Insights on Canadian Society
Mental disorders and access to mental health care

Using data from the 2022 Mental Health and Access to Care Survey, this article provides updated prevalence estimates for some of the most common mental disorders, including mood, anxiety, and substance use disorders. These results are compared to those from the previous 2012 and 2002 Canadian Community Health Survey – Mental Health cycles. The 2022 survey was collected from March to July 2022. This article also describes some key aspects of mental health care services in Canada. The analysis is focused on who Canadians turn to for mental health care, the role of virtual care in mental health care, and the types of mental care where the unmet needs for care are the largest.

• The percentage of Canadians aged 15 years and older who met the diagnostic criteria for a major depressive episode, bipolar disorder, and generalized anxiety disorder has increased in the past 10 years, whereas the prevalence of alcohol use disorders has decreased, and the prevalence of other substance use disorders (including cannabis) has remained stable.
• Youth (ages 15-24), especially women, were most likely to have met diagnostic criteria for a mood or anxiety disorder based on their symptoms in the 12 months before the survey.
• The prevalence of mood, anxiety, and substance use disorders was generally lower among South Asian, Chinese, Filipino, and Black people in Canada when compared to non-racialized, non-Indigenous^Note  people, although there were some variations in the magnitude of the differences depending on the type of disorder.
• About half of the people who met diagnostic criteria for a mood, anxiety, or substance use disorder talked to a health professional about their mental health in the 12 months before the survey.
• Among those who met diagnostic criteria for a mood, anxiety, or substance use disorder in the 12 months before the survey, 1 in 3 reported unmet or partially met needs for mental health care services.
• Unmet needs for counselling or psychotherapy were higher than unmet needs for medication or information about mental health.

Some of the largest changes in the prevalence of mood and anxiety disorders over the past 10 years were observed among women^Note  Note  aged 15-24 years old. The 12-month prevalence of generalized anxiety disorder among young women tripled from 3.8% in 2012 to 11.9% in 2022. Similarly, the prevalence of a major depressive episode in the past 12 months increased among young women, doubling from 9.0% in 2012 to 18.4% in 2022. The 12-month prevalence of a manic, hypomanic, or depressive episode among young women with a history of bipolar disorders also increased from 2.3% in 2012 to 8.1% in 2022.

Prevalence estimates in 2012 are not available for social phobia, though comparisons with 2002 suggests an increase. In 2002, 6.1% of women aged 15 to 24 met the criteria for social phobia. In 2022, the 12-month prevalence was 4 times higher, with 24.7% of women aged 15 to 24 years old meeting diagnostic criteria for social phobia. Although some of these changes may be related to increased stress during the COVID-19 pandemic,^Note  declines in mental health among youth were observed well before 2020.^Note  Across all the mood and anxiety disorders that were assessed in 2022, the 12-month prevalence rates were consistently highest among younger women (Chart 1).

Data table for Chart 1



Data table for chart 1
Table summary
This table displays the results of Data table for chart 1 Age, Women+, Men+, percentage, Error interval (+/-) and percentage , calculated using plus and minus units of measure (appearing as column headers).

	Age	Women+			Men+
		percentage	Error interval (+/-)		percentage	Error interval (+/-)
			plus	minus		plus	minus
Major depressive episode	15 to 24 years	18.4Note *	3.1	3.1	8.9	2.0	2.0
	25 to 44 years	11.9Note *	2.3	2.2	7.4	1.9	1.9
	45 to 64 years	7.6	1.8	1.8	5.4	1.6	1.7
	65 years and over	2.4	1.0	0.9	1.4	0.8	0.7
Bipolar disorders	15 to 24 years	8.1Note *	2.2	2.3	3.7	1.3	1.4
	25 to 44 years	1.8	0.8	0.8	3.2	1.2	1.2
	45 to 64 years	1.7	1.0	1.0	1.2	0.9	0.8
	65 years and over	Note x: suppressed to meet the confidentiality requirements of the Statistics Act	Note x: suppressed to meet the confidentiality requirements of the Statistics Act	Note x: suppressed to meet the confidentiality requirements of the Statistics Act	Note x: suppressed to meet the confidentiality requirements of the Statistics Act	Note x: suppressed to meet the confidentiality requirements of the Statistics Act	Note x: suppressed to meet the confidentiality requirements of the Statistics Act
Generalized anxiety disorder	15 to 24 years	11.9Note *	2.3	2.4	5.0	1.6	1.6
	25 to 44 years	8.9Note *	2.0	2.0	4.8	1.5	1.5
	45 to 64 years	5.2Note *	1.5	1.4	3.0	1.4	1.4
	65 years and over	2.7	1.2	1.1	1.5	0.9	0.8
Social phobia	15 to 24 years	24.7Note *	3.4	3.4	8.9	2.1	2.1
	25 to 44 years	10.9Note *	2.2	2.2	6.5	1.7	1.7
	45 to 64 years	6.2Note *	1.6	1.6	3.4	1.3	1.3
	65 years and over	1.8	0.8	0.9	1.2	0.8	0.7
x suppressed to meet the confidentiality requirements of the Statistics Act Note * significant difference (p <0.05) between men and women in the same age group Return to note * referrer Notes: Error bars represent the 95% confidence interval of the prevalence estimates. The category "women+" includes women (and/or girls), as well as some non-binary persons. The category "men+" includes men (and/or boys), as well as some non-binary persons. Source: Statistics Canada, Mental Health and Access to Care Survey, 2022.

