One state looks to collect multiyear data to address the mental health crisis

Mental health is top of mind for policymakers in nearly every community as the nation grapples with increasing suicide, depression, overdose and bullying rates. Some officials are trying to address the mental health crisis by regulating social media, while others are tackling substance use disorders to improve behavioral health outcomes. 

It’s unclear what will work and what won’t, but one thing’s for sure: Governments need better mental health data to effectively address it. 

To get those insights, the Buckeye State is launching a multiyear study to uncover the root causes of the ongoing epidemic of persistent emotional distress, suicide and drug abuse. The Ohio Department of Mental Health and Addiction Services is funding a statewide multigenerational study that aims to identify the causes and risk factors of poor mental health outcomes, officials announced last month. 

An initial $20 million grant will support the State of Ohio Adversity and Resilience, or SOAR, study led by Ohio State University’s Wexner Medical Center and College of Medicine. Researchers will be surveying residents and conducting brain imaging scans to investigate the biological, psychological and social factors contributing to individuals’ mental and behavioral health disorders. Depending on available funding, they plan to continue the study for 20 years. 

Census data and health records can only get public officials so far, as behavioral health goes much deeper than what quantitative data can suggest, said Anthony King, a psychologist and associate professor of psychiatry and behavioral health at the Wexner Medical Center. You can tell a lot about a person’s life expectancy from their ZIP code, he said, but it can’t tell you about a person’s past trauma or coping strategies. 

That’s why one portion of the study includes a detailed resident survey to ask individuals about not just their demographics but also their history with mental or behavioral health issues, such as experience with emotional distress or substance use disorders. 

Researchers have already sent more than 300,000 postcards to households across all 88 counties inviting residents to participate and hope to receive responses from as many as 15,000 homes. A little over a month into the study, they have more than 6,000 participants across 77 counties signed up, said K. Luan Phan, SOAR study principal investigator and professor and chair of Ohio State’s Department of Psychiatry and Behavioral Health.  

“Ultimately, what we really want to go toward is something called community-based participatory research,” King said. Beyond expert analysis and insight, lived-experience data can paint a clearer picture of residents’ struggles. 

An individual who dealt with an opioid use disorder in jail, for instance, can provide insight into the mental health impact of incarceration, and that data can help inform policymakers of ways to improve addiction treatment in correctional facilities. 

The questionnaire also asks residents about their social lives, including the roles they play in their family and what social connections they have in their community. Residents are also surveyed on their attitudes toward economic mobility, King said, which can largely impact an individual’s outlook on life. For instance, one prompt asks participants if they feel as though “anyone can make it in the community you live in … if you work hard enough.” 

Questions that acknowledge an individual’s challenges and ask about the impact their attitude has on outcomes can help build the public’s faith in the government and research institutions’ ability to recognize and meet residents’ behavioral health needs, King said. They can also help break down individual internal stigma toward mental health, as many people may be uncomfortable or unfamiliar with addressing behavioral health. 

The survey results will provide officials and researchers with a broad understanding of the mental health challenges residents face, Phan said. Deeper insights will come from the study’s brain health component that will analyze the relationship between the biological, social and psychological factors in managing adverse mental and behavioral conditions.

Of the 15,000 survey participants, researchers will select about 3,600 to undergo neuroimaging with their families for further research, King said. Parents and children from 12 to 18 years with parental consent are encouraged to participate, and about 20 families already have signed up.

Imaging will be conducted in major metropolitan areas like Cincinnati, Columbus and Cleveland, but for families unable to travel, a mobile unit equipped with imaging technology will provide scans in less accessible areas such as rural communities, Phan said. 

The insights gained from Ohio residents should be useful across the nation.

“We also believe that Ohio … represents a microcosm of the United States because of its geographic, social, economic, racial and ethnic diversity. The things that we learn in Ohio could be scaled and disseminated across the country,” Phan said. 

The two studies are “meant to be run in parallel, but also interconnected with each other,” he said. The combined wellness survey and brain health study can offer more descriptive insights on the causes and risk factors of mental health adversity, so policymakers and health care providers can target interventions, policies and programs to different populations. 

The study may show that lower income individuals, for instance, need more government assistance—like health insurance or stable housing—to improve their mental and behavioral health outcomes, King said, which could differ from a wealthy individual whose well-being could be improved more through participation in community and social events. 

The study will help policymakers and health care providers identify ways to support long-term mental health success, not just tackle one issue at a time. Ohio lawmakers want residents to live their fullest lives beyond a therapy session or a prescription, Phan said, as “mental health is the cornerstone of being a great family member, a great worker [or] a great student.” 

Researchers hope Ohio’s research will be as significant as the Framingham Heart Study, which launched in 1948 and identified risks of cardiovascular disease based on longitudinal data on more than 5,000 residents in Framingham, Massachusetts. The study, which is still ongoing, was pivotal to the health care landscape, particularly as heart disease was the leading cause of death among adults by the 1950s. 

The Framingham Heart Study found a link between cardiovascular disease and factors like smoking, sedentary lifestyles, obesity and cholesterol and blood pressure levels. Those findings helped researchers and public health officials to identify the risks of heart disease for more effective treatment and prevention efforts, King said. 

But now it’s time public health officials approach mental health with the same vigor, he said. To effectively tackle the nation’s worsening mental health crisis, officials must better understand the underlying health, emotional and social factors impacting mental and behavioral well-being. “We need a Framingham for the mind.”