EMOTIONAL HEALTH IN THE TERRITORY OF THE MONTREAL … · 4.40 HO ScoreS bsy Chroni Healtc Problemh...

EMOTIONAL HEALTH IN THE TERRITORY OF THE MONTREAL GENERAL HOSPITAL DEPARTMENT OF COMMUNITY HEALTH

Jennifer L. O'Loug .-in

December 1982

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MONTRÉAL

Department of Community Health Montreal General Hospital 159 7, Pine Avenue West Montreal, Que. H3G 1B3

TABLE OF CONTENTS

ABBREVIATIONS . i

ABSTRACT - ii

RÉSUME iii

1. INTRODUCTION • - 1

2. LITERATURE SUMMARY 5 2.1 Bradburn's Index of Psychological Weil-Being. . 5 2.2 MacMillan's Health Opinion Survey (HOS) . . . . 7 2.3 Purpose of This Study 9

3. METHODS . 11 3.1 Survey Instruments . 11 3.2 Sample Selection 11 3.3 Data Collection 12 3.4 Variables 13 3.5 Data Analysis 16

4. RESULTS. . 17 4.1 Survey Response . . . . . . . . . . 17 4.2 Distribution of "Unhappy" Respondents in

in Canada and the DSC-MGH 20 4.3 Distribution of Respondents who Reported

Frequent Psychophysiological symptoms in Canada and the DSC-MGH 22

4.4 Associations Between Emotional Health and Socio-demographic Variables 22

4.5 Association Between Emotional Health and Physical Health Variables 36

4.6 Associations Between Emotional Health and Mental Health Variables 41

4.7 Associations Between Emotional Health and Lifestyle Variables 47

4.8 Dependence of Positive and Negative Affect Scores on Socio-demographic, Physical and

• Mental Health, and Lifestyle Variables. . . . 54 4.9 Dependence of Health Opinion Survey Scores

on Socio-demographic, Physical and Mental Health, and Lifestyle Variables 58

4.10 Summary . . 58

5. DISCUSSION 62 5.1 Survey Response 62 5.2 Prevalence of "Unhappiness" as Measured by

Bradburn's Index of Psychological Weil-Being, and of Anxiety and Depression as Measured by MacMillan's Health Opinion Survey 62

5.3 What "Illness" or "Risk" Has Been Identified? . 64

LIST OF TABLES V

PAGE

TABLE

1.1 Selècted Socio-Demographic Indicators by CLSC in the Department of Community Health of the Montreal General Hospital 4

4.1 Response to the Interviewer - Administered Questionnaire ( IAQ) by CLSC.. 18

4.2 Response to the Lifestyle and Your Health Questionnaire (LHQ) by CLSC 18

4.3 Selected Socio-demographic Characteristics of Respondents in the LHQ Sample 19

4.4 Distribution of "Unhappy" Respondents in Canada and the DSC-MGH by Sex 21

4.5 Distribution of "Unhappy" Respondents in Canada and the DSC-MGH by Age Group 21

4.6 Distribution of Respondents who Reportes Frequent Psychophysiological Symptoms in Canada and the DSC-MGH by Sex 23

4.7 Distribution of Respondents who Reported Frequent Psychophysiological Symptoms in Canada and the DSC-MGH by Age Groups 23

4.8 Positive Affect by Age Group 27

4.9 Negative Affect by Age Group 27

4.10 HOS Scores by Age Group 27

4.11 Positive Affect by Sex 28

4.12 Negative Affect by Sex 28

4.13 HOS Scores by Sex 28

4 i 14 Positive Affect by CLSC of Residence 29

4.15 Negative Affect by CLSC of Residence 29

4.16 HOS Scores by CLSC of Residence 29

4.17 Positive Affect by Ethnic Origin 30

4.18 Negative Affect by Ethnic Origin 30

4.19 HOS Scores by Ethnic Origin 30

4.20 Positive Affect Scores by Maternal Language. . . . 31

4.21 Negative Affect Scores by Maternal Language. . . . 31

4.22 HOS Scores by Maternal Language - 31

4.23 * Positive Affect by Level of Education 32

4.24 Negative Affect by Level of Education. 32

4.25 HOS Scores by Level of Education 32

4.26 Positive Affect by Marital Status. . 33

4.27 Negative Affect by Marital Status 33

4.28 HOS Scores by Marital Status 33

4.29 Positive Affect by Socioeconomic Status 34

4.30 Negative Affect by Socioeconomic Status 34

4.31 HOS Scores by Socioeconomic Status . 34

4.32 Positive Affect by Major Activity 35

4.33 Negative Affect by Major Activity 35

4.34 HOS Scores by Major Activity . . . . . 35

4.35 Positive Affect by Bed-days 38

4.36 Negative Affect by Bed-days 38

4.37 HOS Scores by Bed-days 38

4.38 Positive Affect by Chronic Health Problems . . . . . 39

4.39 Negative Affect by Chronic Health Problems . . . . 39 i

4.40 HOS Scores by Chronic Health Problems 39

4.41 Positive Affect by Medications . . ; . . 40

4.42 Negative Affect by Medications 40

.4.43 HOS Scores by Medications 40

4.44 Positive Affect by Life Events . . . . 43

4.45 Negative Affect by Life Events 43

4.46 HOS Scores by Life Events 43

4.47 Positive Affect by Health Opinion Survey Scores. . 44

4.48 Negative Affect by Health Opinion Survey Scores. . 44 4.49 Positive Affect by Overall Happiness 45

4.50 Negative Affect by Overall Happiness 45

4.51 HOS Scores by Overall Happiness. . . . 45

4.52 Positive Affect by Negative Affect . 46

4.53 Positive Affect by Leisure Time 49

4.54 Negative Affect by Leisure Time. . 49

4.55 HOS Scores by Leisure Time 49

4.56 Positive Affect by Physical Activity 50

4.57 Negative Affect by Physical Activity 50

4.58 HOS Scores by Physical Activity 50

4.59 Positive Affect by Alcohol Use 51

4.60 Negative Affect by Alcohol Use 51

4.61 HOS Scores by Alcohol Use. . .

4.62 Positive Affect by Tobacco Use

4.63 Negative Affect by Tobacco Use

51

52

52

4.64 HOS Scores by Tobacco Use 52

4.65 Pearson Product Moment Correlation Coefficients of Uncategorized Positive and Negative Affect, and HOS Scores with Continuous Variables . . . . 53

4.66 Multiple Stepwise Regression of Socio-demographic, Physical and Mental Health, and Lifestyle Variables on Positive Affect Scores 55

4.67 Multiple Stepwise Regression of Socio-demographic, Physical and Mental Health, and Lifestyle Variables on Negative Affect Scores 56

4.68 Multiple Stepwise Regression, of Socio-demographic Physical and Mental Health, and Lifestyle Variables on Health Opinion Survey Scores/ . . . 57

4.69 Summary of Statistically Significant Associations Between PAS, NAS and HOS Scores and Selected Variables 6 i

LIST OF FIGURES

PAGE

FIGURE

1.1 Territory of the Department of Community Health of the Montreal General Hospital

f

LIST OF APPENDICES

PAGE

APPENDIX

I Questionnaire Items Related to Variables, Range of Scores and/or Coded Categogies *

ABBREVIATIONS

ABS - Affect Balance Scale

PAS - Positive Affect Score

NAS - Negative Affect Score

CHS - Canada Health Survey

HOS - Health Opinion Survey

IAQ - Interviewer - Administered Questionnaire

LHQ - Lifestyle and Your Health Questionnaire

DSC - Department of Community Health (Département de santé communautaire)

MGH - Montreal General Hospital-

CLSC - Local Community Service Centre (Centre local de services communautaires)

NDG - Nôtre-Dame-de-Grâce

11

ABSTRACT

The Department of Community Health of the Montreal General Hospital carried out an adaptation of the national Canada Health Survey in its catchment area. Bradburn's Index of Psychological Well-Being was included as the principal measure of "emotional health" or "happiness", and MacMillan's Health Opinion Survey was added to provide detail on "anxiety" and "depression." St.Henri/Petite Bourgogne respondents aged 25 to 64 years were identified as being relatively "unhappy" compared to other respondents. They also reported more "anxiety" and "depression," as did St.Louis du Parc respondents of the same age group. Respondents who had not completed high school, who were of low socioeconomic status, who reported French as their maternal language, who were widowed, retired, unemployed, or did housework, those in poor physical health, those who reported more than one life event in the past year, who smoked regularly and those who were alone during leisure time tended to be "unhappy" and to report more "anxiety" and "depression."

RÉSUMÉ

i l l

Le département de santé communautaire de l'Hôpital général de Montréal a réalisé une adaptation de l'Enquête Santé Canada auprès de la population de son territoire. L'échelle d'équilibre affectif de Bradburn a servi comme mesure principale de la santé affective, et le questionnaire sur 1'opinion sanitaire de MacMillan fut également utilisé afin de procurer des détails sur l'anxiété et la dépression. Les résidents de Saint-Henri/Petite Bourgogne âgés de 25 à 64 ans furent identifiés comme étant relativement malheureux comparativement aux autres répondants. Ils firent aussi état, comme les répondants du même groupe d'âge à Saint-Louis du Parc, de plus d'anxiété et de dépression. Les personnes enclines à se dire malheureuses, anxieuses ou déprimées, se regroupent, davantage dans les catégories suivantes: les individus, qui n'ont pas complété d'études secondaires, qui | ont un niveau socio-économique peu élevé, qui déclarent le français comme langue maternelle, ceux dont le conjoint est décédé, ceux qui sont retraités, qui sont sans emploi, ceux dont la santé est mauvaise, ceux qui ont connu plus d'un événement stressant et, ceux qui passent leur temps de loisirs seuls.

i !

1. INTRODUCTION

The collection of data on mental as well as physical health was an integral part of the mandate of the national Canada Health Survey (CHS) (1981), as articulated in the proposal for the Canada Health Survey (Collishaw, 1974) and "A New Perspective on the Health of Canadians" (Lalonde, 1974). Specifically, the objectives for the collection of mental health data were to assess the distribution and degree of potential and acute mental health problems over time, and to study the relationship of mental health and illness to physical health, disability, and lifestyle. However, it was decided early in the planning phases of the survey to exclude case-finding for conditions such as retardation, impaired cognitive functioning and psychotic states. Instead, the feeling or affective aspect of experience which they labelled "emotional health" was measured. This was defined as "the overall present state of feeling of the person, reflecting the various internal and external forces working on the individual. This feeling state varies in intensity and nature, having a positive and negative aspect. Positive emotional health is more than the absence of negative feeling and is characterized as general well-being. The negative side is anxiety, depression, and unhappiness" (Stephens, 1976).

The selection of Bradburn's Index of Psychological Weil-Being (Bradburn and Caplovitz, 1965; Bradburn, 1969) as the principal measure of emotional health for the Canada Health Survey was based on a literature review which identified indices that were consistent with the Canada Health Survey orientation to measure positive and negative aspects of health. The use of an existing, easily administered index, though unable to generate rates of specific psychiatric disorder, allowed the possibility of comparison with other studies. In fact, in a recent review of measures of well-being, Kozma and Stones (in Stephens, 1976) concluded that Bradburn's was the best of an imperfect lot. Bradburn 1s single question on overall happiness wa6 also included in the Canada Health Survey, and MacMillan's Health Opinion Survey was added to provide detail on "anxiety" and "depression" (Stephens, 1976). The survey planners felt that these scales would improve the identification, of need (or potential cases) assuming agreement could be reached on the definition of persons in need.

The Department of Community Health (DSC) of the Montreal General Hospital (MGH) carried out an adaptation of the national Canada Health Survey in its catchment area from October vl979 to May

1981. The objectives were to supplement the hospitalization and mortality statistics traditionally used to monitor illness in the community, by studying self-perceived health status in persons living at home. The DSC selected the Canada Health Survey instruments and methodology for its health survey to obtain information comparable with Quebec and Canadian information available from the national survey, and because of the survey's reliability, validity, acceptability and applicability to a Canadian population. Additionally, the survey instruments were available in both French and English (Gofin 1979 a)•

The territory served by the DSC is situated in the west-central part of the heart of the Montreal metropolitan area, and includes a residential population of approximately 200,000 persons. Within this territory, five local community service centres (CLSC1s) cover neighbourhoods representing some of the most disadvantaged and the most favoured segments of Quebec society (Wilkins, 1982). At one extreme of the social hierarchy is the St.Henr i/Petite Bourgogne area, wh ich is predominantly French-speaking, low income, poorly educated, and working class. At the other extreme are the Westmount, NDG, and Montreal West areas, characterized by a high percentage of English-speaking, upper income, univeisity educated professionals. In between is the mixed ethnic neighourhood of St.Louis du Parc, whose many families with young children markedly differentiate the area from the almost child-free downtown office and university - oriented environment of the Metro district (Figure 1.1). Table 1.1 presents selected socio-demographic indicators for each CLSC bas i on the 1971, 1976 and 1981 population census.

The objectives of this report are to study the distribution of "unhappiness" as measured by Bradburn*s Index of Psychological Tieil-Being, and of "anxiety" and "depression" as measured by MacMillan's Health Opinion Survey, in the territory 'of the DSC. Additionally the correlates of these two indices will be studied. The. report is organized into four sections. The first section presents a brief literature review on the measures of emotional health used in the survey. The second section describes the methods of data collection, the variables used in this study, and the analyses performed on the data. The following section presents the results, and the last section discusses the applicability of the findings with respect to planning preventive mental health programs.

