The COVID-19 pandemic has impacted the lives of all people living in Canada. The ongoing economic hardships, changes to our daily routines and separation from loved ones, among other stresses, have been linked to the worsening of mental health and an increase in substance use among many people living in Canada.
The Canadian Centre on Substance Use and Addiction (CCSA) and the Mental Health Commission of Canada (MHCC) have commissioned the Leger polling firm to produce a series of bimonthly surveys over a twelve-month period to explore the long-term impact of the COVID-19 pandemic on mental health and substance use. By tracking trends among the general population and priority populations, CCSA and MHCC aim to build on our understanding of the relationship between mental health and substance use during COVID-19 and better support people living in Canada through these challenging times.
Survey Results
Summary Report One, Baseline Survey (Time 1) and Survey 2 (Time 2)
Leger conducted a baseline survey of 2,502 people living in Canada between October 13 and November 2, 2020, and a second survey of 1,507 people between Nov 19 and Dec 2, 2020. Respondents reported more mental health symptoms and increased substance use since March 2020. People with a history of mental health or substance use concerns were disproportionately impacted by stresses related to the COVID-19 pandemic.
Up to one in two individuals with an existing substance use disorder reported having moderately severe to severe symptoms of depression since March 2020. Around one third of those surveyed who drink alcohol reported drinking more since the start of the pandemic. This increase was greater among respondents with a history of substance use disorders, four in 10 to almost half of whom reported increased consumption during this period.
Other key findings:
- Up to one in two respondents with current mental health symptoms who use cannabis reported increased use since March 2020, compared to two in five of the general population.
- Over one in three respondents with current mental health symptoms who use alcohol reported consuming more since the start of the pandemic.
- Moderate and severe anxiety symptoms were highest among respondents with a history of substance use and mental health disorders. Respondents’ top stressors were their financial situation (14%), social isolation (12%), and the health of family members (11%).
- Only 24% of respondents with problematic substance use and 22% with current mental health symptoms have accessed treatment since March.
Summary Report Two: Survey Three (T3) and Survey 4 (T4)
Leger conducted further surveys in early 2021; a third survey of 1502 people living in Canada between Jan 15 and 25, 2021, and a fourth survey of 1524 people living in Canada between March 1 to 14, 2021.
The second summary report in this series explores the substance use and mental health impacts of the pandemic by gender and household type, drawing on data from all four surveys. Childcare and financial situation were found to be the most commonly reported stresses for people living in households with young children, especially females.
Females living in households with children under the age of 13 were more likely to report symptoms of anxiety and increased substance use than the general population. Of those surveyed, 37% of females and 24% of males living with young children reported moderate to severe anxiety symptoms. Since November 2020, 37% of females and 26% of males living with young children and who use alcohol reported increased use.
Other key findings:
- More females reported concerns with mental health and more males reported problematic use of substances.
- People living alone were more likely to report moderate to severe depression symptoms (20% vs 15%), thoughts of suicide (9% vs 6%) and problematic alcohol use (31% vs 22%) compared to other survey participants.
- Childcare stress is more common among females in households with children (14%) than males (4%); financial situation and social isolation continue to be major pandemic stressors.
- Only 18% of people with current mental health symptoms and 20% with potential problematic substance use say they accessed treatment in February 2021.
Summary Report Three: Survey Five (T5)
The third summary report in this series reveals that stress related to the COVID-19 pandemic is having a greater effect on people with low income and those who are unemployed. Access to mental health and substance use services remains out of reach for many.
The impact of the pandemic on both substance use and mental health is analyzed by income, employment status and access to mental health and substance use services. The extensive survey of more than 8,500 people living in Canada was conducted from October 2020 to May 2021. Key findings include:
- Substance use and mental health concerns are greatest among people with low income or who are unemployed:
- Problematic cannabis use was reported by 50% of respondents with low income or who are unemployed who use cannabis, while problematic alcohol use was reported by more than 30% of those who drink alcohol.
- Similarly, 45% of respondents with low income or who are unemployed reported moderate to severe anxiety, and more than 30% reported moderately severe to severe depression.
- Among people with low income or who are unemployed, 25% reported finances as the top pandemic stress.
- More people are accessing virtual services, but rates of access remain low. Among those surveyed, 20% of those with mental health concerns reported accessing virtual services, compared with 10% of those with substance use concerns.
- People with low income or who are unemployed face significantly more barriers to mental health and substance use treatment services. The most commonly cited barriers include financial constraints, help not being readily available, not knowing how and where to get help, and long waitlists.
Summary Report Four: Survey Six (T6)
Since October 2020, six surveys conducted by Leger have tracked the relationship between mental health and substance use. The latest data from a survey of 1,543 people in Canada in July 2021 allows comparison throughout the pandemic, including by several key demographics.
