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Description

• Percentage of the population aged 12 and over that experienced depression in the past 12 months.

• Prevalence of depression

Corresponding Mandatory Objectives

• None

• Depression. Under Health Conditions, Chronic Conditions.
  http://www.statcan.ca/english/freepub/82-221-XIE/00604/hlthstatus/conditions2.htm#depression
  Population aged 12 and over who show symptoms of depression, based on their responses to a set of questions that establishes the probability of suffering a "major depressive episode".

• As a result of a Communiqué on Health issued by the First Ministers in September 2000, the health ministries from all provinces and territories, and the federal government have selected and reported on a set of comparable health indicators to the public. There are 14 areas for comparable health status and health system performance indicators reporting, organized under the three headings of health status, health outcomes and quality of service. This indicator is one of the comparable health indicators, also referred to as PIRC in Ontario (Performance Indicators Reporting Committee).
  See Statistics Canada’s web site: http://www.statcan.ca/english/freepub/82-401-XIE/2002000/index.htm
  See Ontario Ministry of Health and Long-Term Care web site: http://www.health.gov.on.ca/english/public/pub/ministry_reports/pirc_02/pirc_02.html
  
  Comparable Health Indicator: Healthy Canadians (70-HLT) Prevalence of depression

• Mental Health Supplement to the Ontario Health Survey 1990
• CCHS Cycle 1.2 - Mental Health and Well-being Survey 2001

Canadian Community Health Survey 2000/01 Questions (Cycle 1.1):
Derived variable name: DPSADPP

Depression Questions from CCHS
(questions are identical in Cycles 1.1 and 2.1, variable names listed are from Cycle 1.1)

Question DP_Q02 [Variable DPSA_02]: “During the past 12 months, was there ever a time when you felt sad, blue, or depressed for 2 weeks or more in a row?” 1) Yes, 2) No

Question DP_Q03 [Variable DPSA_03]: “For the next few questions, please think of the 2-week period during the past 12 months when these feelings were the worst. During that time, how long did these feelings usually last?” 1) All Day Long, 2) Most Of The Day, 3) About Half Of The Day, 4) Less Than Half Of A Day

Question DP_Q04 [Variable DPSA_04]: “How often did you feel this way during those 2 weeks?” 1) Every Day, 2) Almost Every Day, 3) Less Often

Question DP_Q05 [Variable DPSA_05]: “During those 2 weeks did you lose interest in most things?” 1) Yes, 2) No

Question DP_Q06 [Variable DPSA_06]: “Did you feel tired out or low on energy all of the time?” 1) Yes, 2) No

Question DP_Q07 [Variable DPSA_07]: “Did you gain weight, lose weight or stay about the same?” 1) Gained Weight, 2) Lost Weight, 3) Stayed About The Same, 4) Was On A Diet

Question DP_Q08A [Variable DPSA_08A]: “About how much did you gain/lose?”

Question DP_Q08B [Variable DPSA_08B]: “Was that in pounds or in kilograms?”

Question DP_Q09 [Variable DPSA_09]: “Did you have more trouble falling asleep than you usually do?” 1) Yes, 2) No

Question DP_Q10 [Variable DPSA_010]: “How often did that happen?” 1) Every Night, 2) Nearly Every Night, 3) Less Often

Question DP_Q11 [Variable DPSA_011]: “Did you have a lot more trouble concentrating than usual?” 1) Yes, 2) No

Question DP_Q12 [Variable DPSA_12]: “At these times, people sometimes feel down on themselves, no good or worthless. Did you feel this way?” 1) Yes, 2) No

Question DP_Q13 [Variable DPSA_013]: “Did you think a lot about death - either your own, someone else’s or death in general?” 1) Yes, 2) No

Question DP_Q14C [Variable DPSA_014C]: “Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you were sad, blue or depressed and also had some other things like (KEY PHRASES).”

Question DP_Q14 [DPSA_14]: “About how many weeks altogether did you feel this way during the past 12 months?”

Question DP_Q15 [DPSA_15]: “Think about the last time you felt this way for 2 weeks or more in a row. In what month was that?”

