Inequalities in Mental Health Across Urban Canada

Abstract

Introduction There is a plethora of research describing the inverse relationship between socioeconomic status, a social determinant of health, and an individual’s health status. Inequalities, such as the discrepancy in health status by income, are harmful to a society’s well being, socially, physically and economically. Mental health disorders are widely prevalent across Canada but are not well documented in terms of the social determinants of health or in terms of health inequalities. This thesis aims to increase knowledge pertaining to the presence of mental health inequalities in urban Canadian cities, as well as how the social determinants of health impact mental health outcomes.

Methods This thesis was conducted in two parts: The first part utilized fifteen years (2001-2015) of the Canadian Community Health Survey and three iterations of the Canadian Census of Population. Relative, absolute and overall mental health inequalities were calculated at the city, provincial and national level using self-reported mental health outcomes (Mood Disorder, Anxiety Disorder, Life Stress, and Poor Mental Health). Comparisons were made of prevalence rates and measures of inequality between cities and provinces, and over time. The second study used the 2012 mental health component of the Canadian Community Health Survey. Fifteen variables describing various social determinants of health were individually fitted into simple logistic regression models, then together in multiple logistic regression models predicting the odds of having a Mood Disorder, Anxiety Disorder, Substance Use Disorder and Any Mental or Substance Disorder.

Results At the national level, the prevalence of Poor Mental Health, Mood Disorders and Anxiety Disorders had significantly increased over time. Inequalities were present in all levels of geographies and were maintained or worsened over time. Prevalence rates and inequalities for Poor Mental Health, Mood Disorders and Anxiety Disorders were city dependent. They were more consistent when comparing cities of similar population than geographical proximity and no city could report a lack of inequality or constantly reported the highest level of inequalities. Demographics, socioeconomic status, culture, mental health status, home life, and other categories were significant when added to the simple logistic regression models. The adjusted odds ratios differed in magnitude and direction by mental health outcome when added to the multiple logistic regression models. Together these results point towards a need for increased city and social determinant specific data surrounding mental health in urban Canada.