Inequalities in the mental health of adults before and during the COVID-19 pandemic: summary
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Overview
More adults in Canada are reporting worse mental health during the COVID-19 pandemic compared to pre-pandemic levels.
Fewer adults reported that their mental health was excellent or very good in late 2020, compared to adults in 2019. Similarly, fewer reported that their sense of belonging to their local community was somewhat or very strong in late 2020.
Both of these measures of positive mental health (‘high self-rated mental health’ and ‘high community belonging’) were even lower by early 2021. Lower average ratings of ‘life satisfaction’ during the pandemic were also reported.
There are also signs that psychological distress has risen. The percentage of adults who had seriously contemplated suicide (‘recent suicide ideation’) was higher in early 2021 than in 2019. However, significant differences in recent suicide ideation were not seen in late 2020 compared to 2019.
Everyone’s life has been disrupted by the pandemic in some way, but some people have been impacted more than others. There were inequalities in mental health outcomes before the pandemic, which may have increased during the pandemic.
To better understand how mental health inequalities have changed in Canada, we conducted analyses to examine:
-
differences in recent suicide ideation and positive mental health between sociodemographic groups:
- before the pandemic, using data from the 2019 Canadian Community Health Survey (CCHS)
- during the pandemic, using data from the 2020 and 2021 Survey on COVID-19 and Mental Health (SCMH)
- whether these differences have increased or decreased during the pandemic
The findings reveal a complex picture of inequality in the mental health of adults over time. See Table 1 for an overview of the results.
Highlights
The magnitude of inequalities have increased for some sociodemographic characteristics, such as:
Age
- Both before and during the pandemic, young adults (18 to 34 years) and middle-aged adults (35 to 64 years) had lower average life satisfaction than older adults (aged 65+).
- Young and middle-aged adults were also less likely than older adults at both time periods to have high self-rated mental health and community belonging.
- These differences were even larger during the pandemic.
Racialized group membership
- Before the pandemic, average life satisfaction was lower among racialized adults (visible minorities and Indigenous identity) than among non-racialized adults. This difference was even larger during the pandemic.
Urban/rural dwellers
- Before the pandemic, there was no difference in high self-rated mental health between adults living in urban areas and those living in rural areas. However, differences emerged during the pandemic, with people in urban areas less likely to have high self-rated mental health.
- Before the pandemic, average life satisfaction was lower among those living in urban areas. This difference increased during the pandemic.
English and French speakers in Quebec
- Before the pandemic, average life satisfaction was lower among Anglophones than Francophones. This difference increased during the pandemic.
Marital status
- Before the pandemic, average life satisfaction was lower among adults who had never been married compared to those who were married or living common law. This difference was even larger during the pandemic.
In contrast, the magnitude of inequalities have decreased for some other sociodemographic characteristics, such as:
Household income
- Before the pandemic, adults in low-income households were less likely to have high self-rated mental health and community belonging than those in high-income households. These differences disappeared during the pandemic.
- Both before and during the pandemic, average life satisfaction was lower among adults in low-income households than those in high-income households, but this difference decreased during the pandemic.
Education
- Both before and during the pandemic, adults with a high school education or less were less likely to have high self-rated mental health compared to those with a post-secondary education. However, this difference shrunk during the pandemic.
- Before the pandemic, average life satisfaction was lower among adults with a high school education or less, compared to those with a post-secondary education. There was no difference between these groups during the pandemic.
Parents
- Before the pandemic, adults with children under 18 had higher average life satisfaction and were more likely to have high self-rated mental health than those without children under 18. However, these differences disappeared during the pandemic.
Household composition
- Before the pandemic, adults living alone were less likely to have high self-rated mental health and community belonging compared to those living with others. However, these differences disappeared during the pandemic.
- Both before and during the pandemic, average life satisfaction was lower among adults living alone than among those living with others. This difference was smaller during the pandemic.
Marital status
- Both before and during the pandemic, average life satisfaction was lower among adults who were separated, divorced or widowed than among those who were married or living common law. This difference shrunk during the pandemic.
Summary table
Table 1. Overview of inequality results, 2019 CCHS and 2020/2021 SCMH
| Inequality in recent suicide ideation | Inequality in high self-rated mental health | Inequality in high community belonging | Inequality in average life satisfaction | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2019 | 2020/2021 | Change | 2019 | 2020/2021 | Change | 2019 | 2020/2021 | Change | 2019 | 2020/2021 | Change | ||
| Gender | Female (ref: male) | ||||||||||||
| Age | 18-34 (ref: 65+) | ||||||||||||
| Age | 35-64 (ref: 65+) | ||||||||||||
| Racialized group member | Yes (ref: no) | ||||||||||||
| Immigrant status | Yes (ref: no) | ||||||||||||
| Household income | Low (ref: high) | ||||||||||||
| Household income | Middle (ref: high) | ||||||||||||
| Place of residence | Population centre (ref: rural area) | ||||||||||||
| Educational attainment | ≤ High school (ref: post-secondary) | ||||||||||||
| Parent of child < 18 years old | Yes (ref: no) | ||||||||||||
| Household composition | Living alone (ref: living with others) | ||||||||||||
| Official language minorities | English in QC (ref: French in QC) | ↑a | |||||||||||
| Official language minorities | French outside QC (ref: English outside QC) | ||||||||||||
| Indigenous identity | Yes (ref: no) | ||||||||||||
| Inequality in recent suicide ideation | Inequality in high self-rated mental health | Inequality in high community belonging | Inequality in average life satisfaction | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2019 | 2021 | Change | 2019 | 2021 | Change | 2019 | 2021 | Change | 2019 | 2021 | Change | ||
| Marital status | Never married (ref: married/ common law) | ||||||||||||
| Marital status | Separated/divorced/ widowed (ref: married/common law) | ||||||||||||
Table abbreviations and symbols
Abbreviations:
- CCHS, Canadian Community Health Survey
- QC, Quebec
- Ref., reference group
- SCMH, Survey on COVID-19 and Mental Health
Symbols:
- ≈ = no evidence of difference/change
- ↓ = significantly lower than reference group
- ↑ = significantly higher than reference group
- ↗ = significantly larger inequality during the pandemic than pre-pandemic
- ↘ = significantly smaller inequality during the pandemic than pre-pandemic
- aFinding observed for one measure of inequality (absolute or relative), but not both.
Related resources
- Positive mental health and perceived change in mental health among adults in Canada during the second wave of the COVID-19 pandemic
- Self-rated mental health, community belonging, life satisfaction and perceived change in mental health among adults during the second and third waves of the COVID-19 pandemic in Canada
- Prevalence of suicidal ideation among adults in Canada: results of the second Survey on COVID-19 and Mental Health
- Suicide ideation in Canada during the COVID-19 pandemic
- Key health inequalities in Canada: a national portrait
- From risk to resilience: an equity approach to COVID-19
- Canadian Community Health Survey – Annual Component (CCHS): detailed information for 2019
- Survey on COVID-19 and Mental Health (SCMH): detailed information for September to December 2020
- Survey on COVID-19 and Mental Health (SCMH): detailed information for February to May 2021
- Map of Canadian mental health during the COVID-19 pandemic
- Positive Mental Health Surveillance Indicator Framework
- Suicide Surveillance Indicator Framework
- Health Inequalities Data Tool
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