Component of Statistics Canada Catalogue no. 82-003-X Health Reports Article Validation of self-rated mental health by Farah N. Mawani and Heather Gilmour July 2010 Statistics Canada, Catalogue no. 82-003-XPE • Health Reports, Vol. 21, no. 3, September 2010 1 Validation of self-rated mental health • Research article Validation of self-rated mental health by Farah N. Mawani and Heather Gilmour Abstract tudies of the extent to which the widely used Background measure, self-rated health, captures mental This article assesses the association between S self-rated mental health and selected World 1-3 Mental Health-Composite International Diagnostic health suggest the need for a specifi c self-rated Interview (WMH-CIDI)-measured disorders, self-reported diagnoses of mental disorders, and mental health (SRMH) measure. In fact, a number psychological distress in the Canadian population. Data and methods of surveys in Canada and worldwide have used such Data are from the 2002 Canadian Community Health Survey: Mental Health and Well-being. Weighted frequencies and cross-tabulations were a measure: for example, the Ontario Health Survey: used to estimate the prevalence of each mental morbidity measure and self-rated mental health by Mental Health Supplement; the Canadian Community selected characteristics. Mean self-rated mental health scores were calculated for each mental morbidity measure. The association between Health Survey; and the World Mental Health self-rated mental health and each mental morbidity measure was analysed with logistic regression Initiative Surveys in 28 countries. models. Results In 2002, an estimated 1.7 million Canadians aged 15 or older (7%) rated their mental health as fair or poor. Respondents classifi ed with mental morbidity consistently reported lower mean self- Recent research has demonstrated Data and methods rated mental health (SRMH) and had signifi cantly associations between SRMH and social higher odds of reporting fair/poor mental health 4 Data source than did those not classifi ed with mental morbidity. class, family support and family cultural Gradients in mean SRMH scores and odds of confl ict,5 community belonging,6 service This analysis is based on data from the reporting fair/poor mental health by recency of 7-11 WMH-CIDI-measured mental disorders were use, continuation of antidepressant 2002 Canadian Community Health apparent. A sizeable percentage of respondents therapy,12 and distress, activity restriction Survey cycle 1.2: Mental Health and classifi ed as having a mental morbidity did not and social role functioning.13 However, Well-being, which began in May 2002 perceive their mental health as fair/poor. relatively little is known about what and was conducted over eight months. It Interpretation Although self-rated mental health is not a SRMH actually represents and how is the only Statistics Canada population substitute for specifi c mental health measures it well it measures current mental health survey that includes both self-rated is potentially useful for monitoring general mental health. status and predicts future mental health mental health and several specifi c status.13 Only one study13 has examined and non-specifi c measures of mental Keywords cross-sectional associations between morbidity. It covered people aged 15 or agoraphobia, bipolar disorder, depression, panic disorder, social phobia, perceived mental health, SRMH and a range of validated mental older living in private dwellings in the population health surveys health measures. The study found that 10 provinces. Residents of institutions, Authors SRMH was correlated more strongly Indian reserves, certain remote areas Farah N. Mawani (613-682-1862; with self-rated general health than with and the three territories, and full-time [email protected]) is with the the mental health measures that were members of the Canadian Forces were Mental Health Commission of Canada, Ottawa, Ontario, K1Z 7K4. Heather Gilmour (613-951- examined. The current study evaluates excluded. 2114; [email protected]) is with the associations between SRMH and a wider The sample was selected using the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6. range of mental health measures and uses area frame for the Labour Force Survey. different analytic techniques than the A multi-stage stratifi ed cluster design aforementioned study. was used to sample dwellings within 2 Health Reports, Vol. 21, no. 3, September 2010 • Statistics Canada, Catalogue no. 82-003-XPE Validation of self-rated mental health • Research article this area frame. One person aged 15 or Defi nitions interviewers. In this analysis, four older was randomly selected from each categories were created for each disorder sampled household. Respondents were Self-rated