Mood Disorders in Ontario Samantha Davie Background___________ _________________________________________________________ Across Canada, the proportion of individuals with mood disorders is on the rise (Simpson, Meadows, Frances, & Patten, 2012). However, the proportion of Ontarians with a diagnosed mood disorder has been suggested to be higher than the Canadian average (Statistics Canada, 2011b). Mood disorders do not affect the population in the same way. Many factors have been shown to be related to mood disorders. Characteristics such as age, sex, and marital status have been shown to be associated with mood disorders, both internationally and in Canada (Statistics Canada, 2011b; Grant et al., 2009; Bulloch, Lavorato, Williams, & Patten, 2012; Mayo Clinic, 2012b; Mayo Clinic, 2012a). Also, economic characteristics such as income, education, and employment status have also been shown to be associated with mood disorders (Orpana, Lemyre, & Gravel, 2009; Grant et al., 2009; Bulloch et al., 2012). Despite the variety of risk factors shown to be associated with mood disorders, it is important to identify risk factors which are visible and easily targeted. This will make public health campaigns more targeted and focused, allowing us to allocate resources to groups that would benefit the most from strategies to prevent or reduce levels of mood disorders in Ontario. Therefore, this report examined whether levels of mood disorders vary by sex, age, and employment for a sample of Ontario residents. Information from this study could then help direct public health strategies toward identified priority groups.
Data Source and Population_______________________________________________________ Data for this study were from Canadian Community Health Survey (CCHS), a joint venture between Statistics Canada and Health Canada. The CCHS survey was asked to a random sample of Canadians aged 12 or older. Limitations of the CCHS are that those living on First Nations reserves, Canadian Forces, in institutions, and some remote areas of Ontario and Quebec are excluded (Statistics Canada, 2011a). Nonetheless, the CCHS remains highly representative of the Canadian population. The CCHS posed a question about mood disorders in the 2003 (Cycle 2.1), 2005 (Cycle 3.1), 2007 – 2008 (Cycle 4.1), and 2009 – 2010 (Cycle 5.1) cycles. In each of these surveys, the presence of a current mood disorder was determined using the following question: “do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia, including
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manic depression? Remember, weâ€™re interested in conditions diagnosed by a health professionalâ€? (Statistics Canada, 2003; Statistics Canada, 2005b; Statistics Canada, 2008; Statistics Canada, 2010). This report is limited to adults aged 20 to 75. Age is broken down into age 15 to 19 in the 2003 and 2005 CCHS cycles, which does not allow for the exclusion of children because removing this group would exclude adults aged 18 and 19 (Statistics Canada, 2005c; Statistics Canada, 2006b). Also, the CCHS only asks employment questions to those aged 15 to 75. Because employment is a key risk factor for mood disorders, adults over 75 will be excluded. Therefore, for the purposes of this report, an adult is defined as someone aged 20 to 75.
Results________________________________________________________________________ Overall, mood disorders are on the rise in Ontario (figure 1). The proportion of adult Ontarians with a diagnosed mood disorder rose from 6.2% in 2003, to 6.7% in 2003, to 7.2% in 2007, reaching 7.8% in 2009, a significant rise overall. 14% 12% 10% 8% 6% 4% 2% 0% 2003
Figure one. Proportion of 20 to 75 year old Ontarians with a Diagnosed Mood Disorder The upward trend in mood disorders is seen in both males and females (figure 2). Females are approximately 4% more likely to have a diagnosed mood disorder than males, a significant difference at all time points. This sex difference is in agreement with what other studies have found, which means that sex patterns for mood disorders are similar in Ontario to
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those found in the United States and Canada (Government of Canada, 2006; Grant et al., 2009). The sex difference seen here means that women may be a priority group that would benefit greatly from public health strategies aimed at reducing or preventing mood disorders.
14% 12% 10% 8% FEMALE 6%
4% 2% 0% 2003
Figure two. Proportion of 20 to 75 year old Ontarians with a Diagnosed Mood Disorder, by Sex Mood disorders proportions also differ by age in Ontario. Interestingly, it was the middle age group, aged 45 to 64, that reported the highest proportion of mood disorders, while those aged 65 to 75 reported the lowest levels, a significant trend found in all time points. This age difference is similar to findings for the rest of Canada (Government of Canada, 2006). It should be noted that the difference between the group with the lowest levels and those with the highest levels is only 2%. Therefore, while there are differences in levels of mood disorders by age group, there is not a large enough difference to conclude that age is a meaningful predictor of mood disorders. In other words, these results do not support targeting health promotion and prevention efforts based on age group alone.
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14% 12% 10% 8%
20 to 44 45 to 64
65 to 75 4% 2% 0% 2003
Figure three. Proportion of 20 to 75 year old Ontarians with a Diagnosed Mood Disorder, by Age The proportion of adult Ontarians with a diagnosed mood disorder differs sharply by employment (figure 4). Those who have been unemployed for over a year have higher levels of mood disorders than employed Ontarians. Also, those who work 30 hours per week or more during a usual week (full-time) have significantly lower levels of mood disorders than those who work less than 30 hours per week (part-time). These results provide strong support for the suggestion that employment status is related to mood disorders (Orpana et al., 2009). The unemployed group is approximately 8% more likely to report having a diagnosed mood disorder than full-time employees. Therefore, those who have been unemployed for over one year represent a group that stand the benefit from strategies aimed at reducing or preventing mood disorders, compared to any other group examined in this report.
