, 45.3)
45–65 2,294 41.1 (37.6, 44.8)
Sex Assigned at Birth
Male 2,371 49.2 (45.3, 53.1)
Female 3,308 50.8 (46.9, 54.7)
Current Gender Identity
Male 2,318 48.6 (44.7, 52.4)
Female 3,226 50.2 (46.4, 54.0)
Transgender/Gender Diverse 90 0.9 (0.5, 1.4)
Missing 45 0.4 (0.2, 0.7)
Race/Ethnicity
Hispanic/Latino 882 18.4 (13.8, 24.3)
NH White 3,451 59.5 (53.8, 64.9)
NH Black/African American 706 12.6 (10.0, 15.8)
NH Asian 272 4.4 (3.3, 6.0)
NH American Indian/Alaska Native 56 0.5 (0.3, 0.8)
NH Native Hawaiian/Other Pacific Islander 20 0.2 (0.1, 0.3)
NH Multiracial 257 4.4 (3.4, 5.7)
Missing3 35 0.0 (0.0, 0.1)
Region4
Midwest 1,192 20.6 (17.8, 23.7)
Northeast 1,024 17.4 (14.3, 21.0)
South 1,890 38.0 (33.3, 42.9)
West 1,573 24.1 (19.7, 29.0)
Urbanicity5
Urban 4,092 82.0 (74.2, 87.9)
Rural 672 18.0 (12.1, 25.8)
NH = not Hispanic/Latino.
1
Unweighted number of participants. Counts may not sum to overall total due to question nonresponse.
2
Weighted estimates were calculated with analysis weights and account for the complex MDPS sampling
design.
3
Includes those (1) with missing Hispanic/Latino status, and (2) with missing racial group among those
reporting not being Hispanic/Latino.
4
Mapping of states to census regions is provided by the U.S. Census Bureau (see, e.g.,
https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf).

5
Urbanicity data are presented for the household sample only. The definition of urban versus rural areas is
provided in
https://www.census.gov/content/dam/Census/library/publications/2020/acs/acs_rural_handbook_2020.pdf.
3.B Research Question 1: What is the past-year prevalence rate of mental

and substance use disorders among adults aged 18 to 65 in the United
States?
The prevalence rates of mental and substance use disorders assessed in the MDPS are
described in the following tables and figures and in Tables A.3 to A.9 in Appendix A. The
past-year prevalence rate of each disorder, any disorder, and the co-occurrence of mental and
substance use disorders is presented for the full study population. Comparisons are also
illustrated by age group, sex assigned at birth, current gender identity, race/ethnicity,
geographic region, and urbanicity.
As shown in Table 3.B.1, MDD was the most common MDPS mental disorder (15.5 percent in
the past year), followed by GAD (10.0 percent in the past year), PTSD (4.1 percent in the past
year), and OCD (2.5 percent in the past year). An estimated 1.8 percent had a lifetime
diagnosis of a schizophrenia spectrum disorder, and 1.2 percent had a past-year diagnosis of a
schizophrenia spectrum disorder. The estimated prevalence rate of anorexia nervosa in the past
year was suppressed (i.e., not shown) due to low precision. Figure 3.B.1 shows these same
estimates in a bar chart.
Prevalence Rates of Mental Disorders
Table 3.B.1 Estimated Prevalence Rates of Past-Year MDPS Mental Disorders

Among Adults Aged 18 to 65
Weighted Count Weighted 95% Confidence

MDPS Mental Disorder (million)1 Percent2 Interval2
Schizophrenia Spectrum Disorders (past year) 2.5 1.2 (0.9, 1.8)
Schizophrenia Spectrum Disorders (lifetime) 3.7 1.8 (1.3, 2.5)
Major Depressive Disorder (past year) 31.4 15.5 (13.6, 17.5)
Generalized Anxiety Disorder (past year) 20.2 10.0 (8.3, 12.1)
Bipolar I Disorder (past year) 3.1 1.5 (0.9, 2.5)
Posttraumatic Stress Disorder (past year) 8.2 4.1 (3.2, 5.1)
Obsessive-Compulsive Disorder (past year) 5.0 2.5 (1.8, 3.5)
Anorexia Nervosa (past year) <0.5 0.1 (0.1, 0.3)
Any MDPS Mental Disorder (including lifetime 50.7 25.1 (22.7, 27.6)
schizophrenia spectrum disorders)
Two or More MDPS Mental Disorders3 16.2 8.0 (6.9, 9.3)
1
Weighted number of participants (i.e., population size) in millions.
2
design.

3
Includes lifetime schizophrenia spectrum disorders if past-year schizophrenia spectrum disorders are not
present.
Figure 3.B.1 Estimated Prevalence Rates of Past-Year MDPS Mental Disorders
SD = spectrum disorder; MDD = major depressive disorder; GAD = generalized anxiety disorder; PTSD =
posttraumatic stress disorder; OCD = obsessive-compulsive disorder.
As shown in Figure 3.B.2, the most common disorders, MDD and GAD, along with OCD and
bipolar I disorder, occurred the most frequently in young adults aged 18 to 25. Adults aged 45
to 65 had the lowest past-year prevalence rates across all MDPS mental disorders.
Figure 3.B.2 Estimated Prevalence Rates of Past-Year MDPS Mental

Disorders, by Age Group

As shown in Figure 3.B.3, past-year and lifetime schizophrenia spectrum disorders tended to
be more common in people identifying as male, whereas other MDPS mental disorders tended
to be more common in people identifying as female.
Figure 3.B.3 Estimated Prevalence Rates of Past-Year MDPS Mental

Disorders, by Gender Identity
Note: Estimates for adults identifying as transgender/gender diverse are suppressed (i.e., not shown) due to low
precision.
As shown in Figure 3.B.4, people who were non-Hispanic Multiracial had the highest
percentage of any MDPS mental disorder (41.3 percent), followed by people who were non-
Hispanic Black (27.6 percent). Estimates are suppressed (i.e., not shown) due to low precision
for some racial/ethnic groups.
Figure 3.B.4 Estimated Prevalence Rates of Any Past-Year MDPS Mental

Disorder, by Race/Ethnicity
Note: Estimates for NH Native Hawaiian/Other Pacific Islander and NH American Indian/Alaska Native are
suppressed (i.e., not shown) due to low precision.

As shown in Figure 3.B.5, the percentage of any MDPS mental disorder was highest among
those household participants living in rural areas (29.1 percent) compared with those living in
urban areas (24.0 percent).
Figure 3.B.5 Estimated Prevalence Rates of Any Past-Year MDPS Mental

Disorder, by Urbanicity1
1
provided in

Prevalence Rates of Substance Use Disorders
As shown in Table 3.B.2, alcohol use disorder was the most common MDPS substance use
disorder (6.7 percent), followed by cannabis use disorder (3.8 percent). An estimated
1.6 percent of people had stimulant use disorder, and 0.5 percent of people had opioid use
disorder.
Table 3.B.2 Estimated Prevalence Rates of MDPS Substance Use Disorders

Among Adults Aged 18 to 65
Weighted 95%
Count Weighted Confidence
MDPS Substance Use Disorder1 (million)2 Percent3 Interval3
Alcohol Use Disorder (past year) 13.4 6.7 (5.5, 8.0)
Opioid Use Disorder (past year) 1.0 0.5 (0.3, 0.8)
Stimulant Use Disorder (past year) 3.2 1.6 (1.1, 2.3)
Sedative/Hypnotic/Anxiolytic Use <0.5 0.2 (0.1, 0.3)
Disorder (past year)
Cannabis Use Disorder (past year) 7.7 3.8 (2.6, 5.4)
Any MDPS Substance Use Disorder (past 21.4 10.6 (8.7, 12.9)
year)
Two or More MDPS Substance Use 3.5 1.8 (1.2, 2.5)
Disorders (past year)
Comorbidity of Any MDPS Substance 11.0 5.5 (3.9, 7.6)
Use Disorder (past year) and Any MDPS
Mental Disorder
1
Excludes prison sample because questions about substance use disorders were not asked.
2
3
design.

As shown in Table 3.B.3, alcohol use disorder occurred most frequently among adults aged 26
to 44 (9.0 percent). Cannabis use disorder occurred most frequently among young adults aged
18 to 25 (8.1 percent). Estimated past-year prevalence rates of some MDPS substance use
disorders are suppressed (i.e., not shown) due to low precision and therefore unavailable for
some age groups.
MDPS substance use disorders tended to be more common in people identifying as male
except for cannabis use disorder, which was more common in people identifying as female
(3.8 percent). Estimated past-year prevalence rates of MDPS substance use disorder are
suppressed (i.e., not shown) due to low precision and therefore unavailable for the people
identifying as transgender or gender diverse.
Table 3.B.3 Estimated Prevalence Rates of Past-Year MDPS Substance Use

Disorders Among Adults Aged 18 to 65, by Age Group and Gender
Identity
Age Group2 Gender Identity2

Past-Year 18–25 26–44 45–65 Female Male
Substance
Use % % % % %
Disorder1 (95% CI) (95% CI) (95% CI) (95% CI) (95% CI)
Alcohol Use 5.1 9.0 4.9 5.8 7.4
Disorder (2.5, 10.1) (6.9, 11.7) (3.6, 6.7) (4.4, 7.7) (5.5, 9.8)
Opioid Use * 0.7 0.3 0.4 0.6
Disorder (0.4, 1.3) (0.1, 0.7) (0.2, 0.7) (0.3, 1.2)
Stimulant Use * 1.8 1.7 1.0 2.2
Disorder (1.1, 2.9) (0.9, 3.1) (0.6, 1.5) (1.3, 3.7)
Cannabis Use 8.1 4.2 1.6 3.8 3.4
Disorder (3.6, 17.2) (2.7, 6.3) (0.9, 3.1) (2.0, 7.0) (2.3, 5.0)
CI = confidence interval.
* Estimates for young adults aged 18–25 for opioid use disorder and stimulant use disorder are suppressed (i.e.,
not shown) due to low precision.
1
2
design.
precision.

As shown in Figure 3.B.6, people who identified as non-Hispanic Multiracial had the highest
prevalence rate of any substance use disorder in the past year (15.5 percent), followed by
people who identified as non-Hispanic Black (14.7 percent).
Figure 3.B.6 Estimated Prevalence Rates of Any Past-Year MDPS Substance

Use Disorder, by Race/Ethnicity
Note: Estimates for NH American Indian/Alaska Native, and NH Native Hawaiian/Other Pacific Islander are
As shown in Figure 3.B.7, the prevalence rates of any MDPS substance use disorder were
similar across household participants living in urban and rural areas.
Figure 3.B.7 Estimated Prevalence Rates of Any Past-Year MDPS Substance

Use Disorder, by Urbanicity1
1
provided in

3.C Research Question 2: What proportion of adults in the United States
with mental and substance use disorders received treatment in the past
year?
All MDPS participants were asked about the mental health and substance use treatment they
may have received in the past year. Section 3.C presents findings of treatment received by
MDPS participants with MDPS mental and substance use disorders. Comparisons are also
illustrated by age group, current gender identity, race/ethnicity, geographic region, and
urbanicity. The corresponding data can also be found in Tables A.10 to A.16 in Appendix A.
Treatment questions within the MDPS instrument did not focus on treatments for specific
symptoms or disorders. Instead, treatment rates indicate that adults received some type of
mental health or substance use treatment in the past year. Thus, the treatment rates presented
in this section for adults with PTSD should not be interpreted to mean that adults received
treatment specifically for PTSD symptoms. However, in clinical practice, treatments for
various disorders often overlap. For example, antidepressants can be prescribed for disorders
apart from MDD, such as GAD, OCD, and PTSD. Because questions focus on past-year
treatment, MDPS estimates do not present treatments received before this period. Questions
used to determine outpatient treatment, inpatient treatment, and medication use among those
with mental disorders are presented in the text box titled “Mental Health Treatment: Questions
Included in the MDPS Instrument.” Although they are not presented in this report, the MDPS
also contains questions on the number of visits, the actual medication used, and any lifetime
treatment.