FIGURE 1.1 Paye 3

Territory of the Department of Community-Health of the Montreal General Hospital

VEZINA

/ TABLE 1.1

SELECTED SOCIO-DEMOGRAPHIC INDICATORS BY C.L.S.C. IN THE DEPARTMENT OF COMMUNITY HEALTH OF THE MONTREAL GENERAL HOSPITAL

C.L.S.C, ' . POPULATION M Total 0-14 15-64 65 +

N % % % LANGUAGE OF USE'2"1

French English Other % % %

WORKING FORCE WITH MANAGERIAL OR '

TEACHING OCCUPATIONS''^ %

EDUCATION FOR PERSONS 15

YEARS AND OLDER « with % with

9 vears unlvprci'+v

SINGLE PARENT FAMILIES'21

%

St. Henri/Petite'Bourgogne 21,910 28.0 60.7 12.4 79, S 14.9 5,7 2.6 53.9 6.7 32.0

Metro 34,405 4,3 78.4 17,4 28,9 49, 7 22.4 12,7 25.2 49.6 30.6

Westnount/N.D.G. East 55,598 14.2 67,6 18,3 22.6 62.0 15.4 18.9 23.8 43,5 23.1

Montreal West/N.D.G. West 45,305 1S.1 68.2 16,? 12.3 64,? 23.1 23.0 20.9 32.0 22.6 St. Louis du."Pare 45,150 19.S 71.6 8,9 4 37,7 14,5 47.8 2.6 53.0 14.6 27.8

D.S.C. 202,365 14.3 70,7 15,0 23.3 61.0 15,7 10.8 28,3 32,0 22.8

r u1981 Census 1976 Census r n1971 Census

2. LITERATURE SUMMARY (1)

2.1 Bradburn's Index of Psychological Well-Being

In the early 1960's, Bradburn and Caplovitz (1965) of the US national Opinion Research Centre developed a measure of psychological well-being or "happiness". Their work focused on the measurement- of short-term stress and strain arising from events in normal, ordinary, day to day life, rather than on indicators of long-term problems. Bradburn undertook to assess the stresses by enumerating particular positive and negative episodes that had occurred in the respondents' lives in the recent past. He proposed a ten-item battery containing items referring to five negative and five positive feelings. To reflect positive feelings or affect, the respondent is asked if, in the preceding few weeks, he has felt

1) "on top of the world" 2) "particularly excited or interested in something" 3) "pleased about having accomplished something" 4) "that things were going your way" 5) "proud" because someone complimented you on

something you had done".

Similarly, to elicit negative affect, the respondent is asked if, in the past few weeks, he has felt

1) "so restless you couldn't sit long in a chair" 2) "bored" 3) "very lonely or remote from other people" 4) "depressed or very unhappy" 5) "upset because someone criticised you".

(1) More complete reviews of Bradburn's Index of Psychological Weil-Being and' MacMillan's Health Opinion Survey are available from the author of this report.

In administration, the two sets of items were ansystematically mixed together. For each question, the respondent answered "Yes" or "No." The number of positive items checked gave the positive affect score (PAS). The number of negative items correspondingly provided a negative affect score (NAS). Bradburn reported that the measures of positive and negative affect were independent of each other although both scores correlated strongly with Bradburn"s single question on overall happiness ("Taking all things together, how would you say things are these days - would you say you are: Very happy; Pretty happy; Not too happy"). Additionally, the positive and negative scores were, to some extent, correlated with different variables. Negative affect scores were related "primarily to variables that have been dealt with by the traditional 'mental illness' approaches", such as indicators of "marital adjustment," "anxiety," and "worry" (Bradburn, 1969). These particular variables showed no association with positive affect scores. Conversely, Bradburn reported that variables such as "social participation," "companionship with one's spouse," and "experiencing novel situations" were correlated with the positive affect scores (Bradburn, 1969).

This pattern of independence between the positive and negative affect scores led Bradburn to theorize that people's feelings of psychological well-being are composed of two distinct subjective feeling states which vary independently of each other. Overall psychological well-being reflects the degree to which the individual has an excess of positive over negative affect, negative over positive affect, or whether the two affects are balanced for the individual. The overall score or Affect Balance Scale (ABS) score is expressed as the arithmetic difference between the positive affect score and the negative affect score. Bradburn claimed support for his hypothesis that psychological well-being is the balance between positive and negative affect in the finding that the ABS score was more highly associated with three questions that were used as general indicators of "happiness" and "life satisfaction," than were either the positive or negative affect scores taken singly. For example, the gamma coefficients of association between the ABS score and Bradburn's single question on overall happiness in two waves of interviews averaged 0.42 while the gamma coefficients of association between each of the positive and negative affect scores and the same general measure averaged 0.32 (Bradburn, 1969). Bradburn observed that "As one moves from a predominance of positive over negative feelings through a balance of the

two, to a predominance of negative over positive feelings, the percentage of respondents reporting that they are Very Happy' declines. As the balance tips in the direction of negative feelings, the proportion reporting that they are 'Not Too Happy1 increases sharply".

Evidence for the convergent and concurrent validity of Bradburn's Index of Psychological Well-Being is reported in the literature (Berkman, 1971b? Warr, 1978; Moriwaki, 1974), althouqh questions have been raised regarding the utility of the balance model of psychological well-being, question phrasing, and the internal consistency of the positive and negative affect scores. Several studies suggest that positive and negative affect scores yield more information than does the Affect Balance Scale score, and should be studied separately until convincing evidence on the usefulness of the balance model is presented (Cherlm and Reeder, 1975; McDowell, 1982).

Bradburn's Index of Psycholog ical Well-Being has been completed by over 30,000 adults in surveys conducted in metropolitan, urban, and rural areas (Bradburn and Caplovitz, 1965; Bradburn, 1969; Gaitz and Scott, 1972, Beiser, 1974; Moriwaki, 1973, Moriwaki, 1974; George, 1978; Palmore et al, 1979; Fontana, 1980; Warr, 1978; Canada Health Survey, 1981).

2.2 MacMillan's Health Opinion Survey (HQS)

The Health Opinion Survey was developed in the late 1950 s as an indicator of mental illness measuring "anxiety and "depression," within a more extensive psychiatric interview schedule for the Stirling County study (MacMillan, 1957). The HOS was essentially the product of a pool of items selected by the U.S. Army to screen unsuitable candidates, to avoid mentally ill recruits and to reject other men who. were unfit for combat due to a disposition to overreact to a stressful situation in the field and to freeze in the face of danger (Tousignant et al, 1974). The questions m the HOS were not considered capable of covering the characteristic features of disorders described by psychiatric nomenclature, although MacMillan (1957) claimed the HOS could be used as a psychological screening test.

Since its development the HOS has been used in epidemiological studies independently of the whole psychiatric interview used in the Stirling County study (Gurin et al, 1960). The economical advantages including the brief time of application, the possibility of using lay interviewers, and the amount of preliminary work which had already been done constituted advantages for investigators who did not have the time or budget to launch wide scale projects. Additionally, the HOS produced a symptom score that lent itself to statistical manipulation and permitted group comparisons.

Briefly the HOS measures the frequency of occurrence of sixteen psychophysiological symptoms of "anxiety" and "depression." The respondent is asked to respond to the following questions:

1. "Have you ever been bothered by your heart beating hard?"

2. "How often are you bothered by an upset stomach?"

3. "Do your hands ever tremble enough to bother you?"

4. "Are you ever troubled by your hands or feet sweating so that they feel damp and clammy?"

5. "Have you ever been bothered by shortness of breath when not exerting yourself?"

6. "Do you ever have spells of dizziness?"

7. "Do you feel weak all over much of the time?"

8. "Do you feel healthy enough to carry out the things you would like to do?"

9. "Do you feel you are bothered by all sorts (different kinds) of ailments in different parts of your body?"

10. "Do you ever have loss of appetite?"

11. "Do you have any trouble in getting asleep and staying asleep?"

12. "Has ill health affected the amount of work you do?"

13. "Have you ever felt you were going to have a nervous breakdown?"

t

14. "Are you ever bothered by nightmares?"

15. "Do you tend to lose weight when- important things are bothering you?"

16. "Do you tend to feel tired in the morning?"

A three-point response category is used to reflect the frequency of experiencing each symptom, and values of 1, 2, and 3 are assigned to "Often, "Sometimes", and "Never" respectively. A single score for the 16 items ranges from 16 (all symptoms experienced often) to 48 (all symptoms never experienced).

MacMillan (1957) attempted to validate the HOS by demonstrating that it could discriminate between "sick" and "well" respondents as determined by one psychiatrist. Tousignant et al. (1974) however has challenged MacMillan's results, stating that the HOS items tend to underrepresent what clinicians regard as serious pathology. Although the questionnaire possesses some psychometric qualities (statibility over time, internal consistency, criterion validity) Tousignant et al. (1974) state that the lack of face validity and the influence of two biases - physical health and social desirability - militate against use of the HOS as a measure of "anxiety" and "depression." They reported that in fact, three categories of problems are screened by high scores on the HOS: chronic mental disorder, transition stress situations, and poor physical health.

Dohrenwend and Dohrenwend (1982) agree that the HOS measures some kind of nonspecific psychological distress. Because it correlates highly with measures of "self-esteem," "helplessness - hopelessness," "dread," "sadness," and "confused thinking," they refer to the HOS as a measure of "demoralization". However, "demoralization" is very often indirectly related to diagnosable mental disorders.

2.3 Purpose of This Study

This report extracts the information on emotional health as measured by Bradburn1s Index of Psychological Well-Being and

MacMillan1s Health Opinion Survey from the application of the national Canada Health Survey in the DSC-MGH catchment area. It identifies risk groups in the DSC's five CLSC territories by comparing the patterns of response on Bradburn's Index of Psychological Weil-Being and MacMillan's Health Opinion Survey in Canada and the DSC. Additionally, it studies the associations between emotional health as measured by positive and negative affect and HOS scores and selected socio-demographic, physical and mental health, and lifestyle characteristics of the survey respondents. In this section, positive and negative affect scores, rather than ABS scores are studied because the utility of the balance model of psychological well-being has not been demonstrated in the literature. The results are then discussed with respect to planning preventive mental health programs.

3. METHODS

3.1 Survey Instruments

The content of the national Canada Health Survey is based on self-perceived health status. It includes questions about lifestyle risk factors such as alcohol consumption, tobacco use, emotional health, physical activity and seat belt use collected in the self-administered "Lifestyle and Your Health Questionnaire" (LHQ). In the "Interviewer Administered Questionnaire" (IAQ), information is obtained on physical health, and on consequences of heaith status such as health professional consultations, activity limitation, disability, medication use, and hospitalizations.

Following a feasibility study (Gofin, 1979 a), the Canada Health Survey questionnaires were modified by adding questions concerning limitations in activities of daily living to the Interviewer-Administered Questionnaire (IAQ) and questions concerning reproductive behavior to the self-administered Lifestyle and Your Health Questionnaire (LHQ). The additional questions were pretested for acceptability and applicability in Westmount and St.Henri, two sectors selected for their differences in socioeconomic status and language (Gofin, 1979 b). IAQ and LHQ questionnaires were administered in French or English according to the respondents' language. Additionally, in CLSC St.Louis du Parc, Portugese and Greek interviewers completed interviews for respondents of these ethnic groups. The LHQ was also available in Portugese and Greek.

3.2 Sample Selection

The sampling frame was the voters' list for the 1979 spring federal election, the most complete and recent lists available to the DSC (Gofin, 1979 a). The lists comprised 97% of eligible voters; recent immigrants and persons under the age of 18 were not included (Gofin, 1979 a). Enumerated households were numbered consecutively and selected using a random number generator.

The survey was administered to a random sample of households in two phases. In the first phase from October 1979 1 to January 1980, data was collected from 149 households in CLSC St.Henri/Petite Bourgogne and 170 households in CLSC Metro. In the second phase from September 1980 to May 1981, data was collected from 138 households in CLSC St.Louis du Parc, 137 households in CLSC Montreal West/NDG West, and 142 households in CLSC Westmount/NDG East.

3.3 Data Collection

The IAQ interviews were completed in French, English, Portugese or Greek by trained interviewers. Prior to the survey, interviewers received an intensive training program consisting of lectures, role-playing, group interviews, and mock home interviews. The training program oriented the interviewers to the survey instruments, the procedures, and interview techniques. Additionally, each interviewer was provided with a complete manual of procedures.

The survey interviews were conducted at the respondents1

homes, where the interviewer collected health information on all household members from a responsible adult member. Each household member 15 years and older was requested to complete the LHQ and return it to the interviewer. The questions comprising Bradburn1s Index of Psychological Weil-Being and MacMillan's Health Opinion Survey were included in the LHQ. The interviewers were required to edit the IAQ1 s and LHQ1 s for completeness, leg ibility, and consistency, and the project supervisor completed a second check. Individual anonymity and confidentiality were maintained for all respondents.

The data from the IAQ and LHQ questionnaires were coded onto coding sheets according to instructions in coding manuals, keypunched, and placed on tape.

