Prevalence of mental disorders and service utilization in seniors: results from the Canadian community health survey cycle 1.2.

OBJECTIVE: This paper examined the 12-month rate of mental disorders and subsequent service use among Canadian seniors aged 65-79 and 80 and over and adults aged 20-49 and 50-64. METHODS: This is a secondary analysis of data [n = 33,695] of the population-based Canadian Community Health survey, Cycle 1.2 (CCHS 1.2). Major Depressive Episodes (MDEs), specific Anxiety Disorders (AD) and Alcohol Abuse/Dependence rates were assessed. RESULTS: The 12-month rates for the two senior groups aged 65-79 and 80+ for MDEs, ADs, and Substance Dependence (SD) are 1.7% and 1.6%; 1.4% and 0.8%; and 0.1% and 0.0%, respectively. Seniors aged 65-79 and 80+ had significantly lower rates than adults aged 20-49 and 50-64 for all mental disorders and SD. Among the total sample, seniors aged 65-79 and 80+ had significantly lower utilization rates than adults aged 20-49 and 50-64 for all three provider categories (GP only, GP and Other Health Professional, Any Other Health Professional but GP). Females aged 65-79 and 80+ were less likely to have reported service use for mental health reasons as opposed to those females aged 20-49 and 50-64. Males aged 65-79 and 80+ were more likely to have reported having used mental health services in the past 12 months as opposed to males aged 20-49 and 50-64. CONCLUSIONS: The presence of common mental disorders is lower in seniors as compared to younger adults. Age and gender influence mental health service utilization rates. Copyright © 2010 John Wiley & Sons, Ltd.

Comparing mental health of francophone populations in Canada, france, and belgium: 12-month prevalence rates of common mental disorders (part 1).

OBJECTIVE: To compare the 12-month prevalence of common mental disorders among francophones in Canada, France, and Belgium. This is the first article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations. METHODS: This is a secondary analysis of data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) in 2002 and the European Study of Epidemiology of Mental Disorders-Mental Health Disability (ESEMeD) from 2001 to 2003, where comparable questionnaires were administered to representative samples of adults in Canada, France, and Belgium. In Canada, francophone respondents living in Quebec (n = 7571) and outside Quebec (n = 500) completed the French version of the CCHS 1.2 questionnaire. Francophone respondents in Belgium (n = 389) and in France (n = 1436) completed the French version of the ESEMeD population survey questionnaire. Major depressive episodes (MDEs), specific anxiety disorders (ADs), and alcohol abuse and (or) dependence disorders' rates were assessed. RESULTS: The overall prevalence rate for the presence of any MDE, AD, or alcohol abuse and (or) dependence was similar in all francophone populations studied in Canada and Europe and averaged 8.5%. CONCLUSIONS: Mental disorders were equally distributed in all francophone populations studied. Cross-national comparisons continue to be instrumental in providing information useful for the creation of appropriate policies and programs for specific subsets of populations.

Comparing mental health of francophones in Canada, france, and belgium: 12-month and lifetime rates of mental health service use (part 2).

OBJECTIVES: To compare 12-month and lifetime service use for common mental disorders in 4 francophone subsamples using data from national mental health surveys in Canada, Quebec, France, and Belgium. This is the second article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations. METHODS: Comparable World Mental Health-Composite International Diagnostic Interviews (WMH-CIDI) were administered to representative samples of adults (aged 18 years and older) in Canada during 2002 and in France and Belgium from 2001 to 2003. Two groups of francophone adults in Canada, in Quebec (n = 7571) and outside Quebec (n = 500), and respondents in Belgium (n = 389) and France (n = 1436) completed the French version of the population survey. Prevalence rates of common mental health service use were examined for major depressive episodes and specific anxiety disorders (that is, agoraphobia, social phobia, and panic disorder). RESULTS: Overall, most francophones with mental disorders do not seek treatment. Canadians consulted more mental health professionals than their European counterparts, with the exception of psychiatrists. CONCLUSIONS: Patterns of service use are similar among francophone populations. Variations that exist may be accounted for by differences in health care resources, health care systems, and health insurance coverage.

Neighbourhood ethnic diversity buffers school readiness impact in ESL children.

