86Health Promotion and Chronic Disease Prevention in Canada Research, Policy and Practice Vol 40, No 3, March 2020 Author reference: Public Health Agency of Canada, Ottawa, Ontario, Canada Correspondence: Mélanie Varin, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON  K1S 5H4; Email: melanie.varin@canada.ca At-a-glance An update on positive mental health among adults in Canada Mélanie Varin, MSc; Elia Palladino, BHSc; Tanya Lary, MA; Melissa Baker, PhD Tweet this article Highlights • The Quick Stats table presents recent estimates of positive mental health outcomes and associated risk and protective factors among adults in Canada. • The majority of adults in Canada have high positive mental health. • Out of the five positive mental health outcomes, life satisfaction had the highest prevalence (87.1%) and social well-being the lowest (68.1%). • Sociodemographic factors includ- ing sex, age group, income quin- tile, education level, province, urban/rural status and immigra- tion status were significantly asso- ciated with positive mental health outcomes. Happiness Happiness is measured using data from the CCHS 2015 – Annual Component. Respondents were asked, “In the past month, how often did you feel happy?” Response options were: “every day,” “almost every day,” “about 2 or 3 times a week,” “about once a week,” “once or twice” or “never.” A high level of happi- ness is defined as reporting feeling happy “every day” or “almost every day” in the past month. Life satisfaction Life satisfaction is measured using data from the CCHS 2015 – Annual Component. Respondents were asked, “In the past month, how often did you feel satisfied with your life?” Response options were: “every day,” “almost every day,” “about 2 or 3 times a week,” “about once a week,” “once or twice” or “never.” High life Abstract This At-a-glance presents updated estimates for the Positive Mental Health Surveillance Indicator Framework for adults aged 18 years and older. Using data from the 2015 and 2017 Canadian Community Health Survey, we calculated the prevalence of positive mental health and associated determinants. Estimates for positive mental health out- comes for adults ranged from 68.1% to 87.1%. We also explored the associations between sociodemographic factors and positive mental health among adults in Canada. Our findings suggest sociodemographic differences in odds of self-rated mental health, happiness, life satisfaction, and psychological and social well-being. Keywords: positive mental health, adult, public health, Canada Methods We explored associations between socio- demographic factors and PMH outcomes using the Canadian Community Health Survey (CCHS) 2015 and 2017. To account for the complex survey design of the CCHS, we weighted estimates with the survey sampling weights provided by Statistics Canada and estimated variance using the bootstrap method. We ran five adjusted logistic regression models. All statistical analyses were performed using SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). The PMHSIF includes five PMH outcomes: self-rated mental health, happiness, life satisfaction, psychological well-being and social well-being. Self-rated mental health Self-rated mental health is measured using data from the CCHS 2017 – Annual Component. Respondents were asked, “In general, would you say your mental health is…?” Response options were: “excellent,” “very good,” “good,” “fair” or “poor.” For this study, high mental health is defined as reporting mental health as “excellent” or “very good.” Introduction According to the Public Health Agency of Canada (PHAC), mental health is “the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the chal- lenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and per- sonal dignity.”1 This definition is consis- tent with other internationally recognized definitions of mental health.2 PHAC recog- nizes that mental health promotion is essential to health and well-being and has identified it as a key priority area.3 As such, the state of positive