mental health to identify respondents who met the chosen to overrepresent young people Self-rated mental health was measured criteria for the disorder in the past month, (15 to 24) and seniors (65 or older), by asking respondents, “In general, in the past 2 to 12 months, in their lifetime thereby ensuring adequate sample sizes would you say your mental health is: but not in the past 12 months, or never. for these age groups. More detailed excellent? very good? good? fair? poor?” Respondents who met the criteria descriptions of the design, sample and The responses were dichotomized: fair/ for lifetime major depressive episode interview procedures can be found in poor and good/very good/excellent. reported: other reports and on Statistics Canada’s To calculate mean self-rated mental 1. two or more weeks of depressed mood website.14,15 health scores, responses were assigned or loss of interest or pleasure and at All interviews were conducted using a numerical value, with higher scores least fi ve symptoms associated with a computer-assisted application. Most indicating better mental health: 5 depression, which represent a change interviews (86%) were conducted in (excellent); 4 (very good); 3 (good); 2 in functioning; person; the remainder, by telephone. (fair); and 1 (poor). 2. that symptoms cause clinically Proxy responses were not accepted. The signifi cant distress or impairment in responding sample comprised 36,984 Mental morbidity measures social, occupational or other important persons aged 15 or older, for a response In this study, “mental morbidity areas of functioning; and rate of 77%. measures” refers collectively to three 3. that symptoms are not better accounted types of measures: World Mental for by bereavement, or symptoms last Analytical techniques Health version of the Composite more than two months, or symptoms Cross-tabulations were used to estimate International Diagnostic Interview are characterized by marked the prevalence of and characteristics (WMH-CIDI)-measured disorders (one- functional impairment, preoccupation associated with each mental morbidity month, 2- to 12-month or lifetime); with worthlessness, suicidal ideation, and with levels of SRMH. self-reported disorders that had been or psychomotor retardation. Mean SRMH scores were calculated diagnosed by a health professional; and Respondents who met the criteria for for respondents with each mental non-specifi c psychological distress. major depressive episode in the month morbidity. Signifi cant differences The mental morbidities examined are: or 2 to 12 months before the interview in mean scores between respondents depression, bipolar I, panic disorder and reported: with and without each morbidity were social phobia; self-reports of a diagnosis 1. meeting the criteria for lifetime major examined. by a health professional of dysthymia, depressive episode; Unadjusted logistic regression models psychosis, schizophrenia and obsessive- 2. having a major depressive episode in were used to assess the association compulsive disorder; and the K6 measure the month or 2 to 12 months before the between each mental morbidity and of psychological distress (defi ned on next interview; and SRMH. For each morbidity, multivariate page). 3. clinically signifi cant distress or logistic regression models that controlled Respondents were classifi ed with impairment in social, occupational or for sex, age, marital status, education, mental morbidity if they met the criteria other important areas of functioning. household income, immigrant status for at least one WMH-CIDI-measured In this analysis, depression excludes and the presence of chronic physical disorder; self-reported a diagnosis of at respondents who also met the criteria for conditions were also used. Proportional least one mental disorder; and/or were lifetime manic episode. odds models were not used because the classifi ed as having high or moderate For bipolar I, respondents who met proportional odds assumption is not met. distress. the criteria for a lifetime manic episode All estimates and analyses were based reported: on weighted data that refl ect the age WMH-CIDI-measured disorders 1. a distinct period of abnormally and and sex distribution of the household The Canadian Community Health Survey persistently elevated, expansive or population aged 15 or older in the 10 measured several mental disorders using irritable mood lasting at least one provinces in 2002. To account for the WMH-CIDI, an instrument based week; survey design effects, standard errors and on defi nitions in the Diagnostic and 2. three or more of seven symptoms (or coeffi cients of variation were estimated Statistical Manual of Mental Disorders, four or more if mood is only irritable) with the bootstrap technique.16-18