Survey on Mental Health and Stressful Events (SMHSE), Cycle 2

Addendum to the Supplement to Statistics Canada's Generic Privacy Impact Assessment related to the Survey on Mental Health and Stressful Events, Cycle 2

Date: August 2023

Program manager: Director, Centre for Population Health Data
Director General, Health Statistics

Original Supplement to the Generic Privacy Impact Assessment:
Supplement to Statistics Canada's Generic Privacy Impact Assessment related to the Survey on Mental Health and Stressful Events (SMHSE) (statcan.gc.ca)

Reference to Personal Information Bank (PIB):

No modifications to original SPIA.

Description of changes to the statistical activity:

Statistics Canada is conducting the second cycle of the Survey on Mental Health and Stressful Events, under the authority of the Statistics ActFootnote 1, on behalf of the Public Health Agency of Canada. The first cycle collected information to better understand how stressful events can impact the mental health of Canadians, and covered mental health status and well-being, post-traumatic stress disorder (PTSD), social support and healthy behaviours, and access to and use of mental health services and supports. In addition, sociodemographic information such as age, gender, occupation, marital status, postal code, Indigenous identity, population group, immigration and citizenship, education and income were included. Email addresses were also collected from respondents who expressed interest in participating in follow-up surveys.

For the second cycle of the survey, content from cycle 1 will be repeated with new questions added to assess a wider range of potential risk factors for experiencing stressful events and to better characterize potential consequences of stressful events on mental health and participation in the labour force. This includes additional questions about disability, sex at birth, sexual orientation, long-term health conditions, suicide, characteristics of stressful events, and labour market activities. The series of questions about occupation used for the first cycle was modified to better capture current and past history with specific high-risk occupations. Email addresses will no longer be collected as part of the questionnaire for cycle 2 as no follow-up surveys are planned.

This voluntary household survey collects information from individuals aged 18 years and older who live in Canadian provinces. The same sample size and methodology used for cycle 1 of the survey (35,000 respondents) will be used for cycle 2.

Reason for addendum:

While the Supplement to the Generic Privacy Impact Assessment for the Survey on Mental Health and Stressful Events addresses the privacy and security risks for cycle 1, this addendum addresses the new collection of sensitive personal information for cycle 2.

Necessity and Proportionality

The collection and use of personal information for cycle 2 of the Survey on Mental Health and Stressful Events can be justified against Statistics Canada's Necessity and Proportionality Framework:

  1. Necessity: As with the first cycle, a quick and timely assessment of the mental health and well‐being of Canadians, including vulnerable groups, will help inform government decision‐making in order to support Canadians and their families dealing with mental health issues. In addition, the Public Health Agency of Canada (PHAC), the survey sponsor, has a reporting requirement under the Federal Framework on Post-Traumatic Stress Disorder Act, and will use the information to assess the prevalence and impacts of PTSD and other mental health conditions, as well as to inform and develop policies and programs to support the planning of mental health resources.

    The new questions in cycle 2 will be used to characterize social costsFootnote 2 associated with PTSD and vulnerable groups in which exposure to stressful life events and prevalence of PTSD may be elevated. Specifically,

    • Social costs related to labour force participation. Many people with PTSD report that their symptoms affect their ability to work or attend school, but the extent of these impacts is largely unknown; the new survey content about impacts of chronic health conditions on labour market activities aims to fill this data gap.
    • Mental health outcomes. The survey will also fill gaps in data on suicide planning and attempts; whereas the first cycle only asked questions about having seriously contemplated suicide, the second cycle will ask additional questions about having made a plan to attempt suicide and about having attempted suicide.
    • Characterizing vulnerable groups. The additional sociodemographic data collected (sex at birth, sexual orientation, disability status, long-term health conditions, occupational history) is needed for disaggregated analysis of subgroups of the affected population. Treatment of PTSD tends to be highly individualized, and many factors need to be taken into consideration for treatments to be effective. Understanding which groups or subgroups are at higher risk for PTSD will help guide decisions about where awareness and treatment programs are most needed.
    • Improved assessment of PTSD. Additional questions about the nature of specific experiences with stressful events were added to enhance the assessment of the diagnostic criteria for PTSD.

  2. Effectiveness - Working assumptions: Some groups or subgroups are more likely to experience PTSD and its mental health and social impacts than others. Disaggregating results by sex at birth and gender, sexual orientation, long-term health conditions and disability to highlight the experiences of specific subgroups can yield new insights and provide more nuanced information on vulnerable population groups for policymakers to use.

    Data on mental health and its impacts, in particular PTSD, and data on other aspects related to the access and use of mental-health resources are highly sensitive. Additional questions used to identify vulnerable groups, for example, disability status and sexual identity, are also sensitive. For these reasons, experts at Statistics Canada and PHAC have been consulted on the most effective scope and methodology of the survey; wherever possible, questions from existing surveys have been used (e.g., questions about suicide were adapted from those used on Statistics Canada's Canadian Community Health Survey Footnote 3)Footnote 4. Other questions added about stressful events, occupation and impacts on labour market activities have been carefully reviewed by experts at Statistics Canada and Public Health Agency of Canada (PHAC) and have gone through qualitative testing.

