In chapter 2, Bland and Hanson place the recent epidemiological surveys done in Canada in a historical perspective and elaborate on the role that semi- and fully structured interviews have had in making large studies feasible. In this chapter, we briefly review the history of psychiatric epidemiology as a whole and attempt to explain why, for the most part, the field in North America has emphasized psychosocial factors as both causal factors and outcomes, often ignoring genetic and biological ones. We then focus on one of psychiatric epidemiology’s most important figures, Alexander Leighton, whose pioneering studies established the modern psychiatric...

Community surveys were initially done to determine the prevalence of mental disorders within a specific population. Fifty years ago, large-scale studies were simply not feasible for several reasons. Standardized, structured interviews did not exist, and computers were not available for scoring, handling large data sets, and sophisticated statistics. Physicians or other mental health professionals were needed to conduct individual interviews and confirm diagnoses within a community. These mental disorders were diagnosed before the establishment of standardized diagnostic criteria. Without computers, the volume of data collected had to be limited to what could be analysed manually.

Severe psychiatric disorders have low...

Chapters 1 and 2 of this volume together provide an overview of the development of psychiatric epidemiology and establish the context for modern community surveys of mental health in Canada. Chapter 1 also offers an in-depth review of the social theory underpinning Alec Leighton’s work in Stirling County. As noted in that chapter, social theory, while an important part of psychiatric epidemiology during the era of Stirling County, occupies a much less prominent position in the field today. It has, however, continued to be a central focus on scholarly activity in areas outside of psychiatry, especially psychology and sociology.

An...

Analysis of existing data continues to play an important role in the study of the population determinants of a host of outcomes. In Canada, these include childhood development (National Longitudinal Survey of Children and Youth – NLSCY), labour force dynamics (Survey of Labour and Income Dynamics – SLID), educational attainment (Program for International Student Assessment – PISA), and adolescent labour force entry (Youth in Transition Survey – YITS), to name a few. Among the more recent Statistics Canada surveys are those that analyse mental disorder and addictions. These have made it possible for psychiatric epidemiologists and social scientists to map out the population parameters...

The Canadian Community Health Survey: Mental Health and Well-Being (CCHS)¹ is funded as part of the Health Information Roadmap Initiative,² a plan to modernize and standardize health information across the country. Statistics Canada, the CIHI, and Health Canada jointly support the series of projects that make up the Roadmap Initiative. The CCHS has a two-year collection cycle comprising two surveys: a regional survey in the first year (cycle 1.1) and a province-level survey in the second (cycle 1.2). Each second year of the survey cycle is designed to focus in depth on a particular topic. During consultations for the development...

From the perspective of public health, affective disorders are among the most important health conditions. Their importance derives from a combination of two factors: high prevalence and their considerable impact on psychosocial functioning and mortality. For many years, the full significance of these disorders was under-appreciated. This changed with publication of the first (1990) Global Burden of Disease report, which ranked Unipolar Major Depressive Disorder as the fourth leading cause of disease burden and as the world’s leading single cause of disability.¹ The Global Burden of Disease report projected that the relative burden of major depression would increase in subsequent...

Anxiety disorders are a category of psychiatric disorders identified in theDiagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), which includes panic disorder (panic attacks), agoraphobia, specific phobia, social phobia, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), acute stress disorder, generalized anxiety disorder (GAD), anxiety disorder due to a general medical condition, substance-induced anxiety disorder, and anxiety disorder not otherwise specified.^1,2The identification ofDSMdiagnoses in general population samples are commonly obtained using the Composite International Diagnostic Interview (CIDI), a structured interview developed by the World Health Organization based on the Diagnostic Interview Schedule (DIS) and...

When trying to apply a set of seventeen definitions that have been suggested to define adult severe mental illness (SMI) to a sample of patients in contact with a specific psychiatric services clinic in Philadelphia, Schinnar et al.¹ found an estimated prevalence of serious mental illness among this specialists’ care clinical population ranging from 4% to 88 %! Since then, efforts have been made to either validate definitions of SMI in populations of patients in contact with specialist services in order to establish their internal and external validity, or to use different sampling frames to evaluate definitions and produce estimates....

A wealth of population data measuring substance use, abuse, and mental health has recently emerged in Canada, allowing researchers to generate national prevalences of co-occurring substance use and mental disorders, and to examine a wide range of related questions and hypotheses about treatment needs and health service utilization. In this chapter, we provide a brief summary of the extant international literature on these topics, and summarize key findings from a comprehensive research program using the Canadian Community Health Survey (cycle 1.2) to explore the comorbidity of substance use and other mental disorders in Canada. In addition to prevalence estimates, our...

Child psychiatric disorder involves maladaptive processes in cognitive, affective, physiological, and/or behavioural domains of functioning, or in the ways in which these domains are integrated.^1–3These maladaptive processes emerge over time as the child interacts with the environment. The most common approaches to the classification of childhood disorder are: (1) ‘categorical’ classification systems such as the American Psychiatric Association’s (APA)Diagnostic and Statistical Manual of Mental Disorders(DSM),⁴ and (2) empirically based ‘dimensional’ classification systems arising from multivariate statistical analyses of children’s behaviour such as the Child Behavior Checklist.⁵

TheDSMincludes commissioned literature reviews and clinical consensus on...

