Related Experiment Video
Updated: Oct 29, 2026

Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Undercounting mental health-related impairments and disability in US federal surveys
Alice Qu1, Kenton J Johnston2, Bradley D Stein1
1Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States.
Introduction:
US federal surveys use the ACS Six Questions (ACS-6) and Washington Group Short Set on Functioning (WG-SS) to inform disability-related policy and resource allocation. The ACS-6 is used more broadly in general household and health surveys, and the WG-SS is primarily used in health surveys. However, these surveys largely focus on physical function and may miss psychosocial impairments experienced by populations with mental health conditions.
Methods:
We used data from 2017-2019 and 2022-2024 of the National Survey on Drug Use and Health, which assesses functional impairment attributable to mental health using the World Health Organization Disability Assessment Schedule (WHODAS). We examined overall and racial/ethnic differences in undercounting of mental health-related disabilities in the ACS-6 and WG-SS scales.
Results:
Among adults with serious mental illness (SMI), the ACS-6 failed to identify 39.5% as having disability, and the WG-SS failed to identify 12.8%. Individuals who reported difficulty socializing had the lowest identification rate across WHODAS domains. Relative to non-Hispanic White individuals, the disability measures identified fewer non-Hispanic Black individuals and non-Hispanic Asian/Pacific Islander individuals.
Conclusion:
This undercounting may limit resources for individuals with mental health-related disabilities. Researchers and policymakers should revise disability questions to capture social impairments, fluctuating mental health symptoms, and cultural influences.
Related Concept Videos
Surveys
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Stress and Mental Health
Individuals with depression often experience challenges in both their personal and professional...
Intellectual Disability
Bias in Epidemiological Studies
Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...