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Chartbook on Mental Health and Disability

Appendices: Glossary

This alphabetical list provides an explanation of terms that may require clarification. The definitions are taken from original surveys or cited publications as closely as possible, to convey the original authors’ perspectives. Surveys that are mentioned in this Glossary are explained in more detail in the Surveys.


704 Report: Annual Report of the Rehabilitation Services Administration’s funded Independent Living Centers.


ADL: See Activities of daily living (ADLs).


Activities of daily living (ADLs): The National Health Interview Survey (NHIS) asks questions to identify people who "need the help of other persons with personal care needs such as eating, bathing, dressing or getting around...(inside the) home." (Adams & Marano, 1995). These particular activities are termed activities of daily living.

The Survey of Income and Program Participation (SIPP) definition of ADL includes eating, bathing, dressing or getting around inside the home, but also specifies getting into and out of bed or a chair, and toileting.

(See also instrumental activities of daily living.)


Activity limitation(s): On the National Health Interview Survey (NHIS), activity limitation refers to a long-term reduction in a person’s capacity to perform the average kind or amount of activities associated with his or her age group. (See major activity for an explanation of the activities associated with each age group.) People are classified into one of four categories:

  1. unable to perform the major activity,
  2. able to perform the major activity but limited in the kind or amount of this activity,
  3. not limited in the major activity but limited in the kind or amount of other activities, and
  4. not limited in any way.

The NHIS classifies people as limited (groups 1-3) or not limited (group 4). People are not classified as limited in activity unless one or more chronic health conditions are reported as the cause of the activity limitation.


Census of State and Federal Adult Correctional Facilities: See Surveys for survey description.


Center for Mental Health Services (CMHS) Client Patient Sample Survey: See Surveys for survey description.


Children’s Global Assessment Scale (CGAS) was used as a measure of functional impairment in the MECA. The CGAS score is chosen from a continuous scale ranging from 1 (extremely impaired) to 100 (doing very well). The CGAS score used was the lower of the two scores reported by the parents’ interviewer and the youth interviewer.


Comorbidity is a technical term for having more than one condition or disorder at the same time.


Diagnostic and Statistical Manual (DSM-III, DSM-III-R and DSM-IV): The Diagnostic and Statistical Manual classifies and describes mental disorders and their symptoms. Many current studies of mental illness and disability use DSM diagnoses to define the mental disorders.


Disabled worker: Under the Social Security definition, disabled workers are people under age 65 who receive benefits as part of the Old Age, Survivors and Disability Insurance (OASDI) program. They have been determined to be disabled under Social Security criteria (i.e., cannot engage in "substantial gainful activity.") They have also earned at least a certain minimum amount of wages in employment covered under Social Security in order to receive income from Social Security Disability Insurance (SSDI).


Disability: On the NHIS, disability refers to any long- or short-term reduction of a person’s activity as a result of an acute or chronic condition.

On the 1997 SIPP, people age 15 and over were considered to have a disability if they met any of the following criteria:

  1. used a wheelchair, a cane, crutches, or a walker;
  2. had difficulty performing one or more functional activities;
  3. had difficulty with one or more activities of daily living (ADLs);
  4. had difficulty with one or more instrumental activities of daily living (IADLs).

Inclusion criteria related to mental disability were:

  1. had one or more specified conditions (a learning disability, mental retardation or another developmental disability, Alzheimer’s disease, or some other type of mental or emotional condition) ; or
  2. had any other mental or emotional conditions that seriously interfered with everyday activities (frequently depressed or anxious, trouble getting along with others, trouble concentrating or trouble coping with day-to-day stress.

In addition, people were included who

  1. had a condition that limited the ability to work around the house.

A person was also considered to have a disability if

  1. the person was 16 to 67 and had a condition that made it difficult to work at a job or business, or
  2. received federal benefits based on an inability to work.

Disability due to a mental disorder is a general term used in this Chartbook to refer to limitations in functioning associated with a mental disorder. Related terms used by other researchers include mental health disability, severe mental illness, serious mental illness, and mental disability.


Disability program recipients defines people covered by Social Security Disability Insurance, Supplemental Security Income, Special Education or Early Intervention Services, and/or disability pensions.


Drop-out rate is used in the IDEA analysis. It is calculated by dividing the number of students age 14 and older who dropped out by the number of students age 14 and older who are known to have left school via graduating with a diploma, receiving a certificate of completion, reaching maximum age for services, died, or dropped out.