Mental Health Treatment Receipt
Mental Health Treatment: Questions Included in the MDPS Instrument

Have you ever received professional counseling, medication or other treatment to help with your mental health,
emotions, or behavior?
If yes:
During the past 12 months, have you received inpatient or residential treatment, that is have you stayed
overnight or longer to receive professional counseling, medication, or other treatment for your mental health,
emotions, or behavior at any of these places?
 a hospital,
 a residential mental health treatment center,
 a residential drug or alcohol treatment or rehab center,
 or some other place.
Treatment can also be provided without needing to stay overnight. This type of care is called outpatient
treatment. During the past 12 months, have you received outpatient professional counseling, medication, or
other treatment for your mental health, emotions, or behavior at any of these places?
 a mental health treatment center;
 a drug or alcohol treatment or rehab center;
 the office of a therapist, psychologist, psychiatrist, mental health professional, or doctor;
 a school, college, or a university clinic;
 a shelter for the homeless;
 a jail, prison, or juvenile detention facility;
 phone, text, video, telemedicine; or
 some other place.
During the past 12 months, did you take any medication that was prescribed by a doctor or health care
professional to help with your mental health, emotions, behavior, energy, concentration, or ability to cope with
stress?

Table 3.C.1 gives the weighted percentage and count of adults with each MDPS mental disorder who
received any mental health treatment in the past year.
Table 3.C.1 Receipt of Outpatient Treatment, Inpatient Treatment, or

Medication for a Past-Year MDPS Mental Disorder
Weighted 95%
MDPS Mental Disorder (million)1 Percent2 interval2
Schizophrenia Spectrum Disorders (past year) 1.8 72.9 (51.3, 87.3)
Major Depressive Disorder (past year) 18.4 59.6 (52.8, 66.0)
Generalized Anxiety Disorder (past year) 13.2 65.9 (59.8, 71.5)
Bipolar I Disorder (past year) * * *
Posttraumatic Stress Disorder (past year) 5.9 71.7 (59.1, 81.6)
Obsessive-Compulsive Disorder (past year) 3.7 73.5 (61.4, 82.9)
Anorexia Nervosa (past year) * * *
Any MDPS Mental Disorder (past year) 30.4 60.8 (55.7, 65.6)
* Estimates are suppressed (i.e., not shown) due to low precision.
1
2
design.
Figure 3.C.1 shows that adults with schizophrenia spectrum disorders were most likely to
receive any treatment. Individuals with MDD were least likely to receive any treatment.
Differences across disorders were not large. Among individuals with any MDPS mental
disorder, only about 6 in 10 received at least some treatment, usually outpatient treatment or
medications, which may overlap. Four in 10 received no treatment at all.
Figure 3.C.1 Receipt of Outpatient Treatment, Inpatient Treatment, or

Medication for a Past-Year MDPS Mental Disorder

Figure 3.C.2 shows the rates of treatment use for past-year MDPS mental disorders across age
groups. Although more than half of adults reported that they received treatment across all
MDPS mental disorders, it is notable that unmet need remains high. Forty percent of adults
with an MDPS mental disorder received no treatment at all.

Medication for a Past-Year MDPS Mental Disorder, by Age Group
MDD = major depressive disorder; GAD = generalized anxiety disorder; PTSD = posttraumatic stress disorder;
OCD = obsessive-compulsive disorder.
* Estimates for young adults aged 18–25 for PTSD and OCD and for adults aged 45–65 for OCD are
Note: Estimates for schizophrenia spectrum disorders (past year and lifetime) are suppressed (i.e., not shown)
due to low precision.

Figure 3.C.3 shows that the rates of any treatment use among adults who identified as female
were above 60 percent for all disorders and greater than 90 percent for past-year schizophrenia
spectrum disorders. Treatment receipt for adults who identified as male was above 50 percent
for the MDPS mental disorders shown. Estimated past-year prevalence rates of mental health
treatment use are suppressed (i.e., not shown) due to low precision and therefore unavailable
for some disorders for males and transgender or gender diverse participants.

Medication for an MDPS Mental Disorder, by Gender Identity
* Estimates for adults identifying as male are suppressed (i.e., not shown) due to low precision.
precision.

As shown in Figure 3.C.4, adults identifying as non-Hispanic White were the most likely to
receive treatment (67.1 percent), followed by those who identified as non-Hispanic Multiracial
(66.3 percent).

Medication for a Past-Year MDPS Mental Disorder, by
Race/Ethnicity
Note: Estimates for NH American Indian/Alaska Native and NH Native Hawaiian/Other Pacific Islander are
As shown in Figure 3.C.5, rates of mental health treatment use were similar across household
participants living in urban and rural areas.

Medication for a Past-Year MDPS Mental Disorder, by Urbanicity1
1
provided in

Substance Use Disorder Treatment Receipt
This section presents treatment received by MDPS participants with substance use disorders.
Comparisons are also illustrated by age group, current gender identity, race/ethnicity, and
geographic region. Questions used to determine outpatient treatment, inpatient treatment, and
medication use among those with substance use disorders are presented in the text box titled
“Substance Use Treatment: Questions Included in the MDPS Instrument.” Although they are
not presented in this report, the MDPS also contains questions on the number of visits; the
actual medication used, such as methadone and buprenorphine; and any lifetime treatment.
Substance Use Treatment: Questions Included in the MDPS Instrument

The next questions ask about treatment such as professional counseling, medication, or other treatment you may
have received for use of alcohol or drugs, not including cigarettes. These treatment types can be received
during an overnight stay, outpatient visit, or over the phone or internet.
Have you ever received professional counseling, medication or other treatment for your alcohol or drug use?
If Yes:
During the past 12 months, have you received inpatient or residential treatment, that is have you stayed
overnight or longer to receive professional counseling, medication, or other treatment for your alcohol or
drug use at any of these places?
 a residential drug or alcohol treatment or rehab center,
 a hospital,
 a residential mental health treatment center, or
Treatment can also be provided without needing to stay overnight. This type of care is called outpatient
treatment. During the past 12 months, have you received outpatient professional counseling, medication, or
other treatment for your alcohol or drug use at any of these places?
 a drug or alcohol treatment or rehab center;
 a mental health treatment center;
 the office of a therapist, psychologist, psychiatrist, mental health professional, or doctor;
 a school, college, or a university clinic;
 a shelter for the homeless;
 a jail, prison, or juvenile detention facility;
 phone, text, video, telemedicine; or
The next questions are about prescription medication you may have used to cut back or stop your alcohol or
drug use. These medications are different from medications given to stop an overdose. During the past 12
months, did you use any medication prescribed by a doctor or health care professional to help cut back or stop
your alcohol or drug use?
Please, answer ‘yes’ even if you took them only once. For medications that you take currently, you can also look
at your prescription bottles if necessary. Did you take any of the following (list of medications provided within
instrument for all participants, such as methadone, Antabuse, etc.)?
As shown in Figure 3.C.6, rates of substance use treatment were low, especially among adults
with stimulant use disorders, alcohol use disorders, and cannabis use disorders. Estimated
past-year rates of substance use treatment are suppressed (i.e., not shown) due to low precision
and therefore unavailable for some treatment types.

Medication for a Past-Year MDPS Substance Use Disorder
* Estimates for medication and inpatient treatment are suppressed (i.e., not shown) due to low precision.
Note: Estimates for opioid use disorder are suppressed (i.e., not shown) due to low precision. Excludes prison
sample because questions about substance use disorders were not asked.
Table 3.C.2 shows these findings, including weighted percentages and weighted counts of
adults who received past-year treatment for an MDPS substance use disorder.
Table 3.C.2 Receipt of Outpatient Treatment, Inpatient Treatment, or

Medication for a Past-Year MDPS Substance Use Disorder
Weighted Count Weighted 95% Confidence

Substance Use Disorder (million)1 Percent2 Interval
Alcohol Use Disorder (past year) 1.8 13.7 (9.4, 19.4)
Opioid Use Disorder (past year) * * *
Stimulant Use Disorder (past year) 0.7 24.2 (15.0, 36.7)
Sedative/Hypnotic/Anxiolytic Use Disorder * * *
(past year)
Cannabis Use Disorder (past year) <0.5 3.7 (1.9, 7.3)
Any MDPS Substance Use Disorder (past 2.6 12.2 (8.6, 16.8)
year)
1
2
design.
Note: Excludes prison sample because questions about substance use disorders were not asked.

As shown in Figure 3.C.7, across all age groups and substance use disorders, most adults
received no treatment at all. Similarly, as shown in Figure 3.C.8, across gender identities and
substance use disorders, most adults received no treatment at all.
Figure 3.C.7 Receipt of Outpatient Figure 3.C.8 Receipt of Outpatient

Treatment, Inpatient Treatment, or Treatment, Inpatient Treatment, or
Medication for a Past-Year MDPS Medication for a Past-Year MDPS
Substance Use Disorder, by Age Group Substance Use Disorder, by Gender Identity
Note: Estimates for young adults aged 18–25 are suppressed Note: Estimates for adults identifying as transgender/gender
(i.e., not shown) due to low precision. diverse are suppressed (i.e., not shown) due to low precision.
3.D Feasibility Study Preliminary Results
The MDPS included three feasibility studies: (1) testing the performance of two types of
mental health household screening instruments, (2) acquiring administrative records from state
psychiatric hospitals, and (3) contacting proxy participants to complete interviews on behalf of
household and state psychiatric hospital participants who lacked the ability to consent for
study participation. The MDPS team developed protocols for each of these feasibility studies,
and preliminary feasibility study results are described as follows.
Household Screening Instruments. The administration of adaptive and non-adaptive

screening instruments within the multistage household study design was feasible. The adaptive
screening instrument adapted, or tailored, items in real time based on participant responses.

