Mental Health and Addictions Epidemiological & Demographic Analysis

168 Pages·2011·4.77 MB·English

Mental Health and

Addictions
Epidemiological &
Demographic Analysis
Report prepared by:
Mark Asbridge, PhD
Chris Pauley, MASc
Donald Langille, MD, MHSc
Steve Kisely, MD, PhD
Alyce Whipp, MSc

Dalhousie University, Department of Community Health and Epidemiology
September, 2011

i Mental Health and Addictions Epidemiological & Demographic Analysis
BRIEF INTRODUCTION TO THIS DOCUMENT
This document is the result of a Nova Scotia Health Research Foundation request for proposals
(RFP) to complete a synthesis and epidemiological analysis of the mental health and addictions
populations in Nova Scotia.1 To this end, the RFP calls for a synthesis of available data on
mental health and addictions populations, and the analysis of the utility, strengths and
weakness of this data, both in general, and as it pertains to the development of a mental health
and addictions strategy for monitoring and evaluating the mental health and addictions system.
That RFP emerged from the March 2010 throne speech where the Nova Scotia government
committed to developing an evidence-based Mental Health and Addictions Strategy for the
province, and from a recommendation from the office of the Auditor General. It also builds on
the “Current State of Mental Health and Addictions Services in Nova Scotia” document released
in April 2011.
The report is divided into two broad sections. The first addresses the epidemiology of mental
health and addictions, and the second provides an overview of the state of data available for
monitoring mental health and addictions in Nova Scotia, and reviews surveillance systems and
the role of case registries.
For the first section, we provide an in-depth review of mental health and addictions conditions
currently being experienced by Nova Scotians of all ages, across regions and social
circumstances. The report draws on a range of data sources, from routinely collected
administrative data, such as physician billing data, to epidemiologic population level survey
data. These data are supplemented with a review of previous studies of mental health and
addictions in Nova Scotia, as well as regional, provincial, and federal reports from governmental
departments and non-governmental organizations.
Despite our best efforts, this report provides only limited information on the mental health and
addictions conditions being experienced by particular Nova Scotia populations. Limited data
were available on the Aboriginal population, for Francophones and for African Nova Scotians,
and no data were available on homeless populations. Surveys of Nova Scotians carried out by
Statistics Canada typically do not include large enough samples to make inferences about
smaller sub-populations, though purchasing an oversample of these populations in the future on
routine repeated national surveys would help to address this issue. Some data will be available
shortly on the Unama’ki communities of northern Nova Scotia, but was not ready in time to
include in this report. We will send this information along as it becomes available.
Similarly, only limited data were available on concurrent disorders. Measurement of concurrent
disorders is a complex issue and, even employing a broad-based definition whereby concurrent

1 The original RFP also called for the identification of current services in place in Nova Scotia to address
the mental health and addiction treatment needs of the population. This objective was moved to the sister
report: “National Jurisdictional Review of Mental Health and Addiction Service Delivery Models.”
ii Mental Health and Addictions Epidemiological & Demographic Analysis
disorders were defined as experiencing two or more conditions in a 12-month period; few
individuals reported experiencing multiple conditions. This is due, in part, to the rarity of certain
conditions seen in population-level surveys using random samples, and the small samples that
restrict reporting of these rare conditions. As you will note, many tables include empty cells as
counts are too small to report (as per Statistics Canada/PHRU policy).
The documents will, despite these limitations, help the Advisory Committee responsible for
overseeing the Mental Health and Addictions Strategy for Nova Scotia to understand the
prevalence, ten-year incidence, distribution, and determinants of mental health and addictions
conditions in Nova Scotia.
Of particular importance, the second, third and fourth sections of this report provide an
extensive review of the state of mental health and addictions data in the province, data used to
inform, monitor, and evaluate the mental health and addictions systems in Nova Scotia. We
discuss what data is currently available as well as gaps and limitations, and offer suggestions
for improving mental health and addictions monitoring and surveillance, describe the role of
case registers, and outline ways to improve the overall provincial information system. Strong
data and information systems are essential to monitoring and improving the overall health of the
population, as is assuring that the requisite psychiatric epidemiological expertise is made
available. This information will be invaluable in identifying problems and problem areas, and in
informing the development of approaches to address these concerns and to monitor progress
as the Nova Scotia Mental Health Strategy develops.
Work was begun on the review in May 2011 by a research team from the Department of
Community Health and Epidemiology at Dalhousie University. By the end of July, progress was
sufficient to allow the sharing of the approach taken and some preliminary results with the
Advisory Committee. Feedback from that meeting was very positive and the work was continued
as outlined. A penultimate draft of the document was ready by mid-August and the final
document was delivered in electronic format on September 2nd. It is our sincere hope that this
work contributes significantly to the Advisory committee’s capacity to carry out its important
mandate.