OBJECTIVES: Contextual factors, as measured by neighbourhood characteristics, shape the experiences children have and affect their "school readiness", i.e., whether they are well or poorly prepared for the transition from home to kindergarten. This study assessed the independent effects of individual and neighbourhood factors on school readiness; specifically, it examined whether and to what degree neighbourhood factors modified children's language ability and thus their school readiness in a population of children in Saskatoon, Saskatchewan. METHOD: The study included all children attending kindergarten in 2001, 2003 and 2005 in Saskatoon. School readiness and child characteristics were measured by the Early Development Instrument (EDI). The EDI measures child development at school commencement in five domains: physical health and well-being, social competence, emotional maturity, cognitive and language development, and communication skills and general knowledge. Data from the 2001 Census were used to characterize Saskatoon's neighbourhoods. Multilevel modeling examined the independent and buffering or exacerbating effects of individual and neighbourhood factors on the relation between English as a Second Language (ESL) status in children and EDI domain scores. RESULTS: ESL children had significantly lower scores on all EDI domains compared with non-ESL children. Certain factors (e.g., younger age, male, Aboriginal status, having special needs) were significantly related to lower readiness in terms of the emotional maturity, and communication skills and general knowledge domains. Importantly, children who lived in neighbourhoods that were highly transient (with a higher proportion of residents who had moved in the previous year) had lower EDI scores on both domains, and those in neighbourhoods with lower rates of employment had lower EDI scores on communication skills and general knowledge. Neighbourhood ethnic diversity mitigated the negative impact of ESL status on school readiness for both domains. ESL children from neighbourhoods with a high degree of ethnic diversity had higher EDI scores than ESL children from neighbourhoods with low ethnic diversity. DISCUSSION: The current study provided insight regarding the impact of contextual factors in addition to individual factors, such as ESL status, on school readiness outcomes. Future research should continue to examine contextual factors related to ESL status and early child developmental outcomes, particularly focusing on the mechanisms of influence.

Official language minority communities in Canada: is linguistic minority status a determinant of mental health?

OBJECTIVES: Language has been identified as a determinant of mental health. Within Canada, individuals may speak an official language and still belong within the linguistic minority (Francophones outside Quebec and Anglophones within Quebec). The objectives of this study were to compare mental health problems between minority and majority official language communities, and examine the association between official language minority and mental health problems. METHODS: Data from the Canadian Community Health Survey, Cycle 1.2 were used to make two comparisons: Francophones to Anglophones within Quebec, and Francophones to Anglophones outside Quebec. Twelve-month and lifetime prevalences of mental disorders (major depressive episode, anxiety disorders, and alcohol/substance abuse/dependence) and mental health indices were compared. Logistic regression analysis examined whether official language minority status was a determinant of mental health. RESULTS: Mental health between minority and majority language groups was similar. Official language minority status was not a significant determinant of mental health. Self-rated mental health indices varied between groups. In some cases, minority language groups reported lower levels of life satisfaction (minority Anglophones versus majority Francophones), while in other cases more majority Anglophones reported poor life satisfaction and mental health (majority Anglophones versus minority Francophones). CONCLUSIONS: Overall, few differences were found between language groups, though variations in self-rated mental health indices were observed. In order to better understand the role of context in determining health outcomes, future research should examine mental health problems among official language minority groups provincially to help stakeholders in directing resources and programs to populations in most need.

Using traditional spirituality to reduce domestic violence within aboriginal communities.

OBJECTIVES: We report the results of involving traditional healing elders (THE) in the clinical care of aboriginal families who were involved in domestic violence in the context of a clinical case series of referrals made for domestic violence. METHODS: Psychiatric consultations were requested from senior author L.M.M. for 113 aboriginal individuals involved with domestic violence as recipients or perpetrators (or both) between July 2005 and October 2008. As part of their clinical care, all were encouraged to meet with a THE, with 69 agreeing to do so. The My Medical Outcomes Profile 2 scale was being used as a clinical instrument to document effectiveness. Elders used traditional cultural stories and aboriginal spirituality with individuals, couples, and families to transform the conditions underlying domestic violence. RESULTS: For those people who met with the THE, a statistically significant change (p < 0.0001) occurred in symptom severity from baseline to final interview of 4.6-1.52 on a scale of 0-6. The most common presenting symptom was being beaten (39 people), followed by drinking (37 people), drugs (13 people), grudges and anger (12 people), sadness (9 people), hates self (8 people), fear (7 people), sleep problems (6 people), anxiety (5 people), and lost spirituality (2 people). Each person chose two primary symptoms to rate. CONCLUSIONS: Including elders in the care of people who are the recipients of domestic violence is effective. We speculate that it helps by providing traditional stories about relationships and roles that do not include violence. Spiritual approaches within aboriginal communities may be more effective than more secular, clinical approaches. Research is indicated to compare elder-based interventions with conventional clinical care.