mental health (PMH) and well-being in Canada must be continuously monitored and updated. In 2016, PHAC developed the Positive Mental Health Surveillance Indicator Framework4 (PMHSIF) to monitor the state of PMH and well-being in Canada. The PMHSIF is based on the social eco- logical model, which takes into account the multifaceted levels of a social sys- tem.2,3 This At-a-glance includes updated estimates for PMH outcomes, and associ- ated risk and protective factors at the indi- vidual, family, community and society levels for adults aged 18 years and older. https://doi.org/10.24095/hpcdp.40.3.04 mailto:melanie.varin@canada.ca http://twitter.com/share?text=%23HPCDP Journal – At-a-glance: An update on %23positivementalhealth among adults in Canada&hashtags=PHAC,mentalhealth&url=https://doi.org/10.24095/hpcdp.40.3.04 https://doi.org/10.24095/hpcdp.40.3.04 87 Health Promotion and Chronic Disease Prevention in Canada Research, Policy and PracticeVol 40, No 3, March 2020 satisfaction is defined as reporting feeling happy “every day” or “almost every day” in the past month. Psychological well-being Psychological well-being is measured using six questions from the CCHS 2015 – Annual Component. Respondents were asked how often in the past month they 1) liked most aspects of their personality; 2)  had experiences that challenged them to grow and become a better person; 3) felt their life had a sense of direction or meaning to it; 4) felt good at managing the responsibilities of their daily life; 5)  felt confident to think or express their own ideas and opinions; and 6)  felt that they had warm and trusting relationships with others. Response options were: “every day,” “almost every day,” “about 2 to 3 times a week,” “about once a week,” “once or twice” and “never.” These response options were converted to number of days: “28 days,” “20 days,” “10 days,” “4 days,” “1.5 days” and “0 day.” We added the number of days together for all six questions. High psychological well-being is defined as having a total of 20 or more days in the past month. Social well-being Social well-being is measured using data from the CCHS 2017 – Annual Component. Respondents were asked, “How would you describe your sense of belonging to your local community? Would you say it is...?” Response options were: “very strong,” “somewhat strong,” “somewhat weak” or “very weak.” High social well-being is defined as reporting sense of belonging as “very strong” or “somewhat strong.” Results Main findings Table 1 displays the 2019 edition of the PMHSIF Quick Stats. Of adults aged 18  years and older in Canada, 69.9% reported high mental health, 85.9% reported high levels of happiness, 87.1% high life satisfaction, 75.2% high psycho- logical well-being, and 68.1% reported high social well-being. These estimates should not be compared to those found in the 2016 edition of the PMHSIF Quick Stats,4 as the CCHS – Annual Component underwent significant methodological changes that affect the data beginning with 2015.5 Sociodemographic determinants and PMH outcomes Table 2 displays the odds ratios (ORs) for PMH outcomes, adjusted for sex, age, household income, education, province, urban/rural status and immigrant status. Sex Compared to all PMH outcomes, sex was only significantly associated with self- rated mental health. The odds of reporting high mental health were 18% greater for males compared to females (adjusted odds ratio [aOR] = 1.18, 95% confidence interval [CI]: 1.11–1.26). Age Overall, the population aged 65 years and older had greater odds of positive mental health compared to the adult population aged 18 to 64 years. They were more likely to have high self-rated mental health, hap- piness, life satisfaction, psychological well- being and social well-being (Table 2). Income As household income adequacy increased, the odds of having high self-rated mental health, happiness, life satisfaction, psy- chological and social well-being increased in a significant, stepwise fashion. For instance, the odds that adults in