  3. Proportionality: As with the first cycle, and all surveys at Statistics Canada, all directives and policies with respect to data collection and publication will be followed to ensure the confidentiality of the data. Individual responses will be grouped with those of others when reporting results. As with all Statistics Canada statistical programs, strict disclosure controls will apply, ensuring that individual responses and results for small groups will not be published. This approach reduces any potential impact on vulnerable populations or subsets of populations, as the grouping of results will protect the confidentiality of individuals within a particular subset of the population. As permitted by the Statistics Act, with consent of individual respondents, survey responses may be shared with PHAC, Health Canada, and provincial or territorial ministries of health, and the Institut de la statistique du Québec (for Quebec residents only) strictly for statistical and research purposes, for example, to aid in future policy decisions. The findings will similarly support decision-making at all levels of government and improve knowledge and understanding of the mental health and well‐being of Canadians and will help inform government policymaking in order to support vulnerable Canadians and their families dealing with mental health issues.

    While the new questions about disability, sex at birth, sexual orientation, long-term health conditions, and occupation are sensitive, research suggests that members of these groups are more likely to experience certain types of stressful events and can also be at increased risk for mental health impacts of stressful events. These questions will be used to determine which groups have the highest needs for support and may guide program decisions related to mental illness prevention and treatment.  New questions about impacts on labour market activities and suicide are also sensitive but will provide greater insights into the effects of stressful events among those affected, potentially leading to more successful mitigations and interventions through resulting policy changes. There are no recent studies with the comprehensive combination of indicators that will be included on the second cycle questionnaire to validate or expand upon. Furthermore, the lingering impacts of the COVID-19 pandemic on mental health present a need for timely data on this topic. Therefore, this new collection of cross-sectional data on these combined indicators is needed for experts and policymakers to better understand the underlying trends and dynamics with the aim of better supporting affected individuals and communities. All new questions and response categories were also carefully considered with input from experts at Statistics Canada and PHAC to ensure they accurately capture the data needed to help inform and develop policies and programs related to mental health (including PTSD) and its impacts.

  4. Alternatives: Measures of sexual orientation, disability status, suicide planning and attempts, and work productivity are or have been included on other Statistics Canada surveys (e.g., the Canadian Community Health Survey, the Survey on COVID-19 and Mental Health). However, these surveys do not include comprehensive measures of PTSD and the associated mental health and social impacts.

    Administrative data sources for the new required information were considered, but Statistics Canada's existing and potential options do not provide the ability to identify people with diagnosed or undiagnosed PTSD.

    The possibility of using crowdsourcing or web‐panel survey methodologies was also explored. However, based on discussions between health and methodology experts within Statistics Canada and the Public Health Agency of Canada, it was determined that a cross-sectional survey with at least 35,000 units was again necessary to produce reliable and accurate results by province that meet Statistics Canada's Quality Guidelines.

    As a result, it was determined that a new survey cycle to collect this information was required.

Mitigation factors:

As with the first cycle, some questions contained in the second cycle of the Survey on Mental Health and Stressful Events are considered sensitive as they relate to an individual's mental health and well-being. The overall risk of harm to the survey respondents is deemed manageable with existing Statistics Canada safeguards that are described in Statistics Canada's Generic Privacy Impact Assessment and in the Supplement for the Survey on Mental Health and Stressful Events, including the following measures:

  • Mental-Health Resources
    As with other mental health surveys conducted by Statistics Canada, mental-health resources and contact information will be mailed to respondents along with the survey invitation and will be provided to respondents at the beginning of the survey and as a help button within the electronic questionnaire. In addition, in the case of telephone follow-up for non-response, interviewers will be trained and equipped to offer mental health resources and contact information to survey respondents.
  • Transparency
    Prior to collection, individuals selected to participate in the survey will again be clearly informed that the survey is voluntary. They will also be informed of the survey's purpose and topics, so that they can make an informed decision about whether they want to participate. This notification to all potential participants will be done in writing on the questionnaire, or verbally by the interviewer before any questions are asked. Respondents will be informed that the survey will include behaviours and symptoms associated with depression, anxiety, and post-traumatic stress disorder (PTSD); suicide risk; substance use; social impacts of PTSD; general mental health; and access to and use of mental health care services and supports. This information will be provided through invitation and reminder letters and will be repeated at the beginning of the questionnaire. Information about the survey, as well as the survey questionnaire, will also be available on Statistics Canada's website.
  • Confidentiality
    Individual responses will be grouped with those of others when reporting results. Individual responses and results for very small groups will never be published. Following careful analysis of the data, consideration will be given prior to the release of aggregate data to ensure that marginalized and vulnerable communities are not disproportionally impacted. As permitted by the Statistics Act, and only with the consent of the respondent, survey responses may be shared with PHAC, Health Canada and provincial and territorial ministries of health, strictly for statistical and research purposes, and in accordance with Statistics Canada's security and confidentiality requirements.

Conclusion:

This assessment concludes that, with the existing Statistics Canada safeguards and additional mitigation strategies developed for this survey, any remaining risks are such that Statistics Canada is prepared to accept and manage the risk.

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