Mental health indicators improve from pandemic lows, but depression and anxiety symptoms remain

Three years into the COVID-19 pandemic, new national data show that while some mental health impacts have begun to subside, some groups face disproportionate challenges, with more than one in three young adults, Indigenous and LGBTQ2S+ people experiencing symptoms of a mental disorder in 2023.

Published last week, the third cycle of the Statistics Canada (StatCan) and the Public Health Agency of Canada’s (PHAC’s) Survey on COVID-19 and Mental Health found that key quality-of-life indicators have rebounded from their 2021 lows, including self-perceptions of mental health as well as feelings of personal belonging and satisfaction with life.

Fifty-seven per cent of Canadian adults not living in the territories, on a reserve or in an institution reported their mental health was very good or excellent, up from 52 per cent in early 2021 and approaching the 60-per-cent high recorded in late 2020.

Similarly, those reporting a “strong sense of belonging” accounted for 62 per cent of respondents, up from 57 per cent in 2021 and nearing a 2020 high of 64 per cent. This year saw the highest proportion reporting they were highly satisfied with their lives, to 54 per cent from 51 and 45 per cent in 2020 and 2021, respectively.

Suze Berkhout, a clincian-investigator at University Health Network’s Centre for Mental Health in Toronto, says that with day-to-day experiences improving since the height of the pandemic, it’s an intuitive trend.

“The horizon … that let you figure how out you plan things, how you think about your life … that was really disrupted, early in the pandemic,” she said in an interview with CTVNews.ca.

“It’s not like everything is what it was pre-March-2020, but there is more of a kind of predictability, at least … that kind-of, I think, makes it easier for people to regain this sense of who they are, where they’re going; what they’re doing.”

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Conducted between February and May, the 2023 survey cycle “provides a snapshot into the mental health of adults in Canada as this global health emergency came to an end,” the published release reads.

It’s the latest in a yearslong effort.

A 2022 StatCan review of the survey’s previous cycles found that while roughly two-thirds of Canadians appeared to live with “no mental health difficulties,” the remainder experienced low-to-moderate (26 per cent) or severe (nine per cent) difficulties.

Throughout the pandemic, respondents in the latter two groups were more likely to experience the death of a colleague or loved one, financial difficulties including job losses and interpersonal challenges, among other factors.

“Although these impacts have already been identified as a concern among people with severe mental health difficulties, they have likely been exacerbated during the COVID-19 pandemic,” the study read.

To Mark Berber, a psychiatrist and professor at the University of Toronto’s medical school, the mental health impacts of the past few years among Canadians have been serious.

“The lockdowns had a terribly negative effect, psychologically, on people,” he said in an interview. “People weren’t allowed to go and exercise at the gym, people weren’t allowed to go for a walk in the park, they weren’t allowed to go to school and be with their friends; people’s businesses and careers were decimated.”

But while this year’s broad indicators could be cause for optimism, the data also implies that the impact of some prominent mental health symptoms remains steady.

Last week’s survey release shows that reported symptoms of depression, anxiety and post-traumatic stress disorder (PTSD) have not dropped below the prevalence first recorded in 2020, with more than one in five Canadians in all three survey cycles saying they had experienced moderate-to-severe symptoms of at least one of them.

“You may well have a very strong sense of belonging, but still have significant struggles with mental health challenges,” Berkhout said.

Symptoms of depression were the most common, impacting a reported 17 per cent of respondents, but down from 19 per cent in 2021. Anxiety and PTSD symptoms have risen gradually through the course of the survey, to 15 and eight per cent from 13 and six per cent, respectively, since 2020.

Experts are quick to note, however, that numbers like these do not correspond directly to diagnoses of any particular mental disorder. In times of crisis, when everyone is under emotional strain, it may just be a reaction to reality.

“The business being cut off, the kids not allowed to go to school; your stress goes through the roof,” Berber said.

“That does not mean you have major depressive disorder, or bipolar disorder, or generalized anxiety disorder or post-traumatic stress disorder; it just means you have symptoms that may indicate those diseases, or that may indicate just great stress.”

Long-term research from StatCan show that the recent highs are part of a decade-long rise in reported symptoms of mood and anxiety disorders.

Published this September, the Mental Health and Access to Care Survey found that last year, 14 per cent of Canadians aged 15 or older had met diagnostic criteria for a major depressive episode in their lifetime, up from roughly 11 per cent in 2012. Symptom rates for bipolar and generalized anxiety disorders also substantially increased in that time, to 3.4 and 13 per cent from 2.6 and nine per cent, respectively.

“Findings from the Mental Health and Access to Care Survey suggest in 2022, there were more than five million people in Canada who were experiencing significant symptoms of mental illness,” the study read. “Declines in population mental health were evident in Canada before the start of the COVID-19 pandemic.”

But just as with interpreting the pandemic-era numbers, experts urge caution.

From the evolving culture and stigma regarding mental health among Canadians, to shifting classification of experiences or symptoms by the medical community, to the complications of who gets access to what resources in the first place, Berkhout says it can be exceedingly challenging to quantify how the country’s psychology is changing.

“You might have jumped from 1.5 per cent of people screening positive in 2012 to 2.1 per cent,” she said. “On a detailed, clinical assessment, do you actually have a difference in the numbers? Possibly not.”

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SYMPTOMS MOST REPORTED AMONG YOUNG, MARGINALIZED CANADIANS

This year’s survey cycle reveals disparities between Canadians in experiences of mental health, with young adults, Indigenous and LGBTQ2S+ people among the most likely to report they were experiencing symptoms of depression, anxiety or post-traumatic stress.

While 17 per cent of all 2023 respondents reported moderate-to-severe symptoms of depression, those same experiences were found among one in three of those aged 18-24, 29 per cent of Indigenous respondents and 45 per cent of those identifying as a member of the LGBTQ2S+ community. Similar trends appeared in the anxiety and PTSD symptom data.

In all, one-third or more of respondents from each of the above demographics reported they had lived with symptoms of depression, anxiety or PTSD, with LGBTQ2S+ respondents doubling the total-population rate for each.

Berkhout says that the discrepancy can be linked to the additional stressors and the barriers to care that some groups often face.

“You have many more historic conditions, that then generate the kinds of challenges that will, at some point, potentially get translated into a kind of symptoms … things like intergenerational trauma … [a] phenomenon that then increases vulnerabilities,” she said.

“People who are minoritized … they’re less likely to receive things like early intervention for issues, which then become bigger and bigger with time … you’re a step behind.”