The non-adaptive instrument included the same items for every participant. Each MDPS
screening instrument was helpful, especially for uncommon disorders. For example, screening
resulted in the MDPS sample including an adequate number of cases to generate a precise
prevalence rate of schizophrenia spectrum disorders. Screening was also efficient; household
participants completed each instrument in 15 minutes on average. This time included
administration of the mental health screening instrument as well as questions on demographic
characteristics. Future MDPS analyses will assess the agreement (or concordance) between
individual participants’ screening instrument and clinical interview results for the specific
MDPS disorders, and ways to optimize the screeners.
State Psychiatric Hospital Administrative Records. All four participating hospitals agreed
to provide the MDPS team with primary diagnostic codes from administrative records. Each
hospital provided a spreadsheet that included the case ID, the primary diagnosis, and the
secondary diagnosis. Approximately 70 percent of hospital participants provided consent for
the study team to receive information from their hospital record. These feasibility study results
suggest that future studies might be able to use information from administrative records to
shorten clinical interviews, or possibly eliminate the need for clinical interviews, within
hospital samples. Future MDPS analyses will assess the degree to which diagnoses from the
hospital records agree with disorders indicated by participant responses to the MDPS clinical
interview.
Proxy Participants. The MDPS team developed protocols for identifying and interviewing
proxy participants in households and state psychiatric hospitals. Proxy participants were
determined to be necessary when a selected participant did not sufficiently understand study
protocols (and so could not provide consent to participate) or showed cognitive impairment
that limited their ability to participate. In the hospital sample, 9 percent of the selected sample
(58 participants) needed a proxy participant. The study team received contact information for
only 16 (approximately 28 percent) of these hospital sample proxy participants. In the
household sample, less than 1 percent (29 participants) of those selected for a clinical
interview needed a proxy participant. Hospital and household proxy participants were difficult
to engage—only four proxy participants completed a clinical interview. To increase the
feasibility of using proxy interviews in future studies like the MDPS, more work will be
necessary to develop protocols to increase proxy participant engagement.
4. MDPS Lessons Learned
The MDPS required novel approaches to provide prevalence rates of mental and substance use
disorders and treatment in the U.S. adult population. One goal of the MDPS pilot program was
to investigate research methods to inform future studies. These methods focused on including
household and non-household populations within the same study and facilitating participant

engagement across all study populations. The MDPS team carefully considered strategies to
support the conduct of clinical interviews within a large population survey, virtual interviewer
training and supervision, virtual data collection, non-household facility engagement, and data
collection protocols appropriate for adults from non-household settings. Lessons learned over
the course of the study’s implementation are summarized here.
 The SCID-5® clinical interview, originally developed for use in clinical settings, can be
tailored for efficient use in a large-scale population survey.
Lay person–administered interviews are not well suited to assess schizophrenia spectrum
disorders because their assessment requires clinical judgment. The SCID-5® is the gold
standard for measuring such disorders. It is used extensively in clinical studies but not in
large-scale population surveys. The SCID-5® administration may take several hours, which is
not feasible within household or non-household settings. Working with the SCID-5®
developer, the MDPS team created an efficient instrument designed to assess MDPS disorders
of interest. The average administration time for the SCID-5® portion of the MDPS interview
was less than 1 hour in every household and non-household study population. To achieve
efficiency and maintain interview quality, interviewers received extensive training, ongoing
supervision, reviews of their work, and calibration exercises to confirm their knowledge of the
instrument.
 Virtual clinical interviewer training and ongoing supervision are possible and can result
in high interview quality.
All clinical interviewer training was conducted virtually through video conference calls.
Interviewers completed pretraining reading and video assignments. Virtual trainings were
spaced over 10 days (4 hours per day). Training included viewing didactic presentations,
viewing and scoring prerecorded interviews, conducting supervised mock interviews, and
holding group discussions to attain consistency across interviewers. All interviewers were
required to complete a standardized certification interview to demonstrate competence.
Clinical interview supervision meetings were conducted regularly to help maintain high
interview quality. Ten percent of MDPS clinical interviews were reviewed by supervisors who
watched the video and independently scored the interview. Providing feedback about reviewed
interviews improved the quality of interviewers’ skills and corrected errors. During the study,
only a small proportion of reviewed interviews required supervisors to correct miscoded items
or diagnostic codes. SCID-5® interrater reliability exercises were periodically conducted
across interviews. Interrater reliability was consistently high.
 Recruiting homeless shelters requires continued communication and special attention to

the shelter organizational structure, context, and size.
Continued proactive communication with homeless shelter staff was necessary to successfully
recruit shelters to participate in the MDPS. Selected shelters varied considerably in
organizational structure, context, and size. Different approaches were required to inform and
engage the administrators who approve study participation. For example, the large, publicly

funded, and bureaucratically operated facilities required a lengthy and formal contracting
process to obtain county or municipal government approval. Here, the key to success was
learning local regulatory requirements, understanding the review and approval processes,
allowing sufficient time for review, and having sheer persistence. In smaller shelters,
sometimes operated by faith-based entities, typically the shelter director could approve the
facility’s participation. Here, the key was establishing and maintaining a relationship with the
shelter director. In all shelters, it was important to offer as much flexibility as possible around
the study recruitment and interviewing logistics.
 It is helpful to offer various tokens of appreciation in non-household settings for facilities

and study participants.
MDPS procedures added burden to staff at non-household facilities who were already
overburdened. The MDPS team found that tokens of appreciation were appreciated and helped
to recognize facility staff and participant effort. The MDPS offered facilities $250 in
appreciation for their participation and provided a tablet computer for video-based interviews
(when needed). Prison facilities could not accept this token of appreciation. Non-household
participants were offered tokens of appreciation for their time, but the tokens differed by
setting. Prisoner participants could not accept monetary payments and instead received a
snack. State psychiatric hospital participants received a credit to their hospital store account.
Meanwhile, homeless shelter participants received a $30 gift card.
 To support non-household data collection, it is important to have a site coordinator from

the study team as well as two facility points of contact.
Having an MDPS team member to act as a site coordinator working directly with facility
points of contact helped to reduce and, at times eliminate, facility staff members’ burden
associated with the study. For example, several state psychiatric hospitals and prisons
requested an on-site study coordinator to assist with tablet setup to support virtual clinical
interviews. Clinical supervisors were ideal site coordinators because they understood the study
goals, the interviewer’s job, the instruments, and the equipment. The study team also learned
that it was helpful to request two facility points of contact (primary and secondary) for the
study. Then, it was important to schedule meetings with these facility points of contact at least
1 week before data collection began to ensure that facility staff understood their roles and had
appropriate plans to support the data collection.
 During in-person data collection, the clinical interviewer should be the first to contact a
non-household participant.
MDPS protocols requested that clinical interviewers introduce the study to eligible facility
participants. But sometimes non-household facilities requested that their staff initially
approach eligible participants. Response rates were higher within facilities where MDPS
interviewers first approached participants compared with those where facility staff initiated
contact. The MDPS team concluded that interviewers were better prepared to respond to
participants’ questions and concerns. This technique encouraged participation and promoted

research subject protections. Facility staff engagement was still important, especially in
responding to questions about the study’s legitimacy.
 Virtual technology can support the effective administration of clinical interviews in non-
household settings.
A novel feature of the MDPS was the conduct of video-based interviews with participants in
prisons, homeless shelters, and state psychiatric hospitals. This strategy was implemented
because of the COVID-19 pandemic and the limited ability of facilities to allow on-site
visitors. Facilities were given the option for virtual or in-person data collection; eight prisons,
four homeless shelters, and one state psychiatric hospital facility participated in virtual MDPS
data collection. Virtual data collection was feasible when supported by facility staff. Success
was dependent on working with these facility staff to minimize the burden of teleconferencing
or videoconferencing and providing tailored technical and logistical support.
 Methods to assess participants’ ability to understand study protocols are especially

important to include in state psychiatric hospitals and homeless shelters.
The MDPS research protocol included two methods to assess participants’ ability to
understand study protocols and complete research interviews: (1) a knowledge check; and (2)
a short, standardized test of cognitive impairment, the Short Blessed Test. This protocol was
used for household and non-household populations. The study team learned that these
protocols were especially important with the state psychiatric hospital and homeless shelter
populations. Although less than 1.0 percent of the eligible household population and
2.3 percent of selected prison participants failed the knowledge check or the Short Blessed
Test, 8.0 percent of selected state psychiatric hospital participants and 7.0 percent of homeless
shelter participants failed one of these tests. Having the checks of participant capacity within
the MDPS helped to ensure that potentially vulnerable adults were able to participate in the
research study while also receiving appropriate protections.
5. Conclusions
5.A Summary of Findings
The MDPS was designed to answer two research questions related to the prevalence rates of
mental and substance use disorders and their treatment (as follows). Because schizophrenia
spectrum disorders are understudied in population surveys, a key goal for the MDPS design
was to determine a prevalence rate of schizophrenia spectrum disorders.
1. What are the prevalence rates among U.S. adults aged 18 to 65 of past-year and
lifetime schizophrenia spectrum disorders (defined as including schizophrenia,
schizoaffective disorder, and schizophreniform disorder); past-year bipolar I disorder,
MDD, GAD, PTSD, OCD, and anorexia nervosa; and past-year alcohol, opioid,
cannabis, stimulant, and sedative/hypnotic/anxiolytic use disorders?

2. What proportion of adults in the United States with these mental or substance use
disorders received any treatment in the past year?
Study findings show that the prevalence rates of past-year and lifetime schizophrenia spectrum
disorders among U.S. adults aged 18 to 65 were 1.2 percent (95 percent CI: 0.9 to 1.8 percent)
and 1.8 percent (95 percent CI: 1.3 to 2.5 percent), respectively. Past-year prevalence rates for
the other mental disorders assessed in the MDPS were bipolar I disorder, 1.5 percent
(95 percent CI: 0.9 to 2.5 percent); MDD, 15.5 percent (95 percent CI: 13.6 to 17.5 percent);
GAD, 10.0 percent (95 percent CI: 8.3 to 12.1 percent); PTSD, 4.1 percent (95 percent CI:
3.2 to 5.1 percent); OCD, 2.5 percent (95 percent CI: 1.8 to 3.5 percent); and anorexia nervosa,
0.1 percent (95 percent CI: 0.1 to 0.3 percent). Twenty-five percent of the sample had at least
one MDPS mental disorder in the past year (95 percent CI: 22.7 to 27.6 percent), and
8.0 percent (95 percent CI: 6.9 to 9.3 percent) had two or more.
Past-year prevalence rates for each substance use disorder were alcohol, 6.7 percent
(95 percent CI: 5.5 to 8.0 percent); cannabis, 3.8 percent (95 percent CI: 2.6 to 5.4 percent);
stimulants, 1.6 percent (95 percent CI: 1.1 to 2.3 percent); and opioids, 0.5 percent (95 percent
CI: 0.3 to 0.8 percent). Eleven percent of the MDPS sample had at least one substance use
disorder (95 percent CI: 8.7 to 12.9 percent), and 1.8 percent (95 percent CI: 1.2 to
2.5 percent) had two or more. Six percent of the MDPS sample had a co-occurring MDPS
mental disorder and a substance use disorder (95 percent CI: 3.9 to 7.6 percent).
Among those with an MDPS mental disorder, 60.8 percent (95 percent CI: 55.7 to
65.6 percent) received some form of treatment in the past year. Among those with an MDPS
substance use disorder, 12.2 percent (95 percent CI: 8.6 to 16.8 percent) received some form
of treatment in the past year.
5.B Methodological Differences Between the MDPS and Prior Studies
The MDPS methodology differed from past population surveys and prior psychiatric
epidemiological studies in two key ways. First, the MDPS surveyed adults residing in prisons,
homeless shelters, and state psychiatric hospitals, along with those living in households. This
survey methodology was adopted to make the MDPS sample more representative of the U.S.
adult population aged 18 to 65. This feature is important because past research suggests that
adults residing in these facilities have significantly higher rates of mental and substance use
disorders. Second, rather than utilizing a fully structured diagnostic interview administered by
trained lay interviewers or self-administered surveys, the MDPS design included the semi-
structured SCID-5®, which was administered by trained mental health clinicians. A semi-
structured interview was selected for use in the MDPS because fully structured interviews are
not well suited to assess schizophrenia spectrum disorders, which were high priorities for the
MDPS. In particular, the SCID-5® allows clinicians to probe on each mental and substance use
disorder symptom, using their clinical judgment, while still strictly adhering to DSM-5
criteria.