Question DP_Q16 [Variable DPSA_16]: “During the past 12 months, was there ever a time lasting 2 weeks or more when you lost interest in most things like hobbies, work or activities that usually give you pleasure?” 1) Yes, 2) No

Question DP_Q17 [Variable DPSA_17]: “For the next few questions, please think of the 2-week period during the past 12 months when you had the most complete loss of interest in things. During that 2-week period, how long did the loss of interest usually last?” 1) All Day Long, 2) Most Of The Day, 3) About Half Of The Day, 4) Less Than Half Of A Day

Question DP_Q18 [Variable DPSA_18]: “How often did you feel this way during those 2 weeks?” 1) Every Day, 2) Almost Every Day, 3) Less Often

Question DP_Q19 [Variable DPSA_19]: “During those 2 weeks did you feel tired out or low on energy all the time?” 1) Yes, 2) No

Question DP_Q20 [Variable DPSA_20]: “Did you gain weight, lose weight, or stay about the same?” 1) Gained Weight, 2) Lost Weight, 3) Stayed About The Same, 4) Was On A Diet

Question DP_Q21A [Variable DPSA_21A]: “About how much did you gain/lose?”

Question DP_Q21B [Variable DPSA_21B]: “Was that in pounds or in kilograms?”

Question DP_Q22 [Variable DPSA_22]: “Did you have more trouble falling asleep than you usually do?” 1) Yes, 2) No

Question DP_Q23 [Variable DPSA_23]: “How often did that happen?” 1) Every Night, 2) Nearly Every Night, 3) Less Often

Question DP_Q24 [Variable DPSA_24]: “Did you have a lot more trouble concentrating than usual?” 1) Yes, 2) No

Question DP_Q25 [Variable DPSA_25]: “At these times, people sometimes feel down on themselves, no good, or worthless. Did you feel this way?” 1) Yes, 2) No

Question DP_Q26 [Variable DPSA_26]: “Did you think a lot about death - either your own, someone else’s, or death in general?” 1) Yes, 2) No

Question DP_Q27C [Variable DPSA_27C]: “Reviewing what you just told me, you had 2 weeks in a row during the past 12 months when you lost interest in most things and also had some other things like (KEY PHRASES).”

Question DP_Q27 [Variable DPSA_27]: “About how many weeks did you feel this way during the past 12 months?”

Question DP_Q28 [Variable DPSA_28]: “Think about the last time you had 2 weeks in a row when you felt this way. In what month was that?”

• Using variable DPSADPP, respondents with a value of 0.9 or greater are considered to be depressed.
• The number of “not stated” (coded as 9.99) respondents are likely small and can be excluded. In the CCHS 2000/01, the “not stated” were less than 1%. The “not applicable” respondents were those in Brant County where depression was not included as optional content (n=727). To exclude “not applicable” and “not stated” respondents, select DPSADPP < 1. Users should check numbers before excluding these non-respondents.
• Before releasing and/or publishing CCHS, users should ensure that the number of sampled respondents who contributed to the estimate is at least 10 when bootstrapping or 30 when using C.V. tables, regardless of the estimate’s coefficient of variation. For estimates based on sufficient sample size, determine the coefficient of variation of the rounded weighted estimate and follow the guidelines below:
  • Acceptable (0.0 16.5) Estimates can be considered for general unrestricted release. Requires no special notation.
  • Marginal (16.6 33.3) Estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning of high sampling variability.
  • Unacceptable (greater than 33.3) Statistics Canada recommends not releasing estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged and the following warning should accompany the estimates: “The user is advised that . . . (specify the data) . . . do not meet Statistics Canada’s quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid”. These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
• Prior to data analysis, ensure data are weighted by the appropriate variable.

Method of Calculation

Basic Categories

• Age groups for age-specific rates: 12-19, 20-44, 45-64, 65+
• Sex: male, female
• Geographic areas for CCHS - all 37 Public Health Units in Ontario