DSM, DSM-III, DSM-III-R, DSM-IV: An abbreviation for the Diagnostic and Statistical Manual and its versions. (see Diagnostic and Statistical Manual)


Emotional disturbance, as used in the IDEA data, means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance:

  1. an inability to learn that cannot be explained by intellectual, sensory, or health factors;
  2. an inability to build or maintain satisfactory interpersonal relationships with peers and teachers;
  3. inappropriate types of behavior or feelings under normal circumstances;
  4. a general pervasive mood of unhappiness or depression;
  5. a tendency to develop physical symptoms or fears associated with personal or school problems.

Emotional disturbance also includes schizophrenia, but it does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.


Epidemiologic Catchment Area (ECA) Survey: See Surveys for survey description.


Functional activity or activities: The SIPP asked respondents about their ability to perform the sensory and physical activities that include seeing, hearing, speaking, lifting/carrying, using stairs, walking, or grasping small objects. (Difficulty in performing any of these functional activities is classified as a functional limitation in the SIPP.

The NHIS-D asked respondents about their ability to perform the following activities:

  1. lift 10 pounds,
  2. walk up 10 steps without resting,
  3. walk a quarter of a mile,
  4. stand for approximately 20 minutes,
  5. bend down from a standing position,
  6. reach up over the head or reach out,
  7. use fingers to grasp or handle something and
  8. hold a pen or pencil.

Inability to perform any of these activities is classified as a functional limitation.


Functional disability: On the NHIS-D, functional disability includes:

  1. limitations in or inability to perform a variety of physical activities;
  2. serious sensory impairment;
  3. serious symptoms of mental illness that severely interfered with life for the past year;
  4. long-term care needs;
  5. use of selected assistive devices;
  6. developmental delays;
  7. for children under age 5, inability to perform age-appropriate functions.

Functional limitation(s): See functional activities for definitions of specific physical activities that are used to define functional limitations. In the Colpe NHIS-D study of mental and emotional problems among children and youth, functional limitations were defined using four variables from Phase I of the NHIS-D:

  1. Does your child have significant problems at school with paying attention in class?
  2. Does your child have significant problems at school with controlling behavior?
  3. Does your child have significant problems at school with communicating with others?
  4. Because of a physical, mental, or emotional problem, does your child now have any difficulty playing or getting along with others his/her age? (The study controlled for the possibility that a child might have difficulty getting along with others because of a physical problem by including only those who had also been identified as having a mental or emotional problem.)

Graduation rate: Used in the IDEA analysis, it is calculated as the number of students age 14 and older who graduated with a standard diploma divided by the number of students age 14 and older who are known to have left school via graduating with a diploma, receiving a certificate of completion, reaching maximum age for services, died, or dropped out.)


IADL: See Instrumental activities of daily living (IADLs).


IDEA: IDEA stands for the Individuals with Disabilities Education Act, Part B Program. IDEA is now the major federal program that provides states with financial assistance to educate children and youth with disabilities. Before 1995, special education was also funded under ESEA.

IDEA includes children with mental retardation, hearing impairments including deafness, speech or language impairments, visual impairments including blindness, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities. In order to qualify under IDEA, children must need special education and related services by reason of their disability.


ILCs/Independent Living Centers are consumer-controlled, community-based, cross-disability, nonresidential, private nonprofit agencies that are designed and operated within a local community by individuals with disabilities and provide an array of independent living services: information and referral, independent living skills training, peer counseling, and individual and systems advocacy. Most centers are also actively involved in one or more of the following activities: community planning and decision making; school-based peer counseling, role modeling, and skills training; working with local governments and employers to open and facilitate employment opportunities; interacting with local, state, and federal legislators; and staging recreational events that integrate individuals with disabilities with their non-disabled peers.

Many of the ILCs are supported with funds from the U.S. Rehabilitation Services Administration. The federally-funded Centers are required to report annually (the "704 Report"). The national program started in 1978, and provide a model for the development of other centers.


Instrumental activities of daily living (IADLs): The NHIS collects information on people’s needs for assistance from others in performing instrumental activities of daily living. The IADLs include: "doing everyday household chores, necessary business, shopping or getting around for other purposes." People who need assistance in activities of daily living (ADLs) were not asked about IADLs.

