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The Gold Standard: Ontario’s Depression Strategy

By Michelle Gold
Network, Winter 2007

Depression is a common condition. It occurs in a wide variety of circumstances and can affect people at various stages throughout the life cycle. Most people experience feelings of sadness at times in their life. When a depressed mood persists, however, and begins to interfere with everyday living, it may be the sign of a serious state of depression. The Ontario Ministry of Health and Long-Term Care is currently completing the first phase in the development of a provincial Depression Strategy. An advisory committee has provided advice to the ministry on key strategies that should be included. CMHA, Ontario was a participating member.

The prevalence of major depression in Ontario for persons 15 years and older is 4.8 percent.1 This represents more than half a million people in the province experiencing depression in one year. The lifetime prevalence of depression in Canada is 12.2 percent. Of those who met the criteria for depression in Canada’s population health survey, approximately 75 percent said it interfered with their home or social life. Over 50 percent indicated it interfered with their work.2 Depression’s broad reach is likely to affect us all, either through personal experience or in our relations with family, co-workers and friends. Taking action through a comprehensive plan to address depression is long overdue.

Depression is a major workplace issue. It can affect productivity, increase absenteeism and involve worker replacement costs. In 2002, one million employed Canadians 18 years and older reported having a major depressive episode during the past year.3 Mental health claims are the fastest growing category of disability costs in Canada. The economic cost of lost productivity in Ontario due to depression, as measured by short-term and long-term disability days, is estimated to have been $8.8 billion in Ontario in 2000.4

Depression is common among people with chronic physical conditions, such as heart disease, stroke, cancer, diabetes, Parkinson’s disease and multiple sclerosis.5 This may be in part a consequence of limitations in functional ability, pain and/or loss of social roles. People who are depressed tend to have greater difficulty complying with treatment regimes. As a result, the use of health care services tends to increase. Health care costs for individuals with major depression associated with their chronic illness were found to be 50 percent higher than costs for persons having chronic conditions alone.6 Research has also identified depression as a risk factor for developing heart disease itself.7 Yet despite this overwhelming evidence, depression is under-diagnosed in people with physical health conditions, and even when identified, often inadequately treated.

By age 20, a child having a parent with major depression has a 40 percent chance of experiencing a depressive episode themselves.8 Risk factors in families that account for the increased rates of depression in children include, but are not limited to, genetic predisposition. Marital discord and difficulties in parenting may be more common in parents with depression and may increase the risk of depression in children. The severity and chronicity of parental depression also have an impact on children. While children of parents with severe depression are at also at risk of experiencing depression, children of parents with dysthymia, defined as mild, chronic depression, have significantly higher lifetime rates of dysthymia than offspring of parents with episodic major depression.9 Thus, the experience of dealing with chronic depression in the family puts children at greatest risk.

Canadian statistics report the highest rates of depression among those 15 to 24 years (6.4 percent).10 This is of concern as suicide rates among Canadian youth remain high. In a new study delving into this same data, adolescents in Ontario aged 15 to 18 years were found to have a lifetime prevalence of depression of 11.3 percent for females and 3.5 percent in males. In the same study, suicidality, defined as suicide ideation or attempts, was 16.3 percent for females and 7.2 percent for males completing the study. Youth from low-income households were almost twice as likely to report suicidality.11 These findings draw attention to the need to screen and treat the high rate of depression in youth, as well as address social factors that influence youth mental health.

While the occurrence of depression in Canadians 65 years and older is reported to be 2.6 percent in national population surveys, these studies have been limited to individuals living in the community and therefore misrepresent the true prevalence of depression in seniors. The Canadian Study of Health and Aging included a large sample of seniors living in institutions, such as long-term care homes. Among those living in institutions, the rate of depression was 7.7 percent.12 Among those with dementia residing in institutions, it was 9.5 percent.

