Determinants of health, mental health disorders and health satisfaction in Canada

Introduction: Mood and anxiety disorders are the most prevalent mental health disorders worldwide; they can cause significant physical distress and impaired functioning. In Canada, quantifying and describing the impact of these disorders is a priority. Objectives: (1) To explore the trends in the prevalence of mood and/or anxiety disorders by geographical regions in Canada, and to assess key determinants of health associated with mental health disparities across these regions. (2) To assess whether food security, access to regular medical doctor, and sense of belonging to the community mediate the relationship between mood and/or anxiety disorders and general health satisfaction. Methods: This serial cross-sectional study used data from a nationally representative sample of Canadians, aged 18-59, from the Canadian Community Health Survey, annual cycles 2011-2016. Bivariate relationships were examined using chi-square tests for categorical variables and t-tests for continuous variables. Adjusted logistic regression models were used to identify which factors were associated with the prevalence of mood and/or anxiety disorders (using SAS 9.4). Mediation models were based on the Sobel product of coefficients approach (using Stata version 13). Results: The prevalence of mood and/or anxiety disorders increased across all regions between 2011 and 2016, with Quebec consistently having the lowest prevalence, and the Atlantic region having the highest. In most regions, individuals who drank occasionally or regularly, males, immigrants, non-Caucasians and those with a strong sense of belonging to a community were less likely to be diagnosed with a mood and/or anxiety disorder. Across most regions, sexual orientation and food security were the characteristics associated with our outcome. In our second analysis, for most years, respondents who described having fair/poor general health satisfaction reported a weak sense of belonging to the community, being food insecure, and having a mood and/or anxiety disorder. In our mediation analysis, food security and sense of community belonging partially mediated the association between mood and/or anxiety diagnosis and general health satisfaction. Conclusions: This research provided new data for provincial governments to identify programs and policies that intervene to improve key health determinants associated with mood and/or anxiety disorders across regions in Canada.Medicine, Faculty ofExperimental Medicine, Division ofMedicine, Department ofGraduat