On the SIPP, instrumental activities of daily living include: going outside the home, keeping track of money or bills, preparing meals, doing light housework, taking prescription medicine in the right amount at the right time, and using the telephone.

(See also activities of daily living.)


Inventory of Local Jail Mental Health Services. See Surveys for survey description.


Inventory of Mental Health Services in Juvenile Justice Facilities. See Surveys for survey description.


Labor force participation rate (LFPR): The LFPR, which is the number of people in a given population that are in the labor force divided by the number of people in that population, is a primary measure in labor market analysis.


Major activity: In NHIS, people are classified in terms of the major activity usually associated with their particular age group. The major activities for the age groups are:

  1. ordinary play for children under 5 years of age,
  2. attending school for those 5-17 years of age,
  3. working or keeping house for people 18-69 years of age, and
  4. the capacity for independent living (the ability to take care of personal needs such as eating and dressing, without the help of another person) for those 70 and over.

People ages 18-69 years who are classified as keeping house are also classified according to their ability to work at a job or business. (See activity limitation.)


Major depressive disorder is characterized by abnormally depressed mood and marked loss of pleasure (not due to normal grieving) every day for at least two weeks. By definition, major depressive disorder causes clinically significant distress or impairment in social, occupational or other important areas of functioning. In the National Comorbidity Survey Replication (NCS-R), major depressive disorder was assessed using the Composite International Diagnostic Interview (CIDI) and the Structured Clinical Interview for DSM-IV.


MECA: The Methods for the Epidemiology of Child and Adolescent Mental Disorders. See Surveys for details.


Mental condition The Survey on Income and Program Participation (SIPP) asks a number of questions designed to identify people who have a mental disability. Regarding conditions, the SIPP asks whether people have

  1. a learning disability,
  2. mental retardation,
  3. Alzheimer’s, senility or dementia, or
  4. any other mental or emotional condition.

The SIPP uses the term mental conditions to refer to these four specific conditions.


Mental disability is a term used by the U.S. Census and surveys done through the U.S. Census, like the Survey of Income and Program Participation (SIPP). In the SIPP, people were asked about specific mental conditions and symptoms and were classified as having a mental disability if they answered affirmatively to any of the conditions or symptoms.


Mental disorder is defined in the Report of the Surgeon General on Mental Health (U.S. Department of Health and Human Services, 1999) as a health condition characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. We use the term mental disorder in the Chartbook to encompass a variety of related terms including mental illness and psychiatric disorder. Not all mental disorders are disabling. When a person experiences limitations in functioning as a result of a mental condition, we use the term disability due to a mental disorder.

The term mental disorder also is used in specific surveys. In the Epidemiologic Catchment Area (ECA) studies, the presence of a mental disorder was determined by asking about a person’s symptoms, using the Diagnostic Interview Survey (DIS). People whose symptoms met the criteria for diagnosis based on the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III or DSM-IIIR) were classified as having a mental disorder. The term mental disorder is also used by the National Comorbidity Study (NCS) and the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA).


Mental health: As defined in Mental health: Report of the Surgeon General (1999), "the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people and the ability to adapt to change and to cope with adversity; from early childhood until late life, mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem."


Mental health disability: A constructed measure using data from the core National Health Interview Survey (NHIS, 1994-95) and the National Health Interview Survey on Disability (NHIS-D, 1994-95). The measure includes:

  1. having a limitation in any activity in any way due to a mental health problem (core questionnaire);
  2. having any of 7 mental health symptoms that seriously interfere with day-to-day activities (working, going to school, or managing day-to-day activities); and
  3. having any of these 7 symptoms or any of 9 mental health disorders that cause work disability (an inability to work or a limitation in the kind or amount of work a person can do).

The 7 mental health symptoms are:

  1. frequently depressed or anxious
  2. have a lot of trouble making and keeping friendships
  3. have a lot of trouble getting along with other people in social or recreational settings
  4. have a lot of trouble concentrating long enough to complete everyday tasks
  5. have serious difficulty coping with day-today stress
  6. frequently confused, disoriented, or forgetful
  7. have phobias or unreasonably strong fears, that is a fear of something or some situation where most people would not be afraid

The nine mental health disorders are:

  1. Schizophrenia
  2. Paranoid or delusional disorder, other than schizophrenia
  3. Manic episodes or manic depression, also called bipolar disorder
  4. Major depression (major depression is a depressed mood and loss of interest in almost all activities for at least 2 weeks)
  5. Antisocial personality, obsessive-compulsive personality, or any other severe personality disorder
  6. Alzheimer’s disease or another type of senile disorder
  7. Alcohol abuse disorder
  8. Drug abuse disorder
  9. Other mental or emotional disorders that seriously interfered with ability to work, attend school, or manage day-today activities.

