2012 Canadian Community Health Survey – Mental Health (CCHS – MH) An Introduction

Prepared by: Ruben Mercado and Peter Kitchen McMaster Research Data Centre

7/3/2015

Outline  CCHS-MH Overview  Abstract  Content Development  Survey Objectives / Research Purpose  Target Population  Data Accuracy  Final Sample Size  Geography  Survey Weights  CCHS-MH Contents  Modules of 2012 CCHS-MH compared to CCHS Cycle 1.2 (2002)  Derived Variables (Topics and Number of Variables in microdata file)  References  Data Access

7/3/2015

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

• Abstract

Overview

– The CCHS collects information related to health status, health care utilization and health determinants for the Canadian population. The first survey referred to as “Annual component” (2001, 2003, 2005, etc.) collects data from over 65,000 households on a range of population health topics and aims to produce reliable estimates at the health region level. The second survey (2002, 2004, etc.), termed as “Focus Content Component” with a sample size of about @30,000 households, focuses on a particular topic that changes every cycle (mental health, nutrition, etc. ). and aims to produce reliable estimates at the province level. – The 2012 CCHS - Mental Health (2012 CCHS – MH), is NOT an Annual survey but the fourth CCHS “Focus Content” cycle that collected information about the factors, influences and processes that contribute to mental health through a multidisciplinary approach focusing on health, social and economic determinants. Previous Focus content cycles were: Mental Health and Well-Being (2002), Nutrition (2004), Healthy Aging (2008-2009). The next cycle will focus on Nutrition (2015). – Previous related cycle - CCHS Cycle 1.2 (2002) – Mental Health and Well-being was the first CCHS Focus content survey which tackled mental health issues. Many of the questions in this survey (18 modules) were carried forward in the 2012 CCHS-MH survey in order to evaluate changes in patterns of mental health and service use. The rest of the modules were included with substantial revisions in addition to new modules added in the 2012 CCHS-MH. 7/3/2015

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

• Content development

Overview

– The CCHS-MH parameters and content were developed by the Health Statistics Division at Statistics Canada, based on a multistage consultation process between a number of institutions and experts on mental health: • • • • • •

Health Canada, Public Health Agency of Canada, Mental Health Commission of Canada Provincial Health Ministries, and An expert advisory group consisting of specialists from Health Canada, the Public Health Agency of Canada, the Mental Health Commission of Canada, and academic experts. Department of National Defence, Veterans Affairs, Correctional Service Canada, Citizenship and Immigration, and the Royal Canadian Mounted Police. (Consultations for potential survey supplements)

– Content selection was based on the following criteria: • Issue(s) identified as data gaps from the stakeholder consultations; • Significant number of people affected by the targeted issue; • Significant impact on family, community, and health care costs; • Data that have potential for health improvement with policy intervention; • Issues identified as priorities for the support/development of programs and policy, surveillance requirements and/or research; and • Comparability with the 2002 CCHS – Mental Health and Well-Being – Questionnaire design started in December 2009 and involved extensive consultations with stakeholders. A pilot survey was conducted in April 2011 carried out in London, Toronto, Montreal and Quebec City. 7/3/2015

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

Overview • Survey Objectives / Research Purpose The following CCHS-MH objectives provides a general view of potential research topics that could be undertaken using the micro data file: – To assess the mental health status of Canadians on both illness and positive mental health continuums through selected mental or substance disorders, mental health problems, and wellbeing; – To assess timely, adequate, and appropriate access to and utilization of formal and informal mental health services and supports as well as perceived needs; – To assess functioning, ability and disability in relation to mental health and illness; – To examine links between mental health and social, demographic, geographic, and economic variables or characteristics (covariates); and – To evaluate changes in patterns of mental health, service use, and functioning from the 2002 CCHS on Mental Health and Well-Being.

7/3/2015

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

Overview • Target Population – The CCHS-MH covers the population 15 years of age and over living in the 10 provinces. – Excluded in the survey’s coverage are residents of the three territories, persons living on reserves or other Aboriginal settlements, full-time members of the Canadian Forces, and the institutionalized population

• Data Accuracy/ Collection – In view of the sensitive nature of the survey, interviewers were properly trained on the use of computer assisted -- personal interviewing (CAPI) and other survey tools like a response booklet (i.e. used for sensitive modules and responses repeated frequently, etc.). The use of the response booklet helped reduce response burden, addressed issues of sensitivity and increased privacy. – Derived variables are included in the micro data file to facilitate data analysis and to minimize the risk of error (e.g. Drug Identification Numbers were coded to the ATC classification system according to Health Canada Drug Product Database, disorder classification rel. to WHO-CIDI, etc.)