5.C Considering MDPS Findings in the Context of Prior Research
This MDPS findings report provides the first national estimates of schizophrenia spectrum
disorders from a study where trained clinicians administered a DSM-5–based diagnostic
interview. The lifetime prevalence rate of schizophrenia spectrum disorders among U.S. adults
aged 18 to 65 was 1.8 percent, with a 95 percent CI of 1.3 to 2.5 percent. Prior studies have
estimated the national prevalence rate of schizophrenia primarily by screening for psychotic
symptoms or by examining health insurance claim records (e.g., Desai et al., 2013; Hasin &
Grant, 2015; Kessler, Birnbaum, et al., 2005). These prior studies suggested that the lifetime
prevalence rate of schizophrenia ranged from 0.25 percent to 1.0 percent (Desai et al., 2013;
Kessler, Birnbaum, et al., 2005). MDPS results suggest that schizophrenia spectrum disorders
among U.S. adults may be more prevalent than previously assumed.
The prevalence rates of many other nonpsychotic disorders within the MDPS were generally
within an expected range based on findings from prior research. There were three
exceptions—MDD, GAD, and OCD. The MDPS prevalence rates for MDD (15.5 percent) and
GAD (10.0 percent) were substantially higher than rates in past nationally representative
studies. The most obvious explanation is that the MDPS was conducted during the COVID-19
pandemic. Social isolation, financial problems, business and school closures, death and
hospitalization of family and friends, and the general stress of living during the COVID-19
pandemic could all cause greater anxiety and depression. A systematic review conducted by
the World Health Organization estimated that the prevalence rates of MDD and GAD
increased approximately 25 percent after the onset of the COVID-19 pandemic (COVID-19
Mental Disorders Collaborators, 2021). The elevated prevalence rate may also be the result of
a temporal trend, as studies suggest MDD is increasing over time, with a prevalence rate of
5.3 percent in the NESARC-I and -II (conducted in 2001–2002 and 2004–2005) (Hasin &
Grant, 2015), 6.7 percent in the NCS-R (conducted in 2003) (Kessler, Chiu, et al., 2005), and
10.4 percent in the NESARC-III (conducted in 2012) (Hasin et al., 2018). In NSDUH, the
past-year prevalence rate of major depressive episode was relatively stable between 2005 and
2016, ranging from 6.5 percent to 6.9 percent (SAMHSA, 2020). But since 2016, the past-year
prevalence rate has increased from 6.7 percent to 7.8 percent in 2019 (SAMHSA, 2022).
Unlike GAD and MDD, the prevalence of OCD has not been well studied in past surveys. The
MDPS past-year prevalence rate was 2.0 percent, twice that of the NCS-R: 1.0 percent. This
result is important because OCD is especially disabling and difficult to treat (Macy et al.,
2013). It has been suggested that the prevalence rate of OCD has also been particularly
affected by the COVID-19 pandemic (Maye et al., 2022).
The prevalence rates of substance use disorders in the MDPS were consistently lower than the
corresponding rates from other studies. For example, the prevalence rate of past-year
substance use disorder in the MDPS was 10.6 percent, compared with 17.3 percent from the
2021 NSDUH (SAMHSA, 2022). The rate of alcohol use disorder in the MDPS (6.7 percent)
was lower than those found in the 2021 NSDUH (11.3 percent; SAMHSA, 2022) and in the

NESARC-III (13.9 percent; Olfson et al., 2019). The reasons for these discrepancies are
unclear. The MDPS, the 2021 NSDUH, and the NESARC-III all utilized DSM-5 criteria. The
MDPS and the 2021 NSDUH were conducted during the COVID-19 pandemic; the NESARC-
III was conducted before the COVID-19 pandemic. All three surveys were nationally
representative. The surveys did use different instruments and data collection techniques; these
methodological differences between studies are likely important. The influence of study
methods on substance use disorder prevalence rates should be further investigated.
The MDPS also examined the rates of treatment among those with specific mental and
substance use disorders. For all MDPS mental disorders, treatment rates were higher than
those reported in prior studies. Among adults with any MDPS mental disorder, 60.8 percent
received some type of treatment. The questions within the MDPS instrument ask about any
outpatient treatment, inpatient treatment, or medication use in the year before the interview.
Any treatment could include one or more contacts in the past year with a specialty (e.g.,
psychiatrist) or non-specialty (e.g., primary care doctor) provider. Any treatment could also
include use of one or more medications in the past year. NSDUH uses a similarly broad
definition of “any treatment,” but treatment results are presented for all U.S. adults aged 18 or
older who meet criteria for “any mental illness” (defined differently from “any MDPS mental
disorder”). With those methodological considerations in mind, in 2021, the NSDUH estimate
of the percentage of U.S. adults with any mental illness who received mental health services
was 47.2 percent (SAMHSA, 2022). The NESARC-III estimate of mental health treatment
received among those with mental disorders was even lower (Olfson et al., 2019). The MDPS
finding that 60.8 percent of adults with a mental disorder received any treatment is
encouraging. This finding suggests that more U.S. adults may be accessing treatment than in
the past. This increase may in part be because of the increasing availability of and access to
telehealth services, prompted by the COVID-19 pandemic (Palzes et al., 2022). However,
several factors temper this enthusiasm. Many adults with mental disorders continue to receive
no treatment at all. For example, 40.4 percent of adults with MDD did not report any past-year
treatment, and 34.1 percent of adults with GAD did not report any past-year treatment.
Furthermore, past research suggests that among individuals who receive any treatment, many
do not receive treatment consistent with recommended best practices for their condition
(Young et al., 2001, 2008).
Finally, the MDPS found that only 12.2 percent of adults with substance use disorders receive
any treatment, a figure consistent with findings from other studies (Olfson et al., 2019;
SAMHSA, 2022).
5.D Implications of Findings
Consistent with previous research, the MDPS continues to demonstrate that many U.S. adults
experience mental and substance use disorders (Hasin & Grant, 2015; Kessler, Chiu, et al.,
2005). Importantly, the study suggests that more adults may be experiencing depression and

anxiety than in the past. The increased numbers of adults with MDD and GAD will require a
commensurate increase in resources to treat these disorders. If the increased prevalence rates
of MDD and GAD are a result of the COVID-19 pandemic, this greater need for resources
may decrease as the impact of the pandemic dissipates. But, for now, increased resources may
be necessary to meet current needs for the treatment of depression and anxiety.
The study also suggests that rates of schizophrenia spectrum disorders may be two, or even
three, times higher than previously assumed. These disorders place a disproportionate burden
on patients, family members, and society. Treatment of these disorders depends heavily on
federal/state funding, which in turn is partially based on the number of individuals estimated to
have these disorders. Increased funding may be necessary to sufficiently meet the demands
faced by the public mental health service system to adequately meet the treatment needs of
individuals with schizophrenia spectrum disorders.
5.E Study Limitations
The MDPS provides the most recent national estimates to date for the prevalence rates of
specific mental disorders among U.S. adults. The pilot nature of the MDPS also supported
several lessons learned that are relevant to future research. However, the study also had
limitations. First, the study’s scope was focused on providing estimates that represent the total
U.S. adult population. The MDPS was not designed to provide prevalence rates of disorders
within any one specific non-household population. For the homeless population, the MDPS
focused on developing data collection methods to assess mental and substance use disorders
and their treatment among adults in homeless shelters. The study did not include adults who
are homeless but not in shelters. Second, the MDPS included a very limited assessment of
treatment. The study was not designed to assess treatment quantity and quality specific to the
disorder or the trajectory of adults’ treatment use over time. Third, the MDPS was not
designed to provide prevalence rates with acceptable precision for various demographic
subpopulations (e.g., for certain racial/ethnic groups). And finally, the COVID-19 pandemic
affected the study’s implementation. In-person data collection was limited in households,
which reduced participant response rates. Several non-household facilities refused to
participate in the MDPS because of the burden placed on their facilities by the COVID-19
pandemic.
5.F Recommendations for Future Research
The MDPS goals, scope, design, lessons learned, and limitations led to several
recommendations for future research:
 The MDPS provided several lessons about conducting studies of this nature in prisons,
homeless shelters, and state psychiatric hospitals. These lessons could be applied to future
studies designed to specifically derive probability-based estimates for any one of these
non-household populations. Future studies designed to estimate the national prevalence

rates of mental and substance use disorders and their treatment rates among adults in
homeless shelters or prisons would especially valuable.
 Future studies should utilize the lessons learned from the MDPS to develop scalable
methods for estimating mental and substance use disorder prevalence rates and their
treatment rates among the unsheltered homeless population. Future research should
include the implementation of a large-scale study to examine the national prevalence rates
of mental and substance use disorders among the sheltered and the unsheltered homeless
populations.
 Few population study samples include a large enough number of individuals with
uncommon but seriously impairing disorders to support a detailed examination of
treatment received. Consequently, future research is necessary to provide information on
the quantity and quality of treatments received by individuals with disorders such as
schizophrenia spectrum disorders, bipolar I disorder, and OCD.
 The MDPS used a multistage design for the household sample that included rostering,
screening, and clinical interviews. This design allowed for the identification and inclusion
of a higher proportion of participants with disorders of interest. However, this design also
results in lower response rates (because multiple stages require participant participation)
and higher costs than those of a single-stage design. A multistage design may not be
necessary to accurately estimate all types of mental and substance use disorders. Future
studies should assess the costs and benefits of one-stage versus multistage designs because
the optimal approach may depend on the mental and substance use disorders of interest.
 There is increased interest in understanding behavioral health disparities across
populations defined by race/ethnicity, gender identity, age group, and geographic area. To
estimate the impact of less prevalent but impairing disorders among high-priority
subpopulations, future studies will need to include a sufficiently large sample size from
which to generate precise estimates for those subpopulations of interest.
 The MDPS was conducted during the COVID-19 pandemic, which offered an opportunity
to understand the prevalence rates of mental and substance use disorders within this
unprecedented historical context. The pandemic likely influenced study outcomes. Future
research should examine the generalizability of MDPS findings beyond a COVID-19
pandemic context.
 The MDPS dataset will be available for public use. The dataset will provide rich
opportunities for future analyses such as determining the association between
demographic factors and mental and substance use disorders in multivariate models,
examining patterns of comorbidity between disorders, and investigating types of
medication received by individuals with different mental or substance use disorders.

