Variations in the Prevalence of Psychiatric Disorders and Social Problems across Canadian Provinces

Article excerpt

Objective: To determine provincial 12-month prevalence rates for selected psychiatric disorders and to assess the association between these and the Canadian Social Problem Index (SPI).

Method: Psychiatric data for depression, mania, panic disorder, social phobia, and agoraphobia were derived from the results of the 2002 Canadian Community Health Survey: Mental Health and Well-Being. The Canadian SPI was updated for 2002, and correlations were calculated between the SPI and the 5 diagnostic prevalence values across provinces.

Results: The results showed that the SPI had maintained its tendency to increase from east to west in Canada, a trend reflected by depression and mania. The psychiatric disorders did not show strong correlations with the SPI in 2002, but depression and mania did show relatively strong associations with index values from earlier years. High-to-low ratios across provinces for individual social problems averaged over 5, and the results were essentially of the same magnitude for the ranges of particular psychiatric diagnoses.

Conclusions: The differences in need found here suggest that per capita allocation of funding for mental health and social programs may not be appropriate. The mixed findings on the association between mental disorders and social problem behaviour across provinces leads to more research questions than research answers.

(Can J Psychiatry 2005;50:637-642)

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Clinical Implications

* Canadian provinces differ significantly in levels of social problem behaviour and in the prevalence of mental disorders.

* Per capita allocation of resources may not be appropriate across regions because of differing need.

* The extent of social problem behaviour may be related to mental illness levels several years earlier.

Limitations

* The CCHS 1.2, while extremely valuable, did not collect data on schizophrenia.

* Ecologic trends do not show cause and effect.

* The many differences among provinces indicate that definitive conclusions are ordinarily not possible. The focus should be on the generation of hypotheses.

Key Words: mental illness, depression, mania, phobia, panic disorder, social problems, psychiatric epidemiology

A recent Canadian study (1) found that provinces or territories that rank highly on one social problem tend to rank highly on others and that such problems (for example, homicide, attempted murder, sexual assault, assault, robbery, alcoholism, divorce, and suicide) could be parsimoniously described by a single index, namely, the SPI.

The provinces have shown an east-to-west gradient with the highest SPI values being found in the west. Significantly higher rates have been found in Canada's northern territories. The level of the SPI has increased steadily over several decades, with a slightrecent decrease (1991-1996). A related study has shown that the prevalence of childhood trauma (a consequence of many social problems) has also risen over time, especially for girls (2).

Notably, the clustering of social problems is not restricted to geopolitical areas; individuals who exhibit one social problem have an increased likelihood of engaging in other types of social problem behaviours. In a survey of 3258 adults in Edmonton (3), individuals provided information that allowed for the assignment of psychiatric diagnoses (8 "core" diagnoses were used) and for the assessment of participation in 8 social problem behaviours (that is, drug abuse, unemployment, spouse abuse, child abuse, alcohol abuse, suicidal behaviour, divorce, and felony). The results showed that nearly one-half of those engaging in any social problem behaviour had exhibited 2 or more such behaviours. Further, there was a high level of association between social problems, as a class, with psychiatric disorders, again as a class. …