Mental illness: As defined in Mental health: Report of the Surgeon General (1999), "the term refers collectively to all mental disorders. Mental disorders are health conditions that are characterized by alternatives in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.

In some reports based on the NHIS, depression, anxiety, and other mental conditions are collectively described as mental illness.


The Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA). See Surveys for details.


NCS: See National Comorbidity Survey in Surveys for survey description.


NCS-R: See National Comorbidity Survey Replication in Surveys for survey description.


NHIS: See National Health Interview Survey in Surveys for survey description.


NHIS-D: See National Health Interview Survey on Disability in Surveys for survey description.


NHIS-MH: See National Health Interview Survey, Mental Health Supplement in Surveys for survey description.


National Comorbidity Survey: See Surveys for survey description.


National Comorbidity Survey Replication: See Surveys for survey description.


National Health Interview Survey (NHIS): See Surveys for survey description.


National Health Interview Survey on Disability (NHIS-D): See National Health Interview Survey on Disability in Surveys for survey description.


National Health Interview Survey, Mental Health Supplement (NHIS-MH): See National Health Interview Survey, Mental Health Supplement in Surveys for survey description.


National Nursing Home Survey: See Surveys for survey description.


Non-institutionalized: Many estimates from federal surveys are based only on people who are not in institutions at the time of the survey, that is, the non-institutionalized people in the population. Institutions include correctional institutions, mental (psychiatric) hospitals, residential treatment centers, tuberculosis hospitals, chronic disease hospitals, homes for the aged, homes and schools for the mentally handicapped, homes and schools for the physically handicapped, homes for unwed mothers, homes for dependent and neglected children, training schools for juvenile delinquents, and detention homes for juveniles.


OASDI: See Old Age, Survivors, and Disability Insurance.


Old Age, Survivors and Disability Insurance (OASDI): This federally-administered program provides monthly benefits to retired and disabled workers and their dependents and survivors. Benefits are earned in employment covered under Social Security. The part of OASDI that provides benefits to workers on the basis on disability is called Social Security Disability Income (SSDI).


Perceived disability: In the NHIS-D, people were asked if they considered themselves to have a disability or are considered by others to have one. This reflects the definition of disability used in the Americans with Disabilities Act (ADA).


Personal assistance: In the NHIS core questionnaire, respondents are asked if they "need the help of other people" with personal care needs (activities of daily living) or handling other routine needs (instrumental activities of daily living). Those who answer affirmatively are categorized as needing personal assistance.


Prevalence: Prevalence is the number of cases of a disease, number of infected people, or number of people with a given attribute present during a particular interval of time. It is often expressed as a rate or percentage (for example, the prevalence of arthritis per 100 people during a year).


Psychiatric disorder: In the National Comorbidity Survey, respondents were interviewed about symptoms, using a structured diagnostic interview. Respondents whose symptoms met the criteria for a mental disorder as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual, Revised Third Edition (DSM-III-R) were classified as having a psychiatric disorder.


Rehabilitation Services Administration Program Data: See Surveys for description of data source.


Role impairment is a measure of disability due to major depressive disorder that was used in the National Comorbidity Survey Replication (NCS-R). Role impairment was a measure of the extent to which depression interfered with functioning in work, household, relationship, and social roles, and was assessed by scores on the Sheehan Disability Scale (SDS) and the World Health Organization disability assessment scale (WHO-DAS).