3.4 Variables

The variables studied in this research include:

I - Socio-demographic Variables: Age Sex CLSC of Residence Ethnic Origin Maternal Language Level of Education Marital Status Socioeconomic Status Major Activity

II - Physical Health Variables:

Bed-days Medications Chronic Health Problems

III - Mental Health Variables:

Overall Happiness Life Events MacMillan's Health Opinion Survey Score Positive Affect Scores Negative Affect Score Affect Balance Scale Scores

IV - Lifestyle Variables:

Leisure Time Alcohol Use Tobacco Use Physical Activity

Appendix I shows which questions in the IAQ and LHQ questionnaires contributed to the variables, the range of recorded scores, and coded categories. A description of some of the variables follows, for clarification.

Socioeconomic status was recorded using a revised socioeconomic index for occupations in Canada (Blishen and

^McRoberts, 1976), Scores ranged between 18,0 and 75.3, with the higher scores indicative of high socioeconomic status. An index score was assigned to each individual, based on present or past occupation. Individuals with no present or past occupations were assigned index scores according to the highest index score for the household in which he/she lives. For example, in a household where both the husband and wife were currently employed in different occupations, children were assigned the higher of the two index scores. For chi-squàre analysis, responses were categorized as high (60-75.3), moderate (40-57), or low (18-39) socioeconomic status.

Major activity refers to what the respondent was doing most of the past 12 months. Responses included "working", "keeping house", "school", "retired", and "unemployed".

Bed-days is the number of days, in the past two weeks during which the respondent stayed in bed because of a health problem. Responses ranged between 0 and 14, and for chi-square analysis responses were categorized as none, one, or more than one.,

Number of chronic health problems was derived from a list of conditions considered chronic regardless of onset or duration. For chi-square analysis responses were categorized as none, one, or more than one.

Medications refers to the number of medicines, pills, or ointments taken or used by the respondent in the last two days. The respondent was asked specifically about use of pain relievers such as aspirin, tranquilizers, medicines for the nerves or medicines to help you sleep, medicine for the heart or blood pressure, antibiotics, stomach remedies or medicines, laxatives, cough or cold remedies, skin ointments or salves, and vitamins or minerals. For chi-square analysis, responses were categorized as none, one or more than one.

Life events was measured by a checklist of thirteen items, including a "none of these response" based on the Schedule of Recent Events described by Holmes and Rahe (1973) . Respondents were required to indicate which of the events had occurred in their lives in the last twelve months. The number of events was the recorded variable. For chi-square analysis, reponses were categorized as none, one, or more than one.

MacMillan's Health Opinion Survey measures the frequency of occurrence of sixteen psychophysiological symptoms of anxiety and depression. A single score for the sixteen items was derived from responses which were weighted to reflect frequency ("often", "sometimes", "never") and ranges from 16 (all symptoms experienced often) to 48 (all symptoms never experienced). For chi-square analysis, responses were categorized as frequent symptoms (16-31) or infrequent symptoms (32-48).

To obtain a score for Bradburn's Index of Psychological Weil-Being, respondents were asked about the relative frequency with which they experienced five positive and five negative feelings during the past two weeks. Each item had three response categories: "often", "sometimes", "never", which were assigned values of one, two or three. Scores for positive and negative affect were derived by adding the, assigned values obtained for the five positive and five negative items respectively. For chi-square analyses the scores were categorized as strong affect (4-8) or moderate/weak affect (9-15) for both positive and negative affect scores. Positive and negative affect scores were then combined into a single Affect Balance Scale score. For chi-square analyses responses on the ABS were categorized as strong, moderate, or weak to retain comparability with the Canada Health Survey (1981) results.

Leisure time refers to the amount of leisure time spent with others during the past two weeks. Responses were categorized as "Alone a Lot", "Spent Some Time with Others" or "With Others a Lot".

The measure of physical activity used in this report is a "Physical Activity Index" which summarizes information about physical activity during discretionary time in exercise, sport, physical activity and household chores. The index is a summation of frequency, of each activity reported in the previous two weeks multiplied by the average duration in minutes of each activity and by the average metabolic cost of that activity. Scores range between 0 and 70,000. For analysis, scores were categorized as "Inactive" (0-1749), "Moderately Active" (1750-2999) or "Active" (3000 +).

3.5 Data Analysis

Differences in the distribution of scores on Bradburn's Index of Psychological Weil-Being and MacMillan's Health Opinion Survey scores in Canada and the DSC, were analyzed in frequency tables. The associations between positive, negative, and HOS scores and selected socio-demographic, health, and lifestyle variables were tested using chi-square analysis. For chi-square testing, positive, negative, Affect Balance Scale, and HOS scores were categorized as detailed earlier. Correlation coefficients were computed between uncategorized positive and negative affect and HOS scores and the continuous socio-demographic, health and lifestyle variables.

Multiple stepwise regression was used to describe the effects of the socio-demographic, health, and lifestyle variables on positive and negative affect and on HOS scores. For multiple regression analyses, positive and negative affect and HOS scores, and the continuous socio-demographic, health and lifestyle variables were not categorized.

4. RESULTS

This section of the report présents the results of the data analysis. The first part presents the survey response. The next section compares the distribution of scores on Bradburn's Index of Psychological Well-Being and MacMillan's Health Opinion Survey in Canada and the DSC. The next section studies the associations between positive, negative affect and HOS scores and selected socio-demographic, health, and lifestyle variables.

4.1 Survey Response

A total of 736 households were visited, and 587 or 79.8 per cent of those completed the Interviewer-Administered Questionnaire (IAQ). Information was collected on 1,458 individuals. Approximately 17 per cent or 122 households refused to be interviewed and 27 households or 3.7 per cent were unable to be interviewed because of a language problem, or because no one was home after repeated visits to the household. Table 4.1 presents the IAQ response by CLSC.

Of the 1,129 IAQ respondents 15 years and older who were asked to complete the Lifestyle . and Your Health Questionnaire (LHQ), 900 or 79.7 per cent filled it out, and 229 or 20.3 per cent refused. Analyses not presented in

. this report indicated that LHQ nonrespondents were not different from LHQ respondents by sex, socioeconomic status, level of education and maternal language. However, a high proportion of LHQ nonrespondents were young (15-19 years). Table 4.2 presents the LHQ response by CLSC. Forty-six respondents who completed the LHQ did not respond to Bradburn's ten questions. The 854 respondents who completed Bradburn's ten questions represent 75.6 per cent of IAQ respondents 15 years and older who were asked to complete the LHQ. Twenty three respondents who completed the LHQ did not respond to MacMillan's HOS questions. The 887 respondents who completed MacMillan's questions represent 77.7 per cent of IAQ respondents 15 years and older who were asked to complete the LHQ.

TABLE 4 . 1

RESPONSE TO THE INTERVIEWER-ADMINISTERED QUESTIONNAIRE (IAQ) BY CLSC

TOTAL OCCUPIED HOUSEHOLD ' UNITS

N

COMPLETED INTERVIEW

%

REFUSED INTERVIEW

%

UNABLE TO BE INTERVIEWED

%

DSC-MGH 736 7 9 . 8 16.6 3 .7

S t - H e n r i / P e t i t e Bourgogne 149 79.9 14 .8 5 .3

Metro 170 8 0 . 0 14.7 5 .3

Westmount/NDG East 142 81 .7 18 .3 -

Mbntreal. West/NDG West 137 77 A 19 .0 3.7

St -Louis du Parc 138 79.7 16.7 3 .6

TABLE 4 . 2

RESPONSE TO THE LIFESTYLE AND YOUR HEALTH QUESTIONNAIRE (LHQ) BY CLSC

IAQ RESPONDENTS 15 YEARS AND OLDER

N

COMPLETED LHQ

%

REFUSED LHQ

%

DSC-MGH 1129 79.7 20.3

S t - H e n r i / P e t î t e Bourgogne 254 80 .3 19.7

METRO 200 89 .0 11.0

Westmount/NDG East 233 77 .2 22 .8

Montreal West/NDG West 191 81 .1 18.9

St-Louis du Parc 251 72 .9 27.1

< • m

TABLE 4.3

Selected Sociodemographic Characteristics of Respondents in the LHQ Sample

N

Age

Sex

15-19 20-24 25-44 45-64 65 + Total

Males Females Total.

Ethnic Origin European Non European Total

Maternal Language English French Other Total

Lev.sl of Education Less than secondary Secondary Post-Secondary Total

Marital Status Married Widowed, Divorced or Separated Single Total

82 131 334 215 136 898

425 473 898

799 94

893

292 354 247 893

503 193 195 891

435 136 321 892

9.1 14.6 37.2 23*1 15.1

100.0

47. 3 52. 7

100.0

89.5 10.5

100.0

32. 7 39.6 27. 7

100.0

56.5 21.7 21.9

100.0

48.8

15.3

36.0 100.0

Table 4 3 presents selected socio-demographic characteristics of LHQ respondents. Over sixty per cent of respondents were between 25 and 64 years of age, with the mean age of the sample being 41.1 years, 52.7 per cent •of respondents were female; most respondents described their ethnic origin as European; French was the maternal language of 39.6 per cent of respondents, and 32.7 per cent ot respondents first learned and used English in childhood. More than one fifth reported that their maternal language was neither French nor English. A substantial proportion (56 5 per cent) of respondents had not completed secondary school and 21.9 per cent had post secondary schooling. Almost half of respondents were married, 36.0 per cent were single, and 15.3 per cent were widowed, divorced, or separated.

4.2 Distribution of "Unhappy" Respondents in Canada and the DSC-MGH

This section compares the proportions of unhappy respondents (ie those who scored "negative" on the Affect Balance Scale) in Canada and the five CLSC zones of the DSC-MGH. Affect Balance Scale scores are studied in this section to retain comparability with the Canada Health Survey, which did not report results for the two subscores of the Affect Balance Scale (positive and negative affect).

Table 4.4 compares the proportion of "unhappy" respondents in Canada and the DSC-MGH by sex. Higher proportions of both male and female St.Henri/Petite Bourgogne respondents were "unhappy" compared to respondents in other CLSCs and in the national survey. Additionally, a relatively high proportion (9.8 per cent) of Montreal West/NDG West male respondents were "unhappy".

Table 4.5 presents the proportions of "unhappy" respondents by age group. Higher proportions of St.Henri/Petite Bourgogne respondents 25 to 64 years and 65 years and older were "unhappy" compared to other respondents in the DSC-MGH and in Canada. Additionally, 10.6 per cent of Montreal West/NDG West respondents 15-24 years were "unhappy", also a relatively high proportion compared to other respondents.

TABLE 4.4

Distribution of "Unhappy" Respondents in Canada and the DSC-MGH by Sex

Total Males . Femal es Total N N % N X N %

CANADA 15808 304 3.9 466 S.8 770 4.9

St. Henri/Pte Bourgogne 199 10 10.4 15 14.6 25 12.6

Metro 175 2 2.3 6 7.0 8 4.6

Westmount/NDG East 161 3 4.6 5 S.3 8 S.O

Montreal West/NDG West 142 6 9.8 5 6.2 11 7.8

St. Louis du Parc 165 6 7.3 6 7.2 12 7.3

TABLE 4.5

Distribution*of "Unhappy** Respondents in Canada and the DSC-MGH by Age Group

Total . 15-24 25-64 .65 + Total N N • % N % N % N %

CANADA 15808 215 4.9 447 4.5 108 7.1 770 4.9

St.Henri/Pte Bourgogne 199 1 2.1 19 17.1 5 12.8 25 12.6

Metro 175 2 5.0 5 4.3 1 5.3 8 4.6

Westmount/NDG East 161 0 - 6 . 5.7 2 7:1 a 5.0

Montreal West/NDG West 142 4 10.6 6 7.2 1 4.8 11 7.8

St. Louis du Parc 165 3 5.9 9 8.7 O 12 7.3

4.3 Distribution of Respondents who Reported Frequent Psycho-physiological Symptoms in Canada and the DSC-MGH

This section compares the proportion of respondents who reported frequent psychophysiological symptoms of "anxiety" and "depression," in Canada and the five CLSC zones of the DSC-MGH. Table 4.6 presents the results by sex and indicate s that h igher proport ions of females reported frequent psychophysiological symptoms in both the Canadian and the DSC-MGH surveys. Higher proportions of St.Henri/Petite Bourgogne and St.Louis du Parc respondents of both sexes reported frequent psychophysiological symptoms, compared to respondents in other CLSCs and in the Canada Health Survey. Table 4.7 presents the results by age group and indicates that comparatively high proportions of St.Henri/Petite Bourgogne and St.Louis du Parc respondents 25 to 64 years reported frequent psychophysiological symptoms. Although 11.1 per cent of Metro respondents 65 years and older reported frequent psychophysiological symptoms, the results must be interpreted cautiously because of the small denominator.

4.4 Associations between Emotional Health and Socio-demographic Variables

This section studies the associations between positive and negative affect and HOS scores, and the socio-demographic variables of age, sex, CLSC of residence, ethnic origin, maternal language, level of education, marital status, socioeconomic status, and major activity. For clarity of presentation, tables referred to are presented at the end of the section.

