The Canadian Community Health Survey (CCHS) - Cycle 1.2 >

Complementary information for the release of the Canadian Forces Supplement (September 2003)

Objectives
Content
Methodology
Definitions

Objectives

The major objectives of the Canadian Forces (CF) Supplement were analogous to those of the second cycle of the Canadian Community Health Survey -- to determine prevalence rates of selected mental disorders, to assess the burden these illnesses create, and to assess the utilization of mental health services with respect to perceived needs.

For the purpose of developing the CCHS 1.2 and Supplement questionnaires, mental health was defined as the balance in all aspects of an individual’s life – including the social, physical, spiritual, economic, and mental aspects. With the support of an expert group and various consultations, Statistics Canada developed this first ever national survey on mental health in response to important data gaps from a research, consumer and policy perspective.

Content

The content for Cycle 1.2 and the CF Component is partly based on a selection of mental disorders from the WMH-CIDI (World Mental Health – Composite International Diagnostic Interview Instrument). The WMH-CIDI is a lay-administered psychiatric interview that generates a profile of those with a disorder according to the definitions of the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition (DSM-IV), an international classification system.

The selection of mental disorders and problems was based on a set of criteria. The disorder or problem needed to be common to the Canadian population and, or CF and have a 12-month prevalence of at least 1%, be measurable through the use of an already-tested and validated instrument, and amenable to intervention. The impact of the selected instruments on response burden (interview length, clarity of concepts and questions) was also considered during the survey development. Though most modules were common to both surveys, some were unique to each. For example, the Supplement contained modules relating to Post-traumatic Stress Disorder (PTSD) and Generalized Anxiety Disorder (GAD) while the CCHS 1.2 did not. Conversely, the CCHS 1.2 contained modules relating to Agoraphobia and Manic episode (mania) while the Supplement did not.

Top of Page

For each measured mental disorder, questions were asked about feelings, symptoms, and their relative frequency, severity, intensity, and impact in daily life. A similar approach was used to profile problems related to alcohol dependence.

The Supplement also collected information on well-being and correlates of mental health such as number of years of service in the CF, number of deployments, time between deployments, spirituality, use of health care resources, and medication use. Socio-demographic information was collected, including age, income, education and family composition.

Methodology

The target population for the Supplement was all full time Regular members of the Canadian Forces, and Reservists who had paraded at least once in the past six months prior to survey commencement. In order to improve the efficiency of the survey design, each target population (Regular Force members and Reservists) was stratified by gender and rank.

Data collection took place monthly between May and December 2002. Those durations allowed for spreading the workload in the field and more time in which to contact respondents who might be departing or returning from field deployments and or training courses. The vast majority of Supplement interviews were conducted face-to-face during working hours in private on-base rooms, reserved by DND for survey interviewing. The computer-assisted interviewing method was used. A total of 5,155 Regular Force members were interviewed, yielding a response rate of 79.5%. For the Reserve Force the analogous numbers were 3,286 members interviewed and a response rate of 83.5%.

Definitions

Measured mental disorders within the 12-month period prior to the survey

Major depressive episode — at least one episode of 2 weeks or more with persistent depressed mood and loss of interest or pleasure in normal activities, accompanied by problems such as decreased energy, changes in sleep and appetite, impaired concentration, and feelings of guilt, hopelessness, or suicidal thoughts.

Social phobia — persistent, irrational fear of social or performance situations in which the person may be closely watched and judged by others, as in public speaking, eating, or working. The fear is recognised by the person as excessive or unreasonable. The avoidance, anxious anticipation, or distress in these feared situation(s) interferes significantly with the person’s everyday activities.

Top of Page

Post-traumatic stress disorder (PTSD) — can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults. People who suffer from PTSD often relive the experience through recurrent and intrusive distressing recollections of the event, such as images, thoughts, perceptions, dreams, or flashbacks. There is intense psychological distress associated with internal or external cues that resemble aspects of the traumatic event. Persistent avoidance of stimuli associated with the trauma and numbing in response to the stimuli is also observed. The disturbance can be severe enough and last long enough (at least 1 month) to significantly impair the person’s daily life.

Panic disorder — repeated and unexpected attacks of intense fear and anxiety where at least one of the attacks has been followed by 1 month or more of persistent concern or worry about having another attack or its physiological manifestations such as palpitations, chest pain, smothering or choking, dizziness, sweating, nausea or abdominal distress, trembling, and hot flushes or chills.

General anxiety disorder (GAD) — is associated with a pattern of frequent, persistent worry and anxiety about several events or activities during at least a 6-month period. This anxiety or worry is associated with 3 or more symptoms such as: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, shakiness, headaches, sleep disturbance, excessive sweating, palpitations, shortness of breath, and various gastrointestinal symptoms. The anxiety, worry, or physical symptoms associated with the anxiety or worry cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Classification as alcohol dependent — based on sets of questions which examine aspects of tolerance, withdrawal, loss of control, and social or physical problems related to alcohol in daily life. The information collected on alcohol dependence provides a profile of behaviours of alcohol use which leads to clinically significant impairment or distress.

Any mental disorder or alcohol dependence

Respondents were classified as having “Any mental disorder or alcohol dependence” if the pattern of answers met the criteria for at least one of the measured mental disorders or alcohol dependence covered in the survey (i.e. major depressive disorder, social anxiety disorder, PTSD, panic disorder, GAD, or alcohol dependence)

Kinds of help for problems with emotions, mental health or use of alcohol and drugs asked about in Supplement

The following kinds of help were asked about in the Supplement: information about mental health problems, its treatments or available services; medication; counselling or therapy; help for financial or housing problems; help for problems with personal relationships; help for employment status or work situation; other (specified by respondent). The Supplement did not attempt to link types of help received or not received and needed with specific disorders.