This summary report compares mental health and substance use impacts on youth and older adults. It also assesses the prevalence of mental health and substance use stigma. Key findings include:
- Youth (aged 16 to 24 years) were most likely to report mental health and substance use concerns, and less ability to handle pandemic stress. Almost 45% of youth reported moderate to severe anxiety symptoms, and about 40% of youth who use alcohol, cannabis or both reported increased use in the past month.
- Older adults (aged 65 years and older), by comparison, showed signs of better mental health, less problematic substance use and stronger coping skills. Just 9% of older adults reported moderate to severe anxiety symptoms. About 20% of older adults who use alcohol, cannabis or both reported increased use.
- Perceived stigma toward depression was still common, although shifting among youth. More than half or respondents (53%) said they believed stigma toward people with depression was still present.
- Perceived stigma toward alcohol use disorder was even more prevalent. Two-thirds of respondents (68%) said they believed stigma toward people with an alcohol use disorder was still present.
- People with past and current substance use concerns showed signs of worsening mental health. In July 2021, 22% of people with a history of substance use disorder reported seriously contemplating suicide in the past month. In November 2020, it was 13%.
Summary Report Five: Survey Seven (T7), Survey Eight (T8) and Survey Nine (T9)
This fifth report in the series focuses on the intersection of substance use and suicidal ideation during the pandemic. The report includes a cross-section of findings taken across nine periods between October 2020 and January 2022. The most recent of the surveys were conducted from Aug. 31 to Sept. 13, 2021, Nov. 12 to 20, 2021, and Jan. 11 to 20, 2022.
The findings show that since the COVID-19 pandemic began in Canada in March 2020:
- Nealy 8% of those surveyed reported seriously contemplating suicide.
- About one in three people with a history of substance use disorders reported suicidal ideation during the pandemic (30% of women and 36% of men).
- About one in six people with substance use concerns reported suicidal ideation during the pandemic (17% of women and 16% of men).
- Rates of suicidal ideation have been high among youth (17%) and Black respondents (15%).
- People who were unemployed either before (15%) or during the pandemic (16%), were more likely to report suicidal ideation, compared with people who were employed (8%).
Summary Report Six: Inclusive of Survey One through Survey Seven (T1 to T7)
The sixth report in this series focuses on the effects of COVID 19 on the 2SLGBTQ+ communities in Canada. The report includes a cross-section of findings taken across seven periods between October 2020 and September 2021.
The survey results show that COVID-19 has had a disproportionate effect on the substance use health and mental health of the 2SLGBTQ+ communities when compared with other respondents. Key findings include:
- About one in four (24%) 2SLGBTQ+ respondents reported excellent or very good mental health during the pandemic, compared with nearly half (43%) of other respondents.
- Almost half (46%) of 2SLGBTQ+ respondents reported moderate to severe anxiety symptoms, while just fewer than a quarter (22%) of other respondents reported feeling the same.
- About 30% of 2SLGBTQ+ respondents who consumed alcohol reported consuming more, compared with 20% of other respondents.
- About 20% of 2SLGBTQ+ respondents who used cannabis reported using more since the start of the pandemic, compared with 10% of other respondents.
- 2SLGBTQ+ respondents reported finances being a significant barrier to accessing mental health and substance use services, and overall reported facing more barriers than other respondents to accessing mental health services.
- 30% of all 2SLGBTQ+ respondents and 40% of 2SLBTQ+ youth respondents reported accessing virtual mental health services since the start of the pandemic; fewer report accessing in-person services.
- 2SLGBTQ+ ethno-racialized respondents were more likely to report thoughts of suicide, anxiety and depression symptoms, compared with other respondents.
Summary Report Seven: Final Summary Report: Regional Spotlight and Key Factors (T1 to T10)
The seventh and final summary report in the series looks at regional differences and key factors in how the pandemic has affected people with mental health and substance use in Canada.
Across Canada, people with moderate to severe depression symptoms were three times more likely to report problematic alcohol use compared with those who do not. As well, suicidal ideation was three times more likely for individuals with a history of substance use disorder compared with those who do not. The study also found regional differences. Since the onset of the COVID-19 pandemic in March 2020:
- Mental health concerns have been lowest in Quebec.
- In all regions, fewer than 1 in 3 respondents with mental health concerns accessed mental health services. In Ontario, access to mental health services has increased.
- Overall, fewer than 1 in 4 respondents with problematic alcohol or cannabis use accessed substance use services. Ontario and Canada overall had a significant decline.
- In Ontario, virtual mental health services were accessed almost 3 times more than in-person services.
- Alberta, Saskatchewan and Manitoba respondents accessed substance use services the most.
- Financial concerns have been the most common stressor across most regions. Social isolation was largest stressor for respondents from Quebec.
The summary supports the interconnected relationship between substance use and mental health. It also highlights that COVID-19 has had a disproportionate effect on substance use and mental health of youth, low-income and unemployed people, ethno-racialized people, and the 2SLGBTQ+ communities when compared with other respondents.