Mental Health and Addictions Research Program (Chiu, Amartey, Wang, Vigod, Kurdyak), ICES; Institute of Health Policy, Management and Evaluation (Chiu, Vigod, Kurdyak), Dalla Lana School of Public Health, University of Toronto; Women's College Hospital and Research Institute (Vigod); Department of Psychiatry, Faculty of Medicine (Vigod, Kurdyak), University of Toronto; Social and Epidemiological Research Department (Kurdyak), Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ont.
CMAJ. 2020 Mar 30;192(13):E329-E337. doi: 10.1503/cmaj.190603.
Mental illness is widely perceived to be more of a public health concern now than in the past; however, it is unclear whether this perception is due to an increase in the prevalence of mental illness, an increase in help-seeking behaviours or both. We examined temporal trends in use of mental health services as well as objectively measured and perceived mental health.
We conducted a repeat cross-sectional study of Ontario residents who participated in Statistics Canada's Canadian Community Health Survey (2002-2014). We assessed temporal trends in objectively measured past-year major depressive episode (based on criteria of the , and ) and past-month psychological distress (Kessler Psychological Distress Scale-6 score ≥ 8) and perceived, self-rated mental health. We also examined use of mental health services, including service use among those with a need for mental health care.
A total of 260 090 survey participants were included. The age- and sex-standardized prevalence of a major depressive episode (4.8%, 95% confidence interval [CI] 4.2%-5.3% in 2002 v. 4.9%, 95% CI 4.2%-5.7% in 2012; = 0.9) and psychological distress (7.0%, 95% CI 6.3%-7.6% in 2002 v. 6.5%, 95% CI 5.7%-7.5% in 2012; = 0.4) did not change significantly over time. However, self-rated fair or poor mental health status increased from 4.9% in 2003-2005 to 6.5% in 2011-2014 ( < 0.001), as did the use of mental health services (7.2% to 12.8%, < 0.001). The percentage of individuals who had subjective or objectively measured mental health problems and did not access mental health services decreased significantly over time.
Given the stable prevalence of objectively measured psychiatric symptoms, the increase in use of mental health services appears to be, at least partly, explained by an increase in perceived poor mental health and help-seeking behaviours.
精神疾病现在被广泛认为比过去更受关注，但是，这种看法是由于精神疾病的患病率增加、寻求帮助的行为增加还是两者兼而有之，尚不清楚。我们检查了精神卫生服务的使用情况以及客观测量和感知到的精神健康状况的时间趋势。
我们对参加加拿大统计局加拿大社区健康调查（2002-2014 年）的安大略省居民进行了一项重复的横断面研究。我们评估了过去一年中重度抑郁发作（基于《精神障碍诊断与统计手册》第四版标准）和过去一个月心理困扰（Kessler 心理困扰量表-6 得分≥8）以及感知到的自我评定精神健康状况的时间趋势。我们还检查了精神卫生服务的使用情况，包括有精神卫生保健需求者的服务使用情况。
共纳入 260090 名调查参与者。年龄和性别标准化的重度抑郁发作患病率（2002 年为 4.8%（95%置信区间 4.2%-5.3%），2012 年为 4.9%（95%置信区间 4.2%-5.7%）；=0.9）和心理困扰（2002 年为 7.0%（95%置信区间 6.3%-7.6%），2012 年为 6.5%（95%置信区间 5.7%-7.5%）；=0.4）在一段时间内没有明显变化。然而，自评为“一般”或“差”的心理健康状况从 2003-2005 年的 4.9%增加到 2011-2014 年的 6.5%（<0.001），精神卫生服务的使用也从 7.2%增加到 12.8%（<0.001）。在一段时间内，有主观或客观测量的精神健康问题但未获得精神卫生服务的个体百分比显著下降。
鉴于客观测量的精神症状的患病率稳定，精神卫生服务使用的增加至少部分归因于感知到的心理健康状况不佳和寻求帮助的行为增加。
