Trends in mental health inequalities in urban Canada

Abstract

Objectives

Canadians do not all enjoy equal levels of health. The presence of income-related health inequalities has been well established in Canada, but there is a lack of consistent reporting of mental health inequalities in Canada’s largest cities. This study reports the prevalence and inequalities in mental health outcomes at the city, provincial, and national levels over time.

Methods

Self-reported poor mental health, life stress, and physician-diagnosed self-reported mood and anxiety disorder from the Canadian Community Health Survey were pooled over five-year intervals and combined with neighbourhood income information from the Canadian Census. First, prevalence rates were calculated for each interval at the neighbourhood level for urban communities. Second, the distributions of these neighbourhood rates were summarized at the city level and for Canada as a whole using overall prevalence rates and concentration indices of inequality. Finally, trends in these city- and country-level outcomes were also explored.

Results

At the national level, starting from 2001 to 2005, the prevalence of poor mental health (27.9%), mood disorder (7.3%), and anxiety disorder (6.8%) had significantly increased by 2011–2015. Inequalities were present in 2001–2005 and worsened over time. The prevalence rate at the national level of life stress was 66.6% in 2001–2005 and decreased over time.

Conclusion

The large and increasing values of inequalities and the difference in prevalence rates and inequalities in cities highlight the necessity for mental disorder-specific data and for city-level analysis of inequalities. The next steps in reducing inequalities involve deconstructing the health inequalities, and continued monitoring.

Résumé

Objectifs

Les Canadiens ne bénéficient pas tous du même niveau de santé. L’existence d’inégalités de santé liées au revenu est bien établie au Canada mais la façon dont sont rapportées les inégalités de santé mentale dans les plus grandes villes canadiennes manque d’uniformité. Cette étude présente la prévalence et les inégalités dans les résultats de santé mentale aux niveaux urbain, provincial et national sur une période de temps.

Méthodes

La mauvaise santé mentale auto-rapportée, le stress de la vie, les troubles de l’humeur et de l’anxiété diagnostiqués par un médecin et auto-rapportés dans l’enquête sur la santé des collectivités canadiennes, ont été amalgamés par intervalles de 5 ans, et combinés avec des informations sur le revenu par quartier tiré du recensement canadien. D’abord les taux de prévalence pour chaque intervalle ont été calculés au niveau des quartiers dans les communautés urbaines. Deuxièmement les distributions de ces taux par quartiers ont été groupées par ville et au niveau du Canada tout entier en utilisant les taux de prévalence globale et les indices de concentration d’inégalité. Finalement les tendances dans les résultats obtenus à l’échelle des villes et du pays ont été explorées.

Résultats

Au niveau national en partant de 2001–2005, la prévalence de la mauvaise santé mentale (27,9 %), des troubles de l’humeur (7,3 %) et des troubles de l’anxiété (6,8 %) ont augmenté de façon significative dès 2011–2015. Ces inégalités étaient déjà présentes en 2001–2005 et ont empiré au fil du temps. Le taux de prévalence du stress de vie au niveau national était de 66,6 % en 2001–2005 et a diminué au fil du temps.

Conclusion

Le niveau élevé et croissant des inégalités et la différence au niveau des taux de prévalence et des inégalités dans les villes soulignent qu’il est nécessaire d’avoir des données spécifiques sur les troubles mentaux et des analyses d’inégalités à l’échelle de la ville. Les prochaines étapes pour réduire les inégalités comprennent la déconstruction des inégalités de santé et une surveillance continuelle.

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Acknowledgements

This research was conducted at The Saskatchewan Research Data Centre which is part of the Canadian Research Data Centre Network (CRDCN). This service is provided through the support of the University of Saskatchewan, the Province of Saskatchewan, the Canadian Foundation for Innovation, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, and Statistics Canada. The authors would also like to specially thank our RDC analyst Ruben Mercado for his help and support and Dr. Anne Leis for her help in completing the French translation of the abstract. We also thank our anonymous reviewers for their helpful comments and suggestions.

Funding

This research was funded in part by the Urban Public Health Network. No other financial support was received for the research, authorship, and/or publication of this article.

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Contributions

SM was involved in all aspects of the study. CN contributed study conception and design. CP advised on study methods, analysis, and interpretation of data. PP, NM, and CN were involved in planning and supervised the work. All authors provided critical feedback and helped shape the research, analysis and manuscript. All authors approved the final version for publication.

Corresponding author

Correspondence to Sharalynn Missiuna.

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Ethics approval was exempted by the University of Saskatchewan Behavioural Research Ethics Board.

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The authors declare no competing interests.

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Missiuna, S., Plante, C., Pahwa, P. et al. Trends in mental health inequalities in urban Canada. Can J Public Health (2021). https://doi.org/10.17269/s41997-021-00498-4

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Keywords

  • Mental health
  • Inequalities
  • Social determinants of health
  • Cities
  • Canada

Mots-clés

  • Santé mentale
  • inégalités
  • déterminants sociaux de la santé
  • villes
  • Canada