Age

Table 4.8 indicates that positive affect scores are not associated with age group. Although age is not associated with negative affect scores, Table 4.9 indicates that higher percentages of young respondents aged 15-19 years, and of respondents 45 years and older, reported strong negative affect, compared to respondents between 20 and 44 years. The correlation coefficients between uncategorized positive and negative affect scores and age were 0.072 (p=.036) and

TABLE 4.6

Distribution of Respondents who Reported j Frequent Psychophysiological Symptoms in

Canada and the DSC-MGH, by Sex

Total N

Males N . %

Females N %

Total N %

CANADA 15808 199 2.4 494 5.7 693 4.1

St. Henri/Pte Bourgogne 199 7 7.2 15 24.6 22 12.0

Metro 175 2 2.2 4 4.6 6 3.4

Westmount/NDG East 161 0 - 2 2.0 2 1.2

Montreal West/NDG West 142 3 4.5 5 5.8 8 5.3

St. Louis du Parc 165 7 8.0 8 9.3 15 8.6

TABLE 4.7

Distribution of Respondents who Reported Frequent Psychophysiological Symptoms in Canada and the DSC-MGH by Age Group

Total N

15-24 . N %

25-64 N 2

65.+ N %

Total N %

CANADA 15808 107 2.4 444 4.2 123 6.7 693 4.1

St Henri/Pte Bourgogne • 199 3 6.1 16 14.3 3 7.7 22 11.0

Metro 175 1 2.4 3 2.6 2 11.1 6 3.4

Westmount/NDG East 161 0 - 2 i:8 0" - 2 1.*

Montreal West/NDG West 142 2 5.0 5 5.7 1 4.0 8 5.3

St. Louis du Parc 165 4 7.7 ,10 9.1 1 8.3 15 8.6

f

*

0.076 (p=0.027) respectively, confirming that age and the affect scores are not linearly related (Table 4.65).

Table 4.10 indicates that Health Opinion Survey scores were also not associated with age group. The correlation coefficient between uncategorized HOS scores and age confirms this result (r=-0.039, p=0.246) (Table 4.65).

Sex

Tables 4.11 and 4.12 indicate that although a higher proportion of females than males reported both strong positive and negative affect, the difference was not significant.

Similarly a higher proportion of female respondents reported frequent psychophysiological symptoms compared to male respondents (7.3 per cent compared to 4.6 per cent) but the difference was not significant (Table 4.13).

CLSC of Residence

Table 4.14 indicates that positive affect scores are not associated with CLSC of residence. However negative affect scores are associated with CLSC of residence (Table 4.15). Higher proportions of St.Henri/Petite Bourgogne (14.0 per cent) and St.Louis du Parc (10.8 per cent) respondents reported strong negative affect, compared to respondents from CLSCs Metro (5.1 per cent), Montreal West/NDG West (6.3 per cent) and Westmount/NDG East (4.9 per cent).

HOS is also significantly associated with CLSC. Higher proportions of St.Henri/Petite Bourgogne (10.9 per cent) and St.Louis du Parc (8.6 per cent) respondents reported frequent psychophysiological symptoms, compared to respondents from Metro (3.4 per cent); Montreal West/NDG West (5.3 per cent) and Westmount/NDG East (1.1 per cent) (Table 4.16).

Ethnic Origin

A lower proportion of respondents of non-European origin (Asian, African, Native American or Other) reported strong positive affect, and a higher proportion reported strong negative affect, compared to respondents of European origin. The difference was not significant (Tables 4.17 and 4.18).

*

Similarly respondents of European origin did not report more psychophysiological symptoms than respondents of non-European origin (Table 4.19).

Maternal Language

Positive affect scores were not associated with maternal language (Table 4.20). However, negative affect scores were associated with maternal language with a higher proportion of French respondents (11.2 per cent) reporting strong negative affect compared to English respondents (5.7 per cent) and respondents who reported other maternal languages including Greek, Portugese, and Italian (7.7 per cent) (Table 4.21).

Maternal language was not associated with HOS scores (Table 4.22).

Level of Education

Positive affect scores were not associated with level of education (Table 4.23). However, level of education, was associated with negative affect scores. A linear trend was apparent, with 13.6 per cent of respondents with less than secondary, 8.6 per cent of those with secondary, and 2.4 per cent of respondents with post-secondary school education reporting strong negative affect (Table 4.24).

Table 4.25 indicates that a lower proportion of respondents with post-secondary school. education reported frequent psychophysiological symptoms compared to respondents with secondary and less than secondary school education (2.4 per cent compared to 6.3 and 9.0 per cent respectively). The difference was significant according to chi-square analysis.

Marital Status

Although neither positive nor negative affect scores were associated with marital status (Table 4.26 and 4.27), a much higher proportion of widowed persons (18.0 per cent) reported strong negative affect compared to respondents who were married, divorced, separated or single.

Similarly, marital status was not with HOS scores, although a higher proportion of widowed respondents (10.8 per cent) reported frequent psychophysiological symptoms compared to respondents who were married (6.4 per cent), divorced (5.6

*

per cent), separated (6.1 per cent), and single (4.8 per cent) (Table 4.28) .

Socioeconomic Status

Table 4.29 indicates that positive affect were not associated with socioeconomic status. A correlation coefficient of -0.041 (p=0.248) between uncategorized Blishen scores and positive affect, confirmed these results (Table 4.65). Negative affect was however associated with socioeconomic status (Table 4.30), A linear trend was apparent, with 14.1 per cent of respondents with low socioeconomic status, 6.8 per cent of respondents with moderate socioeconomic status, and 3.7 per cent of respondents with high socioeconomic status reporting strong negative affect. However, a correlation coefficient of 0.090 (p=0.012) between uncategorized Blishen and negative affect scores indicated that the association between the two variables (Table 4.65) is very weak.

Table 4.31 indicates that a higher proportion of respondents with low socioeconomic status (8.9 per cent) reported frequent psychophysiological symptoms compared to respondents with moderate socioeconomic status (4.3 per cent) and respondents with high socioeconomic status (4.4 per cent). The association was significant. The correlation coefficient between uncategorized HOS scores and socioeconomic scores was 0.133 (p=0.0001) indicating that the association is very weak (Table 4.65).

Major Activity

Positive and negative affect scores were not statistically significantly associated with major activity (Tables 4.32 and 4.33). However, it is important to note that higher proportions of respondents who reported "Housework" (11.9 per cent), "School" (10.7 per cent) or "Retired" (12.7 per cent) as their major activity also reported strong negative affect, compared to respondents who were "Working" (6.7 per cent), or "Unemployed" (5.0 per cent).

Major activity was not significantly associated with HOS scores (Table 4.34). However, higher proportions of respondents who were "Unemployed" (7.3 per cent), who were "Retired" (10.7 per cent), or who were doing "Housework" (7.9 per cent) reported frequent psychophysiological symptoms, compared to other respondents.

TABLE 4 . 8

Page 27

Positive Affeçt by Age Group

Posit ive Af fect 15 - 19

N X

Agé

20 - 24

N X

Group

25 - 44

N X

45 - 64

N X

65+

N X

Total

N . X

Strong 32 40.S i

48 37.8 124 38.0 60 30.8 44 37.3 308 36.5

Moderate -Weak

i 47 59.5 ' 79 62.2 202 62.0 135 69.2 74 62. 7 537 63.6

TOTAL i

79 100.0 i 127 100.0 326 100.0 195 100.0 118 100.0 845 100.0

! X8 = 3.76 DF = 4

I p » 0.43

| TABLE 4 .9

I Negative Affect by Age Group

Negative Af fect 15 - 19

N X

Age 20 - 24

N %

Group 25 - 44

N X

45 - 64'

N X

• 65+

N %

Total

N X

Strong. 10 12.?\ i.

9 7.1 19 5.9 23 11.7 11. 9.4 72 8.6

Modérate -Weak

i 69 87.3 118 92.9 306 94.1 173 88.3 106 90.6 772 91.5.

TOTAL 79 100.0 127 100.0 325 100.0 196 100.0 117 100.0. 844 100.0

x2 = 7 . 7 5 1 DF e 4

p « 0 . 1 0

i - -

! TABLE 4.10

KOS SCORE BY AGE GROUP

HOS Symptoms .15 - 19

N %

20 - 24

N %

25 - 44

N %

45 - 64

N % 65

N % TOTAL

N %

Frequent. 5 6.2 5 3.8 17 S.I 19 9.2 7 5 .6 53 6 .1

Infrequent 75 93. S 125 96.2 316 94.9 187 90.S 119 94.4 822 93.9

TOTAL 80 100.0 1

130 100.0 333 100.0 206 TO0.0 126 J 0 0 . 0 875 100.0

X? = 5.33 DF I = 4

TABLE 4.11

Posi t ive Af fec t by Sex

Positive Affect

' Hale i

N % i

Female N %

Total N %

Strong 136 34.4 172 38.1 308 36.4

Modérate-Ueak 259 65.6

i 280 61.9 539 63.6

TOTAL 1

395 100.0 i

452 100.0 847 100.0

' xa = 1.19 | OF = 1 , p = 0.27 !

TABLE 4.12

Negative Affect by Sex

i

Negative Affect

; Male N % i

Female N %

Total N %

Strong 31 7.8 41 9.1 72 8.S

Modérate-Heak 365 92.2 409 90.9 774 91.S

TOTAL 396 100.0 450 100.0 846 100.0

' x2 » 0.44 DF s 1

p = 0.50

TABLE 4.13

I HOS Score by Sex i

HOS Symptoms . Male N % i

Female N %

Total N % .

Frequent 1 19 4.6 34 7.3 53 6,0

Infrequent 393 95.4 431 92.7 824 9 4 . 0

Total 412 100.0 465 100.0 877 100.0

X 2 = 2.80 DF = 1 |

p = 0.09

TABLE 4.14

POSITIVE AFFECT BY CLSC

Positive Affect Metro

N %

St-Henri

N %

Mtl West/ NDG West

N %

Westmount/ NDG East

N X

St-Louis du Parc

N %

TOTAL

N %

Strong 56 32.0 77 36.S 58 40.3 62 36.0 55 33.3 308 36.4

Moderate-Weak 119 66.0 123 61 .S 86 59.7 101 62.0 HQ 66.7 539 « . 6

TOTAL 175 100.0 200 100.0 144 100.0 163 100.0 165 100.0 847 100.0

X*= 3.64 DF - 4 p = 0.45

TABLE 4.15

NEGATIVE AFFECT BY CLSC

Negative Affect Metro

N . %

Mtl/West/ St-Henn" NDG West

N % N %

Westmount/ NDG East

-N. %

St-Louis du Parc

N t

TOTAL

N %

Strong 9 S.I 28 14.o\ 9 6.3 8 4.9 18 ÏO.sj 72 «.5

Moderate-Weak 166 94.9 172 66.0 1 34 93.7 154 95 . 1 148 £9.2 774 91.5

TOTAi 1 1

175 100.0 |200 100.0 143 100.0 I

162 100.0 1166 100.0 •1

846 100.0

X 15.00 DF = 4

p « 0 . 0 0

Table 4."16

HOS Score by CLSC

HOS Symptoms Metro

N %

St-Henri

N %

Montreal/ NDG West

N %

Westmount/ NDG East

N %

St-Louis du Parc

N %

Total

N t

Frequent 6 3.4 22 10.9 6 5.3 2 ï . ï 15 8.6 53 6.0

infrequent 170 96.6 179 69.1 144 94.7 172 96.9 159 9/ .4 824 94.0

Total 176 100.0 201 I0O.0 152 100.0 174 100.0; 174 100.0 677 100.0

X2 = 20.19 DF s 4 p s 0.00

Table 4.17

Posit ive A f fec t by Ethnic Origin

Positive Affect

European N %

Non-European N X

Total N X-

Strong 281 37.1 27 30.3 308 36.4

Moderate-Weak

i

477 62.9 62 69. 7 539 63.6

TOTAL 758 100.0 89 100.0 847 100.0

x* " 1.56 OF = 1

p « 0.21

Table 4.18

Negative Affect by Ethnic Origin

Negative Affect

European N X

Non-European N X

Total N X

Strong 63 8.3 9 10.1 72 8. S

Moderate -Weak 694 91.7- 80 89.9 774 91.6

TOTAL 757 100.0 89 100.0 846 100.0

x1 = 0.32 OF = 1

p = 0;56

Table 4.19

HOS SCORE BY ETHNIC ORIGIN

HOS Symptoms • European Non-European Total N X N % H X

Frequent 49 6.2 4 4.3 53 6.0

Infrequent 736 93.S 88 95.7 824 94.0

Total 785 100.0 92 100.0 877 100.0

X2 » 0.52 DF = 1 p = 0.47 .

Table 31

Table 4.20

Posit ive Af fect by Maternal Language

Positive Affect

English N %

French N X.

Other N X.

Total N X

Strong 111 37.5 139. 37.9 58 31.5 308 36.4

Modérate-Weak 185 62.5 228 62.2 126 66.5 539- -63.6

TOTAL -296 100.0 367 100.0 1184 100.0 847 100.0

x® = 2.39 DF = 2 p = 0.30

Table 4.21

Negative Affect by Maternal Language

Negative Affect-

English N X

French N *

Other N %

Total N *

Strong . .17 5.7 41. 11.2. 14 7.7 72 -8i5

Modérate-Weak. 279 94.3 326 88.8 169 92.3 774 91.5

TOTAL 296 J 00.0 367 j00 .0 183 200.0 .846 200.0

x« - 6.42 DF « 2 p = 0.04

Table 4.22

HOS SCORE BY MATERNAL LANGUAGE

HOS Symptoms English French Other Total

N X N % N X N X

Frequent 12 4.2 26 7.4 13 6.6 51 6.1

Infrequent 271 95.8 324 9 2.6 185 9 3.4 780 93.9

Total 283 100.0 350 100.0 198 100.0 831 100.0

X2 » 2.84 DF » 2

p = 0 . 2 4

I u y c

Table 4.23

Positive Affect by Level of Education

Positive . Affect

Less than Secondary H %

Secondary

N %

Post Secondary N X.