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Appendix A. Tables of MDPS Disorder Prevalence Rates
and Treatment Estimates

Table A.1 MDPS Sample Sizes and Weighted Response Rates, by Household
and Non-Household Sample Components
Weighted
Household and Non-Household Sample Components Count Response Rate
Household Population
Sampled households for rosters 234,270 -
Completed household rosters 1
25,752 17.4
Sampled adults for screeners 41,868 -
Completed screeners—adults rostered 2
29,084 67.4
Selected adults for clinical interviewing 12,906 -
Completed clinical interviews—adults screened2 4,764 31.2
Non-Household Populations
Prisons
Sampled institutions 50 -
Responding institutions 2
22 43.5
Completed clinical interviews—adults 3
321 49.6
State Psychiatric Hospitals
Homeless Shelters
Sampled adults (from responding institutions) 1,233 -
Combined Household and Non-Household Populations 15,391
Completed clinical interviews—adults 5,679 -
1
The American Association for Public Opinion Research (AAPOR) (2016) RR3 formula and base weights were
2
The AAPOR (2016) RR1 formula and person-level base weights adjusted for nonresponse follow-up were
3
The AAPOR (2016) RR1 formula and person-level base weights were used for the weighted response rate
calculation.
Note: Weighted conditional response rates are included for only the household and prison samples because those
two samples were selected using probability-based sampling methods.

Table A.2 Demographic Characteristics of MDPS Participants
Total Sample
Weighted 95% Confidence

Demographic Characteristics Count1 Percent2 Interval2
Overall 5,679 - -
Age Group
18–25 691 16.8 (14.1, 19.9)
26–44 2,694 42.1 (38.9, 45.3)
45–65 2,294 41.1 (37.6, 44.8)
Sex Assigned at Birth
Male 2,371 49.2 (45.3, 53.1)
Female 3,308 50.8 (46.9, 54.7)
Current Gender Identity
Male 2,318 48.6 (44.7, 52.4)
Female 3,226 50.2 (46.4, 54.0)
Transgender/Gender Diverse 90 0.9 (0.5, 1.4)
Missing 45 0.4 (0.2, 0.7)
Race/Ethnicity
Hispanic/Latino 882 18.4 (13.8, 24.3)
NH White 3,451 59.5 (53.8, 64.9)
NH Black/African American 706 12.6 (10.0, 15.8)
NH Asian 272 4.4 (3.3, 6.0)
NH American Indian/Alaska Native 56 0.5 (0.3, 0.8)
NH Native Hawaiian/Other Pacific Islander 20 0.2 (0.1, 0.3)
NH Multiracial 257 4.4 (3.4, 5.7)
Missing3 35 0.0 (0.0, 0.1)
Region4
Midwest 1,192 20.6 (17.8, 23.7)
Northeast 1,024 17.4 (14.3, 21.0)
South 1,890 38.0 (33.3, 42.9)
West 1,573 24.1 (19.7, 29.0)
Urbanicity5
Urban 4,092 82.0 (74.2, 87.9)
Rural 672 18.0 (12.1, 25.8)
1 Unweighted number of participants. Counts may not sum to overall total due to question nonresponse.
2 Weighted estimates were calculated with analysis weights and account for the complex MDPS sampling design.
3 Includes those (1) with missing Hispanic/Latino status, and (2) with missing racial group among those reporting not being
Hispanic/Latino.
4 Mapping of states to census regions is provided by the U.S. Census Bureau (see, e.g.,
https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf).
5 Urbanicity data are presented for the household sample only. The definition of urban versus rural areas is provided in

Table A.3 Estimated Prevalence Rates of MDPS Disorders Among Adults
Aged 18–65 in the United States
Total Sample
Weighted 95%
MDPS Disorder (past year unless otherwise indicated) (million)1 Percent2 Interval2
Mental Disorders
Schizophrenia Spectrum Disorders 2.5 1.2 (0.9, 1.8)
Major Depressive Disorder 31.4 15.5 (13.6, 17.5)
Generalized Anxiety Disorder 20.2 10.0 (8.3, 12.1)
Bipolar I Disorder 3.1 1.5 (0.9, 2.5)
Posttraumatic Stress Disorder 8.2 4.1 (3.2, 5.1)
Obsessive-Compulsive Disorder 5.0 2.5 (1.8, 3.5)
Anorexia Nervosa <0.5 0.1 (0.1, 0.3)
Any MDPS Mental Disorder 50.7 25.1 (22.7, 27.6)
Two or More MDPS Mental Disorders 3
16.2 8.0 (6.9, 9.3)
Substance Use Disorders 4
Alcohol Use Disorder 13.4 6.7 (5.5, 8.0)

Opioid Use Disorder 1.0 0.5 (0.3, 0.8)
Stimulant Use Disorder 3.2 1.6 (1.1, 2.3)
Sedative/Hypnotic/Anxiolytic Use Disorder <0.5 0.2 (0.1, 0.3)
Cannabis Use Disorder 7.7 3.8 (2.6, 5.4)
Any MDPS Substance Use Disorder 21.4 10.6 (8.7, 12.9)
Two or More MDPS Substance Use Disorders 3.5 1.8 (1.2, 2.5)
Comorbidity of Any MDPS Mental Disorder and Any 11.0 5.5 (3.9, 7.6)
MDPS Substance Use Disorder4
1
2
design.
3
Includes lifetime schizophrenia spectrum disorders if past-year schizophrenia spectrum disorders are not
present.
4

Table A.4 Prevalence Rates of MDPS Disorders, by Participant Age Group
18–25 26–44 45–65
Weighted 95% Weighted 95% Weighted 95%
MDPS Disorder (past year unless Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence P-
otherwise indicated) (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 value3
Mental Disorders
Schizophrenia Spectrum Disorders <0.5 1.3 (0.6, 2.9) 1.2 1.5 (0.8, 2.5) 0.8 1.0 (0.6, 1.8) 0.63
Schizophrenia Spectrum Disorders 0.7 2.0 (1.1, 3.8) 1.8 2.1 (1.2, 3.6) 1.2 1.5 (1.0, 2.3) 0.54
(lifetime)
Major Depressive Disorder 7.1 21.0 (15.7, 27.4) 15.7 18.4 (15.3, 21.9) 8.6 10.3 (8.2, 12.8) 0.00
Generalized Anxiety Disorder 5.9 17.6 (9.8, 29.7) 9.3 10.9 (9.2, 12.9) 5.0 6.0 (4.9, 7.4) 0.00
Bipolar I Disorder 1.2 3.4 (1.1, 9.7) 1.2 1.4 (0.7, 2.6) 0.7 0.9 (0.6, 1.3) 0.22
Posttraumatic Stress Disorder 1.5 4.5 (2.4, 8.4) 5.2 6.1 (4.6, 8.0) 1.5 1.8 (1.3, 2.5) 0.00
Obsessive-Compulsive Disorder 2.0 5.8 (3.1, 10.9) 2.2 2.6 (1.8, 3.8) 0.8 1.0 (0.6, 1.6) 0.00
Anorexia Nervosa * * * * * * * * *
Any MDPS Mental Disorder 12.4 36.9 (27.7, 47.1) 24.8 29.1 (25.5, 33.0) 13.5 16.2 (13.8, 18.9) 0.00
Two or More MDPS Mental 4.9 14.5 (10.1, 20.2) 7.7 9.1 (7.6, 10.9) 3.5 4.3 (3.5, 5.2) 0.00
Disorders4
Substance Use Disorders5
Alcohol Use Disorder 1.7 5.1 (2.5, 10.1) 7.6 9.0 (6.9, 11.7) 4.1 4.9 (3.6, 6.7) 0.03
Opioid Use Disorder * * * 0.6 0.7 (0.4, 1.3) <0.5 0.3 (0.1, 0.7) 0.23
Stimulant Use Disorder * * * 1.5 1.8 (1.1, 2.9) 1.4 1.7 (0.9, 3.1) 0.08
Sedative/Hypnotic/Anxiolytic Use * * * * * * * * *
Disorder
Cannabis Use Disorder 2.7 8.1 (3.6, 17.2) 3.5 4.2 (2.7, 6.3) 1.4 1.6 (0.9, 3.1) 0.01
Any MDPS Substance Use 4.2 12.4 (5.5, 25.6) 11.4 13.5 (11.0, 16.5) 5.7 6.9 (5.2, 9.1) 0.00
Disorder
Two or More MDPS Substance * * * 1.8 2.2 (1.2, 3.7) 1.1 1.3 (0.7, 2.7) 0.53
Use Disorders
Comorbidity of Any MDPS Mental 3.1 9.1 (3.0, 24.8) 5.7 6.8 (5.3, 8.7) 2.2 2.7 (1.8, 3.9) 0.00
and Any MDPS Substance Use
Disorder5
1 Weighted number of participants (i.e., population size) in millions.
3 P-values represent statistical testing results of weighted chi-square tests. Weighted chi-square tests account for MDPS sampling design but not other participant
characteristics. Bold values are significant at p<0.05.

4 Includes lifetime schizophrenia spectrum disorders if past-year schizophrenia spectrum disorders are not present.
5 Excludes prison sample because questions about substance use disorders were not asked.

Table A.5 Prevalence Rates of MDPS Disorders, by Participant Sex Assigned at Birth
Male Female
Weighted Weighted 95%

Count Weighted 95% Confidence Count Weighted Confidence P-
MDPS Disorder (past year unless otherwise indicated) (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 value3
Mental Disorders
Schizophrenia Spectrum Disorders 1.5 1.5 (1.0, 2.3) 1.0 1.0 (0.5, 1.8) 0.18
Schizophrenia Spectrum Disorders (lifetime) 2.0 2.0 (1.4, 2.9) 1.7 1.7 (1.0, 2.8) 0.51
Major Depressive Disorder 12.6 12.7 (10.6, 15.0) 18.7 18.2 (15.4, 21.3) 0.00
Generalized Anxiety Disorder 7.0 7.1 (5.5, 9.0) 13.2 12.9 (9.8, 16.8) 0.01
Bipolar I Disorder 1.1 1.1 (0.6, 2.2) 1.9 1.9 (1.0, 3.5) 0.29
Posttraumatic Stress Disorder 3.0 3.0 (1.9, 4.6) 5.2 5.1 (3.9, 6.7) 0.03
Obsessive-Compulsive Disorder 2.0 2.0 (1.1, 3.8) 3.0 2.9 (2.0, 4.3) 0.29
Anorexia Nervosa * * * * * *
Any MDPS Mental Disorder 20.7 20.8 (18.0, 23.8) 30.1 29.3 (25.4, 33.5) 0.00
Two or More MDPS Mental Disorders4 5.9 5.9 (4.3, 8.0) 10.3 10.1 (8.5, 11.9) 0.00
Alcohol Use Disorder 7.4 7.5 (5.6, 10.0) 6.0 5.8 (4.4, 7.7) 0.25
Opioid Use Disorder 0.6 0.6 (0.3, 1.2) <0.5 0.4 (0.2, 0.7) 0.33
Stimulant Use Disorder 2.2 2.2 (1.3, 3.6) 1.0 1.0 (0.6, 1.5) 0.03
Sedative/Hypnotic/Anxiolytic Use Disorder * * * * * *
Cannabis Use Disorder 3.6 3.6 (2.5, 5.3) 4.1 4.0 (2.2, 7.1) 0.82
Any MDPS Substance Use Disorder 11.2 11.3 (9.0, 14.2) 10.2 9.9 (7.0, 13.9) 0.53
Two or More MDPS Substance Use Disorders 2.2 2.2 (1.3, 3.7) 1.3 1.3 (0.7, 2.4) 0.21
Comorbidity of Any MDPS Mental and Any MDPS 4.3 4.4 (3.3, 5.8) 6.7 6.5 (3.8, 11.0) 0.28
Substance Use Disorder5