The prevalence of mood, anxiety, and substance use disorders was generally lower among South Asian, Chinese, Filipino, and Black people in Canada when compared to non-racialized, non-Indigenous^Note  people, although there were some variations in the magnitude of the differences depending on the type of disorder (Chart 3). This could be related to socio-cultural differences in willingness to report symptoms of mental illness or the stigma associated with mental illness.^Note  Other Statistics Canada surveys have found a similar pattern of results using measures of positive mental health (i.e., very good or excellent self-rated mental health).^Note 

Data table for Chart 3



Data table for chart 3
Table summary
This table displays the results of Data table for chart 3 Type of disorder, Percentage and Error interval (+/-), calculated using plus and minus units of measure (appearing as column headers).

	Type of disorder	Percentage	Error interval (+/-)
			plus	minus
South Asian	Any mental disorder	13.2Note *	2.1	2.2
	Anxiety disorder	7.1Note *	1.7	1.6
	Mood disorder	6.7Note *	1.6	1.5
	Substance use disorder	2.2Note *	1.0	0.9
Chinese	Any mental disorder	9.5Note *	2.0	2.0
	Anxiety disorder	5.1Note *	1.5	1.4
	Mood disorder	4.8Note *	1.3	1.4
	Substance use disorder	0.9Note *	0.6	0.5
Black	Any mental disorder	15.9Note *	2.8	2.8
	Anxiety disorder	8.7Note *	2.0	2.1
	Mood disorder	8.9	2.2	2.1
	Substance use disorder	2.6Note *	1.3	1.3
Filipino	Any mental disorder	11.3Note *	2.5	2.4
	Anxiety disorder	5.4Note *	1.6	1.7
	Mood disorder	7.0	1.9	2.0
	Substance use disorder	1.4Note *	0.8	0.7
Other racialized groups	Any mental disorder	18.2	3.6	3.6
	Anxiety disorder	10.1	2.6	2.6
	Mood disorder	9.3	2.7	2.6
	Substance use disorder	2.4Note *	1.4	1.3
Non-racialized (ref.)	Any mental disorder	19.4	1.3	1.3
	Anxiety disorder	11.0	1.0	1.0
	Mood disorder	8.6	0.9	0.9
	Substance use disorder	4.2	0.7	0.6
Note * significant difference (p <0.05) with the non-racialized group Return to note * referrer Note: Error bars represent the 95% confidence interval of the prevalence estimates. Source: Statistics Canada, Mental Health and Access to Care Survey, 2022.

Data sources

The primary data source was the Mental Health and Access to Care Survey (MHACS), a survey of Canadians ages 15 years and older living in the 10 provinces. The survey was completed by 9,861 respondents from March 17 to July 31, 2022. The sample was selected from the population that completed the long-form questionnaire of the 2021 Census. To evaluated changes in the prevalence of specific mental disorders over time, data from the 2012 Canadian Community Health Survey - Mental Health^Note  and 2002 Canadian Community Health Survey: Mental Health and Wellbeing^Note  were also used.

MHACS was administered using an interviewer-assisted electronic questionnaire (iEQ), which differs from to 2012 and 2002 versions of the survey which were administered in person. Excluded from the survey's coverage are: persons living on reserves and other Aboriginal settlements, full-time members of the Canadian Forces, and persons living in collective dwellings, such as institutional residences.

Definitions

Mental disorders

MHACS used a modified version of the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI)^Note  to classify people with select mood, anxiety, or substance use disorders. Although this is not a clinical diagnosis, this is a standardized instrument that is used to assess mental disorders in population surveys according to the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV) criteria.^Note  A fifth edition of the DSM was published in 2013 and the revised classification of disorders might affect some prevalence estimates; however, a revised version WHO-CIDI was not available at the time of the survey collection. To facilitate comparison, the same definitions were used for social phobia in 2002^Note  and for all the other disorders in 2012.^Note 

Prevalence estimates for each disorder included both whether diagnostic criteria were met at any point in the lifetime (lifetime prevalence) or within the 12 months before completing the survey (12-month prevalence). This study used 12-month prevalence estimates when evaluating use of mental health care services among people with mental disorders.

