Abstract
Background
Canada and Australia although geographically distant have similarities in human geography and history. Each has had a national mental health policy for some years, but Australia has driven policy implementation in this area harder than has Canada. Comparable epidemiological surveys from Australia in 1997 and Canada in 2002 allow us to explore relative rates of mental disorders and compare estimates of access to care from mental health services.
Methods
We compare findings from the Australian National Survey of Mental Health and Wellbeing (1997) with those from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (2002).
Results
Differences in prevalence rates and in service utilisation emerge between the two countries: Anxiety Disorders are estimated as almost 2% higher in Canada than in Australia while there is suggestion that Major Depressive Disorder, Alcohol Dependence and Drug Dependence may be more prevalent in Australia. More of the people with co-morbid disorders in Australia than in Canada make use of mental health services and a finding of marginal significance suggests that this may be true across all disorders.
Conclusions
Causation cannot be determined from this study but possible explanations for differences in prevalence include changes in global economic, political and security contexts and concerns between 1997 and 2002 and the possible role of greater availability of alcohol in Australia. The findings also provide encouragement that strenuously implementing a national mental health policy may have been of benefit to people with mental health problems in Australia.
Similar content being viewed by others
References
Alegria M, Kessler RC, Bijl R, Lin E, Heeringa SG, et al (2000) Comparing data on mental health service use between countries. In: Andrews G, Henderson S (eds) Unmet need in psychiatry. Cambridge University Press, Cambridge, pp 97–118
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al (2004a) Prevalence of mental disorders in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 109(Suppl. 420):21–27
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al (2004b) Use of mental health services in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 109:47–54
Andrews G, Carter GL (2001) What people say about their general practitioners’ treatment of anxiety and depression. Med J Aust 175(Suppl):S48–S51, [see comment] [erratum appears in Med J Aust 2001 Nov 19;175(10):560]
Andrews G, Hall W, Teeson M, Henderson S (1999) The mental health of Australians, mental health branch. Commonwealth Department of Health and Aged Care, Canberra
Andrews G, Henderson S, Hall W (2001a) Prevalence, comorbidity, disability and service utilisation. Overview of the Australian national mental health survey. Br J Psychiatry 178:145–153
Andrews G, Issakidis C, Carter G (2001b) Shortfall in mental health service utilisation. Br J Psychiatry 179:417–425
Andrews G, Peters L (1998) The psychometric properties of the composite international diagnostic interview. Soc Psychiatry Psychiatr Epidemiol 33:80–88
Ash D, Benson A, Dunbar L, Fielding J, Fossey E, Grey J, et al (2007a) Mental health services in Australia. In: Meadows G, Singh B, Grigg M (eds) Mental health in Australia: collaborative community practice. Oxford, New York, pp 63–98
Ash D, Brown P, Burvill P, Davies J, Hughson B, Meadows G, et al (2007b) Mental health services in the Australian states and territories. In: Meadows G, Singh B, Grigg M (eds) Mental health in Australia: collaborative community practice. Oxford, New York, pp 99–131
Australian Bureau of Statistics (2000) The national survey of mental health and wellbeing confidential unit record file, users guide. Australian Bureau of Statistics, Canberra
Australian Bureau of Statistics (2003) National health survey: mental health, Australia, 2001. Australian Bureau of Statistics, Canberra
Australian Bureau of Statistics (2006) Information paper: use of the Kessler psychological distress scale in ABS health surveys, Australia, 2001, 4817.0.55.001. Canberra. Retrieved April 16, 2008 from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/ProductsbyCatalogue/B9ADE45ED60E0A1CCA256D2D0000A288?OpenDocument
Australian Health Ministers (1992a) National mental health plan. mental health branch. Commonwealth Department of Health and Family Services, Canberra
Australian Health Ministers (1992b) National mental health policy. mental health branch. Commonwealth Department of Health and Family Services, Canberra
Bijl RV, DeGraaf R, Hiripi E, Kessler RC, Kohn R, Offord DR, et al (2003) The prevalence of treated and untreated mental disorders in five countries. Health Aff 22:122–133
Bijl RV, Ravelli A (2000) Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands mental health survey and incidence study. Am J Public Health 90:602–607
Bland RC, Newman SC, Orn H (1997) Help-seeking for psychiatric disorders. Can J Psychiatry 42:935–942