the high- est income group (Q5) will have high life satisfaction are 3.07 times greater than adults in the lowest income group (Q1) (aOR = 3.07, 95% CI: 2.60–3.63). Addi- tional odds ratios for other income groups can be seen in Table 2. Education Overall, postsecondary graduates were more likely to report high self-rated mental health, happiness and life satisfaction compared to high school graduates and the population with less than high school education. For instance, the odds of post- secondary graduates having high self- rated mental health are 75% greater than the odds of those with less than high school education (aOR  =  1.75, 95% CI: 1.57–1.95). Similarly, the odds of high school graduates having high self-rated mental health are 35% greater than those who did not graduate from high school (aOR = 1.35, 95% CI: 1.19–1.53). There was no relationship between education level and psychological or social well-being. Additional odds ratios are presented in Table 2. Province There were a few provincial differences in odds of PMH outcomes. In comparison to adults in Nova Scotia, adults in British Columbia, Alberta, Saskatchewan, Ontario, Quebec, New Brunswick and Prince Edward Island were more likely to have high hap- piness (Table 2). Similarly, Saskatchewan (aOR = 1.43, 95% CI: 1.03–1.97), Quebec (aOR  =  1.57, 95% CI: 1.25–1.97) and Prince Edward Island (aOR=1.68, 95% CI: 1.17–2.40) had significantly higher odds of reporting high life satisfaction compared to Nova Scotia. Adults in Newfoundland and Labrador had the greatest odds of reporting high self-rated mental health (aOR  =  1.22, 95% CI: 1.01–1.48) and high social well-being (aOR = 1.50, 95% CI: 1.20–1.87). Additional odds ratios are presented in Table 2. Urban/rural status Urban/rural status was significantly asso- ciated with happiness, life satisfaction and psychological and social well-being. Indi- viduals living in a rural area had greater odds of reporting high levels of happiness (aOR  =  1.26, 95% CI: 1.14–1.40), high life satisfaction (aOR  =  1.26, 95% CI: 1.12–1.41), high psychological well-being (aOR=1.10, 95% CI: 1.01–1.20) and high social well-being (aOR  =  1.11, 95% CI: 1.03–1.19) compared to those living in an urban area. There was no association between urban/rural status and self-rated mental health. Immigrants Immigrants had greater odds of high self- rated mental health (aOR = 1.39, 95% CI: 1.27–1.51) and high social well-being (aOR  =  1.34, 95% CI: 1.22–1.48) com- pared to non-immigrants. However, immi- grants were less likely to report high happiness (aOR  =  0.76, 95% CI: 0.66– 0.86). There was no relationship between immigrant status and high life satisfaction or high psychological well-being. Conclusion This At-a-glance article includes preva- lence estimates from the 2019 edition of PMHSIF – Adult. Based on our results, older age and the highest income quintile were associated with all five positive men- tal health outcomes. Adults with a post- secondary education and those living in a rural area had a greater likelihood of hap- piness, life satisfaction, psychological well- being and social well-being. Immi grants 88Health Promotion and Chronic Disease Prevention in Canada Research, Policy and Practice Vol 40, No 3, March 2020 and males were more likely to have high self-rated mental health compared to non- immigrants and females. Identifying socio- demographic differences in PMH outcomes has the potential to further a greater understanding of adult positive mental health. Conflicts of interest The authors have no conflicts of interest to disclose. Authors’ contributions and statement MV, EP, TL and MB drafted the At-a- glance. MV analyzed the prevalence esti- mates for self-rated mental health and conducted the logistic regression model analyses. All co-authors interpreted the data and reviewed and/or revised the At-a-glance. The content and views expressed in this At-a-glance are those of the authors and do not necessarily reflect those of the Government of Canada. References 1. Public Health Agency of Canada. Mental health promotion: promoting mental health means promoting the best of ourselves [Internet]. Ottawa (ON): Public Health Agency of Canada; [modified 2014 May 6; cited 2019 Jun 25]. Available from: https://www.canada .ca/en/public-health/services/health -promotion/mental-health/mental -health-promotion.html 2. Orpana H, Vachon J, Dykxhoorn J, et al. Monitoring positive mental health and its determinants in Canada: the development of the Positive Mental Health Surveillance Indicator Frame- work. Health Promot Chronic Dis Prev Can. 2016;36(1):1-10. 