Indicator Comments

• Depressions are among the most common mental disorders, and the most treatable. Approximately 8% of adults will experience major depression at some time in their lives. The number of Canadians who suffer from major depression is comparable to leading chronic conditions, such as heart disease, diabetes or thyroid conditions. Depression causes substantial suffering and disruption in the lives of those affected and of those around them through impairment in social, occupational, educational functioning. It is a recurrent illness with frequent relapses.¹
• Depression is more prevalent among women than men, and among younger than older individuals. Depression is also associated with socioeconomic status, ethnicity, immigration status, geography of residence (urban vs. rural), health behaviours, psychological well-being, social resources, stress and physical illness.^1,2
• Many individuals with depression are initially seen by family physician and General Practitioners (GPs) as opposed to mental health specialists. GPs are the most frequently consulted professionals for problems related to mental illness. However, physicians in primary care settings often under-diagnose depression and their referral rates to mental health professionals are low. Consequently, many individuals who do seek treatment remain undiagnosed or receive incorrect medication or inadequate doses.^1,3-5
• Depression is associated with considerable utilization of health services. Many individuals fail to reach or sustain symptom-free states over the long-term. There is a tendency for depressive episodes to recur and for the course to become chronic._1,2,6,7
• Information collected in surveys may exclude factors, such as genetic make-up and family history, which may increase susceptibility to depression.
• The data used for this indicator are self-reported. The prevalence of depression may therefore be over or under-estimated. Self-report data may be subject to errors in recall, over or under-reporting due to social desirability, and errors from proxy reporting.
• Depression was an optional module in Cycle 1.1 (2000/02) and Cycle 2.1 (2003) of the CCHS. For Cycle 1.1, all Health Regions in Ontario selected depression as optional content with the exception of Brant. For Cycle 2.1, the following Health Regions selected depression for optional content: Brant; Haldimand-Norfolk; Durham; Haliburton, Kawartha and Pine Ridge; Peterborough; Elgin-St.Thomas; Middlesex-London; Oxford; Halton; Hamilton; Huron; Perth; Muskoka-Parry Sound; Niagara; Peel; Simcoe; York; and Toronto.
• Results from Cycle 1.1 will be representative of the province since only Brant did not participate; however, regional estimates from Central Region may not be. Provincial estimates for Cycle 2.1 are not available since 19 areas did not include depression as an optional module.
• The depression module was not available in Cycle 3.1 (2005).
• The CCHS Cycle 1.1 has four derived variables for depression:
  1. DPSADSF Depression Scale - Short Form Score Based on: DPSA_02, DPSA_03, DPSA_04, DPSA_05, DPSA_06, DPSA_08A, DPSA_08B, DPSA_10, DPSA_11, DPSA_12, DPSA_13, DPSA_16, DPSA_17, DPSA_18, DPSA_19, DPSA_21A, DPSA_21B, DPSA_23, DPSA_24, DPSA_25, DPSA_26.
  This variable assesses the respondent’s depression state. The items used to measure depression are based on the work of Kessler and Mroczek(from the University of Michigan). They chose a subset of items from the Composite International Diagnostic Interview (CIDI) that measure major depression. The CIDI is a standardized instrument that is used to assess mental disorders in accordance with the definitions and criteria of ICD-10 and DSM-IV.⁸
  2. DPSADPP Depression Scale - Predicted Probability
  Based on: DPSADSF
  A predicted probability of 0 was assigned to respondents who denied the stem questions. A Major Depressive Episode was defined as a score of 0.9 on the probability scale, that is to say that the individual had a 90% likelihood of a positive diagnosis of having had a major depressive episode in the year prior to the survey. A major depressive episode was characterized by 2 weeks or more with persistent depressed mood and loss of interest or pleasure in normal activities, accompanied by problems such as decreased energy, changes in sleep and appetite, impaired concentration, and feelings of guilt, hopelessness, or suicidal thoughts.
  3. DPSADWK Number of weeks felt depressed
  Based on: DPSA_14, DPSA_27
  This variable indicates the number of weeks the respondent felt depressed.
  4. DPSADMT Specific month last felt depressed
  Based on: DPSA_14, DPSA_15, DPSA_27, DPSA_28
  This variable determines the specific month when the respondent last felt depressed.
• Use the Predicted Probability variable (DPSADPP) to estimate depression prevalence.
• Depression was measured similarly in the 1996/97 OHS using a scale from question MHC6_2 to MHC6_28. These variables were on the 1996/97 OHS but not the NPHS public use file. The 27 items used are based on the work of Kessler and Mroczek from the University of Michigan. The selected a subset of items from the Composite International Diagnostic Interview (CIDI) that measured major depressive episode (MDE). While the OHS 1996/97 and CCHS questions were identical, different imputation methods were used and comparisons should be made with caution.
• This indicator is not comparable to that based on the OHS 1990.
• Depression was measured in Cycle 1.2 of the CCHS in the “Mental Health and Well Being” Survey, the first national survey on mental health.⁹ Data are not available at the health unit level. These depression data were based on a Composite International Diagnostic Interview instrument. Major depressive disorder defined for this survey required at least one episode of two weeks or more with persistent depressed mood and loss of interest or pleasure in normal activities, accompanied by problems such as decreased energy, changes in sleep and appetite, impaired concentration, and feelings of guilt, hopelessness, or suicidal thoughts. Data from this survey are also restricted to population aged 15 and over. This survey found that 4.5% of Ontario respondents met all of the criteria for major depressive disorder in their lifetime (95% CI 4.0, 5.0; (females=5.6%; males=3.3%).
• Caution is recommended when comparing depression data from NPHS/CCHS with the Mental Health and Well-being Survey. The depression data reported from NPHS/CCHS are referring to the “risk of depression” derived from a set of questions on mental health that involves thoughts and feelings about various subjects.
• Based on the 2000/01 CCHS (Cycle 1.1) Share File, the prevalence of depression was 7.1% in Ontario.