7/3/2015

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

Overview • Final Sample Size – Final sample size of @25,000 individuals from the 10 provinces. This translates to 68.9% response rate based on the initial sample. About 87% were derived from the CAPI collection method.

• Geography – Data can be analyzed at the Provincial and CMA levels. However, data limitations may be encountered below these levels.

• Survey Weights – A survey weight is given to each person included in the final sample. Weights must always be used when computing statistical estimates to make inference at the population level possible.

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Prepared by: R. Mercado and P. Kitchen, McMaster RDC

2012 CCHS – MH vs. CCHS Cycle 1.2 (2002) Module Module Name No. 1 General Health

Major Topic/s Self-perceived (mental) health Sense of belonging Potential mental health issues Occurrence of emotional problems Screening for several disorder modules (Depression, General Anxiety Disorder and Mania) Height and Weight Perception of over/underweight - data allows for BMI calculation Long-term health condition diagnosed by a health professional

New or Change (from CCHS-2002) Minor

2

Screening Section

3

Height and Weight (self-reported)

4

Chronic conditions

5

Pain and discomfort

Pain and discomfort - state and impact on quality of life and mental health

New

6

Physical Activity

Participation in moderate/vigorous physical activity in past 7 days Average duration of participation

New

7

Positive Mental Health

Emotional, psychological and social well-being - allows for classification of "flourishing", "moderate" or "languishing" mental health (Based on MCH-SF instrument - C. Keyes)

New

8

Stress

Success in dealing with stress Main source of stress Role of social support and personal ability in coping with source of stress

Major

9

Distress

Hopelessness, boredom, fear, anger Interference with life - allows for measurement of overall level of distress (Source: K10 Distress scale)

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Minor

No change

Minor

No change

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

2012 CCHS – MH … (cont.) Module Module Name No. 10 Depression and Suicide

11

12

13 14

15

16

17

Major Topic/s

Lifetime and past 12 month episodes of depression lasted 2 weeks or longer Sub-block questions on Suicide - general questions - follow up questions on frequency, severity and impacts on life; use of professional services/treatment (Source: WHO-CIDI) Mania Lifetime and past 12 months episode of mania lasted for several days or longer - follow up questions on frequency, severity and impacts on life - use of professional services/treatment (Source: WHO-CIDI) Generalized Anxiety Disorder Lifetime and past 12 month episodes - follow up questions on frequency, severity and impacts on life - use of professional services / treatment (Source: WHO-CIDI) Smoking Current and past smoking habits (i.e. frequency, number of cigarettes smoked in a day and age started smoking daily) Alcohol Use, Abuse and Frequency and amount of alcohol consumption during lifetime Dependence and in the past 12 months Additional sets of questions - on alcohol abuse and alcohol dependence (Source: Modified from WHO-CIDI, see Appendix A of the User Guide) Substance Use, Abuse Use of illegal drugs and Dependence Non-medical use of precription drugs Questions on abuse of and dependence on cannabis Questions on abuse of and dependence on all other drugs (Source: Modified from WHO-CIDI, see Appendix A of the User Guide) WHO-Disabilty Assessment Assessment of functioning and disability Schedule Degree of difficulty in doing common daily activities Overall impact of difficulties on their life Two-week Disability Number of days respondent stayed in bed or reduced normal activities due to a health problem

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New or Change (from CCHS-2002) Minor

New

New Major

Major

New

Minor

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

2012 CCHS – MH … (cont.) Module Module Name No. 18 Mental Health Services

19

20

21

22

Major Topic/s

Utilization of health care services for emotional, mental health, or alcohol or drug use problems - professional and non-professional help / sources - includes hospitalization, employee assistance program (EAP), use of internet, support groups, help-lines - additional questions on expenses incurred and discrimination encountered while using services Medication Use Prescription and Non-prescription medications taken for emotional, mental health or alcohol or drug use problems Follow-up questions on name or ID number of medication Includes one question on the use of natural health product Perceived Need for Care and Different kinds of help received or thought they needed for Help Needed emotional, mental or drug/alcohol use problems Sub-module on why they did not get help (or more) if they thought they need it or if they got help but not "enough" (based on G. Meadows, et al, 2000 - Australian survey on mental health) Mental Health Experiences Experiences with people who have had emotional and mental health problems For those who received treatment, questions on negative opinions or unfair treatment they experienced and how it impacted their lives (Based on Stuart et al 2005; Inventory of Stigmatizing Experiences) Family Mental Health Impact Caregiving for family members who have emotional, mental or alcohol (Caregiving) or drug use problems (e.g. personal care, housework, emotional support, getting around, taking medication, etc.) Number of hours a week spent helping with their problem/s If their problem/s cause any embarrassment, anxiety, worry, depression