3. Public Health Agency of Canada (PHAC). Departmental Plan 2019–20. [Internet]. Ottawa (ON): PHAC; 2019 [cited 2019 May 21]. Available from: https://www.canada.ca/content/dam /phac-aspc/documents/corporate /transparency/corporate-management -reporting/reports-plans-priorities /2019-2020-report-plans-priorities/phac -aspc-2019-2020-departmental-plan -eng.pdf 4. Centre for Chronic Disease Prevention. Positive Mental Health Surveillance Indicator Framework: Quick Stats, adults (18 years of age and older), Canada, 2016 edition. Health Promot Chronic Dis Prev Can. 2016;36(1): 11-2. 5. Statistics Canada. Canadian Community Health Survey 2017 – Annual Compo- nent (CCHS) [Internet]. Government of Canada. 2018 [cited 2019 Jul 3]. Available from: http://www23.statcan .gc.ca/imdb/p2SV.pl?Function= getSurvey&Id=329241 https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html https://www.canada.ca/en/public-health/services/health-promotion/mental-health/mental-health-promotion.html https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/reports-plans-priorities/2019-2020-report-plans-priorities/phac-aspc-2019-2020-departmental-plan-eng.pdf https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/reports-plans-priorities/2019-2020-report-plans-priorities/phac-aspc-2019-2020-departmental-plan-eng.pdf https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/reports-plans-priorities/2019-2020-report-plans-priorities/phac-aspc-2019-2020-departmental-plan-eng.pdf https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/reports-plans-priorities/2019-2020-report-plans-priorities/phac-aspc-2019-2020-departmental-plan-eng.pdf https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/reports-plans-priorities/2019-2020-report-plans-priorities/phac-aspc-2019-2020-departmental-plan-eng.pdf https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/reports-plans-priorities/2019-2020-report-plans-priorities/phac-aspc-2019-2020-departmental-plan-eng.pdf https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/reports-plans-priorities/2019-2020-report-plans-priorities/phac-aspc-2019-2020-departmental-plan-eng.pdf http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&Id=329241 http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&Id=329241 http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&Id=329241 89 Health Promotion and Chronic Disease Prevention in Canada Research, Policy and PracticeVol 40, No 3, March 2020 TABLE 1 POSITIVE MENTAL HEALTH SURVEILLANCE INDICATOR FRAMEWORK QUICK STATS, ADULTS (18 YEARS OR OLDER), CANADA, 2019 EDITION INDICATOR GROUP INDICATOR MEASURE(S) LATEST DATA DATA SOURCE (YEAR) POSITIVE MENTAL HEALTH OUTCOMES Self-rated mental health % of population who self-rate their mental health as being “excellent” or “very good” 69.9% CCHS (2017) Happiness % of population who report being happy “every day” or “almost every day” 85.9% CCHS (2015) Life satisfaction % of population who report being satisfied with life “every day” or “almost every day” 87.1% CCHS (2015) Mean life satisfaction rating (0–10 scale) 8.1 CCHS (2017) Psychological well-being % of population who have high psychological well-being 75.2% CCHS (2015) Social well-being % of population who report that they “very strongly” or “somewhat strongly” belong to their local community 68.1% CCHS (2017) INDIVIDUAL DETERMINANTS Resilience In development Coping % of population who report a high level of coping 56.9% CCHS – Mental Health (2012) Control and self-efficacy % of population who report a high level of perceived control over life chances 41.6% GSS Social Networks (2008) Violence % of the population who report experiencing, before age 15 years, any of these three types of childhood violence: physical or sexual abuse by an adult and/or exposure to violence by parents or guardians 34.0% GSS Victimization (2014) % of population who report being the victim of physical or sexual abuse in the past 12 months 3.9% GSS Victimization (2014) % of population who report being the victim of spousal violence in the past 5 years 2.7% GSS Victimization (2014) Health status % of population who self-rate their health as “excellent” or “very good” 59.9% CCHS (2017) % of population with no or mild disability 68.5% CCHS (2015) Physical activity % of population who are “active” or “moderately active” during their leisure-time based on self-reported data 69.4% CCHS (2017) % of population aged 18–79 years who meet physical activity guidelines by accumulating at least 150 minutes of moderate-to-vigorous physical activity each week, in bouts of 10 minutes or more 16.4% CHMS (2016–2017) Substance use % of population whose reported alcohol consumption falls within the low-risk alcohol drinking guidelines 83.4% CTADS (2017) Spirituality % of population who report that religious or spiritual beliefs are “very important” or “somewhat important” in their daily life 62.7% CCHS – Mental Health (2012) FAMILY DETERMINANTS Family relationships In development Family health status and substance use by family members % of population with a family member who has problems with their emotions, mental health or use of alcohol or drugs 39.8% CCHS – Mental Health (2012) % of population with a family member who has problems with their emotions, mental health or use of alcohol or drugs, who report that their life is affected “a lot” or “some” by their family member’s problems 35.6% CCHS – Mental Health (2012) Household composition % of population living with a spouse or partner 70.5% CCHS (2017) % of population living in a lone-parent household 8.8% CCHS (2017) % of population living alone 16.1% CCHS (2017) Household income % of the total Canadian population below low-income cut-offs after tax 8.8% SLID (2011) Continued on the following page 90Health Promotion and Chronic Disease Prevention in Canada Research, Policy and Practice Vol 40, No 3, March 2020 INDICATOR GROUP INDICATOR MEASURE(S) LATEST DATA DATA SOURCE (YEAR) COMMUNITY DETERMINANTS Community involvement % of population that are members of or participate in at least one recreational or professional organization, group, association or club 63.4% GSS Social Identity (2013) Social networks % of population who report having no close friends or family members 6.1% GSS Social Identity (2013) % of population who report having between 1 and 5 close friends or family members 57.1% GSS Social Identity (2013) % of population who report having 6 or more close friends or family members 36.8% GSS Social Identity (2013) Social support % of population who report a high level of perceived social support 94.2% CCHS – Mental Health (2012) Workplace environment % of employed population aged 18–75 years experiencing high job strain 14.8% CCHS – Mental Health (2012) Neighbourhood social environment % of population who report that their neighbourhood is a place where neighbours help each other 88.5% GSS Victimization (2014) % of population who report that social disorder in their neighbourhood is “a very big problem” or “a fairly big problem” 5.3% GSS Victimization (2014) Neighbourhood built environment In development SOCIETY DETERMINANTS Inequality In development Discrimination and stigma % of population who experienced unfair treatment at least once in the past 5 years based on characteristics such as gender, race, age or appearance 11.5% GSS Victimization (2014) % of population with a mental health problem who report having been affected by negative opinions or unfair treatment, due to their mental health