Like so many other areas of Canadian psychiatric epidemiology, researchers have only just begun to explore psychiatric disorders and impairment in later life. Recent interest has been fuelled by the release of the Canadian Community Health Survey (CCHS 1.2), the first national survey of psychiatric disorders in Canada. For the first time, the prevalence of five major disorders (major depressive disorder, bipolar disorder, social phobia, agoraphobia, panic disorder), as well as substance abuse/dependence can be estimated in a large, representative sample of Canadians, which includes older adults. Prior to this survey, only a few studies (the Edmonton Study¹ and the...

The last fifty years have witnessed a concerted effort by psychiatric epidemiologists in many parts of the world to determine the rates of various psychiatric disorders in the community. We now know that mental disorders are more prevalent and begin earlier in life than had previously been assumed.¹ Canada has been one of the developed countries which had made a significant contribution to this new knowledge. One productive area in this work has been the attention paid to gender, with the ensuing interest in both the psychosocial and biological aspects of gender as possible locations for etiological factors for the...

The population characteristics of Canada and the perceived and documented health outcomes of Canadians are in a dynamic interaction with a complex array of factors. Shifting demographic and biometric population characteristics, and the impact of those shifts on health outcomes, are increasingly being influenced by factors originating external to Canada. The consequences of the increasing pace of globalization that has occurred over the past half century are reflected both in the traditionally described determinants of health of Canadians and in the manner in which the determinants of health relate to each other. The relative significance of each of those determinants...

An epidemiology of stigma, either in the sense of having a coherent picture of the distribution and determinants of stigma at the population level, or in the sense of having a unified body of researchers who share the same disciplinary roots, does not yet exist. Significant contributions to the field have been made by sociologists, social psychologists, geographers, psychiatrists, and, only recently, epidemiologists. What has unified the field, and perhaps conferred an epidemiologic flavour, has been the underlying goal of reducing the burden of disability caused by mental illness by acting on the social factors that determine its occurrence, severity,...

The large number of mental patients in prisons and jails, and the challenges that they pose for provision of services by these institutions, have become a practically intractable problem. With public concern about the violence perpetrated by the mentally ill adding further to the problem, more research is required into coordination of services among branches of government, inter-institutional arrangements, and better community best practices on diversion programs for the mentally ill and to the prevention of reincarceration.

When serious and bizarre crimes come to the attention of the public and the courts, it is not unusual that mental illness is...

Almost a decade ago, one of us (Isaac Sakinofsky) published a book chapter with the same title as this inSuicide in Canada.¹ At that time, it was the cumulative year by year increase in suicide rates, particularly in young persons, that clamoured for attention. Cohort studies were published during the 1980s showing that successive waves of birth cohorts were going forward into the future burdened by an increased potential for suicide, each incrementally larger than that in the preceding cohort.^2-7Increasing incidences of depressive illness in young people were being blamed for this sorry state of affairs^8,9as well...

The purpose of this chapter is to provide a critical review of the literature on current issues in access and provision of mental health supports and services for those who are living with major depression in Canada. The prevention and control of depression is critical due to its prevalence and the social costs associated with the disability it produces. Effective health promotion programs, prevention, detection, and treatment strategies could, therefore, have a sizeable impact on the health of Canadians. This chapter begins with key findings from the descriptive epidemiology of depression, prevention, and health promotion strategies, screening for depression, and...

The purpose of this chapter is to discuss the factors that contribute to the mental health of the working population. In the first section, we consider the salience of this topic and the related economic burden of mental illness in the working population. This is followed by brief reviews of the organizational characteristics that contribute to an unhealthy workplace and individual characteristics that would render a worker susceptible to such an environment. We then look at two examples of how population-based epidemiological surveys have been used to explore the topic. We conclude with a discussion of the strengths and limitations...

In the health field in the last two decades, there has been tremendous international interest in the use of research evidence in public policy making. Compelled by concern about numerous documented research-policy ‘gaps,’ researchers have called on policy makers to apply more research evidence in the service of improving public policies for health and health care. Many Canadian researchers have been in the forefront of this changing landscape.^1-3Research funding agencies have had considerable influence. In particular, the Canadian Health Services Research Foundation (CHSRF), led by Jonathan Lomas, has made ‘knowledge transfer and exchange’ the central aim of a wide...

We began this book with an overview of where psychiatric epidemiology has come from; and the various chapters have described the recent advances, showing where we have been. It seems appropriate, then, to conclude the book with some thoughts of where we think psychiatric epidemiology should be going in the future, bearing in mind Niels Bohr’s admonition that ‘prediction is difficult, especially about the future.’ (This has also been attributed at various times to Yogi Berra, Mark Twain, and Albert Einstein, reflecting the fact that we can’t always talk about the past with much assurance, either.) However, this chapter is...