iii Mental Health and Addictions Epidemiological & Demographic Analysis
TABLE OF CONTENTS
BRIEF INTRODUCTION TO THIS DOCUMENT II

GLOSSARY VII

INDEX OF TABLES IX

TABLE OF FIGURES AND MAPS XIII
SECTION 1: THE EPIDEMIOLOGY OF MENTAL HEALTH AND ADDICTIONS IN NOVA
SCOTIA 1
METHODOLOGY FOR EPIDEMIOLOGICAL STUDY 1
REPORTED INCIDENCE OF DIAGNOSED/TREATED MENTAL DISORDERS 1
ANNUAL DIAGNOSED/TREATED PREVALENCE RATES FOR MENTAL HEALTH AND ADDICTIONS
CONDITIONS 2
SELF-REPORTED PREVALENCE OF MENTAL DISORDERS AND ADDICTIONS 3
KEY DETERMINANTS OF MENTAL HEALTH AND ADDICTIONS 4
INCIDENCE, PREVALENCE AND KEY DETERMINANTS OF CONCURRENT DISORDERS 4

EPIDEMIOLOGICAL FINDINGS 5

SUBSTANCE USE CONSUMPTION AND DISORDERS 7
ALCOHOL CONSUMPTION AND DISORDERS 7
Incidence and Prevalence 7
Key determinants 8
Costs and Consequences 10
TOBACCO AND SMOKING 12
Incidence and prevalence 12
Key determinants 12
Treatment 13
Costs and Consequences 13
CANNABIS AND OTHER DRUG USE 14
Incidence and prevalence 14
Key determinants 14
Treatment 15
Costs and Consequences 17
GAMBLING 18
Incidence and prevalence 18
Key determinants 18
Treatment 19
Costs and Consequences 19
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MENTAL HEALTH: DIAGNOSED/TREATED AND SELF-REPORTED CONDITIONS 20
MENTAL HEALTH: GENERAL OVERALL MENTAL HEALTH 21
Incidence and Prevalence 21
Key Determinants 22
Treatment 22
Cost and Consequences 22
SPECIFIC MENTAL HEALTH CONDITIONS: DIAGNOSED/TREATED AND SELF-REPORT 23
Incidence/Prevalence 23
Key Determinants 26
Treatment 27
Costs and Consequences 27
INCIDENCE AND PREVALENCE OF CONCURRENT DISORDERS IN NOVA SCOTIA 28

TABLES 29

MAPS 92
SECTION 2: REPORT ON THE STATE OF DATA 107
OVERVIEW OF NOVA SCOTIA DATA ON MENTAL HEALTH AND ADDICTIONS 107
WHAT DATA ARE CURRENTLY BEING COLLECTED ON INDICATORS OF MENTAL HEALTH AND ADDICTIONS
IN NOVA SCOTIA? 107
Administrative health and health service use data 107
Population epidemiologic health survey data 117
WHAT GAPS (UNMET NEED) EXIST BETWEEN NEED FOR SERVICES, SERVICE ACCESS, AND SERVICE
DELIVERY? 118
WHAT IS THE ADEQUACY OF CURRENT DATA FOR INFORMING DECISION MAKING AND POLICY
DEVELOPMENT AROUND MENTAL HEALTH AND ADDICTIONS? 119
WHAT ARE SOME OF THE LIMITATIONS OF CURRENTLY AVAILABLE DATA IN TERMS OF HOW THEY ARE
COLLECTED AND MAINTAINED? 121
WHAT ADDITIONAL GAPS IN DATA COVERAGE EXIST? 123
OPPORTUNITIES TO IMPROVE DATA COLLECTION AND USE 126
SUMMARY 132

