Health Reports
Understanding the perceived mental health of Canadians during the COVID-19 pandemic

by Leanne C. Findlay, Rubab Arim, and Dafna Kohen

DOI: https://www.doi.org/10.25318/82-003-x202000400003-eng

The World Health Organization declared the outbreak of the novel coronavirus (COVID-19) an international public health emergency on January 30, 2020, and a pandemic on March 11.^{Note 1} Governments and public health authorities worldwide have initiated public health plans to mitigate risks created by the virus, including strict physical distancing, extreme reductions in travel and closures of many businesses and schools. Although the impact on physical health is substantial (including hospitalizations and deaths), the impact of the COVID-19 pandemic on the mental health of Canadians is less clear.

Evidence from the 2003 SARS outbreak and the 2009 H1N1 pandemic demonstrated the toll that public heath emergencies can play on the mental health of a population.^{Note 2Note 3} While many individuals may be resilient in the face of a pandemic, a substantial proportion may experience psychological impairment and others may experience increased symptoms of mental disorders related to anxiety or post-traumatic stress.^{Note 4}

Early evidence from around the world confirms the negative impact of COVID-19 on mental health. According to Huang and Zhao,^{Note 5} one in three Chinese citizens experienced symptoms of anxiety during the COVID-19 pandemic and one in five, depression symptoms. Younger individuals were particularly impacted, another study finding that among a large sample of college students, one quarter reported increased anxiety as a result of the pandemic.^{Note 6}

For many Canadians, the challenges of physical distancing, reduced ability to work or contribute to society, and pressures related to taking care of their family in isolation may lead to greater anxiety, loneliness, and stress. Previous findings from Statistics Canada’s CPSS1 suggested that fewer Canadians reported excellent or very good mental health during COVID-19 compared to data from 2018.^{Note 7}

The mental health consequences of the COVID-19 pandemic may be especially concerning for particular groups of the Canadian population that may already be at risk for lower mental health. This may include women, individuals of lower socioeconomic status, and those with low social support.^{Note 2Note 8Note 9} It is also possible that situations specifically related to COVID-19, such as concerns about the ability to meet financial responsibilities^{Note 10} or particular health conditions (e.g., respiratory disease or cardiovascular diseases) that may compromise an individual’s ability to fight the infection,^{Note 1} may further worsen mental health at this time. Finally, confinement related to physical distancing and social isolation may contribute to lower mental health,^{Note 4Note 11} in particular among families who are more likely to be balancing multiple responsibilities such as those related to work and home schooling.

The objective of this study is to report on the self-perceived mental health of Canadians during the COVID-19 pandemic. Based on recent data from the CPSS1, this report provides a description of Canadians’ perceived mental health based on their socioeconomic and health characteristics, as well as particular concerns that may be related to mental health.

Methods

Data source

Canadian Perspectives Survey Series 1 – Impacts of COVID-19

The cross-sectional Canadian Perspectives Survey Series 1 (CPSS1) collected information related to COVID-19 concerning the labour market, behaviours, and health impacts for the Canadian population 15 years of age or older living in the 10 provinces. The CPSS1 sample was selected from four Labour Force Survey (LFS) rotation groups that responded to the LFS for the last time in April, May, June, or July of 2019. Excluded from the LFS coverage are persons living on reserves and Aboriginal settlements in the provinces; full-time members of the Canadian Armed Forces; the institutionalized population; and households in extremely remote areas with very low population density. These groups together represent less than 2% of the Canadian population aged 15 or older. Data were collected from March 29 to April 3, 2020. One household member was selected at random. Of the 7,242 individuals who were invited to complete the survey, 4,627 people (52% women) responded, yielding a 63.9% response rate representing 31 million Canadians. Additional information on the survey is available at: https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5311

Measures

Several socioeconomic and health characteristics of respondents were examined, including current age, sex, highest level of education, household size, presence of children under the age of 18 living in the household, and marital status. In terms of employment or financial stability, current employment status and concern about COVID-19 impacts on the ability to meet financial obligations were included in the current study. Finally, whether respondents had a compromised immune system as well as whether they had diabetes or a chronic condition affecting their lungs, heart or kidneys were considered.

Individuals also reported whether their mental health was excellent, very good, good, fair or poor. These responses were dichotomized to reflect better (excellent, very good) and worse (good, fair, poor) mental health similar to other studies.^{Note 13} Finally, respondents indicated their level of concern for a variety of situations related to health, society and family, including concern for their own health, civil disorder, and family stress.