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New or Change (from CCHS-2002) Major

Major

New

New

New

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

2012 CCHS – MH … (cont.) Module Module Name No. 23 Social Provisions Scale

24

Negative Social Interactions

25

Contact with Police

26

Childhood Experiences

27

Spirituality

28

Labour Force

29

Work stress

30

Income

31

Socio-demographic characteristics Education Administration information

32 33

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Major Topic/s Degree to which social relationships provide various dimensions of social support (Based on Cutrona and Russel, 1989; Caron, 1996 - Social Provisions Scale) (Also used in CCHS - Annual) Negative Interactions affecting well-being or causing stress or discomfort (Based on N. Krause/U. Michigan - Negative Interaction instrument) Contact with police for various reasons (e.g. information, victim of crime, being arrested, etc.) Additional questions if related to their own mental health issue or that of a family member Physical and sexual abuse before the age of 16 (Conducted only for age 18 or older - using response booklet) (Most questions based on Childhood Experiences of Violence Questionnaire - CEVQ-SF used in the Ontario surveys - OHSUP and Child Health Study) Importance of spirituality in one's life (Based on CCHS-2002 and National Comorbidity Survey (NCS)) Work life including job attachment, occupation and usual hours worked (Asked of 15 -75 users old respondents) Aspects of one's job or business that could be stressful (e.g. required to learn new things, hectic job, exposure to conflict with colleagues /supervisors) Individual and household income Sources of income Whether income covers basic expenses Includes immigrant status, country of birth, ethnic origin and language Education levels of all members of household Permission to link with administrative information - health card Permission to share with provinces and federal partners

New or Change (from CCHS-2002) New

New New

New

Major Major No change Minor

Minor Minor Minor

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

2012 CCHS – MH Derived Variables Topic Alcohol Use, Abuse and Dependence Bipolar disorder Chronic conditions Childhood experiences WHO Disability Assessment Schedule 2.0 Depression Dwelling and household variables Distress Education Generalized anxiety disorder General health Geography Health utilities index - Pain and discomfort Height and weight - Self reported Hypomania Income Labour force Medication use Mental health experience Mania Negative social interactions Physical activity short Positive mental health Perceived need for care Sample variables (administration) Screener mental disorders Socio-demographic characteristics Smoking Social provisions scale Mental health services utilization Substance use, abuse and dependence Stress- Work stress

No. of variables 17 21 5 1 1 48 9 3 4 21 2 10 1 5 16 8 5 31 1 38 1 2 10 7 2 5 9 3 10 10 46 7

•

Note that the number of variables for the selected disorders (i.e depression, bipolar disorder, generalized anxiety disorder, alcohol abuse or dependence, mania, substance / drug abuse or dependence ), appear to be many but these include the main, intermediate and temporary variables.

•

Appendix C of the Survey User Guide provides the main variables of the above cited primary disorder variables and the respective comparable variable in 2002. These are summarized in the foregoing slide.

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

7/3/2015

WHO-CIDI Mental and Substance Disorders: Primary Variables for Analysis and Comparable 2002 Variables CONCEPT

2012

Any selected disorder (mental or substance) -- lifetime Any selected disorder (mental or substance) -- past 12 months Any selected disorder (mental or substance) - interference -- flag Any mood disorder -- lifetime Any mood disorder -- past 12 months Major depressive episode – lifetime Major depressive episode – past 12 months Major depressive episode – age at most recent episode Major depressive episode – duration longest episode Major depressive episode – interference – flag Major depressive episode – interference – mean Suicide – lifetime – thought Suicide – lifetime – plan Suicide – lifetime – attempt Suicide – past 12 months – thought

MHPFL MHPFY MHPFINT MHPFLM MHPFYM DEPDDPS DEPDDY DEPDREC DEPDPER DEPFINT DEPDINT DEPFSLT DEPFSLP DEPFSLA DEPFSYT

Suicide – past 12 months – plan Suicide – past 12 months - attempt

DEPFSYP DEPFSYA

Bipolar disorder – lifetime Bipolar disorder - past 12 months Bipolar disorder – interference – flag Bipolar disorder – interference – mean Bipolar I disorder – lifetime Bipolar I disorder – past 12 months Bipolar I disorder – interference – flag Bipolar I disorder – interference – mean Bipolar II disorder – lifetime Bipolar II disorder – past 12 months Bipolar II disorder – interference – flag Bipolar II disorder – interference – mean