APPROACHES TO ADDICTIONS AND MENTAL HEALTH SURVEILLANCE 133
ADMINISTRATIVE HEALTH DATA 134
Primary care research networks in the UK 135
Serial survey data 137
Pharmaco-surveillance 137
INTERNATIONAL EXAMPLES OF THE USE OF ADMINISTRATIVE DATA 140
Australia 141
United Kingdom 145
LIMITATIONS 149

v Mental Health and Addictions Epidemiological & Demographic Analysis
CASE REGISTERS FOR MENTAL HEALTH AND ADDICTION 150
INTRODUCTION 150
TYPES OF CASE REGISTERS 151
APPLICATIONS OF CASE REGISTERS 153
LIMITATIONS 153
THE FUTURE 154

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GLOSSARY
ASDUS - Atlantic Student Drug Use Survey (Addictions Services, Nova Scotia Department of
Health and Wellness)
ASSIST - Alcohol, Smoking and Substance Involvement Screening Test developed by the
World Health Organization
AUDIT – Alcohol Use Disorders Identification Test
BAC – Blood Alcohol Content
CADUMS – Canadian Alcohol and Drug Use Monitoring Survey
CCHS – Canadian Community Health Survey
CDHA – Capital District Health Authority (Halifax, Nova Scotia DHA)
CIHI – Canadian Institutes of Health Information
DAD – Discharge Abstract Database at the Canadian Institutes of Health Information
DHA – Nova Scotia District Health Authority
DHA 1 –South Shore Health
DHA 2 –South West Health
DHA 3 – Annapolis Valley Health
DHA 4 – Colchester East Hants Health Authority
DHA 5 – Cumberland Health Authority
DHA 6 – Pictou County Health Authority
DHA 7 – Guysborough Antigonish Strait Health Authority
DHA 8 – Cape Breton Health Authority
DHA 9 – Capital District Health Authority
DSM-IV - Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
ICD-9 - International Statistical Classification of Diseases and Related Health Problems, 9th
Edition
ICD-10 - International Statistical Classification of Diseases and Related Health Problems, 10th
Edition
vii Mental Health and Addictions Epidemiological & Demographic Analysis
IWM – Inpatient Withdrawal Management
MHOIS - Mental Health Outpatient Information System, housed at PHRU until 2006
MSI – Nova Scotia Medical Services Insurance
PHRU – Population Health Research Unit, Dalhousie University