Table A.6 Prevalence Rates of MDPS Disorders, by Participant Current Gender Identity
Male Female Transgender/Gender Diverse
MDPS Disorder (past year unless Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence P-
otherwise indicated) (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 value3
Mental Disorders
Schizophrenia Spectrum Disorders 1.5 1.5 (1.0, 2.3) 0.9 0.9 (0.5, 1.7) * * * 0.19
(lifetime)
Major Depressive Disorder 12.3 12.5 (10.4, 14.9) 18.0 17.7 (14.9, 20.8) * * * 0.00
Bipolar I Disorder 1.1 1.1 (0.6, 2.2) 1.9 1.9 (1.0, 3.5) * * * 0.36
Posttraumatic Stress Disorder 3.0 3.1 (2.0, 4.7) 5.0 4.9 (3.7, 6.5) * * * 0.06
Obsessive-Compulsive Disorder 2.0 2.0 (1.1, 3.8) 2.9 2.9 (1.9, 4.3) * * * 0.25
Two or More MDPS Mental 5.6 5.7 (4.2, 7.8) 9.9 9.8 (8.2, 11.6) 0.5 30.3 (18.0, 46.2) 0.00
Disorders4
Alcohol Use Disorder 7.2 7.4 (5.5, 9.8) 5.9 5.8 (4.4, 7.7) * * * 0.43
Opioid Use Disorder 0.6 0.6 (0.3, 1.2) <0.5 0.4 (0.2, 0.7) * * * 0.01
Stimulant Use Disorder 2.2 2.2 (1.3, 3.7) 1.0 1.0 (0.6, 1.5) * * * 0.05
Disorder
Cannabis Use Disorder 3.3 3.4 (2.3, 5.0) 3.9 3.8 (2.0, 7.0) * * * 0.39
Any MDPS Substance Use Disorder 11.0 11.3 (9.0, 14.2) 9.8 9.7 (6.7, 13.7) * * * 0.45
Two or More MDPS Substance Use 1.9 1.9 (1.1, 3.3) 1.3 1.3 (0.7, 2.4) * * * 0.42
Disorders
Comorbidity of Any MDPS Mental and 4.1 4.2 (3.2, 5.5) 6.4 6.3 (3.6, 10.9) * * * 0.21
Any MDPS Substance Use Disorder5


Table A.7 Prevalence Rates of MDPS Disorders, by Participant Race/Ethnicity
Hispanic/Latino NH White NH Black/African American NH Asian
MDPS Disorder (past Weighted 95% Weighted 95% Weighted 95% Weighted 95%
year unless otherwise Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence
indicated) (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2
Mental Disorders
Schizophrenia <0.5 0.6 (0.2, 1.4) 1.2 1.0 (0.6, 1.7) 0.5 2.0 (1.1, 3.5) * * *
Spectrum Disorders
Schizophrenia <0.5 1.1 (0.5, 2.1) 1.5 1.2 (0.8, 2.0) 1.1 4.2 (2.0, 8.5) * * *
Spectrum Disorders
(lifetime)
Major Depressive 4.4 11.8 (8.4, 16.3) 19.9 16.5 (13.9, 19.4) 3.7 14.3 (10.0, 20.1) 1.2 13.7 (7.7, 23.2)
Disorder
Generalized Anxiety 2.2 6.0 (4.6, 7.7) 13.0 10.8 (8.7, 13.4) 2.5 9.7 (5.5, 16.6) 0.7 7.6 (3.9, 14.2)
Disorder
Bipolar I Disorder <0.5 0.7 (0.4, 1.4) 1.9 1.6 (1.0, 2.4) * * * * * *
Posttraumatic Stress 1.1 3.0 (2.0, 4.5) 5.5 4.6 (3.5, 6.1) 1.1 4.3 (2.6, 7.1) * * *
Disorder
Obsessive-Compulsive 1.0 2.7 (1.6, 4.7) 2.4 2.0 (1.5, 2.6) 0.8 3.0 (1.2, 7.1) * * *
Disorder
Anorexia Nervosa * * * * * * * * * * * *
Any MDPS Mental 6.3 17.0 (13.1, 21.8) 31.1 25.8 (22.8, 29.1) 7.0 27.6 (20.4, 36.1) 2.1 23.2 (15.0, 34.0)
Disorder
Two or More MDPS 2.4 6.6 (4.5, 9.4) 9.5 7.9 (6.5, 9.6) 2.5 9.8 (5.7, 16.4) <0.5 2.1 (1.2, 3.7)
Mental Disorders3
Substance Use
Disorders4
Alcohol Use Disorder 1.6 4.3 (2.6, 7.0) 7.9 6.5 (5.2, 8.2) 2.7 10.7 (5.8, 18.9) * * *
Opioid Use Disorder * * * 0.8 0.7 (0.4, 1.2) * * * * * *
Stimulant Use 0.9 2.4 (1.1, 5.0) 1.7 1.4 (0.8, 2.3) <0.5 1.6 (0.7, 3.8) * * *
Disorder
(continued)

Table A.7 Prevalence Rates of MDPS Disorders, by Participant Race/Ethnicity (continued)
MDPS Disorder (past Weighted 95% Weighted 95% Weighted 95% Weighted 95%
year unless otherwise Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence
indicated) (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2
Sedative/Hypnotic/ * * * * * * * * * * * *
Anxiolytic Use
Disorder
Cannabis Use Disorder 1.1 3.0 (1.2, 7.2) 4.5 3.7 (2.2, 6.4) 1.3 5.2 (2.7, 9.9) * * *
Any MDPS Substance 2.6 7.1 (4.5, 11.0) 13.2 10.9 (8.7, 13.7) 3.7 14.7 (9.2, 22.6) <0.5 4.6 (2.3, 8.7)
Use Disorder
Two or More MDPS 0.7 1.9 (0.8, 4.5) 1.7 1.4 (1.0, 2.1) 0.7 2.9 (1.0, 8.0) * * *
Substance Use
Disorders
Comorbidity of Any 0.8 2.3 (1.2, 4.2) 6.8 5.7 (3.9, 8.2) 2.0 7.9 (3.7, 16.2) <0.5 3.3 (1.5, 7.1)
MDPS Mental and Any
MDPS Substance Use
Disorder4
(continued)

Table A.7 Prevalence Rates of MDPS Disorders, by Participant Race/Ethnicity (continued)
NH American Indian/Alaska NH Native Hawaiian/Other Pacific
Native Islander NH Multiracial
MDPS Disorder (past year unless Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence
otherwise indicated) (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 P-value5
Mental Disorders
Schizophrenia Spectrum Disorders * * * * * * * * * 0.07
Schizophrenia Spectrum Disorders * * * * * * <0.5 5.6 (2.3, 12.8) 0.17
(lifetime)
Major Depressive Disorder * * * * * * 1.8 20.0 (12.6, 30.2) 0.36
Generalized Anxiety Disorder * * * * * * 1.8 19.8 (9.9, 35.9) 0.03
Bipolar I Disorder * * * * * * * * * 0.02
Posttraumatic Stress Disorder * * * * * * <0.5 4.1 (1.8, 9.0) 0.00
Obsessive-Compulsive Disorder * * * * * * * * * 0.25
Any MDPS Mental Disorder * * * * * * 3.7 41.3 (29.2, 54.6) 0.01
Two or More MDPS Mental Disorders3 * * * * * * 1.4 15.5 (6.7, 32.0) 0.00
Alcohol Use Disorder * * * * * * 0.9 10.6 (4.4, 23.4) 0.01
Opioid Use Disorder * * * * * * * * * 0.02
Stimulant Use Disorder * * * * * * * * * 0.06
Disorder
Cannabis Use Disorder * * * * * * * * * 0.04
Any MDPS Substance Use Disorder * * * * * * 1.4 15.5 (8.1, 27.8) 0.02
Two or More MDPS Substance Use * * * * * * * * * 0.01
Disorders
Comorbidity of Any MDPS Mental and * * * * * * 1.1 12.3 (6.2, 22.7) 0.02
Any MDPS Substance Use Disorder4
1
2
Weighted were estimates calculated with analysis weights and account for the complex MDPS sampling design.
3
Includes lifetime schizophrenia spectrum disorders if past-year schizophrenia spectrum disorders are not present.
4
5
P-values represent statistical testing results of weighted chi-square tests. Weighted chi-square tests account for MDPS sampling design but not other participant characteristics. Bold
values are significant at p<0.05.

Table A.8 Prevalence Rates of MDPS Disorders, by Participant Geographic Region
Midwest Northeast South West
Weighted 95% Weighted 95% Weighted 95% Weighted 95%