BIPDL BIPDY BIPDINT BIPFINT BIPD1 BIPD1Y BIPFINT1 BIPDINT1 BIPD2 BIPD2Y BIPFINT2 BIPDINT2

Source: 2012 CCHS – MH User Guide - Micro data Files

2002

DEPBDDPS DEPBDDY DEPBDREC DEPBDPER DEPBFINT DEPBDINT DEPBFSLT DEPBFLSA DEPBFSYT DEPBISYT DEPBFSYA DEPBISYA

CONCEPT Bipolar I disorder (mania) 2002 definition – lifetime Bipolar I disorder (mania) 2002 definition – past 12 months Bipolar I disorder (mania) 2002 definition – age at most recent episode Bipolar I disorder (mania) 2002 definition – duration of longest episode Bipolar I disorder (mania) 2002 definition – interference – Bipolar I disorder (mania) 2002 definition – interference -mean Generalized anxiety disorder – lifetime Generalized anxiety disorder – past 12 months Generalized anxiety disorder – age at most recent episode Generalized anxiety disorder – duration longest episode Generalized anxiety disorder – interference – flag Generalized anxiety disorder – interference – mean Any substance use disorder (alcohol or drug) – lifetime Any substance use disorder (alcohol or drug) – past 12 months Alcohol abuse or dependence – lifetime Alcohol abuse or dependence – past 12 months Alcohol abuse – lifetime Alcohol abuse – past 12 months Alcohol dependence – lifetime Alcohol dependence – past 12 months Alcohol abuse or depedence – interference – flag Alcohol abuse or dependence – interference – mean Cannabis abuse or dependence – lifetime Cannabis abuse or dependence – past 12 months Cannabis abuse – lifetime Cannabis abuse – past 12 months Cannabis dependence – lifetime Cannabis dependence – past 12 months Drug abuse or dependence (excluding cannabis) – lifetime Drug abuse or dependence (excluding cannabis) – past 12 months Drug abuse (excluding cannabis) – lifetime Drug abuse (excluding cannabis) – past 12 months Drug dependence (excluding cannabis) – lifetime Drug dependence (excluding cannabis) – past 12 months Drug abuse or dependence (including cannabis) – interference – flag Drug abuse or dependence (including cannabis) – interference – mean

2012

2002

MIADEPS MIADEY MIADREC MIADPER MIAFINT MIADINT GADDGDS GADDDY GADDREC GADD05Y GADFINT GADDINT MHPFLSA MHPFYSA AUDDL AUDDY AUDDLA AUDDYA AUDDLD AUDDYD AUDFINT AUDDINT SUDDLC SUDDYC SUDDLCA SUDDYCA SUDDLCD SUDDYCD SUDDLO SUDDYO SUDDLOA SUDDYOA SUDDLOD SUDDYOD SUDFINT SUDDINT

MIABDEPS MIABDEY MIABDREC MIABDPER MIABFINT MIABDINT

Prepared by: R. Mercado and P. Kitchen, McMaster RDC

7/3/2015

References •

CCHS-MH 2012 Product Profile http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5015

•

CCHS-MH 2012 Questionnaire http://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=getInstrumentList&Item_ Id=119788&UL=1V&

•

The Daily – related to CCHS 1.2 / CCHS-MH http://www5.statcan.gc.ca/COR-COR/CORCOR/objList?lang=eng&srcObjType=SDDS&srcObjId=5015&tgtObjType=DAILYART http://www.statcan.gc.ca/daily-quotidien/130918/dq130918a-eng.htm

•

CCHS 1.2 (2002) Related Documents http://www5.statcan.gc.ca/COR-COR/CORCOR/objList?lang=eng&srcObjType=SDDS&srcObjId=5015&tgtObjType=STUDIES

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Prepared by: R. Mercado and P. Kitchen, McMaster RDC

CCHS-MH 2012 Data Access • RDC Program http://www.statcan.gc.ca/rdc-cdr/

• RDC Access at McMaster RDC: http://socserv.mcmaster.ca/rdc/

E-mail: [email protected] Phone: 905-525-9140 ext. 27968 7/3/2015

Prepared by: R. Mercado and P. Kitchen,McMaster RDC