Analysis

Descriptive statistics were examined overall and separately for individuals with better or worse mental health. Comparison tests (chi-square tests) were performed between the two groups. Correlations among the concern variables were examined to explore the degree to which they were related. They ranged from r=0.05 between overloading the health system and violence in the family, to r=0.80 between the ability to cooperate during crisis and the ability to cooperate and support one another after the crisis. Finally, a multivariable logistic regression model was conducted to explore associations between all statistically significant factors (based on the comparison tests) and mental health. This model excluded two concern variables: (a) violence in the home, due to low proportions (8% in the total sample) and the uncertainty as to whether violence was in their own home or in general, as well as (b) ability to cooperate or support one another after the crisis, due to a high correlation with the ability to cooperate during the crisis. All analyses were performed using survey and bootstrap weights in order to render the sample representative of the Canadian population living in the 10 provinces.

Results

Overall, 54% of Canadians aged 15 and older reported excellent or very good mental health during the COVID-19 pandemic. Descriptive characteristics of the sample as well as a comparison of the characteristics of those who reported better or worse mental health are shown in Table 1. Younger individuals and women were less likely to report better mental health than worse mental health. By comparison, individuals with higher education (i.e., a Bachelor’s degree or above), who were married or common law, or were living in a household with two people were more likely to report better versus worse mental health. In general, respondents with children under 18 living in their household were less likely to report better mental health than those who did not have children. The ability to meet financial obligations also showed a significant difference—among those who felt that COVID-19 had a minor or no impact on their ability to meet financial obligations, 76% reported excellent or very good mental health, whereas among those who reported a moderate or major impact, only 25% reported excellent or very good mental health. Finally, individuals with a compromised immune system as well as those with diabetes or a chronic condition affecting their lungs, heart, or kidneys were less likely to report better mental health (compared to worse mental health).

Overall, approximately four in five Canadians were extremely or very concerned about overloading the health system and vulnerable peoples’ health. Individuals’ concerns about the impact of COVID-19 also differed between those with better mental health compared with worse mental health. For example, individuals who reported better mental health were less likely to be very or extremely concerned about a member of their household’s health, civil disorder, and family stress from confinement (see Figure 1 and Table 2).

Finally, a multivariable model was explored to determine the independent associations of the socioeconomic, health, and concern variables in predicting better mental health (Table 3). When all factors were considered simultaneously, respondents who were younger, female, and those with a compromised immune system or with diabetes or a chronic condition were less likely to report better mental health. In addition, respondents who were very or extremely concerned about family stress from confinement were also less likely to report better mental health. The latter finding suggests that although various health, social, and family-related concerns may be associated with mental health, family stress appears to be an important factor over and above other concerns related to the impact of COVID-19.

Discussion

The objective of this study was to describe the self-perceived mental health of Canadians during the early phase of the COVID-19 pandemic. The results show that younger adults, women, and individuals with a compromised immune system, diabetes, or chronic health condition are less likely to report better mental health. Although the ability to meet financial obligations was not statistically significant in the final model (due to an association with the other variables also included in the model), the proportion of individuals who reported better mental health was much smaller. Only 25% of respondents who felt that COVID-19 would have a major or moderate impact on their ability to meet their financial obligations reported excellent or very good mental health compared to 75% of those who felt that COVID-19 would have a minor or no such impact.

The findings also suggest that family factors may play an important role in Canadians’ mental health during COVID-19. Respondents with at least one child in the household were generally less likely to report better mental health. In the presence of all factors in the multivariable model, concerns about family stress due to confinement was significantly associated with worse mental health. This could suggest that family stress is particularly important for the mental health of Canadians during this period.

In terms of the specific concerns reported by Canadians, more than four in five Canadians were very or extremely concerned about overloading the health care system and about vulnerable people’s health. In addition, 55% were concerned about the health of a household member, and one in three about family stress due to confinement. Specific to this study, individuals’ concerns about the impact of COVID-19 differed between those with better mental health and worse mental health. This finding is similar to those from China, whereby 75% of Chinese respondents were concerned about a family member catching COVID-19, and those who were more concerned reported higher levels of stress.^{Note 14}

Several limitations of the current study should also be noted. First, slightly more Canadian-born individuals compared to those not born in Canada responded to the CPSS1, limiting an examination of differences for immigrant and newcomers. In addition, because of the brevity of the survey, only a selected number of characteristics of the sample can be described; more detailed measures of mental health, including specific symptoms of mental health disorders, were not collected. It is also important to note that the CPSS1 was not conducted in long-term care residences or in remote areas with low population density; therefore, the findings should be interpreted accordingly. Finally, it was not possible to explore a more fine-grained breakdown of age categories, including those over age 80 who may be particularly isolated or have a different profile or association with mental health outcomes.

Many factors have been suggested to alleviate stress and anxiety regarding COVID-19, including increased social support^{Note 6} and providing up-to-date, accurate information.^{Note 9} According to Goldmann and Galea,^{Note 15} post-disaster mental health conditions reach their peak within a year after the situation but some symptoms can continue for months or years, suggesting that mental health consequences may continue long after the days of physical distancing end. The findings of this study may assist in identifying targeted groups for intervention strategies for individuals particularly at risk for lower mental health during the pandemic, especially with regards to the concerns highlighted in this report.