• None

References

1. Public Health Agency of Canada. A Report on Mental Illnesses in Canada. Ottawa, Canada. URL: http://www.phac-aspc.gc.ca/publicat/miic-mmac/pref_e.html
2. Statistics Canada. Psychological health - depression. Health Rep 1999;11(3):63-75.
3. Wang J, Langille DB, Patten SB. Mental health services received by depressed persons who visited general practitioners and family doctors. Psychiatr Serv 2003; 54(6): 878-883
4. Statistics Canada, The Daily, catalogue 11-001-XIE, September 3, 2002:2-4.
5. Lefebvre A, Lesage A, Cyr M, Toupin, J, Fournier L. Factors related to utilization of services for mental health reasons in Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 1998;33:291-298.
6. Tranter R, O’Donovan C, Chandarana P, Kennedy S. Prevalence and outcome of partial remission in depression. J Psychiatry Neurosci 2002;27(4):241-7.
7. Judd LJ, Paulus MJ, Schettler PJ, Akiskal HS, Endicott J, Leon AC, Maser JD et al. Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness. Am J Psychiatry 2000;157(9)1501-1503.
8. Composite International Diagnostic Interview (CIDI). URL: http://www.crufad.unsw.edu.au/cidi/cidi.htm
9. Canadian Community Health Survey, Cycle 1.2 “Mental Health and Well-Being”. http://www.statcan.ca/english/freepub/82-617-XIE/

1. Beaudet M. Depression. Health Rep 1996;7(4):11-22.
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3. Offord DR, Boyle MH, Campbell C, Goering P, Lin E, Wong M, Racine YA. One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age. Can J Psychiatry 1996;41:559-563.
4. 4. Stephens T, Dulberg C, Joubert N. Mental health of the Canadian population: a comprehensive analysis. Chronic Dis Can 1999;20(3):118-126.
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6. Patten SB. Long-term medical conditions and major depression in the Canadian population. Can J Psychiatry 1999;44:151-157.
7. Patten SB. Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2. J Affect Disord 2001;63;35-41.
8. Patten S. Progress against major depression in Canada. Can J Psychiatry 2002;47(8):775-780.
9. Patten S. The duration of major depressive episodes in the Canadian general population. Chron Dis in Can 2001;22(1).
10. Bland RC. Epidemiology of affective disorders. Can J Psychiatry 1997;42:367-377.
11. De Marco RR. The epidemiology of major depression: Implications of occurrence, recurrence, and stress in a Canadian community sample. Can J Psychiatry 2000;45:67-74.
12. Wade TJ, Cairney J. Age and depression in a nationally representative sample of Canadians: a preliminary look at the National Population Health Survey. CJPH 1997;88(5):297-302.
13. Wade TJ, Cairney J. The effect of sociodemographics, social stressors, health status and psychosocial resources on the age-depression relationship. CJPH 2000; 91(4); 307-312.
14. Parikh SV, Wasylenki D, Goering P, Wong J. Mood Disorders: rural/urban differences in prevalence, health care utilization, and disability in Ontario. J Affect Disord 1996; 38: 57-65.
15. Lin E, Goering P, Chan B. OHIP Utilization, Mental Health: Levels of Need and Variations in Service Use in Ontario. In Goel V, Williams JI, Anderson GM, Blackstien-Hirsch P, Fooks C, Naylor CD (eds.). Patterns of Health Care in Ontario. The ICES Practice Atlas. 2nd edition (Ottawa: Canadian Medical Association, 1996) 271-274.
16. Rhodes AE, Fung K. Self-Reported Use of Mental Health Services vs. Administrative Records: Care to Recall? In Press- Int J Methods Psychiatr Res 2004 13(3):165-175.
17. Rhodes AE, Lin E, Mustard CA. Self-Reported Use of Mental Health Services vs. Administrative Records: Should We Care? Int J Methods Psychiatr Res 2002. 11(3);125-133.
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19. Northern Health Information Partnership. Mental Health in Northern Ontario. Short Report #5, January 2005. URL: http://www.apheo.ca/resources/indicators/MentalHealthinNorthernOntario.pdf
20. Hay C. The Geographic Variation of Depression and Health Service Utilization in Ontario: Administrative Data Analysis. Central East Health Information Partnership, July 2004. URL: http://www.apheo.ca/resources/indicators/GeographicalVariationofDepression.pdf

Date of Last Revision:May 31, 2005.