MDPS Disorder (past year Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence P-
unless otherwise indicated) (million) Percent Interval (million)1 Percent2
1 2 2
Interval2 (million)1 Percent2
Interval2 (million)1 Percent2
Interval2 value3
Mental Disorders
Schizophrenia Spectrum <0.5 1.2 (0.6, 2.3) <0.5 0.9 (0.3, 2.7) 1.3 1.7 (0.9, 3.0) <0.5 0.9 (0.4, 1.7) 0.57
Disorders
Schizophrenia Spectrum 0.7 1.7 (1.1, 2.7) <0.5 1.1 (0.4, 3.3) 1.6 2.1 (1.3, 3.3) 1.1 2.2 (1.1, 4.4) 0.64
Disorders (lifetime)
Major Depressive Disorder 6.8 16.3 (13.2, 20.0) 5.7 16.1 (12.2, 20.9) 12.3 15.9 (12.3, 20.3) 6.6 13.6 (10.9, 16.9) 0.65
Generalized Anxiety Disorder 4.8 11.6 (9.1, 14.6) 3.1 8.8 (6.7, 11.5) 8.9 11.6 (7.9, 16.8) 3.4 7.0 (5.3, 9.2) 0.05
Bipolar I Disorder 0.6 1.5 (0.9, 2.8) <0.5 0.8 (0.4, 1.5) 1.8 2.3 (1.1, 5.0) <0.5 0.7 (0.4, 1.3) 0.18
Posttraumatic Stress Disorder 1.8 4.3 (2.9, 6.4) 1.0 2.8 (1.8, 4.3) 3.8 5.0 (3.5, 7.2) 1.6 3.3 (1.7, 6.0) 0.18
Obsessive-Compulsive 0.8 2.0 (1.3, 3.0) 0.5 1.6 (1.0, 2.5) 2.8 3.7 (2.0, 6.6) 0.9 1.8 (1.2, 2.5) 0.32
Disorder
Any MDPS Mental Disorder 10.6 25.3 (21.6, 29.5) 8.1 23.2 (19.2, 27.7) 21.5 27.9 (23.2, 33.2) 10.6 21.7 (17.5, 26.7) 0.30
Two or More MDPS Mental 3.7 8.9 (6.5, 11.9) 2.3 6.6 (4.9, 8.7) 7.5 9.8 (7.6, 12.5) 2.6 5.4 (4.2, 7.0) 0.02
Disorders4
Alcohol Use Disorder 2.3 5.5 (3.5, 8.4) 2.0 5.6 (3.4, 9.0) 5.6 7.4 (5.7, 9.5) 3.6 7.3 (4.8, 11.0) 0.52
Opioid Use Disorder * * * * * * * * * * * * 0.35
Stimulant Use Disorder 0.7 1.7 (0.8, 3.6) 0.7 2.0 (0.7, 5.4) 0.9 1.2 (0.7, 1.9) 0.9 1.8 (0.9, 3.5) 0.68
Sedative/Hypnotic/Anxiolytic * * * * * * * * * * * *
Use Disorder
Cannabis Use Disorder 1.2 3.0 (2.1, 4.2) 1.0 2.7 (1.4, 5.4) 3.8 5.0 (2.6, 9.3) 1.7 3.4 (2.0, 5.9) 0.65
Any MDPS Substance Use 3.8 9.1 (6.6, 12.5) 2.9 8.1 (5.5, 11.9) 9.1 11.9 (8.1, 17.1) 5.6 11.6 (8.6, 15.5) 0.37
Disorder
Two or More MDPS <0.5 1.2 (0.5, 2.9) 0.8 2.2 (0.8, 6.0) 1.5 1.9 (1.2, 3.0) 0.8 1.6 (0.6, 4.0) 0.71
Substance Use Disorders
Comorbidity of Any MDPS 2.0 4.8 (3.3, 6.8) 1.0 2.8 (1.8, 4.2) 5.5 7.3 (3.9, 13.1) 2.5 5.2 (3.4, 7.9) 0.08
Mental and Any MDPS
Substance Use Disorder5
1
2
Weighted estimates were calculated with analysis weights and account for the complex MDPS sampling design.
3
P-values represent statistical testing results of weighted chi-square tests. Weighted chi-square tests account for MDPS sampling design but not other participant characteristics. Bold values are
significant at p<0.05.
4
Includes lifetime schizophrenia spectrum disorders if past-year schizophrenia spectrum disorders are not present.
5

Table A.9 Prevalence Rates of MDPS Disorders, by Household Participant Urbanicity1
Urban Rural
MDPS Disorder (past Weighted

year unless otherwise Count Weighted 95% Confidence Weighted Count Weighted 95% Confidence
indicated) (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 P-value4
Mental Disorders
Schizophrenia Spectrum 1.8 1.1 (0.7, 1.6) * * * 0.34
Disorders
Schizophrenia Spectrum 2.9 1.8 (1.2, 2.5) * * * 0.85
Major Depressive 26.2 15.8 (13.7, 18.2) 4.9 13.4 (10.5, 17.1) 0.26
Disorder
Generalized Anxiety 14.7 9.0 (7.9, 10.2) 5.3 14.7 (7.4, 27.1) 0.26
Disorder
Bipolar I Disorder 2.0 1.2 (0.8, 1.9) * * * 0.41
Posttraumatic Stress 6.0 3.6 (2.9, 4.6) 2.1 5.7 (3.2, 9.9) 0.19
Disorder
Obsessive-Compulsive 3.5 2.1 (1.6, 2.7) 1.4 4.0 (1.5, 10.3) 0.31
Disorder
Any MDPS Mental 39.6 24.0 (21.6, 26.7) 10.5 29.1 (20.2, 39.9) 0.34
Disorder
Two or More MDPS 12.1 7.4 (6.4, 8.5) 3.8 10.6 (6.5, 16.7) 0.20
Mental Disorders5
Opioid Use Disorder 0.8 0.5 (0.3, 0.8) * * * 0.82
Stimulant Use Disorder 2.8 1.7 (1.1, 2.5) * * * 0.13
Sedative/Hypnotic/ * * * * * *
Anxiolytic Use Disorder
Cannabis Use Disorder 5.9 3.6 (2.6, 4.8) * * * 0.68
(continued)

Table A.9 Prevalence Rates of MDPS Disorders, by Household Participant Urbanicity1 (continued)
Urban Rural
MDPS Disorder (past
year unless otherwise Weighted Count Weighted 95% Confidence Weighted Count Weighted 95% Confidence
indicated) (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 P-value6
Any MDPS Substance 17.4 10.5 (8.9, 12.5) 3.9 10.9 (4.5, 23.8) 0.94
Use Disorder
Two or More MDPS 3.0 1.8 (1.2, 2.8) * * * 0.45
Substance Use
Disorders
Comorbidity of Any 8.3 5.1 (4.1, 6.2) 2.6 7.3 (2.0, 23.8) 0.64
MDPS Mental and Any
MDPS Substance Use
Disorder6
1 Urbanicity data are presented for the household sample only. The definition of urban versus rural areas is provided in


Table A.10 Prevalence Rates of Past-Year Treatment Use Among MDPS Participants with a Past-Year Disorder
Any Outpatient Treatment (not Any Inpatient Treatment (not Any Medication (not disorder Any Treatment (not disorder
disorder specific) disorder specific) specific) specific)
Proportion of Adults with
MDPS Disorders Who Weighted 95% Weighted 95% Weighted 95% Weighted 95%
Received Treatment in Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence
the Past Year (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2 (million)1 Percent2 Interval2
Mental Disorders
Schizophrenia Spectrum 1.6 65.6 (45.4, 81.5) <0.5 11.8 (6.1, 21.5) 1.7 69.0 (47.7, 84.4) 1.8 72.9 (51.3, 87.3)
Disorders
Schizophrenia Spectrum 2.1 57.7 (39.7, 73.9) <0.5 10.4 (5.3, 19.5) 2.5 68.9 (52.4, 81.7) 2.6 72.8 (56.4, 84.7)
Major Depressive 17.1 55.3 (48.6, 61.9) 1.0 3.3 (2.4, 4.7) 14.7 47.7 (41.9, 53.5) 18.4 59.6 (52.8, 66.0)
Disorder
Generalized Anxiety 12.3 61.9 (55.8, 67.6) 0.8 4.1 (2.5, 6.7) 11.5 57.5 (51.1, 63.6) 13.2 65.9 (59.8, 71.5)
Disorder
Bipolar I Disorder * * * <0.5 5.7 (2.5, 12.5) * * * * * *
Posttraumatic Stress 5.6 69.0 (56.7, 79.0) <0.5 5.2 (2.9, 9.3) 4.4 54.3 (44.0, 64.2) 5.9 71.7 (59.1, 81.6)
Disorder
Obsessive-Compulsive 3.2 64.8 (46.6, 79.5) <0.5 6.3 (3.2, 12.3) 3.3 65.3 (52.2, 76.5) 3.7 73.5 (61.4, 82.9)
Disorder
Any MDPS Mental 27.5 55.0 (49.8, 60.1) 1.7 3.3 (2.5, 4.4) 25.1 50.1 (45.3, 55.0) 30.4 60.8 (55.7, 65.6)
Disorder
Alcohol Use Disorder 1.6 12.1 (8.4, 17.1) 0.8 5.9 (2.8, 11.8) 0.8 6.2 (3.9, 9.6) 1.8 13.7 (9.4, 19.4)
Opioid Use Disorder * * * * * * * * * * * *
Stimulant Use Disorder 0.7 23.0 (14.1, 35.3) <0.5 8.2 (4.1, 15.6) <0.5 11.8 (6.5, 20.4) 0.7 24.2 (15.0, 36.7)
Anxiolytic Use
Disorder
Cannabis Use Disorder <0.5 2.5 (1.4, 4.7) * * * * * * <0.5 3.7 (1.9, 7.3)
Any MDPS Substance 2.3 10.8 (7.6, 14.9) 0.9 4.2 (2.2, 8.1) 1.2 5.8 (3.8, 8.6) 2.6 12.2 (8.6, 16.8)
Use Disorder

Table A.11 Prevalence Rates of Past-Year Treatment Use Among MDPS Participants with a Past-Year
Disorder, by Participant Age Group
18–25 26–44 45–65
Proportion of Adults with MDPS Weighted 95% Weighted 95% Weighted 95%
Disorders Who Received Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence P-
Treatment in the Past Year1 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 value4
Mental Disorders
Schizophrenia Spectrum * * * * * * * * *
Disorders
Schizophrenia Spectrum * * * * * * * * *
Bipolar I Disorder * * * 1.0 88.9 (70.2, 96.4) 0.7 94.0 (82.6, 98.1) 0.24
Posttraumatic Stress Disorder * * * 3.9 74.5 (62.3, 83.7) 1.1 74.8 (51.0, 89.4) 0.76
Obsessive-Compulsive Disorder * * * 1.7 76.0 (60.0, 87.0) * * * 0.76
Alcohol Use Disorder * * * 1.3 16.6 (10.8, 24.7) <0.5 12.1 (6.5, 21.5) 0.14
Opioid Use Disorder * * * * * * * * *
Stimulant Use Disorder * * * 0.5 35.2 (19.3, 55.3) <0.5 14.3 (5.5, 32.5) 0.05
Sedative/Hypnotic/Anxiolytic * * * * * * * * *
Use Disorder
Cannabis Use Disorder * * * * * * * * *
Any MDPS Substance Use * * * 1.8 15.8 (11.2, 21.7) 0.7 12.4 (7.5, 19.8) 0.06
Disorder
1 Includes any outpatient, inpatient or residential treatment, or medication received in the past year (not disorder specific).