Total

N %

Strong 129 38.2 71 33.8 .106- 36.4 306 36. S

Moderate -Weak'. 209 61.8 139 66.2 185 63. S 533 63. S

TOTAL 338 100.0 210 100.0 291 100.0 839 100.0

x1 « 1.06 DF = 2

p = 0 . 5 8

Table 4.24

Negative Affect by Level of Education

Negative Affect

Less than Secondary

. N %

Secondary

N %

Post Secondary N %

Total

N %

Strong 46 - 13.6 18 8.6 7 2.4 71 8.6

Moderate -Ueak 292 86.4 191 91.4 284 97.6 767 91.6

TOTAL 338 100.0 209 100.0 291 100.0 838 100.0

xa = 25.32 DF = 2

p = 0.00

Table 4.25 HOS Score by Level of Education

K0S Symptom! Less than Secondary

. N X

Secondary N X

Post Secondary N %

Total N, X

Frequent 31 9.0 14 6.3 7 2.3 52 6.0

Infrequent 315 91.0 208 93.7 293 97.7 816 9 4 . 0

Total 346 100.0 222 100.0 300 100.0 868 100.0

X2ss 12.58 DF » 2

p = 0 . 0 0

*

Table 4.26

Positive Affect by Marital Status

Positive Affect

Married N %

Widowed N %

Divorced N X

Separated N %

Single N .X

Total N S

Strong 146 36.3 20 32.8' .11 32.4 12 36.4 116 37.2 305 36.2

Modérate-Weak 256 63. 7 41 €7.2 24 68. 6 21 63.6 196 62.8 538 63.8

TOTAL 402 200.0 61 200.0 35 200.0 33 200.0 312 200.0 843 100.0

x* « 0.78 DF « 4 p » 0.94

Table 4.27

Negative Affect by Marital Status

Negative Affect

Married N x

Widowed N %

Divorced N %

Separated N %

Single N X

Total N %

Strong 29 7.2 11 18.0 3 8.8 3 9.2 26 8.3 72 8.6

Moderate -Weak .373 92.6 50 82.0 31 91.2 30 90.9 286 91. 7 770 92.4

TOTAL 402 200.0 6 1 200.0 34 200.0 33 100.0 312 200.0 842 200.0

x* = 7.967 OF = 4

p = 0.0928

Table 4.28

HOS Score by Marital Status

HOS Symptoms Married

N X Widowed N % .

Divorced N X

Separated N X

Single N X

Total N X

Frequent 27 6.4 7 • 10.S 2 5.6 2 6.1 15 4.8 53 6.1

Infrequent 395 93.6 58 &9.2 34 9 4 . 4 31 . 93.9 299 95.2 817 93.9

Total 422 100.0 65 100.0 36 100.0 33 100.0 314 100.0 870 100.0

X2 = 3.52 DF = 4 p =0.47

Table 4.29 Positive Affect by Socioeconomic Status

Positive Affect

Low N I

Moderate N i

High N Î

Total

N f

Strong 102 35.9 106 39.7 83 34.4 291 36.7

Moderate-Heak " 182 64.1 161 60.3 158 65.6 501 63.3

TOTAL 284 100.0 267 100.0 241 100.0 792 100.0

x ' - " 1.63 DF « 2 P e0.44

Table 4.30 Negative Affect by Socioeconomic Status

Negative Affect

Low N S

Moderate N i

High . N %

Total

N I

Strong 40 14.1 18 6.6 9 3.7 67 8.5.

Modérate-Weak 244 «5.9 247 93.2 233 96.7 724 91.5

TOTAL 284 100.0 265 100.0 241 100.0 791 100,0

xf ° 19.55 DF - 2

p °0 .00

L .

•Table 4.31

HOS Score by Socioeconomic Status

HOS Symptoms Low

N .% Moderate

N % .

High . N %

Total N %

Frequent 26 «.9 12 4.3 11 4.4 49 6.0

Infrequent 267 91.I 265 95.7 240 95.6 772 94.0

Total 293 100.0 277 100.0 251 100.0 821 J00.0

X2= 6.85 DF = 2 p = 0.032

Table 4.32

Posi t ive A f fec t by Major A c t i v i t y

Positive Affect Working

N %

Keeping House

N %

School

N %

Reti red

N %

Unempl oyed

N %

Total

N %

Strong 167 37 1 55 3 4 . 4 47 3i.fi 24 33.S 12 30.0 305 36.2

Modérate-Weak 283 6219 105 65.6 7.4 61.2 47 66.2 28 70.0 537 63.fi

Total 450 100.Q 160 100.0 121 100.0 71 100.Q 40 700;0 842 100.0

X* « 1.60 DF « 4 p = 0.80

Table 4.33

Negative Affect by Major Activity

Negative Affect Working

N t

Keeping House

N %

School

N %

Retired

N %

Unemployed

N %

Total

N %

Strong 30 6.7 19 17.9 13 10.7 8 11.3 2 5.0 72 8.6

Moderate-Weak 419 93.3 141 fifi.7 108 S9.3 6 3 fifi.7 38 95.0 769 91.4

Total 449 700.0 160 100.0 121 100.0 71 700.0 40 J00.0 841 700.0

X* = 6.32 DF = 4 p = 0.17

Table 4.34

HOS Score by Major Activity

HOS Symptoms Working

H S •

Keeping House

N % School

N %

Retired N %-.

Unemployed N %

Total N %

Frequent 23 4.9 13 7.9 6 5.0 8 10.7 3 7.3 53 6.1

Infrequent 447 95.i 152 92,7 114 95.0 67 fi9.3 38 92.7 818 93.9

Tcfcol 470 100.0 165 100.0 120 700.0 75 700.0 41 700.0 871 100.0

X' =5 .20 DF = 4 p « 0.26

4.5 Association Between Emotional Health and Physical Health Variables

This section studies the associations between positive and negative affect and HOS scores and the physical health variables of bed-days, chronic health problems, and

• medications. Tables referred to are presented at the end of this section.

Bed-Days

Although bed-days was not associated with positive affect (Table 4.35), this variable, was associated with negative affect. A linear trend was apparent, with 7.8 per cent of respondents with no bed-days, 11.5 per cent of respondents with one bed-day, and 21.6 per cent of respondents with more than one bed-day reporting strong negative affect (Table 4.36). The correlation coefficient between bed-days and negative affect scores was significant (r=0.100, p=0.004) but indicates that the association between the two variables is very weak (Table 4.65).

Bed-days was also associated with HOS scores. A linear trend was apparent with 4.8 per cent of respondents with no bed-days reporting frequent psychophysiological symptoms, 11.5 per cent of respondents with one bed-day reporting frequent symptoms, and 25.6 per cent of respondents with more than one bed-day reporting frequent symptoms (Table 4.37). The correlation coefficient between uncategorized HOS scores and bed-days was -0.154 (p=0.0001) indicating that the association is very weak (Table 4.65).

Chronic Health Problems

Table 4.38 indicates that chronic health problems was not associated with positive affect. However number of chronic health problems was associated with negative affect scores (Table 4.39). A linear trend was apparent with 3.9 per cent of respondents with no chronic health problems, 10.7 per cent of respondents with one chronic health problem, and 15.4 per cent of respondents with more than one chronic health problem, reporting strong negative affect. The correlation coefficient, between uncategorized negative affect scores and chronic health problems was 0.152 (p=0.0001) (Table 4.65). Although statistically significant, the results indicate that the association between affect scores and bed-days is very weak.

HOS scores were significantly associated with HOS scores, with 2,1 per cent of respondents with no chronic health problems, 7.3 per cent of respondents with one chronic health problem, and 12.6 per cent of respondents with more than one chronic health problem reporting frequent psychophysiological symptoms (Table 4.40). The association was of moderate strength, as indicated by a correlation coefficient of -0.364 (p=0.0001) between uncategorized HOS scores and chronic health problems (Table 4.65).

Medications

The number of medications taken or used in the previous two days was not associated with positive affect (Table 4.41). Medications was associated with negative affect scores and a linear trend was apparent. Only 6.6 per cent of respondents who had not taken or used any medication in the previous two days reported strong negative affect, compared to 8.8 per cent and 12.8 per cent of respondents who had taken or used one or more than one medication respectively (Table 4.42). The correlation coefficient between negative affect scores and medications (r=0.151 p=0.0001) is indicative of a very weak association (Table 4.65).

A significant association exists between HOS scores and number of medications taken or used in the previous two days. A higher proportion (12.3 per cent) of respondents who had taken or used more than one medication in the past two days reported frequent psychophysiological symptoms, compared to those who had used one (3.5 per cent) or none (4.4 per cent) (Table 4.43). The association between these two variables is of moderate strength as indicated by a correlation coefficient of -0.314 (p=0.0001) between uncategorized HOS scores and medications (Table 4.65).

Table 4.49

Posit ive Af fect by Overall'Happiness

Positive Affect

None

N %

One

N %

More Than One

N . *

Total

N %

Strong 283 36.1 13 SO.0 12 32.4 308 36.4

Moderate -Meak

500 63.9 13 50.0 25 67.6 538 63.6

TOTAL 783 100.0 26 100.0 37 100.0. 846 100.0

x2 = 2.35 DF s 2

p =0.30

Table 4.36

Negative Affect by Bed-Days

Negative Affect

None

N %

One

N %

More Than One

N %

Total

N %

Strong 61 7.8 3 11. S 8 21.6 72 8.5

Moderate -Ueak 721 92.2 23 88.5 29 78.4 773 91.S

TOTAL 782 100.0 26 100.0 37 100.0 845 100.0

x* = 8.97. DF = 2

P s 0.01

Table "4.37

HOS Score by Bed-Days

HOS Symptoms None

N %

One Ti %

More Than One

N %

Total N %

Frequent 39 4 A 3 n . 5 10 25.6 52 5.9

Infrequent 772 95.Z 23 as.5 29 74.4 824 94.1

Total 811 700.0 26 100.0 39 100.0 876 100.0

X2 =30.42 DF «2 p =0.00

t W J J C

Table 4.38

Positive Affect by. Chronic Health Problems

Postive Affect

None

N X

One

N X

More Than One

N X

Total N *

Strong 157 3Z.8 78 34.8 73 35.1 308 36.4

Moderate-Weak 258 62.2 146 65.2 135 64.8 539 63.6

TOTAL 4 1 5 200.0 224 200.0 208 100.0 847 200.0

x* « 0.76 DF » 2

p 8 0.68

Table 4.39

Négative Affect by Chronic Health Problems

Negative Affect

None

N X

One

*

More Than One

N X

Total

N X

Strong 16 3.9 24 20. ? 32 15.4 72 8.5

Moderate-WeiM-

398 96.2 200 89.3 176 84.6 77 A 92.5

TCTAL 414 200.0 224 100.0 2 0 8 200.0 846 100.0

X» « 25.49. DF = 2

p = 0.00

Table 4.40

HOS Score by Chronic Health Problems

HOS Symptoms ' None

N X One

N X

More Than One

N X Total

N X

Frequent 9 2.1 17 7.3 27 12.6 53 6.0

Infrequent 421 97.9 215 92.7 188 «7.4 824 94.0

Total 430 100.0 232 100.0 215 100.0 877- Ï00.O

X2» 28.56 DF = 2

p « 0 . 0 0

Table 4.41

Posit ive Af fec t by Médications

Positive Affect

None

N %

One

N 3

More Than One

N %

Total

N %

Strong 138 35.0 99 39.6 Z1 35.0 308 36.4

Moderate-Weak 256 65.0 151 60.4 132 65.0 539 63.6

TOTAL 394 100.0 250 100.0 203 100.0 • 847 100.0

x2 = 1.60 DF = 2 P = Ô.44

Table 4.42

Negative Affect by Medications

Negative Affect

None

H X

One

N %

More Than One .

N %

Total

N %

Strong 26 6.6 20 8.0 26 12.8 72 8.5

Moderate Weak 367 93.4 230 92.0 177 87.2 774 91.5

TOTAL 393 100.0 250 100.0 203 100.0 846 100.0

x* = 6.71 DF * 2 p = 0.03

Table 4.43

HOS Score by Medications

HOS Symptoms ' None

N %

i 1 One

N %

More Than One

N %

Total N %

Frequent 18 4.4 9 3.5 . 26 12.3 53 6.0

Infrequent 390 95.6 249 96.5 185 «7.7 824 9 4 . 0

Total 408 100.0 258 100.0 211 100.0 877 100.0

X2 = 19.52 DF = 2 p = 0.00

Page '41 t

4.6 Associations Between Emotional Health and Mental Health Variables

This section studies the associations between positive and negative affect and HOS scores and the mental health variables of life events, HOS, overall happiness and affect. Tables referred to are presented at the end of this section.