Bromet EJ, Gluzman SF, Paniotto VI, Webb CPM, Tintle NL, Zakhozha V, et al (2005) Epidemiology of psychiatric and alcohol disorders in Ukraine. Soc Psychiatry Psychiatr Epidemiol 40:681–690
Carlin JB, Doyle LW (2001) Comparison of means and proportions using confidence intervals. J Paediatr Child Health 37:583–586
Craven MA, Bland R (2002) Shared mental health care: a bibliography and overview. Can J Psychiatry 47:iS-viiiS, 1S–103S
De Girolamo G, Bassi M (2003) Community surveys of mental disorders: recent achievements and works in progress. Curr Opin Psychiatry 16:403–411
De Girolamo G, Polidori G, Morosini P, Scarpino V, Reda V, Serra G, et al (2006) Prevalence of common mental disorders in Italy. Soc Psychiatry Psychiatr Epidemiol 41:853–861
Demyttenaere K, et al (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys. JAMA 291(21):2581–2590
First MB (2005) Mutually exclusive versus co-occurring diagnostic categories: the challenge of diagnostic comorbidity. Psychopathology 38:206–210
Goldberg DP, Huxley P (1980) Mental iilness in the community: the pathway to psychiatric care. Tavistock, London
Gossop M, Marsden J, Stewart D, Lehmann P, Edwards C, Wilson A, et al (1998) Substance use, health and social problems of service users at 54 drug treatment agencies. Intake data from the national treatment outcome research study. Br J Psychiatry 173:166–171
Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al (2004) Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 61:807–816
Gravel R, Beland Y (2005) The Canadian community health survey: mental health and well-being. Can J Psychiatry 50:573–579
Harvard School of Medicine. Department of Health Care Policy (2005). World mental health survey initiative. Retrieved December 18, 2007 from: http://www.hcp.med.harvard.edu/wmh/
Henderson S (2002) The national survey of mental health and well-being in Australia: impact on policy. Can J Psychiatry 47:819–824
Hermann R, Mattke S, OECD mental health care panel (2004) Selecting indicators for the quality of mental health care at the health care systems level in OECD countries OECD health technical papers. Organisation for Economic Co-operation and Development, Paris
Katz SJ, Kessler RC, Frank RG, Leaf P, Lin E, Edlund M (1997b) The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care. Am J Public Health 87:1136–1143
Kessler RC, Abelson J, Demler O, Escobar JI, Gibbon M, Guyer ME, et al (2004) Clinical calibration of DSM-IV diagnoses in the world mental health (WMH) version of the world health organization (WHO) composite international diagnostic interview (WMHCIDI). Int J Methods Psychiatr Res 13:122–139
Kessler RC, Andrews G, Colpe LJ, et al (2002) Short screening scales to monitor population prevalences and trends in nonspecific psychological distress. Psychol Med 32:959–976
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:617–627
Kessler RC, Little RJ, Groves RM (1995) Advances in strategies for minimizing and adjusting for survey nonresponse. Epidemiol Rev 17:192–204
Kessler RC, Ustun TB (2004) The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13:93–121
Kirby J, Keon W (2006) Out of the shadows at last. Highlights and recommendations. Ottawa: Final Report of the Standing Senate Committee on Social Affairs, Science and Technology
Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Murray RM, et al (2007) Neighbourhood variation in the incidence of psychotic disorders in Southeast London. Soc Psychiatry Psychiatr Epidemiol 42:438–445
Kringlen E, Torgersen S, Cramer V (2006) Mental illness in a rural area. Soc Psychiatry Psychiatr Epidemiol 41:713–719
Lancet Global Mental Health Group (2007) Scale up services for mental disorders: a call for action. Lancet 370(9594):1241–1252
Lefebvre J, Lesage A, Cyr M, Toupin J, Fournier L (1998) Factors related to utilisation of services for mental health reasons in Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 33:291–298
Lehtinen V, Sohlman B, Nummelin T, Salomaa M, Ayuso-Mateos JL, Dowrick C (2005) The estimated incidence of depressive disorder and its determinants in the Finnish ODIN sample. Soc Psychiatry Psychiatr Epidemiol 40:778–784
Margolese HC, Malchy L, Negrete JC, Tempier R, Gill K (2004) Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences. Schizophr Res 67:157–166
Meadows G, Burgess P, Bobevski I, Fossey E, Harvey C, Liaw ST (2002) Perceived need for mental health care: influences of diagnosis, demography and disability. Psychol Med 32:299–309
Meadows G, Fossey E, Harvey CA, Burgess P (2000a) The assessment of perceived need. In: Andrews G, Henderson S (eds) Unmet need in psychiatry, problems, resources, responses. Cambridge University Press, Cambridge, pp 390–398
Meadows G, Harvey C, Fossey E (2000b) Perceived need for mental health care, findings from the Australian national survey of mental health and well being. Psychol Med 30:645–656
Meadows G, Harvey C, Fossey E, Burgess P (2000c) Assessing perceived need for mental health care in a community survey: development of the perceived need for care questionnaire (PNCQ). Soc Psychiatry Psychiatr Epidemiol 35:427–435