5

Disorder, by Participant Sex Assigned at Birth
Male Female
Proportion of Adults with MDPS Weighted 95% Weighted 95%

Disorders Who Received Treatment in Count Weighted Confidence Count Weighted Confidence P-
the Past Year1 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 value4
Mental Disorders
Schizophrenia Spectrum Disorders * * * 0.8 92.8 (72.6, 98.4) 0.04
Schizophrenia Spectrum Disorders 1.2 58.7 (38.8, 76.1) 1.5 90.6 (75.4, 96.8) 0.02
(lifetime)
Posttraumatic Stress Disorder * * * 4.1 78.0 (67.7, 85.7) 0.26
Obsessive-Compulsive Disorder * * * 2.3 77.7 (67.4, 85.4) 0.40
Opioid Use Disorder * * * * * *
Stimulant Use Disorder <0.5 22.9 (12.0, 39.4) <0.5 26.8 (13.7, 45.9) 0.72
Sedative/Hypnotic/Anxiolytic Use * * * * * *
Disorder
Cannabis Use Disorder * * * * * *
Any MDPS Substance Use Disorder 1.8 16.3 (10.8, 23.7) 0.8 7.7 (4.4, 13.2) 0.05
1
Includes any outpatient, inpatient or residential treatment, or medication received in the past year (not disorder specific).
2
3
4
P-values represent statistical testing results of weighted chi-square tests. Weighted chi-square tests account for MDPS sampling design but not other
participant characteristics. Bold values are significant at p<0.05.
5

Disorder, by Participant Current Gender Identity
Male Female Transgender/Gender Diverse
Disorders Who Received Treatment in Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence
the Past Year1 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 P-value4
Mental Disorders
Schizophrenia Spectrum Disorders * * * 0.7 91.9 (69.3, 98.3) * * * 0.11
(lifetime)
Generalized Anxiety Disorder 4.3 67.4 (53.6, 78.7) 8.4 65.8 (60.0, 71.2) * * * 0.92
Bipolar I Disorder 0.9 83.4 (59.0, 94.6) * * * * * * 0.37
Posttraumatic Stress Disorder * * * 3.9 77.3 (66.4, 85.4) * * * 0.23
Obsessive-Compulsive Disorder * * * 2.2 77.4 (67.0, 85.2) * * * 0.40
Any MDPS Mental Disorder 10.3 52.0 (43.4, 60.4) 19.0 66.6 (61.0, 71.8) * * * 0.02
Alcohol Use Disorder 1.2 17.4 (10.1, 28.3) 0.6 9.8 (5.5, 16.9) * * * 0.31
Stimulant Use Disorder <0.5 22.6 (11.7, 39.2) <0.5 27.1 (13.8, 46.3) * * * 0.56
Disorder
Any MDPS Substance Use Disorder 1.8 16.5 (11.0, 24.0) 0.8 8.0 (4.5, 13.8) * * * 0.07


Disorder, by Participant Race/Ethnicity

Received Treatment in Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence
the Past Year1 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3
Mental Disorders
Schizophrenia <0.5 99.8 (98.6, 100.0) * * * * * * * * *
Spectrum Disorders
Schizophrenia * * * * * * * * * * * *
Spectrum Disorders
(lifetime)
Major Depressive 1.8 42.2 (33.0, 52.1) 13.0 66.3 (57.0, 74.4) 1.6 43.8 (29.5, 59.2) * * *
Disorder
Generalized Anxiety 1.2 54.8 (42.8, 66.2) 9.6 74.9 (66.2, 81.9) * * * * * *
Disorder
Bipolar I Disorder <0.5 97.6 (83.5, 99.7) 1.7 88.5 (76.2, 94.9) * * * * * *
Posttraumatic Stress 0.8 69.7 (51.4, 83.4) 4.1 73.6 (56.8, 85.5) * * * * * *
Disorder
Obsessive-Compulsive <0.5 39.3 (22.6, 58.9) 2.0 83.6 (69.8, 91.8) * * * * * *
Disorder
Any MDPS Mental 2.8 44.9 (36.9, 53.2) 20.7 67.1 (59.9, 73.6) 3.3 48.5 (33.4, 64.0) 0.8 39.2 (22.0, 59.5)
Disorder
Alcohol Use Disorder * * * 1.2 15.4 (10.7, 21.7) * * * * * *
Stimulant Use Disorder * * * 0.6 37.0 (22.1, 54.8) * * * * * *
Anxiolytic Use
Disorder
Cannabis Use Disorder * * * * * * * * * * * *
Any MDPS Substance <0.5 8.6 (4.0, 17.5) 1.8 13.9 (9.6, 19.7) * * * * * *
Use Disorder
(continued)

Disorder, by Participant Race/Ethnicity (continued)
NH Native Hawaiian/Other Pacific

NH American Indian/Alaska Native Islander NH Multiracial
Disorders Who Received Treatment in Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence
the Past Year1 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 P-value5
Mental Disorders
Schizophrenia Spectrum Disorders * * * * * * * * * 0.36
Schizophrenia Spectrum Disorders * * * * * * * * *
(lifetime)
Major Depressive Disorder * * * * * * 1.2 69.8 (47.8, 85.4) 0.00
Generalized Anxiety Disorder * * * * * * * * * 0.08
Bipolar I Disorder * * * * * * * * * 0.50
Posttraumatic Stress Disorder * * * * * * * * * 0.20
Obsessive-Compulsive Disorder * * * * * * * * * 0.04
Any MDPS Mental Disorder * * * * * * 2.4 66.3 (45.1, 82.5) 0.00
Alcohol Use Disorder * * * * * * * * * 0.15
Stimulant Use Disorder * * * * * * * * * 0.08
Disorder
Any MDPS Substance Use Disorder * * * * * * * * * 0.25

Disorder, by Participant Geographic Region
Midwest Northeast South West
Received Treatment in the Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence Count Weighted Confidence P-
Past Year1 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 (million)2 Percent3 Interval3 value4
Mental Disorders
Schizophrenia Spectrum * * * * * * * * * * * *
Disorders
Schizophrenia Spectrum * * * <0.5 77.5 (53.1, 91.3) * * * * * * 0.72
Major Depressive 4.1 60.4 (47.4, 72.1) * * * 7.2 59.9 (49.6, 69.4) 3.9 59.8 (50.5, 68.4) 1.00
Disorder
Generalized Anxiety 3.1 65.1 (51.9, 76.4) 2.4 79.4 (69.3, 86.8) 5.6 63.4 (52.8, 72.9) 2.0 61.1 (50.5, 70.8) 0.04
Disorder
Bipolar I Disorder 0.6 99.0 (92.8, 99.9) * * * * * * * * * 0.22
Posttraumatic Stress 1.2 64.9 (44.6, 80.9) 0.9 92.3 (77.7, 97.6) 2.9 76.0 (61.5, 86.3) * * * 0.11
Disorder
Obsessive-Compulsive * * * <0.5 83.4 (68.8, 92.0) 2.0 72.6 (52.9, 86.2) 0.6 65.4 (45.8, 80.8) 0.33
Disorder
Any MDPS Mental 6.3 60.6 (51.6, 68.9) 5.0 61.6 (44.3, 76.5) 13.0 61.7 (53.6, 69.3) 6.1 58.3 (50.2, 66.0) 0.94
Disorder
Alcohol Use Disorder * * * * * * 0.7 13.6 (8.7, 20.7) <0.5 9.4 (4.3, 19.5) 0.72
Stimulant Use Disorder * * * * * * <0.5 28.3 (15.0, 47.1) * * * 0.89
Anxiolytic Use Disorder
Cannabis Use Disorder * * * * * * * * * * * *
Any MDPS Substance * * * 0.5 19.4 (9.0, 37.0) 0.9 9.7 (5.5, 16.6) 0.7 11.9 (6.2, 21.4) 0.68
Use Disorder
1
2
3
4
P-values represent statistical testing results of weighted chi-square tests. Weighted chi-square tests account for MDPS sampling design but not other participant characteristics. Bold values are
significant at p<0.05.
5

Disorder, by Household Participant Urbanicity1
Urban Rural
Weighted 95% 95%

Proportion of Adults with MDPS Disorders Who Count Weighted Confidence Weighted Weighted Confidence
Received Treatment in the Past Year2 (million)3 Percent4 Interval4 Count (million)3 Percent4 Interval4 P-value5
Mental Disorders
Schizophrenia Spectrum Disorders 1.4 81.7 (57.2, 93.7) * * * 0.16
Schizophrenia Spectrum Disorders (lifetime) 2.2 77.7 (60.7, 88.7) * * * 0.23
Posttraumatic Stress Disorder 4.6 76.2 (66.4, 83.9) 1.2 58.2 (28.8, 82.7) 0.31
Obsessive-Compulsive Disorder 2.5 72.7 (60.7, 82.1) 1.1 75.6 (35.7, 94.5) 0.87
Alcohol Use Disorder 1.5 13.3 (8.7, 19.8) * * * 0.77
Opioid Use Disorder * * * * * *
Stimulant Use Disorder 0.7 24.8 (15.0, 38.2) * * * 0.62
Sedative/Hypnotic/Anxiolytic Use Disorder * * * * * *
Cannabis Use Disorder * * * * * *
Any MDPS Substance Use Disorder 2.2 12.6 (9.0, 17.5) * * * 0.67
1
Urbanicity data are presented for the household sample only. The definition of urban versus rural areas is provided in
2
3
4
5
P-values represent statistical testing results of weighted chi-square tests. Weighted chi-square tests account for MDPS sampling design but not other
participant characteristics. Bold values are significant at p<0.05.
6

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Mental and Substance Use

Mental and Substance Use

4. MDPS Lessons Learned 37

Mental and Substance Use Disorders Prevalence Study: Findings Report i

A. Tables of MDPS Disorder Prevalence Rates and Treatment Estimates 51

Mental and Substance Use Disorders Prevalence Study: Findings Report ii

2.A.1 MDPS Household Three-Stage Design ........................................................................ 7

Mental and Substance Use Disorders Prevalence Study: Findings Report iv

Key findings from the MDPS are highlighted as follows:

Schizophrenia Spectrum Disorders

Other Mental Disorders in the Past Year

Mental and Substance Use Disorders Prevalence Study: Findings Report 1

Substance Use Disorders in the Past Year

Any Mental or Substance Use Disorder in the Past Year

Treatment Receipt Among Those with Mental or Substance Use Disorders

Mental and Substance Use Disorders Prevalence Study: Findings Report 2

Mental and Substance Use Disorders Prevalence Study: Findings Report 3

1.B Study Objectives and Research Questions

The key objectives of the MDPS pilot program are as follows:

The MDPS is designed to answer two research questions:

1.C Study Team

Mental and Substance Use Disorders Prevalence Study: Findings Report 4

1.D Study Timeline

1.E Current Report

2.A Design Overview

Multiple Populations of Interest

Mental and Substance Use Disorders Prevalence Study: Findings Report 5

Mental and Substance Use Disorders Prevalence Study: Findings Report 6

Addressing the Nature of the MDPS Pilot Program

Mental and Substance Use Disorders Prevalence Study: Findings Report 7

Mental and Substance Use Disorders Prevalence Study: Findings Report 8

 Group 1. Those who reported experiencing psychotic symptoms or receiving disability

Mental and Substance Use Disorders Prevalence Study: Findings Report 9

Sample Power, Sample Sizes, and Weighted Response Rates

Mental and Substance Use Disorders Prevalence Study: Findings Report 10

The Household Roster

The Household Screening Interview

Mental and Substance Use Disorders Prevalence Study: Findings Report 11

The Semi-Structured Clinical Interview

Many population surveys use self-administered surveys or fully structured interviews

Mental and Substance Use Disorders Prevalence Study: Findings Report 12

MDPS Mental Disorders MDPS Substance Use Disorders

All instruments were available in English and Spanish.

2.D Data Collection and Quality Control

Mental and Substance Use Disorders Prevalence Study: Findings Report 13

Data Collection Staffing and Timeline

MDPS data collectors included the following:

Mental and Substance Use Disorders Prevalence Study: Findings Report 14

Clinical Interviewers and Supervisors

Data Collection Outcomes

Mental and Substance Use Disorders Prevalence Study: Findings Report 15

2.E Methods—Weighting and Estimation

Mental and Substance Use Disorders Prevalence Study: Findings Report 16

Survey Analysis Weights

5 The tables are published at https://bjs.ojp.gov/library/publications/prisoners-2020-statistical-tables. The total numbers for

Mental and Substance Use Disorders Prevalence Study: Findings Report 17

Mental and Substance Use Disorders Prevalence Study: Findings Report 18

3.A Sample Characteristics

Mental and Substance Use Disorders Prevalence Study: Findings Report 19