Key concepts

Box 1: The questions

The prevalence of medically unexplained physical symptoms (MUPS)  was based on self-reports of diagnosed illness.  Cycles 1.2 and 2.1 of the Canadian Community Health Survey (CCHS) used a checklist of conditions.  Respondents were asked about “long-term health conditions that have lasted or are expected to last six months or more and that have been diagnosed by a health professional.”  Interviewers read a list of conditions including chronic fatigue syndrome, fibromyalgia, and chemical sensitivities.  Respondents who answered positively to at least one of these three conditions were classified as suffering from MUPS.

The prevalence of other chronic conditions was determined in the same way.  Asthma, arthritis or rheumatism, back problems, high blood pressure, migraine, chronic bronchitis, emphysema, diabetes, epilepsy, heart disease, cancer, ulcers, the effects of stroke, bowel disorder, and thyroid disorder were considered in this analysis.

To assess dependency, respondents were asked, “Because of any physical condition or mental condition or health problem, do you need the help of another person . . ., ” and they were read a list of activities.  Dependency in instrumental activities of daily living was considered to be present if respondents reported needing help with at least one of the following:

• preparing meals
• getting to appointments and running errands such as shopping for groceries
• doing everyday housework
• looking after personal finances such as making bank transactions or paying bills

Dependency in activities of daily living was considered to be present if respondents reported needing help with either of the following:

• personal care such as washing, dressing, eating or taking medication
• moving about inside the house

In accordance with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) protocol, cycle 1.2 of the CCHS assessed mental disorders using the definitions and criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).¹⁰  The analysis in this article focuses on the past 12-month prevalence of five mental disorders:  major depressive disorder, bipolar I disorder, panic disorder, social anxiety disorder, and agoraphobia.¹¹  Respondents who met the criteria for at least one of these conditions were considered to have a mental disorder.

Consultations with family doctor/general practitioner was based on the question:  “In the past 12 months, how many times have you seen or talked on the telephone about your physical, emotional or mental health with a family doctor or general practitioner?”

Consultations with specialists was based on the question:  “In the past 12 months, how many times have you seen, or talked on the telephone about your physical, emotional or mental health with any other medical doctor (such as surgeon, allergist, orthopedist, gynaecologist, or psychiatrist)?”

Consultations with alternative practitioners was based on two questions:  “In the past 12 months, have you seen or talked to an alternative health care provider such as an acupuncturist, homeopath or massage therapist about your physical, emotional or mental health?” and  “In the past 12 months, how many times have you seen or talked on the telephone about your physical, emotional or mental health with a chiropractor?”  Respondents who replied affirmatively to the first question or answered “at least one time” to the second were considered to have consulted an alternative practitioner.

Box 2: The data

The estimated prevalence of chronic fatigue syndrome, fibromyalgia and multiple chemical sensitivity, as well as “total MUPS” (medically unexplained physical symptoms), is based on data from cycle 2.1 of the Canadian Community Health Survey (CCHS), conducted from January through December 2003.  The CCHS 2.1 covered the household population aged 12 or older.  It excluded members of the regular Armed Forces and residents of Indian reserves, military bases, health care institutions and some remote areas.  The sample consisted of 135,573 respondents aged 12 or older; the overall response rate was 80.6%.

The estimated prevalence of mental disorders is based on data from cycle 1.2 of the CCHS, which began in May 2002 and was conducted over eight months.  The CCHS 1.2 covered people aged 15 or older living in private households in the 10 provinces.  It excluded members of the regular Armed Forces and residents of the three territories, Indian reserves, military bases, health care institutions and some remote areas.  The sample consisted of 36,984 respondents aged 15 or older; the overall response rate was 77%.

All differences were tested to ensure statistical significance; that is, that they did not occur simply by chance.  To account for survey design effects, standard errors and coefficients of variation were estimated using the bootstrap technique.^13,14  A significance level of p < 0.05 was applied in all.