Diagnostic criteria for the following disorders were assessed:

• Mood disorders
  • Major depressive episode (depression): is identified as a period of 2 weeks or more with persistent depressed mood or loss of interest in normal activities, as well as other symptoms including: decreased energy, changes in sleep and appetite, impaired concentration, feelings of hopelessness, or suicidal thoughts.
  • Bipolar disorder : includes respondents who meet the criteria for bipolar I disorder or hypomanic episode, which includes bipolar II disorder.  It is characterized by at least 7 days (or fewer if hospitalized) of exaggerated feelings of elevated or irritable mood plus a certain number and combination of other manic symptoms such as racing thoughts, talking more than usual, excessive spending, decreased need for sleep, increased pleasure seeking activity, or exaggerated self-confidence.  Many people also experience at least one depressive episode.
• Anxiety disorders
  • Generalized anxiety disorder is identified by a pattern of frequent, persistent worry and excessive anxiety about several events or activities lasting at least 6 months along with other symptoms.
  • Social phobia (social anxiety disorder) is characterized by a persistent, irrational fear of situations in which the person may be closely watched and judged by others, as in public speaking, eating, or using public facilities.
• Substance use disorders include both substance abuse and substance dependence. They can be further subdivided based on the substance involved.
  • Substance abuse is characterized by a pattern of recurrent use where at least one of the following occurs: failure to fulfill major roles at work, school or home, use in physically hazardous situations, recurrent alcohol or drug related problems, and continued use despite social or interpersonal problems caused or intensified by alcohol or drugs.
  • Substance dependence is when at least three of the following occur in the same 12 month period: increased tolerance, withdrawal, increased consumption, unsuccessful efforts to quit, a lot of time lost recovering or using, reduced activity, and continued use despite persistent physical or psychological problems caused or intensified by alcohol or drugs.
  • Alcohol use disorder includes those who met the criteria for abuse or dependence of alcohol.
  • Cannabis use disorder includes those who met the criteria for abuse or dependence of cannabis.
  • Other drug use disorder (excluding cannabis):  includes those who met the criteria for abuse or dependence of substances such as club drugs, cocaine, heroin, solvents, prescription drugs used for nonmedical reasons, and any other illicit drugs.

Mental health care by provider type and format of care delivery

All respondents were asked “During the past 12 months, have you seen or talked on the telephone or over the Internet to any of the following people about problems with your emotions, mental health or use of alcohol or drugs?”

• Psychiatrist
• Family doctor or general practitioner
• Psychologist
• Nurse
• Social worker, counsellor, or psychotherapist
• Family member
• Friend
• Co-worker, supervisor, or boss
• Other – Specify

The first five response options were used to define those who had talked to a health professional about their mental health in the past 12 months.

For each health professional selected above, respondents were asked how they talked with that person.  They could select any of the following options that applied to them: a) in person, b) over the telephone (voice only), c) using video on a phone, tablet or computer or d) text message or written chat. 

Perceived needs for mental health care

The assessment of unmet needs for mental health care was based on questions adapted from the Perceived Need for Care Questionnaire (PNCQ).^Note 

On MHACS, all respondents were asked if they had received four main types of help:

1. Information about the problems, treatments or available services
2. Medication,
3. Counselling, therapy or help for problems with personal relationships
4. “other” types of help.

They were then asked if they felt they needed each of the types of help they had not received and if they felt they needed more of the types of help they had received.

For each type of help, four groups were created:

1. No need - people who were not receiving help and felt that they had no need for it;
2. Need fully met - people who were receiving help and felt that it was adequate;
3. Need partially met - people who were receiving help, but not as much as they felt they needed;
4. Need not met - people who were not receiving help, but felt that they needed it.

A composite variable was created with the same four categories to define perceived needs for all types of help.

Strengths and limitations of using surveys to study mental health and access to care

The data used in this study rely on the accuracy of the survey respondents’ self-reports. Current mental health status may bias the recall of mental health symptoms and health care that was received in the past.^Note  It is also possible that those who received treatment and experienced improvements in their mental health will not be captured among those who currently meet diagnostic criteria for a mental disorder. Administrative data are not subject to these self-report biases and can provide information about on use of mental health services and diagnoses of mental disorders in clinical settings.  However, an important strength of MHACS is that these data can be used to estimate the burden of mental illness in the entire population, not just those who have accessed health care services or who have received a formal diagnosis. This study showed that many people with clinically significant symptoms have not even talked to a health care provider about their mental health.