Life Events

Life events was not associated with positive affect scores (Table 4.44) but was associated with negative affect scores (Table 4.45). A higher proportion of respondents with more than one life event (14.1 per cent) reported strong negative affect, compared to respondents with none (6.6 per cent) or one life event (6.8 per cent). The correlation coefficient between negative affect scores and life events was 0.194 (p=0.0001). Although statistically significant, < the association between negative affect scores and life events is very weak (Table 4.65).

Table 4.46 indicates that a higher proportion (10.2 per cent) of respondents with more than one life event in the previous year reported frequent psychophysiological symptoms, compared to respondents with one life event (4.0 peu cent) and those with no life events (5.1 per cent). The difference was statistically significant. The correlation coefficient between uncategorized HOS scores and life events was -0.174 (p=0.0001) indicating that the association is very weak (Table 4.65).

HOS

Positive affect scores were not associated with MacMillan's Health Opinion Survey scores (Table 4.47). Negative affect scores, however were associated with HOS scores. Almost 50 per cent of respondents with frequent psychophysiological symptoms reported strong negative -affect, compared to 6.0 per cent of respondents with infrequent symptoms (Table 4.48). The correlation coefficient negative affect scores and HOS scores was 0.534 (p=0.0001) indicating that an association of moderate strength exists between the HOS and negative affect (Table 4.65).

)

Overall Happiness

Both positive and negative affect scores were associated with overall happiness (Tables 4.49 and 4.50). Linear trends were apparent in both positive and negative affect. Strong positive affect was reported by 66.7 per cent of respondents who reported they were "Very Happy", 33.0 per cent of respondents who were "Pretty Happy", and only 8.5 per cent of respondents who were "Not Too Happy". Strong negative affect was reported by only 1.7 per cent of respondents who were "Very Happy", 4.8 per cent of respondents who were "Pretty Happy", and 33.6 per cent of respondents who were "Not Too Happy".

Similarly, HOS scores were significantly associated with overall happiness. A linear trend was apparent, with 1.1 per cent of respondents who indicated that they were "Very Happy", 4.0 per cent of respondents who indicated that they were "Pretty Happy", and 20.4 per cent of respondents who indicated that they were "Not Too Happy" reporting frequent psychophysiological symptoms (Table 4.51).

Affect ;

Chi-square analyses indicates there is no association between positive and negative affect scores (Table 4.52). Approximately 30 per cent of respondents with strong negative affect also reported strong positive affect, compared to 37.1 per cent of respondents with moderate/weak negative affect. The correlation coefficient between unçategorized positive and negative affect scores confirms this result (Table 4.65).

Table 4.44

Posit ive Af fect by L i fe Events

Positive Affect

None

N X

One

N X

More Than One

N X

Total

N X

Strong 156 37.8 72 32.6 80 37.6 308 36.4

Moderate-Weak 257 62.2 149 • 67.4 133 62.4 539 63.6

TOTAL 413 100.0 221 100.0 213 100.0 847 100.0 .

x* = 1.85 DF = 2 p s 0.39

Table 4.45

Negative Affect by Life Events

Negative Affect

None

N %

One

N . X

More Than One

N X

Total

N %

Strong 27 6.6 15 6.8 30 14.1 72 8.5

Moderate-Weak 385 93.4 206 93.2 183 85.9 774 91.S

TOTAL 412 100.0 221 100.0 213 100.0 846. 100.0

x« « 11.36 DF s 2 p s 0.00

Table 4,46

HOS Score by Life Events

HOS Symptoms None One

More Than One Total

N X N X N X N X

Frequent 22 5.0 9 4.0 22 10.2 53 6.0

Infrequent 414 95.0 216 96.0 194 89.S 824 94.0

Total 436 100.0 225 100.0 216 100.0 877 100.0

X = 8.94 DF = 2 p ^ 0.01

*

Table 4 .47

Posi t ive Af fec t by Health Opinion Survey Score

Posi t ive Af fec t

Frequent Symptoms

Infrequent Symptoms

Total

N % N % N %

Strong 13 27.7 295 37.0 308 36.5

Moderate-Weak 34 72.3 503 63.0 537 63.5

TOTAL 47 100.0 798 100.0 845 100.0

x2= 1.66 0F= 1

p= 0.19

Table 4 .48

Negative Af fec t by Health Opinion Survey Score

Negative Af fec t

Frequent Symptoms

Infrequent Symptoms

Total

N % N % N %

Strong 23 47.9 48 6.0 71 8.4

Moderate-Weak 25 52.1 748 94.0 773 91.6

TOTAL 48 100.0 796 100.0 844 100.0

x* = 103.08 DF = 1

p = 0.00

Table 4.49

Posi t ive A f fec t by Overall'Happiness

Positive Affect

Very Happy

Pretty Happy

Not too Happy

Total

N % N % N X N %

Strong 116 66.7; 172 33.0 11 8.5 299 36.2

Hoderate-Heak 58 33.3 350 6?.0 119 91JS 527 63.8.

TOTAL 174 700.0 522 100.0 130 100.0 826 700.0

X ' - 115.62 DF= 2

p» 0 . 0 0

Table 4.50

Negative Affect by Overall Happiness'.

Negative Affect

•Very Happy

Pretty Happy

Not too Happy

Total

N x N % N . % N %

Strong 3 3 . 7 25 4.8 44 33.6 72 8.7

Modera te -.Weak . .

172 98.3 495 95.2 87 66.4 754 91.3

TOTAL 175 100.0 520 100.0 131 100.0 826 100.0

x'= 122.61 DF® 2

p~ 0 . 0 0

Table 4.51

HOS Score by Overall Happiness

HOS Symptoms

Very Happy

N . %

Pretty Heppy

N t

Not too Happy N %

Total

N %

Frequent 2 1.1 21 4.0 28 20.4 51 6.0

Infrequent 176 98.9 508 9 6 . 0 109 79.6 793 94.0

Total 178 100.0 529 100.0 137 100.0 844 100.0

X8 = 61.59 DF a 2

p « 0.00

r a y e t o

Table 4 .52

POSITIVE-AFFECT BY-NEGATIVE AFFECT

Pos i t i ve A f f e c t Strong

. N %

Moderate-Weak

N %

TOTAL

N %

Strong 20 25.2 287 37 J 307 36.4

Moderate-Weak

51 77. % 486 62.9 537 63.6

TOTAL 71 100.0 773 100.0 844 100.0

X2 = 2 , 2 5 DF = 1

p = 0 . 1 3

*

4,7 Associations Between Emotional Health and Lifestyle Variables

This section studies the associations between positive and negative affect and HOS scores, and the lifestyle variables of leisure time, physical activity, alcohol use, and tobacco use.

Leisure Time

Both positive and negative affect scores were associated with leisure time (Tables 4.53 and 4.54). A linear trend was apparent in both positive and negative affect scores. For positive affect scores, 22.6 per cent of respondents who were "alone a lot" during leisure time reported strong . posivite affect, compared to 34.8 per cent of respondents who "spent some time with others" and 43.1 per cent of respondents who were "with others a lot". For negative affect scores, 16.3 per cent of respondents who were "alone a lot" during leisure time reported strong negative affect, compared to 9.8 per cent and 4.0 per cent of respondents who "spent some time with others" or were "with others a lot", respectively.

Leisure time was also associated with HOS scores. A higher proportion (13.4 per cent) of respondents who were "alone a lot" during leisure time reported frequent psychophysiological symptoms, compared to respondents who "spent some time with others" (4.9 per cent) and those who spent "a lot of time" with others (3.9 per cent) (Table 4.55).

Physical Activity

Positive affect scores were statistically significantly associated With physical activity (Table 4.56). Half of respondents who were physically active in the last two weeks reported strong positive affect compared to 33.6 per cent of moderately active respondents and 29.7 per cent of inactive respondents. Negative affect scores were not associated with physical activity (Table 4.57).

A higher proportion (8.2 per cent) of inactive respondents reported frequent psychophysiological symptoms compared to moderately active (4.4 per cent) and active (3.1 per cent)

*

respondents (Table 4.58). The association was statistically significant.

Alcohol Use

Tables 4.59 and 4.60 indicate that alcohol use was not associated with positive or negative affect scores.

Similarly, alcohol use was not associated with HOS scores (Table 4.61).

Tobacco Use

Positive affect scores were not associated with tobacco use (Table 4.62). Negative affect scores were associated with tobacco use, with 10.6 per cent of respondents who' smoke regularly reporting strong negative affect compared to 6.5 per cent of respondents who do not smoke and 4.0 per cent of respondents who smoke occasionally (Table 4.63).

A higher proportion (8.8 per cent) of respondents who indicated they were regular smokers reported frequent psychophysiological symptoms compared to occasional smokers (0.0 per cent) and non-smokers (3.5 per cent) (Table 4.64). The difference was statistically significant.

*

Table 4.53

POSITIVE AFFECT BY LEISURE TIME

ALONE ALOT

N %

SPENT SOME TIME WITH . OTHERS N %

WITH OTHERS ALOT

N « TOTAL

N % STRONG 3 6 2 2 . 6 1 0 3

CO »

ro 1 6 2 4 3 . 1 3 0 1 3 6 . 2

MODERATE/WEAK 1 2 3 7 7 . 4 1 9 3 6 5 . 2 2 1 4 5 6 . 9 5 3 0 6 3 . 8

TOTAL 1 5 9 1 0 0 . 0 2 9 6 1 0 0 . 0 3 7 6 1 0 0 . 0 8 3 1 1 0 0 . 0

X2 » 20.62 d f = 2 p - 0 .00

Table 4.54

NEGATIVE AFFECT BY LEISURE TIME

ALONE ALOT

N %

SPENT SOME TIME WITH OTHERS

N %

"WITH OTHERS ALOT

N « TOTAL

N % STRONG 2 6 1 6 . 3 2 9 9 . 8 1 5 4 . 0 7 0 8 . 4

MODERATE/WEAK 1 3 4 8 3 . 7 2 6 8 9 0 . 2 3 5 8 9 6 . 0 7 6 0 9 1 . 6

TOTAL 1 6 0 1 0 0 . 0 2 9 7 1 0 0 . 0 3 7 3 1 0 0 . 0 8 3 0 1 0 0 . 0

X2 = 22.74 d f r 2 P = 0 . 0 0

Table 4.55

HOS Score by Leisure Time

HOS Symptoms

Alone Alot

N %

Spent some time «ith others

N %

With Others Alot

N %

Total

N %

Frequent * 22 J3.4 15 4.9 15 3.9 52 6.0

Infrequent 142 S6.6 292 95. / 374 96. / 808 94.0

Total 164 100.0 307 100.0 389 100.0 860 100.0

X*"- 19.68 OF " 2

p - 0 .00

G

Table 4.56

POSITIVE AFFECT BY PHYSICAL ACTIVITY

INACTIVE N %

MODERATELY ACTIVE N %

ACTIVE N %

TOTAL . N %

STRONG 1 3 2 . 2 9 . 7 5 2 3 3 . 6 1 2 4 5 0 . 2 3 0 8 3 6 . 4

MODERATE/WEAK 3 1 3 7 0 . 3 1 0 3 6 6 . 5 1 2 3 4 9 . 8 5 3 9 6 3 . 6

TOTAL 4 4 5 1 0 0 . 0 1 5 5 1 0 0 . 0 2 4 7 1 0 0 . 0 8 4 7 1 0 0 . 0

X 2 » 2 9 . 6 1

df a 2 p = 0 . 0

Table 4.57

NEGATIVE AFFECT BY PHYSICAL ACTIVITY

INACTIVE N %

MODERATELY ACTIVE N %

ACTIVE N %

TOTAL N %

STRONG

MODERATE/WEAK

TOTAL

4 4 9 . 9

4 0 0 9 0 . 1

4 4 4 1 0 0 . 0

1 0 6 . 4

1 4 5 9 3 . 6

1 5 5 1 0 0 . 0

1 8 7 . 3

2 2 9 9 2 . 7

2 4 7 1 0 0 . 0

7 2 8 . 5

7 7 4 9 1 . 5

8 4 6 1 0 0 . 0

X2 = 2.43

Table 4.58

HOS Score by Physical Activity

HOS Symptoms

Inactive

* N %

Moderately Active

N %

Active

N %

Total

N %

Frequent 38 S.2 7 4.4 8 3.1 53 6.0 !

Infrequent 424 91.8 152 ,95.6 248 96.9 824 94.0

Total 462 100.0 159 100.0 . 256 100.0 877 . 100.0 ' i

I

X 2 - 8.46 OF - 2

p » 0.01

. Page 51 Table 4.59

POSITIVE AFFECT BY ALCOHOL USE

Positive Affect

)ne or more dri nk/day

N X

• 1-6 times/ week

N X '

3nce or more a' month

N . X

Less often than once .a month

N X

Did not5. Drink in past 12 months

N. %• •

TOTAL

N- %

Strong 44 36.4 98 37.4 53 31.4 43 40.2 56 38.4 294 36.5

Moderate-Weak 77 63.6 164 61.6 116 68.6 64 59.8 90 61.6 '511 63.5

TOTAL 121 100.0 262 100.0 169 100.0 107 100.0 146 ipO.O 805 100.0

X*=2.86 DF "4 p «0.58

Table 4.60

NEGATIVE AFFECT BY ALCOHOL USE

Negative Affect

One or mon drink/day

N X

1-6 times/ week

M X

Once or more a month .

