Using the MEPS-HC to Study Change in Adult Mental Health

By Julia A. Rivera Drew and Natalie Del Ponte

The Medical Expenditure Panel Survey-Household Component, or MEPS-HC, data are an invaluable resource for studying short-term trajectories in health, including adult mental health. An integrated series of the MEPS-HC data is available at IPUMS MEPS. Collected on the Self-Administered Questionnaire and, starting in 2019, the Preventive Self-Administered Questionnaire, the MEPS-HC includes two validated adult mental health scales. The Kessler Psychological Distress Scale (K6) and the two-item Patient Health Questionnaire depression screener (PHQ-2) are asked twice per panel, during interview rounds 2 and 4 (see Table 1). There are also two validated scales measuring health-related quality of life (HRQOL) that capture several interrelated health domains, including mental health. These include the Short Form-12 (SF-12) in 2000-2016 and the Veterans RAND-12 (VR-12) starting in 2017 (see Table 2 for VR-12 measures). For more information on the SF-12, see the section on SF-12 scoring on MCS and for more information on the VR-12, see ADDAYA.

Table 1. Validated Adult Mental Health Scales Available in the MEPS

Mental Health Scale/ QuestionItem WordingAvailability
Kessler Psychological Distress Scale (K6)12004-present
AEFFORTDuring the past 30 days, how often did you feel that everything was an effort?
ASADDuring the past 30 days, how often did you feel so sad that nothing could cheer you up?
ANERVOUSDuring the past 30 days, how often did you feel nervous?
ARESTLESSDuring the past 30 days, how often did you feel restless or fidgety?
AHOPELESSDuring the past 30 days, how often did you feel hopeless?
AWORTHLESSDuring the past 30 days, how often did you feel worthless?
The 2 item Patient Health Questionnaire Depression Screener (PHQ-2)22004-present
PHQINTROver the last 2 weeks, how often have you been bothered by the following problems? Little interest or pleasure in doing things.
PHQDEPOver the last 2 weeks, how often have you been bothered by the following problems? Feeling down, depressed, or hopeless.
1 See the very end of the description tab on AEFFORT for guidance on how to score the K6.
2 See the description tab on PHQ2 for guidance on how to score the PHQ2.


Table 2. Veterans RAND 12-Item Questionnaire Measuring HRQOL

VariableVariable Label
HEALTHHealth status
ADDAYAHealth now limits moderate activities
ADCLIMHealth now limits climbing several flights of stairs
ADPALSAccomplished less because of physical health: past 4 weeks
ADPWLMLimited in kind of work because of physical health: past 4 weeks
ADMALSAccomplished less because of emotional problems: past 4 weeks
ADMWLMDid work less carefully because of emotional problems: past 4 weeks
ADPAINPain interfered with normal work: past 4 weeks
ADPCFLHow often felt calm/peaceful: past 4 weeks
ADENGYHow often had a lot of energy: past 4 weeks
ADPRSTHow often felt downhearted/depressed: past 4 weeks
ADSOCAPhysical or emotional health interfered with social activities: past 4 weeks

How Much Change In Mental Health Can We Observe?

Researchers may be interested in combining measures of adult mental health with other information available on the MEPS-HC to study topics such as the impacts of job loss, a major episode of medical care, or divorce on adult mental health. For the study of such questions, it is useful to get a sense of how much change in mental health occurs during the MEPS two-year panel. Below, we include a graph visualizing the number of cases in the MEPS-HC panel covering 2017-2018 where mental health became worse, stayed the same, or improved for those with two observations on individual mental health measures (see Figure 1). In this example, there are roughly 8,500 adults with two mental health measurements (see the note below Figure 1 for sample sizes for each specific measure). Researchers can easily increase sample size by requesting multiple years of data from IPUMS MEPS to create a dataset of multiple panels pooled together.

Difference in reported mental health measure, 2017-2018

All persons 18+ in 2017 and 2018 with a known response in both years

Stacked bar graph of number of adults with responses for 2017 and 2018 for assorted mental health measures; there is one bar per mental health measure that is sub-divided to show the different relationships in measures between the two time points: better, the same, or worse. There is the most variation between the measures in AENGY, ADPCFL, ADPRST, ADNERVOUS, and ARESTLESS though all listed variables include at least 2000 cases where the response differs between the two time points.
Note: The sample size of adults age 18+ with responses for 2017 and 2018 for each of the variables is as follows: ADENGY = 8,649, ADMALS = 8,627, ADMWLM = 8,591, ADPCFL = 8,641, ADPRST = 8,646, ADSOCA = 8,575, AEFFORT = 8,539, AHOPELESS = 8,535, ANERVOUS = 8,589, ARESTLESS = 8,521, ASAD = 8,549, AWORTHLESS = 8,539, PHQDEP = 8,561, PHQINTR = 8,609.

Notes and Resources

Additional measures of adult mental health collected on the MEPS-HC will be added to IPUMS MEPS over the next year. These additional measures include reported ICD-9 or ICD-10 codes associated with various mental health conditions and a general mental health status question asked at each interview. Watch IPUMS user emails for new additions to IPUMS MEPS!

Users new to the MEPS data should note that the MEPS-HC is fielded to a subsample of households responding to the previous year’s NHIS. By linking the two, using restricted linking keys available from AHRQ, analysts can create a dataset where respondents have 3 observations on the K6 over a three-year period. Please refer to our NHIS-MEPS comparability table to identify other measures available for both surveys available through IPUMS.

Below, we highlight several peer-reviewed publications that have used the MEPS-HC data to study mental health to familiarize users with possible applications of the data.

  1. C. Drake, S.H. Busch, & E Golberstein. The effects of federal parity on mental health services use and spending: Evidence from the Medical Expenditure Panel Survey. Psychiatric Services. (2019).
  2. S.H. Rim, K.R. Yabroff, S. Dasari, et al. Preventive care service use among cancer survivors with serious psychological distress: An analysis of the medical expenditure panel survey data. Preventive Medicine. (2019)123:152-159.
  3. C.H. Wu, C.C. Wang, A.J. Katz, et al. National trends of psychotropic medication use among patients diagnosed with anxiety disorders: Results from Medical Expenditure Panel Survey 2004-2009. Journal of Anxiety Disorders. (2013)27(2):163-170.