problem 21.0% CCHS – Mental Health (2012) Political participation % of registered electors who voted in the 2015 federal election 68.3% Elections Canada (2015) Abbreviations: CCHS, Canadian Community Health Survey; CHMS, Canadian Health Measures Survey; CTADS, Canadian Tobacco, Alcohol and Drug Survey; GSS, General Social Survey; SLID, Survey of Labour and Income Dynamics. Note: “In development” refers to measures that are under development either because a data source is currently not available or because more research has to be done to identify a promising measure and data source. Suggested citation: Public Health Agency of Canada, Centre for Surveillance and Applied Research. At-a-glance: An update on positive mental health among adults in Canada. Quick Stats, Adults (18 years of age or older), Canada, 2019 Edition. Ottawa (ON): Public Health Agency of Canada; 2020. For questions or comments, please contact us at: phac.infobase.aspc@canada.ca mailto:phac.infobase.aspc@canada.ca 91 Health Promotion and Chronic Disease Prevention in Canada Research, Policy and PracticeVol 40, No 3, March 2020 TABLE 2 Adjusted odds ratio of positive mental health outcomes, adults aged 18 years and older, Canada, 2015 and 2017 Variable SRMHa Happinessb Life satisfactionb Psychological well-beingb Social well-beinga aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI) Sex Females Ref Ref Ref Ref Ref Males 1.18 (1.11–1.26) 0.95 (0.86–1.04) 0.98 (0.89–1.09) 1.05 (0.98–1.14) 0.95 (0.89–1.02) Age 18–24 0.85 (0.74–0.97) 1.40 (1.16–1.70) 1.07 (0.89–1.28) 0.84 (0.73–0.96) 0.94 (0.82–1.07) 25–44 1.00 (0.92–1.09) 1.31 (1.16–1.49) 1.04 (0.91–1.18) 0.97 (0.88–1.08) 0.87 (0.80–0.94) 45–64 Ref Ref Ref Ref Ref 65+ 1.32 (1.22–1.44) 1.61 (1.42–1.83) 1.88 (1.62–2.18) 1.34 (1.20–1.50) 1.67 (1.54–1.82) Household income adequacy Q1 (lowest) Ref Ref Ref Ref Ref Q2 1.29 (1.17–1.42) 1.34 (1.15–1.56) 1.30 (1.11–1.52) 1.04 (0.91–1.18) 1.13 (1.01–1.25) Q3 1.56 (1.41–1.72) 1.96 (1.68–2.28) 2.09 (1.78–2.45) 1.17 (1.03–1.32) 1.29 (1.15–1.43) Q4 1.81 (1.62–2.01) 2.19 (1.88–2.55) 2.34 (1.98–2.77) 1.42 (1.25–1.61) 1.28 (1.15–1.42) Q5 (highest) 2.28 (2.05–2.54) 2.67 (2.29–3.11) 3.07 (2.60–3.63) 1.60 (1.40–1.82) 1.31 (1.17–1.46) Highest level of education household Less than high school Ref Ref Ref Ref Ref High school graduate 1.35 (1.19–1.53) 1.23 (1.03–1.47) 0.96 (0.81–1.14) 1.03 (0.89–1.21) 0.96 (0.83–1.10) Postsecondary graduate 1.75 (1.57–1.95) 1.37 (1.16–1.63) 1.24 (1.06–1.46) 1.11 (0.96–1.28) 1.09 (0.97–1.23) Province British Columbia 0.96 (0.83–1.11) 1.34 (1.08–1.65) 0.96 (0.75–1.22) 0.93 (0.76–1.13) 1.02 (0.87–1.20) Alberta 1.00 (0.87–1.16) 1.26 (1.02–1.56) 1.07 (0.85–1.34) 1.02 (0.85–1.24) 0.92 (0.78–1.08) Saskatchewan 0.97 (0.81–1.17) 1.41 (1.07–1.87) 1.43 (1.03–1.97) 0.96 (0.77–1.20) 1.21 (0.99–1.48) Manitoba 1.09 (0.91–1.31) 1.25 (0.98–1.61) 1.23 (0.91–1.65) 1.02 (0.82–1.27) 1.13 (0.94–1.36) Ontario 1.04 (0.91–1.18) 1.29 (1.06–1.58) 1.19 (0.95–1.49) 0.95 (0.79–1.14) 1.04 (0.89–1.21) Quebec 1.42 (1.24–1.62) 1.37 (1.12–1.68) 1.57 (1.25–1.97) 0.89 (0.75–1.07) 0.69 (0.59–0.80) New Brunswick 1.03 (0.85–1.24) 1.44 (1.08–1.92) 1.24 (0.92–1.68) 1.08 (0.86–1.37) 1.37 (1.10–1.70) Nova Scotia Ref Ref Ref Ref Ref Prince Edward Island 1.05 (0.85–1.31) 1.68 (1.20–2.36) 1.68 (1.17–2.40) 1.59 (1.21–2.09) 1.34 (1.06–1.70) Newfoundland and Labrador 1.22 (1.01–1.48) 1.18 (0.91–1.54) 1.27 (0.94–1.71) 1.41 (1.11–1.78) 1.50 (1.20–1.87) Urban/rural status Rural 1.01 (0.94–1.08) 1.26 (1.14–1.40) 1.26 (1.12–1.41) 1.10 (1.01–1.20) 1.11 (1.03–1.19) Urban Ref Ref Ref Ref Ref Immigrant status Yes 1.39 (1.27–1.51) 0.76 (0.66–0.86) 0.91 (0.79–1.06) 1.02 (0.91–1.15) 1.34 (1.22–1.48) No Ref Ref Ref Ref Ref Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; Q, quintile; Ref, reference group; SRMH, self-rated mental health. Note: Logistic models adjusted for sex, age, province, urban/rural dwelling, education, household income and immigrant status. a All of these estimates are from CCHS 2017 data. b All of these estimates are from CCHS 2015 data.