Abstract
Objective
To assess whether (household) food insecurity, access to a regular medical doctor, and sense of community belonging mediate the relationship between mood and/or anxiety disorders and self-rated general health.
Methods
We used six annual cycles of the Canadian Community Health Survey, including Canadian adults aged 18–59 years, between 2011 and 2016. Mediation models, adjusted for key determinants of health, were based on a series of weighted logistic regression models. The Sobel products of coefficients approach was used to estimate the indirect effect, and bootstrapping to estimate uncertainty.
Results
The annual (weighted) prevalence of mood and/or anxiety disorders increased from 11.3% (2011) to 13.2% (2016). Across the 6 years, 23.9–27.7% of individuals with mood and/or anxiety disorders reported fair/poor self-rated health as compared with 4.9–6.5% of those without mood and/or anxiety disorders (p<0.001). Similarly, the 7.2–8.9% of the population reporting fair/poor self-rated health were disproportionately represented among individuals reporting food insecurity (21.1–26.2%, p<0.001) and a weak sense of community belonging (10.0–12.2%, p<0.001). A significantly lower prevalence of poor self-rated health was observed among respondents reporting having access to a regular medical doctor in 2012, 2015, and 2016. In 2016, sense of community belonging and food insecurity significantly mediated the effect of mood and/or anxiety disorders on self-rated general health. Access to a regular medical doctor did not mediate this relationship.
Conclusion
Efficient policies that address food insecurity and sense of community belonging are needed to decrease the mental health burden and improve health satisfaction of Canadians.
Résumé
Objectif
Déterminer si l’insécurité alimentaire (du ménage), l’accès à un médecin traitant et le sentiment d’appartenance à la communauté modèrent le lien entre les troubles anxieux et/ou de l’humeur et la santé générale autoévaluée.
Méthode
Nous avons utilisé six cycles annuels (2011 à 2016) de l’Enquête sur la santé dans les collectivités canadiennes incluant des Canadiens adultes de 18 à 59 ans. Nos modèles de modération, ajustés selon les principaux déterminants de la santé, reposaient sur une série de modèles de régression logistique pondérés. Nous avons utilisé l’approche des produits des coefficients de Sobel pour estimer les effets indirects, et l’autoamorçage pour estimer l’incertitude.
Résultats
La prévalence annuelle (pondérée) des troubles anxieux et/ou de l’humeur a augmenté, passant de 11,3 % en 2011 à 13,2 % en 2016. Sur la période de six ans, 23,9 à 27,7 % des personnes ayant des troubles anxieux et/ou de l’humeur ont déclaré avoir une santé moyenne/mauvaise, contre 4,9 à 6,5 % des personnes n’ayant pas de troubles anxieux et/ou de l’humeur (p < 0,001). De même, les 7,2 à 8,9 % de la population ayant déclaré avoir une santé moyenne/mauvaise étaient disproportionnellement représentés chez les personnes disant être en situation d’insécurité alimentaire (21,1-26,2 %, p < 0,001) et avoir un faible sentiment d’appartenance à la communauté (10,0-12,2 %, p < 0,001). Une prévalence significativement plus faible de mauvaise santé autoévaluée a été observée chez les répondants ayant dit avoir accès à un médecin traitant en 2012, 2015 et 2016. En 2016, le sentiment d’appartenance à la communauté et l’insécurité alimentaire modéraient de façon significative l’effet des troubles anxieux et/ou de l’humeur sur la santé générale autoévaluée. L’accès à un médecin traitant ne modérait pas ce lien.
Conclusion
Des politiques efficaces pour aborder l’insécurité alimentaire et le sentiment d’appartenance à la communauté sont nécessaires pour réduire le fardeau des troubles mentaux et améliorer la satisfaction des Canadiens face à leur santé.
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Availability of data and material
Statistics Canada restricts access to detailed microdata from the Canadian Community Health Survey and other data sources to researchers with a study proposal approved through the Statistics Canada microdata application process, and who meet the requirements to become a deemed employee of Statistics Canada. Researchers from post-secondary institutions within Canada or outside Canada may apply for access to the detailed microdata. For information on the application process, visit: https://www.statcan.gc.ca/eng/microdata/data-centres.
Code availability
The underlying analytical codes are available from the authors on request.
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Acknowledgements
We would like to acknowledge and thank the respondents who participated in the Canadian Community Household survey and Statistics Canada for their assistance with data access.
Funding
This work was supported by the following sources of funding: VDL is funded by grants from the Canadian Institutes of Health Research (PJT-148595 and PJT-156147), and the Canadian Foundation for AIDS Research (CANFAR Innovation Grant – 30-101). DM is supported by a Scholar Award from the Michael Smith Foundation for Health Research.
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Initial study concept and design: DN, VDL; analysis and interpretation of data: DN, HT, VDL; statistical analysis: DN, HT, VDL; drafting of the manuscript: DN, AP, VDL; consultation regarding study design and interpretation of findings: DN, AP, HT, KS, DM, VDL; critical revision of the manuscript for important intellectual content: DN, AP, HT, KS, DM, VDL; final approval of the manuscript to be published: DN, AP, HT, KS, DM, VDL; study supervision: VDL, KS, DM.
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Nehumba, D., Paiero, A., Tafessu, H. et al. Household food insecurity, sense of community belonging, and access to a regular medical doctor as mediators in the relationship between mood and/or anxiety disorders and self-rated general health in Canada between 2011 and 2016: a serial cross-sectional analysis. Can J Public Health 113, 944–954 (2022). https://doi.org/10.17269/s41997-022-00658-0
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DOI: https://doi.org/10.17269/s41997-022-00658-0
Keywords
- Sense of community belonging
- Community connectedness
- Household food insecurity
- Healthcare access
- Mental health
- Mood disorder
- Anxiety
- Self-rated general health