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INDEX OF TABLES
TABLE 1: TEN-YEAR CUMULATIVE INCIDENCE OF ALCOHOL AND DRUG DISORDERS AMONG NOVA
SCOTIA ADULTS (BY DHA AND GENDER) BASED ON ICD-9/ICD-10 CODES DRAWN FROM PHRU
DATABASES (NUMBER OF CASES, AGE ADJUSTED RATE PER 100, AND 95% CONFIDENCE
INTERVAL) ............................................................................................................................29
TABLE 2: PREVALENCE OF MENTAL HEALTH, SUBSTANCE USE AND RELATED CONDITIONS AMONG
NOVA SCOTIA AND CANADIAN ADULTS AGE 15 AND OLDER, FROM THE 2002 CANADIAN
COMMUNITY HEALTH SURVEY (PERCENT AND 95% CONFIDENCE INTERVALS) ..........................30
TABLE 3: DESCRIPTIVE STATISTICS FOR ADULTS (15 AND OLDER) DRAWN FROM THE 2009 CANADIAN
ALCOHOL AND DRUG USE MONITORING SURVEY (NOVA SCOTIA UNWEIGHTED SAMPLE N=1008)
...........................................................................................................................................31
TABLE 4: ALCOHOL CONSUMPTION INDICATORS FOR ADULTS (15 AND OLDER) DRAWN FROM THE 2009
CANADIAN ALCOHOL AND DRUG USE MONITORING SURVEY (NOVA SCOTIA UNWEIGHTED SAMPLE
N=1008) .............................................................................................................................33
TABLE 5: PREVALENCE, DISTRIBUTION, AND DETERMINANTS OF DRINKING STATUS AMONG NOVA
SCOTIA ADULTS (15 AND OLDER) DRAWN FROM THE 2010 CANADIAN COMMUNITY HEALTH
SURVEY (WEIGHTED PERCENT AND 95% CONFIDENCE INTERVALS) ..........................................34
TABLE 6: PREVALENCE, DISTRIBUTION, AND DETERMINANTS OF BINGE DRINKING AMONG NOVA
SCOTIA ADULTS (15 AND OLDER) DRAWN FROM THE 2010 CANADIAN COMMUNITY HEALTH
SURVEY (WEIGHTED PERCENT AND 95% CONFIDENCE INTERVALS) ..........................................36
TABLE 7: ALCOHOL AND TOBACCO CONSUMPTION INDICATORS FOR NOVA SCOTIA STUDENTS
(GRADES 7, 9, 10, AND 12) DRAWN FROM THE 2007 STUDENT DRUG USE SURVEY IN THE
ATLANTIC PROVINCES (N, PERCENT AND 95% CONFIDENCE INTERVALS) ..................................38
TABLE 8: DRINKING PATTERNS BY SOCIAL DETERMINANTS FOR NOVA SCOTIA ADULTS (15 AND
OLDER) DRAWN FROM THE 2009 CANADIAN ALCOHOL AND DRUG USE MONITORING SURVEY
(WEIGHTED PERCENT AND 95% CONFIDENCE INTERVALS) .......................................................39
TABLE 9: ALCOHOL USE MEASURES BY SOCIAL DETERMINANTS FOR NOVA SCOTIA ADULTS (15 AND
OLDER) DRAWN FROM THE 2009 CANADIAN ALCOHOL AND DRUG USE MONITORING SURVEY
(WEIGHTED PERCENT AND 95% CONFIDENCE INTERVALS) .......................................................41
TABLE 10: ALCOHOL USE INDICATORS BY SOCIAL DETERMINANTS FOR NOVA SCOTIA STUDENTS
(GRADES 7, 9, 10, AND 12) DRAWN FROM THE 2007 STUDENT DRUG USE SURVEY IN THE
ATLANTIC PROVINCES (WEIGHTED PERCENT AND 95% CONFIDENCE INTERVALS) ......................43
TABLE 11: DRUG AND TOBACCO USE INDICATORS FOR ADULTS (15 AND OLDER) DRAWN FROM THE
2009 CANADIAN ALCOHOL AND DRUG USE MONITORING SURVEY (NOVA SCOTIA UNWEIGHTED
SAMPLE N=1008) .................................................................................................................45
TABLE 12: PREVALENCE, DISTRIBUTION, AND DETERMINANTS OF SMOKING STATUS AMONG NOVA
SCOTIA ADULTS (15 AND OLDER) DRAWN FROM THE 2010 CANADIAN COMMUNITY HEALTH
SURVEY (WEIGHTED PERCENT AND 95% CONFIDENCE INTERVALS) ..........................................46
TABLE 13: PREVALENCE AND DISTRIBUTION OF SECOND-HAND SMOKE EXPOSURE AMONG NOVA
SCOTIA ADULTS (15 AND OLDER) DRAWN FROM THE 2010 CANADIAN COMMUNITY HEALTH
SURVEY (WEIGHTED PERCENT AND 95% CONFIDENCE INTERVALS) ..........................................48
ix Mental Health and Addictions Epidemiological & Demographic Analysis