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Data Source

The cross-sectional 2012 Canadian Community Health Survey–Mental Health (CCHS-MH) sample consisted of the household population aged 15 or older in the 10 provinces. The survey excluded residents of reserves and other Aboriginal settlements, full-time members of the Canadian Forces, and the institutionalized population.  The response rate was 68.9%, yielding a sample of 25,113, which represented 28.3 million Canadians. Analyses were conducted using SAS 9.1. Survey sampling weights were applied so that the analyses would be representative of the Canadian population. Bootstrap weights were applied using SUDAAN 11.0 to account for the underestimation of standard errors due to the complex survey design.Note12

Definitions

The Mental Health Continuum–Short Form (MHC-SF) is summarized in Appendix A.  The three-factor structure of mental well-being found in other populationsNote7,Note13-18 was replicated in this Canadian population sample. The internal consistency (Cronbach’s alpha) for the three subscales was 0.82, 0.77 and 0.83 for emotional well-being, social well-being and psychological well-being, respectively.  Reliability for the total scale was 0.89.

The World Mental Health—Composite International Diagnostic Interview 3.0 (WMH-CIDI)Note19 is a standardized instrument for the assessment of mental disorders and conditions according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria, and is widely used in population surveys.Note20,Note21 Six mental disorders (lifetime and past year) were included in the 2012 CCHS–MH: depression; bipolar disorder; generalized anxiety disorder; alcohol abuse and dependence; cannabis abuse and dependence; and other substance abuse and dependence. Diagnostic algorithms identified respondents meeting the criteria for each disorder. Mental health and mental illness were cross-tabulated to create six categories.

Four age groups were defined: 15 to 24; 25 to 44; 45 to 64; and 65 or older.  Age was used continuously in multivariate analysis.

Highest level of household education was grouped into two categories: those who had or had not completed postsecondary education. Income was represented as the ratio of household income to the low-income cut-offNote22 and divided into quintiles. Employment status indicated whether respondents had been employed during the two weeks before the interview.

Respondents born outside Canada without Canadian citizenship were identified as immigrants. Those born in Canada, the United States or Greenland who indicated that they were First Nations, Métis, or Inuit were categorized as Aboriginal.

Communities of 1,000 or more with a population density of at least 400 per square kilometre were classified population centres (as opposed to  rural areas).

Respondents who answered “very important” or “somewhat important” (versus “not very important” or “not at all important”) to the question, “In general, how important are religious or spiritual beliefs in your daily life?” or answered “a lot” or “some” (versus “a little” or “not at all”) to the question, “To what extent do your religious or spiritual beliefs give you the strength to face everyday difficulties?”  were classified as having strong spirituality.

Physical conditions diagnosed by a health professional and that had lasted or were expected to last six months or more were summed and grouped into 0, 1, 2, or 3 or more chronic conditions. Conditions included were asthma, arthritis, back problems excluding fibromyalgia or arthritis, migraine, chronic bronchitis/emphysema/COPD, diabetes, epilepsy, heart disease, cancer, effects of stroke, bowel disorder/Crohn’s disease/colitis, Alzheimer’s disease or other dementia, chronic fatigue syndrome, multiple chemical sensitivities, or high blood pressure.

Respondents who indicated they were not usually free of pain or discomfort were considered to have chronic painand were asked how many activities their pain prevents.

Limitations

Mental disorders were identified by an algorithm based on responses to the CIDI, not a clinical diagnosis. As well, only certain mental disorders were included on the CCHS–MH, and the institutionalized population was excluded which may result in underestimated prevalence. Because the survey is cross-sectional, temporal order cannot be inferred. Data are self-reported and have not been verified by another source.

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