Despite the magnitude, burden of illness, and social and economic costs associated with depression, there continues to be societal stigma and self-stigma that discourage individuals and families from seeking treatment and support. When help is sought, health providers often lack the training and experience to screen for, diagnose and treat depression. Ontario needs better training and guidelines for health professionals on how to identify and manage depression in diverse populations across the lifespan.

The advisory committee for the Depression Strategy has provided recommendations that address mild, moderate and severe depression using a broad range of interventions, including primary prevention, early intervention, treatment and education. This has the potential to provide, for the first time in Ontario, coordinated policy directions to reduce the burden of depression and improve the quality of care and support.

At the same time, we are increasing our understanding of factors – personal, social and environmental – that promote mental health.13 Many of these important elements fall outside the health care system’s current scope of responsibility. Protective factors need to be enhanced, and this task is the responsibility of schools, workplaces, institutions and communities. Efforts must be multifaceted and go well beyond the scope of what health providers and health policy makers can be expected to do alone. My hope is that the Ministry of Health and Long-Term Care – together with the Ministry of Health Promotion and Ministry of Child and Youth Services, who also identify mental health as a strategic priority – will take leadership in promoting mental health by facilitating supportive environments, community action and healthy public policy.

The Ministry of Health and Long-Term Care will soon be releasing its 10-year strategic health plan for the province. Mental health must remain a priority on the government’s agenda, and this includes Ontario having a depression strategy that supports mental health across the lifespan.

Michelle Gold, MSW, MSc, is senior director of policy and programs at CMHA.


Notes

  1. Patten, S., et al. (2006). Descriptive Epidemiology of Major Depression in Canada. Canadian Journal of Psychiatry51(2): 84-90. www.cpa-apc.org
  2. Government of Canada (2006). The Human Face of Mental Health and Mental Illness in Canada 2006. www.phac-aspc.gc.ca
  3. Shields, M. (2006). Stress and Depression in the Employed Population. Health Reports 17(4): 11-28. www.statcan.ca
  4. Gnam, W., Sarnocinska-Hart, A., Mustard, C., Rush, B., and Lin, E. (2006). The Economic Costs of Mental Disorders and Alcohol, Tobacco, and Illicit Drug Abuse in Ontario, 2000: A Cost of Illness Study. Centre for Addiction and Mental Health, Toronto. www.camh.net
  5. Evans, D., et al. (2005). Mood Disorders in the Medically Ill: Scientific Review and Recommendations. Biological Psychiatry 58(3): 175-189.www.journals.elsevierhealth.com
  6. Evans, D., and Charney, D. (2003). Mood Disorders and Medical Illness: A Major Public Health Problem. [Editorial].Biological Psychiatry 54(3): 177-180.www.journals.elsevierhealth.com
  7. Ibid.
  8. Beardslee, W., Versage, M., and Gladstone, T. (1998). Children of Affectively Ill Parents. A Review of the past 10 Years. Journal of the American Academy of Child and Adolescent Psychiatry 37(11): 1134-1141.www.jaacap.com
  9. Lizardi, H., Klein, D., and Shankman, S. (2004). Psychopathology in the Adolescent and Young Adult Offspring of Parents with Dysthymic Disorder and Major Depressive Disorder. Journal of Nervous and Mental Disease 192(3): 193-199. www.jonmd.com
  10. Statistics Canada (2002). Canadian Community Health Survey. Mental Health and Well-Being. Cycle 1.2.www.statcan.ca
  11. Cheung, A., and Dewa, C. (2006). Canadian Community Health Survey: Major Depressive Disorder and Suicidality in Adolescents. Healthcare Policy 2(2): 76-89.www.longwoods.com
  12. Ostbye, T., et al. (2005). Prevalence and Predictors of Depression in Elderly Canadians: The Canadian Study of Health and Aging. Chronic Diseases in Canada 26(4): 93-99. www.phac-aspc.gc.ca
  13. World Health Organization (2004). Promoting Mental Health: Concepts, Emerging Evidence, Practice. Geneva.www.who.int

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