N %

Less often than once a month

N X

Did not Drink in pasl 12 months

N X

TOTAL

N %

Strong 8 . 6.6 20 7.6 16 9.6 .10 9.3 11 7.6 65 8.1

Moderate-Ueak 114 93.4 243 92.4 151 90.4 97 90.7 134 92.4 739 9J .9

TOTAL 122 100.0 263 100.0 167 100.0 107 100.0 145 100.0 804 100.0 •

X = 1.24 DF- 4 p« 0.87

• i i

T a b l e 4 . 6 1

HOS SCORE BY. ALCOHOL USE

HOS Symptoms

One or more drink/dày

N X.

1-6 times/ week

N X

Once or more a month

N X

Less often than once a month

N X

Did not Drink in past 12nths

N X

Total i

N X ;

Frequent 6 4.8 17 6.3 8 4.6 3 2.7 12 8.2 46 5.6 |

Infrequent 120 95.2 254 93.7 166 95.4 108 97.3 134 91.8 782 94.4 ! 1

Total 125 100.0 271 100.0 174 100.0 111 100.0 146 100.0 828 100.0 |

X s - 4.41 DF - 4 p e 0.35

*

Table 4.62

POSITIVE AFFECT BY TOBACCO USE

DO NOT SMOKE N «

SMOKE OCCASION-

ALY N %

SMOKE REGULARLY

N % TOTAL

N %

STRONG

MODERATE/WEAK

TOTAL

143 38.8

226 61.2

369 100.0

33 33.3

66 66.7

99 100.0

117 35.5

213 64.5

330 100.0

293 36.7

505 63.3

798 100.0

X 2 = 1.37 df = 2 p D 0.50

Table 4.63

NEGATIVE AFFECT BY TOBACCO USE

DO'NOT SMOKE N %

SMOKE OCCASION-

ALY N '%

SMOKE REGULARLY N %

TOTAL . N %

STRONG

MODERATE/WEAK

.TOTAL

24 6.5

343 93.5

367 100.0

4 4.0

96 96.0

100 100.0

35 10.6

294 89.4

329 100.0

63 7.9

733 92.1

796 100.0

X = 6 .40 d f = 2

p = 0 .04

Table 4.64

HOS Score by Tobacco Use

HOS Symptoms

Do Not Srçoke

N %

Smoke Occasionaly

N %

Smoke Regularly

N %

Total

N %.

Frequent 16 3.5 29 45 5.5

Infrequent 438 96.5 38 100.0 301 91.2 777 94.S

Total 454 100.0 38 100.0 330 100.0 822 100.0

X2 « 12.53 DF » 2

p » 0.00

*

TABLE 4.65

Pearson Product Moment Correlation Coefficients of Uncategorized Positive and Negative Affect, and HOS Scores with Continuous Variables

VARIABLE POSITIVE

AFFECT SCORES NEGATIVE

AFFECT SCORES HOS

SCORES :

AGE .072* .076* -0.039

SOCIOECONOMIC STATUS -.041 .090* 0.132***

BED-DAYS .015 .100** -0.154***

CHRONIC HEALTH PROBLEMS .078* .152*** -0.364***

MEDICATIONS .029 .151*** -0.314***

LIFE EVENTS .029 .194*** -0.174***

K.O.S. -.097** .534*** 1.000

AFFECT (Positive/Negativè)

-.087 -.087 — —

* p < .05 * * P < .01

* * * P < .001

r n It is important to note that the correlation coefficients may be significant because of the large sample size.

<

*

4.8 Dependence of Positive and Negative Affect Scores on Socio-demographic, Physical and Mental Health, and Lifestyle Variables

The model of the effects of all socio-demographic, physical and mental health, and lifestyle variables studied on positive affect scores is moderately efficient in predicting positive affect scores. These variables contribute 30.5 per cent to the variation in positive affect scores. Thus there is a considerable amount, of unexplained variation (69.5 per cent). Overall happiness is the best predictor of positive affect scores, entering the model in the first two steps Table 4.66 illustrates that 25.0 per cent of the. variation in positive affect scores is explained by 1 the variation in overall happiness. Although overall happiness is the best predictor of positive affect scores from among the selected variables, 75.0 per cent of the variation is explained by other variables. Physical activity enters the model in the third step and adds only 2.6 per cent to the explained variation in positive affect scores. HOS enters in the fourth step. Table 4.66 indicates that the four variable model explains 28.4 per cent of the variation in positive affect scores. Additions of other variables to the model in subsequent steps, although significant, do not add to the predictive efficiency of the model.

Together all the socio-demographic, health, and lifestyle variables contribute 38.6 per cent to the variation in negative affect scores, indicating that 61.4 per cent of the variation is explained by variables not studied. Table 4.67 indicates that HOS enters the model in the first step and contributes 28.7 per cent to the variation in negative affect scores. Although HOS scores are the best predictors of negative affect scores from among the selected variables, 71.3 per cent of the variation is explained by other variables. Overall happiness enters the model in steps 2 and 3 and contributes a further 4.9 per cent to the explained variation in negative affect scores. Life events enters the model in the fourth step. Table 4.69 indicates that the four variable model explains 34.8 per cent of the variation in negative affect scores. Additions of other variables to the model in subsequent steps, although significant, do not add to the predictive efficiency of the model.

page t>b

Table 4.66

MULTIPLE STEPWISE REGRESSION (MAXIMUM R 2 ) OF SOCIODEMOGRA-PHIC, PHYSICAL AND MENTAL HEALTH, AND LIFESTYLE VARIABLES ON POSITIVE AFFECT SCORES

Step ( 1 ) V a r i a b l e added F d f

1 Overa l l Happiness .154 123.79 682 (Dummy Var iab le 1)

Overa l l Happiness ' .250. 113.29 681 (Dummy V a r i a b l e 2)

Physical A c t i v i t y .276 86 .57 680 (Dunmy Var iab le 1)

4 HOS .284 67 .34 679

5 Leisure Time .289 55.09 678 (Dummy Var iab le 1)

Physical A c t i v i t y .292 46 .51 677 (Dummy Var iab le 2)

NAS .295 40 .31 676

) Seven o f the 30 steps i n t h i s regression are i l l u s t r a t e d

Table 4.67

MULTIPLE STEPWISE REGRESSION (MAXIMUM R 2 ) OF SOCIODEMO-GRAPHIC, PHYSICAL AND MENTAL HEALTH AND LIFESTYLE VARIABLES ON NEGATIVE AFFECT SCORES

Step ( 1 ) Va r iab le added F df P

1 HOS .287 273.90 682 .0001

2 Overa l l Happiness .305 149.56 681 .0001 (Dummy Var iab le 1)

3 Overa l l Happiness .336 114.46 680 .0001 (Dummy Var iab le 2)

4 L i f e Events .348 90 .59 679 .0001 i

5 Sex .353 74.04 678 .0001

6 Level of Education .358 62 .84 676 .0001 (Dummy V a r i a b l e )

(1 ) Six o f the 30 steps i n t h i s regression are i l l u s t r a t e d .

Table 4.68

MULTIPLE STEPWISE REGRESSION (MAXIMUM R 2 ) OF SOCIODEMOGRAPHIC, PHYSICAL AND MENTAL HEALTH AND LIFESTYLE VARIABLES. ON HEALTH OPINION SURVEY SCORES

Step ( 1 ) Var iab le added R^ F d f £

1 Negative A f f e c t 0 .287 273.90 682 .0001

2 Chronic Health Problems 0 .378 206.48 681 .0001

3 C i g a r e t t e Use (Dummy V a r i a b l e - 1 ) 0 .398 149.91 680 .0001

4 Sex 0 .424 124.75 679 .0001

5 Medi c a t i ons 0 .437 105.18 678 .0001

6 Maternal Language (Dummy Var iab le 1) 0 .447 91 .22 677 .0001

7 Overal l Happiness (Dummy Var iab le 1) 0 .453 80 .10 676 .0001

8 Overal l Happiness (Dummy Var iab le 2) 0 .460 71.95 675 .0001

9 Age 0.466 65 .31 674 .0001

0 ) Only 9 to 34 steps i n the regression a l l i l l u s t r a t e d here.

*

4.9 Dependence of Health Opinion Survey Scores on Socio-demographic, Physical and Mental Health, and Lifestyle Variables

The model of the effects of all socio-demographic, physical and mental health, and lifestyle variables studied on HOS scores is moderately efficient in predicting HOS scores. These variables contribute 48.3 per cent to the variation in HOS scores, which indicates that there is a considerable amount of unexplained variation (51.7 per cent). Negative affect scores are the best predictors of HOS scores, entering the model in the first step. Table 4.68 indicates that 28.7 per cent of the variation is HOS scores is explained by the variation in negative affect scores. Chronic health problems enters the model in the second step and is significant. The'variation in this variable explains a further 9.1 per cent of the variation is HOS scores. Cigarette use, sex, medications, and maternal language enter the model in the third, fourth, fifth, and sixth steps respectively. Together, they contribute another 6.9 per cent to the variation in HOS scores. Additional variables, although significant, contribute little to the predictive efficiency of the model. The F-ratio decreases and there is little increase in the amount of explained variance (R2).

4.10 Summary /

A high response rate to the IAQ (80.0 per cent) was achieved, although only 75.6 per cent of eligible respondents completed Bradburn1 s Index of Psychological Well-Being and 77.7 per cent of eligible respondents completed MacMillan's Health Opinion Survey.

Higher proportions of male and female respondents 25 to 64 years in St.Henri/Petite Bourgogne were "unhappy" (scored "negative" on the Affect Balance Scale), compared to the Canadian and DSC-MGH surveys.

When the Affect Balance Scale is broken down into its two subscores (positive and negative affect scores), the St.Henri/Petite Bourgogne results are due principally to negative affect scores. There were no difference in the distribution of positive affect scores by CLSC, but much higher proportions of St.Henri/Petite Bourgogne respondents reported strong negative affect, compared to respondents from other CLSC1 s. It is impor tant to note that a relatively high proportion of St.Louis du Parc respondents reported strong negative affect also.

r

Results on the distribution of Health Opinion Survey scores confirm the findings reported above. Higher proportion of males and females 25-64 years from St.Henri/Pëtite Bourgogne and St.Louis du Parc reported frequent psychophysiological symptoms, compared to their DSC-MGH and Canadian counterparts.

A summary of the correlates of positive and negative affect scores is provided in Table 4.69. Respondents who indicated they were "Very Happy" or "Pretty Happy", who were physically active, and who spent a lot of leisure time in the company of others, reported strong positive affect.

Respondents who reported French as their maternal language, who had not completed secondary school, who lived in St.Henri/Petite Bourgogne and St.Louis du Parc, were widowed, were in school, doing housework or retired and who were of low socioeconomic status tended to report strong negative affect. Additionally, respondents who reported strong negative affect tended to have more than one chronic health problem, to use more than one medication in the previous two days, and to report more than one bed-day in the previous two weeks. They obtained high HOS scores and reported more than one life event in the past 12 months. Finally they tended to be alone a lot during leisure time and to smoke regularly.

Respondents who reported frequent psychophysiological symptoms lived in St.Henri/Petite Bourgogne and St.Louis du Parc, did not complete secondary school, were widowed, retired, keeping house or unemployed and wërë of low socioeconomic status. They tended to report more than one bed-day in the past two weeks and more than one chronic health problem, and they tended to use more than one medication in the previous two days. They reported that they were "Not Too Happy", that they experienced more.than one life event in the previous 12 months. They tendéd to smoke regularly, to be alone a lot during leisure time, and to be physically inactive.

Multivariate analysis indicated that overall happiness was the best predictor from among the variables studied, of positive affect scores. Once this variable is controlled for, physical activity enters the model, although" its predictive ability is small. The complete model of the effects of all the variables studied on positive affect scores is moderately efficient in predicting positive affect scores.

*

Similarly the complete model of the effects of all the variables studied on negative affect scores is moderately efficient in predicting negative affect scores. Health Opinion Survey scores are the best predictors of negative affect from among the variables studied, followed by overall happiness and life events.

The complete model of the effects of all the variables studied on HOS scores is moderately predictive of HOS scores. Negative affect is the best predictor of HOS scores, followed by chronic health problems, cigarette use, sex, medications, and maternal language.

TABLE 4.69 Summary of S t a t i s t i c a l l y Signif icant Associations Between PAS, NAS, and HOS scores and Selected Variables.

SQCIODEMOGRAPHIC VARIABLES B PHYSICAL HEALTH „ — MENTAL HEALTH VARIABLES LIFESTYLE VARIABLES

£ S c

Age Sex Ethnic Drlgir

.Maternal Language

Major Activity

Level of Education

Marital Status.

Socio- flBed-econoraicfidays. Status |

CHP Med1cat1ons| L i fe H Events

Overal1 Happiness HO.S NAS PASlLeisure

H Time Physical Ac t iv i ty

Alcohol Use

Tobacco Use

HOS SCORES

* - * * * * * * H * * * * * * * *+ B * * * * * * * B * * * * * *

PAS SCORES | * + * H * * * * * *

NAS SCORES * * « * * * * * * H * * * * * I * * * * * * * I * * *

* p * . 0 5 * * p S.OI

p 5.001

5. DISCUSSION

In this section of the report, the results will be discussed with respect to planning preventive health programs.