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14% 12% 10% 8%
Full-Time 4% 2% 0% 2003
Figure four. Proportion of 20 to 75 year old Ontarians with a Diagnosed Mood Disorder, by Employment Status
Conclusion_____________________________________________________________________ Based on this report, targeting women and those who have been unemployed for over one year, may be a way to efficiently target efforts aimed at reducing levels of mood disorders or prevention strategies. This will funnel scarce resources toward groups of the population that are most likely to benefit from them. Mood disorders carry a heavy burden on both the individuals, in terms of quality of life, and society, in terms of lost wages and increased health care expenditures. By effectively targeting public health campaigns toward priority groups of the population most likely to benefit from such efforts, we can reduce the burden of such disabling disorders, and increase quality of life for individuals.
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References Bulloch, A., Lavorato, D., Williams, J., & Patten, S. (2012). Alcohol consumption and major depression in the general population: The critical importance of dependence. Depression and Anxiety, 29(12), 1058-1064. doi: 10.1002/da.22001
Canadian Mental Health Association. (2013). Diagnosing mental disorders: Diagnostic and statistical manual of mental disorders. Retrieved February 12, 2013, from http://www.ontario.cmha.ca/about_mental_health.asp?cID=7669
Center for Substance Abuse Treatment. (2008). Appendix Dâ€”DSM-IV-TR mood disorders. Managing depressive symptoms in substance abuse clients during early recovery: A treatment improvement protocol (TIP) series 48 (pp. 143 â€“ 146) (DHHS Publication No. (SMA) 08-4353). Rockville, MD: U.S. Department of Health and Human Services.
Government of Canada. (2006). The human face of mental health and mental illness in canada. (No. HP5-19/2006E). Ottawa, ON: Minister of Public Works and Government Services Canada.
Grant, B. F., Goldstein, R. B., Chou, S. P., Huang, B., Stinson, F. S., Dawson, D. A., . . . Compton, W. M. (2009). Sociodemographic and psychopathologic predictors of first incidence of DSMIV substance use, mood and anxiety disorders: Results from the wave 2 national epidemiologic survey on alcohol and related conditions. Molecular Psychiatry, 14(11), 10511066. doi: 10.1038/mp.2008.41
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Marshall, K. (2000). Part-time by choice. Perspectives on labour and income: The online edition, 1(2), April 19, 2013. doi: Catalogue Number 75-001-XIE
Mayo Clinic. (2012a). Bipolar disorder: Risk factors. Retrieved February 3, 2013, from http://www.mayoclinic.com/health/bipolar-disorder/DS00356/DSECTION=risk-factors
Mayo Clinic. (2012b). Depression (major depression): Risk factors. Retrieved February 3, 2013, from http://www.mayoclinic.com/health/depression/DS00175/DSECTION=risk-factors
Orpana, H. M., Lemyre, L., & Gravel, R. (2009). Income and psychological distress: The role of the social environment. Health Reports, 20(1)
Ramasubbu, R., Taylor, V. H., Saaman, Z., Sockalingham, S., Li, M., Patten, S., . . . McIntyre, R. S. (2012). The Canadian network for mood and anxiety treatments (CANMAT) task force recommendations for the management of patients with mood disorders and select comorbid medical conditions. Annals of Clinical Psychiatry, 24(1), 91-109.
Simpson, K. R. S., Meadows, G. N., Frances, A. J., & Patten, S. B. (2012). Is mental health in the Canadian population changing over time? Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 57(5), 324-331.
Statistics Canada. (2003). Canadian community health survey (CCHS) questionnaire for cycle 2.1: January 2003 to November 2003. (Government Questionnaire).
Statistics Canada. (2005a). Canadian community health survey 2003: User guide for the public use microdata file. (No. 82M0013GPE). Ottawa, ON: Minister of Industry.
Mood Disorders in Ontario | Davie | 8
Statistics Canada. (2005b). Canadian community health survey cycle 3.1: Final questionnaire. (Government Questionnaire).
Statistics Canada. (2005c). CCHS cycle 2.1: Data dictionary: Public use microdata file. (Government Questionnaire Data Dictionary).
Statistics Canada. (2006a). CCHS 3.1 public use microdata file user guide. Ottawa, ON: Statistics Canada.
Statistics Canada. (2006b). CCHS cycle 3.1: Data dictionary public use microdata file. (Government Questionnaire Data Dictionary).
Statistics Canada. (2008). Canadian community health survey (CCHS) 2008 questionnaire. (Government Questionnaire).
Statistics Canada. (2009). 2007-2008 CCHS microdata file user guide. Ottawa, ON: Statistics Canada.
Statistics Canada. (2010). Canadian community health survey (CCHS) annual component: 2010 questionnaire. (Government Questionnaire).
Statistics Canada. (2011a). 2010 and 2009-2010 CCHS microdata file user guide. Ottawa, ON: Statistics Canada.
Statistics Canada. (2011b). Mood disorders, 2009. Retrieved February 2, 2013, from http://www.statcan.gc.ca/pub/82-625-x/2010002/article/11265-eng.htm