Meadows G, Liaw T, Burgess P, Bobevski I, Fossey E (2001) Australian general practice and the meeting of needs for mental health care. Soc Psychiatry Psychiatr Epidemiol 36:595–603
Medina-Mora ME, Borges G, Lara C, Benjet C, Blanco J, Fleiz C, et al (2005) Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican national comorbidity survey. Psychol Med 35:1773–1783
Miranda J, Siddique J, Belin TR, Kohn-Wood LP (2005) Depression in prevalence in disadvantaged young black women. Soc Psychiatry Psychiatr Epidemiol 40:253–258
National Mental Health Strategy Evaluation Steering Committee (1997) Evaluation of the national mental health strategy. Commonwealth Department of Health and Family Services, Canberra
Oakley-Browne M, Wells J, Scott K (2006) Te Rau Hinengaro: the New Zealand mental health survey. Ministry of Health, Wellington
Ovuga E, Boardman J, Wasserman D (2005) The prevalence of depression in two districts of Uganda. Soc Psychiatry Psychiatr Epidemiol 40:439–445
Parslow RA, Jorm AF (2000) Who uses mental health services in Australia? An analysis of data from the national survey of mental health and wellbeing. Aust NZ J Psychiatry 34:997–1008
Pirkola SP, Isometsä E, Suvisaari J, Aro H, Joukamaa M, Poikolainen K, et al (2005) DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population. Soc Psychiatry Psychiatr Epidemiol 40:1–10
Rosenberg E, Lussier MT, Beaudoin C, Kirmayer LJ, Dufort GG (2002) Determinants of the diagnosis of psychological problems by primary care physicians in patients with normal GHQ-28 scores. Gen Hosp Psychiatry 24:322–327
SAS Institute Inc (2004) Base SAS 9.1 procedures guide. SAS Institute Inc, Cary
Simon GE, Goldberg DP, Von Korff M, Üstün (2002) Understanding cross-national differences in depression prevalence. Psychol Med 32:585–594
Singleton N, Bumpstead R, O’brien M (2001) Psychiatric morbidity among adults living in private households, 2000. Stationery Office, London
Statistics Canada (2004) Canadian community health survey, cycle 2.1 (2003): health services access in Canada
Thomas RV, Corney RH (1993) Working with community mental health professionals: a survey among general practitioners. Br J Gen Pract 43:417–421
Vasiliadis HM, Lesage A, Adair C, Wang PS, Kessler RC (2007) Do Canada and the United States differ in prevalence of depression and utilisation of services? Psychiatr Serv 58:63–71
Vicente B, Kohn R, Rioseco P, Saldivia S, Navarrette G, Veloso P, et al (2006) Regional differences in psychiatric disorders in Chile. Soc Psychiatry Psychiatr Epidemiol 41:935–942
Wang J, Langille DB, Patten SB (2003) Mental health services received by depressed persons who visited general practitioners and family doctors. Psychiatr Serv 54:878–883
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850
Whiteford H (2000) Introduction: the Australian mental health survey. Aust NZ J Psychiatry 34:193–196
Wittchen H-U (2000) Met and unmet need for interventions in community cases with anxiety disorder. In: Andrews G, Henderson S (eds) Unmet need in psychiatry. Cambridge University Press, Cambridge, pp 256–276
Wittchen H, Essau C (1993) An overview of the composite international diagnostic interview. Int J Methods Psychiatr Res 3:220–233
World Bank (2006) Data and statistics. country classification. Retrieved March 4, 2008 from: http://www.worldbank.org/data/countrydata/countrydata.html
World Health Organisation (1994) Composite international diagnostic interview (CIDI) researchers manual. World Health Organisation, Geneva
World Health Organisation (1997) Composite international diagnostic interview: CIDI-Auto 2.1; administrator’s guide and reference, fast books
World Health Organization (2004) Global status report on alcohol 2004. World Health Organization, Department of Mental Health and Substance Abuse, Geneva
Zimmerman M, Mcdermut W, Mattia JI (2000) Frequency of anxiety disorders in psychiatric outpatients with major depressive disorder. Am J Psychiatry 157:1337–1340
Acknowledgments
The 1997 Australian National Survey of Mental Health and Wellbeing was funded by the Commonwealth Government of Australia and conducted by the Australian Bureau of Statistics. The 2002 Canadian Community Health Survey on Mental Health and Well Being, Cycle 1.2 was funded by the Government of Canada and conducted by Statistics Canada. This research project was supported by a grant (#OPC 74353) from the Canadian Institutes for Health Research and Statistics Canada. We also want to thank Randy Duncan for his assistance with the statistical calculations.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tempier, R., Meadows, G.N., Vasiliadis, HM. et al. Mental disorders and mental health care in Canada and Australia: comparative epidemiological findings. Soc Psychiat Epidemiol 44, 63–72 (2009). https://doi.org/10.1007/s00127-008-0409-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-008-0409-y