5.1 Survey Response

Approximately 15 per cent of eligible IAQ respondents did not complete Bradburn's Index of Psychological Weil-Being. The nonresponse rate was similar for MacMillan's Health Opinion Survey. The rate of nonresponse is considerable when nonrespondents to the IAQ are included - 20 per cent of households visited did not complete the IAQ and consequently persons 15 years and older from these households were excluded from the LHQ results. The Canada Health Survey reported similar rates of nonresponse. Their data indicated that the socio-demographic characteristics 1 of IAQ respondents 15 years and older who did not respond to the "emotional health" questions, resembled those of LHQ respondents who scored negatively on the ABS. They reported that the prevalence of "unhappy" Canadians as measured by the ABS could thus be underrepresented by approximately 10 per cent. The potential nonresponse bias in the DSC-MGH survey in the measurement of the prevalence of "unhappiness", "anxiety," and "depression" must be taken into consideration by the planners of preventive mental health programs.

5.2 Prevalence of "Unhappiness" as Measured by Bradburn's Index of Psychological Well-Being, and of "Anxiety" and "Depres-sion" as Measured by MacMillan's Health Opinion Survey

The results have identified St.Henri/Petite Bourgogne respondents 25 to 64 years of age as a particular risk group for "unhappiness" as measured by the Affect Balance Scale. Also St.Henri/Petite Bourgogne and St.Louis du Parc respondents 25 to 64 years reported more "anxiety" and "depression" as measured by the HOS, compared to their Canadian counterparts and to other respondents in the DSC-MGH survey. Respondents who have not completed high school, who are of low socioeconomic status, who report French as their maternal language, who are widowed, retired, doing housework, in school or unemployed, those in poor

physical health, those who report more than one life event in the past year, and those who are alonè a lot during leisure time, reported more "unhappiness," "anxiety," and "depression" than other respondents.

The results are not unexpected. In a review of reports on psychological disorder published between 1917 and 1964, Dohrenwend and Dohrenwend (1965) reported that the only variable which is consistently associated with psychological disorder is low socioeconomic status. The finding that more respondents in St.Henri/Petite Bourgogne and St.Louis du Parc appear to be "unhappy", "anxious," and "depressed" compared to respondents from other CLSCs confirms this notion. It is interesting to note that respondents of non-European origin and of those who reported "other" as their maternal language did not report more anxiety, and depression than other respondents. This finding suggests that in St.Louis du Parc, the high proportion of immigrants may not account for the relatively high proportion of respondents who reported frequent psychophysiological symptoms.

Although the results of this analysis can suggest "who" is more at risk for "emotional health problems", they cannot suggest "why". Hypotheses as to why persons of low socioeconomic status have higher prevalences of psychological disorder are'abundant. For example, the risk in St.Henri/Petite Bourgogne could be attributed to the high rate of emigration from the area. During the past 15 years there has been a net loss in population of 45% because of industrial developments. Persons more likely to leave the community may have better "emotional health" than those who remain.

The health care planner is faced with several issues before this information on "risk groups for emotional health problems" is integrated into planning strategies. First, what "illness" or "risk" has actually been measured by MacMillan's Health Opinion Survey and Bradburn's Index of Psychological Weil-Being? Secondly, has the "illness" or "risk" been studied in sufficient detail that specific and effective preventive health measures can be recommended^, or will further studies be required? Is the "illness"' or "risk" identified a priority for the DSC-MGH and for other organizations in the community? Which community organizations are appropriate to carry out defined preventive measures and are they willing to do so? Are the risk groups identified recipient to the identified preventive health measures? This discussion will focus only on the first issue.

*

5.3 What "Illness" or "Risk" Has Been Identified?

The current literature suggests that brief screening scales such as MacMillan's Health Opinion Survey measure "demoralization" rather than diagnosable mental disorders. "This type of nonspecific psychological distress is something like physical temperature: when it is elevated, you know someth ing i s wrong but you do not know what specific thing is wrong until you learn more about the context" (Dohrenwend and Dohrenwend, 1982). These authors estimate that in fact, at least half of those showing severe "demoralization" do not have diagnosable mental disorders. Based on this estimate, only half of the 7.6 per cent of DSC-MGH respondents who scored negatively on the ABS, and half of the 6.1 per cent of respondents who reported frequent psychophysiological symptoms have diagnosable mental disorders. Thus, one can estimate that between three and four per cent of DSC-MGH residents have diagnosable mental disorders. In St.Henri/Petite Bourgogne as many as 7 to 8 per cent of persons 25 to 64 years of age could manifest a diagnosable mental disorder.

Results from this study indicate that negative affect and HOS scores are measuring a similar phenomena (perhaps "demoralization"). The patterns of associations with the socio-demographic, health, and lifestyle variables are similar. Both sets of scores are associated with CLSC of residence, level of education, socioeconomic status, major activity, all three physical health variables, life events, overall happiness, tobacco use and leisure time. The correlation coefficient between the two measures suggest an association of moderate strength, and the multivariate analysis confirm that of all the variables studied, these two scores best predict each other. However, positive affect scores measure a different phenomenon, which is best predicted by overall happiness and physical activity. Several authors have reported that the items in the positive affect score measure "level of activation" as much as they measure "happiness" (Cherlin and Reeder, 1975; McDowell, 1982). Thus the finding that positive affect is predicted by level of physical activity is not surprising. Similarly the association between PAS and leisure time confirms the literature findings that PAS is associated with measures of social participation (Bradburn, 1969; Phillips, 1967; Beiser, 1974). Unlike negative affect and HOS scores, positive affect scores yield little information about "risk groups for emotional health problems" in a community survey such as this one. The distribution of positive affect scores does not vary by the socio-demographic or physical

health characteristics of respondents. Also, except for overall happiness, the mental health variables are not associated with positive affect. Thus health care planners may derive more information on "risk groups for emotional health problems" from the study of negative affect scores and/or HOS scores, than from a study of the distribution of Affect Balance Scale scores, which are hypothesized to reflect the balance between positive and negative affect scores. If . little or no information is derived from positive affect scores, the Affect Balance Scale score is essentially a "watered-down" negative affect score.

The finding that chronic health problems enters the model of the effects of all the variables studied on HOS scores in the second step, after negative affect is an important finding with respect to the comment by Tousignant et al (1974) that three categories of problems aire screened by high scores on the HOS - chronic mental disorder, transition stress situations, and poor physical health. The results indicate that poor physical health is indeed measured by HOS scores.

In conclusion, the results of this study have identified specific subgroups of the DSC-MGH territory as being at higher risk for "emotional health problems", although it is unclear exactly what phenomenon has been measured by Bradburn's and MacMillan's questions. Negative affect and HOS scores appear to measure a similar phenomenon which may be "demoralization", and HOS scores seem to measure poor physicial health as well. Positive affect scores are not very informative in a survey of this nature.

The health care planner may wish to explore the observed phenomena in further research to investigate specific explanatory hypothesis or he may wish use the results for planning preventive strategies in a global way.

*

REFERENCES

Beiser M. Components and correlates of mental well-being. Journal of Health and Social Behavior, 1974, 15, 320

Berkman PL. Life stress and psychological well-being: A replication of Langner's analysis in the Midtown Manhattan study. Journal of Health and Social Behavior, 1971 (a), 12, 35.

Berkman PL. Measurement of mental health in a general population survey. American Journal of Epidemiology, 1971 (b), 94, 105.

Blishen BR, and McRoberts HA. A revised socioeconomic index for occupations in Canada. Canada Review of Sociology and Anthropology, 1976, 13, 71.

Bradburn NM. The Structure of Psychological Well-Being. Chicago: Aldine Publishing Co., 1969.

Bradburn NM, and Caplovitz D. Reports on Happiness: A Pilot Study of Behavior Related to Mental Health., Chicago: Aldine Publishing Co., 1965.

Canada Health Survey. The Health of Canadians. Report of the Canada Health Survey. Statistics Canada, catalogue 82-538E. Ottawa: Supply and Services Canada, 1981.

Cherlin A, and Reeder LG. The dimensions ot psychological well-being: a critical review. Sociological Methods and Research, 1975, 4, 189.

Collishaw NE. The proposed national health survey and the measurement of health. Working series paper no. 74-2. Ottawa: Canada Health Survey, Department of national Health and Welfare and Statistics Canada, 1974.

Dohrenwend BP, and Dohrenwend BS. The problem of validity in field studies of psychological disorder. J Aknown Psychol, 1976,70,52.

Dohrenwend BP, and Dohrenwend BS. Perspectives on the past and future of psychiatric epidemiology: The 1981 Rema Lapouse lecture. American Journal of Public Health, 1982, 72, 1271.

Fontana AF, Marcus JL, Dowds BN, and Hughes LA. Psychological impairment and psychological health in the psychological well-being of the physically ill. Psychosomatic Medicine, 1980, 42, 279.

Gaitz CM, and Scott J. Age and the measurement of mental health. Journal of Health and Social Behavior, 1972, 13, 55.

George LK. The impact of personality and social status factors upon levels of activity and psychological well-being. Journal of Gerontology, 1978, 33, 840.

Gofin R. Draft report on the Canada Health Survey to the DSC-HGM. Unpublished report, 1979 (à).

Gofin R. Community Health Survey Pretest. Unpublished report, 1979 (b).

Gurin G., Veroff J., and Feld S. Americans View Their Mental Health. New York: Basic Books, 1960.

Holmes TH, and Rahe RH. The social readjustment rating scale. Journal of Psychosomatic Research, 1967, 11, 213.

Lalonde M. A New Perspective on the Health of Canadians. Ottawa : Government of Canada, 1974. ""

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APPENDIX I

QUESTIONNAIRE ITEMS RELATED TO VARIABLES. RANGE OF SCORES AND/OR CODED CATEGORIES

VARIABLE

QUESTIONNAIRE AND QUESTION

NUMBER CATEGORIES

AND/OR RANGE OF SCORES

A) Sociodemographic Var iables •

Age IAQ-02 15-97 or 15-19 20-24 25-44 45-64 65 4-

Sex IAQ-03 Male Female

CLSC of Residence S t - H e n r i / P e t i t e Bourgogne Metro Westmount/NDG East Montreal West/NDG West St -Louis du Parc

Ethnic Or ig in IAQ-67d European Non European

Maternal Language IAQ-67c Engl ish French Other

Level o f Education IAQ-69 Less than Secondary Secondary Post Secondary

Mar i ta l Status . LHQ-Some Facts About You-3

Marr ied ( inc lud ing common Widowed Divorced Separated Single(never marr ied)

Socioeconomic Status IAQ-71b, 72f 18 -75 .3 or Low (18-39) Moderate (40 -59 )

High ( 6 0 - 7 5 . 3 )

Major A c t i v i t y IAQ-26 Working Keeping house Re t i red Unemployed School

APPENDIX I

( con t 'd )

VARIABLE

B) Physical Health Var iables

Bed-days

Chronic Health Problems

Medications

C) Mental Health Var iables :

L i f e Events

MacMil lan's Health Opi nion Survey Score

Overal l Happiness

Pos i t ive A f f e c t

Negative A f f e c t

A f f e c t Balance Scale


NUMBER

IAQ-10b, 12b

IAQ-41-66

IAQ-22AA-JJ

LHQ-Some Facts about You - 8

LHQ-Your Feelings - IA - P

LHQ-Your Feel ings - 2

LHQ-Your Feelings - I A , C, E, G, I

LHQ-Your Feelings - I B , D, F, H, J

Balance Between Posi t ive and Negative- 'Affect

CATEGORIES AND/OR RANGE OF SCORES

0-14 or None One More than one


0 -10 or None One More than one


15-48 or Frequent Symptoms (15 -31)

Inf requent Symptoms (32-48)

Very Happy P r e t t y Happy Not Too Happy

4-15 or Strong A f f e c t ( 4 - 8 ) Moderate - Weak A f f e c t (9 -15 )

4-15 or Strong A f f e c t ( 4 -8 ) Moderate - Weak A f f e c t ( 9 -15 )

Pos i t i ve Mixed Negative

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APPENDIX I

( con t 'd )

VARIABLE

D) L i f e s t y l e Var iables

Leisure Time

Physical A c t i v i t y

Alcohol Use

C igare t te Use


NUMBER

LHQ-Your A c t i v i t i e s - 1 C-A

LHQ-Your ^Aètf j&ty - 2 3 S- '-J^

LHQ-Alcohol - . 1 r ? 2 , 4 "Is . ' Z

LHQ-Tobàcco - 2 , ' t f *

CATEGORIES AND/OR RANGE OF SCORES

Alone A Lot Spent Some Time With Others With Others A Lot

0 - 70,000 or I n a c t i v e (0 -1749) Moderately Act ive (1750-2999) Act ive (3000 + •)

One or more dr inks per day 1 -6 times per weeks One to three times a month Less o f t e n than once a month Did not dr ink i n past 12 months

Do not smoke ^ Smoke occasional ly

Smoke r e g u l a r l y &

^ Uj

< o ^

C j A C £

^ % Q c Q A C

EMOTIONAL HEALTH IN THE TERRITORY OF THE MONTREAL … · 4.40 HO ScoreS bsy Chroni Healtc Problemh...

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