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Mental Health and Addictions Epidemiological & Demographic Analysis PDF

168 Pages·2011·4.77 MB·English
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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 iv Mental Health and Addictions Epidemiological & Demographic Analysis 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 vi Mental Health and Addictions Epidemiological & Demographic Analysis 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 viii Mental Health and Addictions Epidemiological & Demographic Analysis 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

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monitoring mental health and addictions in Nova Scotia, and reviews These data are supplemented with a review of previous studies of mental health and and Drug Use Monitoring Survey (CADUMS), was designed by Health.
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