Serious mental illness (SMI): The term "serious mental illness" has been used to designate those individuals with conditions that are disabling. For instance, in the Alcohol, Drug, and Mental Health Administration (ADAMHA) Block Grant formula, 12-month prevalence rates for serious mental illness (SMI) was part of the funding measure. A committee of experts developed an operational definition of SMI. The measure was developed using the National Comorbidity Survey (NCS) and the Baltimore data from the Epidemiologic Catchment Area Study (ECA). The definition is based on disorder and functional impairment. The disorder measure was operationalized in the ECA by the DSM-III, and in the NCS by a modified version of the DSM-III-R. Respondents were defined as having functional impairment if their disorder substantially interfered with vocational capacity, created serious interpersonal difficulties, was associated with a suicide plan or attempt at some time during the past 12 months, or if the disorder met criteria for severe mental illness as operationalized by NIMH (includes diagnoses of schizophrenia, schizo-affective disorder, manic depressive disorder, autism, severe forms of major depression, panic disorder, or obsessive compulsive disorder, because these disorders are so severe that they almost always lead to serious impairment if not treated).

In an earlier study, the 1989 Mental Health Supplement to the National Health Interview Survey (NHIS-MH), serious mental illness was defined as having one or more psychiatric disorders in the past year that interfered seriously with one or more aspects of daily life. Household respondents were asked whether anyone in the household had one of a number of psychiatric disabilities, which were listed by name.


Severe mental illness: In the Epidemiological Catchment Area (ECA) studies, subjects were interviewed using the Diagnostic Interview Survey. In a study conducted by the National Center for Mental Health, the subjects were further classified as having a severe mental illness if their symptoms met the criteria for a particular set of Diagnostic and Statistical Manual (DSMIII) mental disorders and markedly interfered with social, occupational, and or school functioning. The diagnoses that met the criteria included schizophrenia and related disorders, manic-depressive (bipolar) disorder, autism and related disorders, as well as severe forms of major depression, panic disorder and obsessive compulsive disorder.


SIPP: See Survey of Income and Program Participation in the Surveys for survey description.


Social Security benefits: Social security benefits for individuals with disabilities include:

  1. Social Security Disability Insurance (SSDI) which is a part of the Old Age, Survivors and Disability Insurance (OASDI) and
  2. Supplemental Security Income (SSI).

Individuals may receive benefits from either or both programs, depending on their work history, age, and financial resources. See individual listings under these terms for more information about each program.


Social Security Disability Insurance (SSDI): A federal program in the Social Security Administration providing monthly benefits to disabled workers and their dependents. A person builds protection through employment covered under Social Security (compulsory tax on earnings). The disability definition is an inability to engage in substantial gainful activity because of any medically determinable permanent physical or mental impairment. Later amendments made the disability length of time necessary for eligibility to be at least five months.


Social Security Program Data: See Surveys for description of data source.


Special education: Special education refers to free and appropriate public education and related services provided for children and youth with disabilities from birth through age 21. Funding is provided via federal legislation IDEA, part B and, through 1995, by Chapter 1 of ESEA (SOP). (See also IDEA).


Supplemental Security Income (SSI): The federally-administered Supplemental Security Income program provides income support to people 65 and over, blind or disabled adults and blind or disabled children who have little or no income or other financial resources. In order to be considered disabled for SSI, an adult must be unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment that is expected to result in death or last for a continuous period of at least 12 months. Blindness is defined as 20/200 or less vision in the better eye with the use of correcting lenses, or with tunnel vision of 20 degrees or less. Children who have a physical or mental impairment that results in marked or severe functional limitations are eligible for SSI.


Survey of Program and Income Participation (SIPP): See Surveys for survey description.


Synthetic estimates: Synthetic estimates use statistical models to combine information from different data sources to estimate information that is not available from one source by itself.


U.S. Department of Education, Office of Special Education, Data Analysis System: See Surveys for description of data source.


Vocational Rehabilitation: This term refers to programs conducted by state Vocational Rehabilitation agencies operating under the Rehabilitation Act of 1973. Vocational Rehabilitation programs provide or arrange for a wide array of training, educational, medical, and other services individualized to the needs of people with disabilities. The services are intended to help people with disabilities acquire, reacquire, and maintain gainful employment. The federal government provides most of the funding.


With employment outcome: The successful placement of a Vocational Rehabilitation client into competitive, or self-employment for a minimum of 60 days after the completion of all necessary rehabilitation services. This category, "with employment outcome," was formerly called "rehabilitated."


Work disability: On the NHIS-D, work disability is defined as a limitation in or inability to work as a result of a physical, mental or emotional health condition.


Work limitation: On the NHIS, this category includes respondents with a chronic health condition that prevents the performance of work at all, allows only certain types of work to be performed or prevents regular working.